The Republic of Ireland did better than many other countries when it came to dismantling the massive Victorian hospitals which had been the mainstay of the psychiatric services. To be sure, there were some social and medical problems as the institutionalised populations which had been afforded asylum in those hospitals were moved into accommodation in the community, but the problems were demonstrably fewer than those which occurred as a result of similar exercises in other European countries.
There are still difficulties for many people with mental illnesses of various kinds and, notwithstanding the establishment of various forms of accommodation for psychiatric patients living in the community (such as were recommended in the excellent 1984 report on Planning for the Future), many of the most severe problems are encountered among those who are homeless. Indeed, it is likely that some people are homeless precisely because of the nature of their illness.
There is, therefore, both sound and humane sense in the Eastern Health Board's proposal to recruit four outreach workers to support homeless people and to establish two out patient clinics where psychiatric and other health care services will be provided exclusively for those who are homeless. One of the social characteristics of those who have been homeless for some time is that they move from place to place so that it can be difficult for the social and health services to keep in touch with them.
This relatively small expansion of services should make it easier both for those trying to provide services and for those homeless people who need health care to keep in touch. It should prove cost effective in terms of the maintenance of the health of the homeless by, to some extent, preventing the kind of deterioration that can lead to expensive hospitalisation, and in terms of the amelioration of the undoubted suffering to which many are prone who have no homes to shelter them. Anything which may help to create a more stable daily environment for homeless people can only be of benefit in a society that lays claim to be a caring one.
It is good that the initiative has been agreed between the Health Board, Dublin Corporation and the Departments of Health and the Environment, and it is good that there is to be a continuing review of services available in terms of in patient care when this is required. That just leaves one further link to be forged in the chain of care for the homeless. There is need to set up more effective contacts and consultations between the statutory agencies and those voluntary organisations which provide so much care on the ground for these unlucky people.
Moves are under way in this regard on the initiative of the Minister for State, Liz McManus but they will only succeed with the full co operation of the statutory bodies and with an appreciation of the value of the insights which the voluntary groups can provide.