Dublin Simon Health Research Symposium
Almost 200% Increase in 18 – 24 Year Olds Accessing+ Dublin Simon Mental Health Supports Highlights Stark Gap in Service Provision
Charity Unveils Research & Recommendations to Inform Future of Homelessness & Health Management in Ireland at Research Symposium
Key Insights Include:
- 72% increase in the number of young adults residing in national emergency accommodation from March 2020 to January 2023, rising from 828 to 1423.
- Development of New Young Homeless Adult Mental Health Support Co-Designed by Dublin Simon clients and Staff
- 587 incidents of self-harm and suicidal incidents over three-year period reported among homeless population
- Negative interactions at HIV diagnosis have lasting impact on those working to adhere to their medication in the context of homelessness and addiction
- Complexity of undergoing Alcohol & Drug Recovery while experiencing homelessness leading to additional challenges for participants
Dublin, 20th March 2023: Dublin Simon Community today launched its Homelessness & Health Research Symposium at The Spencer Hotel in Dublin 1.
The Symposium consisted of presentations from researchers on the findings of four Homelessness & Health studies regarding young adults’ mental health, adherence to HIV medication, self-harm and suicidality, and experiences of recovery programmes among the homeless population in Dublin, alongside a photography exhibition curated by contributing clients involved in the young adult mental health study.
On opening the event, Keynote Speaker Catherine Kenny, CEO Dublin Simon Community said:
“Over the past fifty years, Dublin Simon has identified gaps in addressing and ending homelessness. As service providers, we have a duty to ensure that our work with clients is as integrated and holistic as it can possibly be. We know that mental health, physical health, and addiction are interrelated, and shouldn’t be treated in isolation. In 2021 alone we assisted with almost 900 people to avail of homeless treatment and health interventions such as detox, recovery beds, and Mental health counselling supports.
“Research is integral to Dublin Simon to help us to make evidence-based decisions, create policies, and to inform our practice. When academic experts and experienced frontline staff collaborate, there is a huge potential for solutions, and we are optimistic that the findings we share today will play a part in bringing about real results for those individuals relying on our support.
“It’s unprecedented what will happen in homeless services in the coming months and the research today clearly underlines the need for fully funded resources by Department of Health for those in homeless services.
“We would like to thank the clients, staff and researchers involved in bringing this research to fruition.”
Responding to Unprecedented Need for Young Adult Mental Health Services
Throughout the Covid-19 pandemic, the Dublin Simon Community ‘Sure Steps’ Counselling services recorded a trebling of referrals for young adults aged 18 – 24 experiencing homelessness with mental health difficulties, with members of this cohort reporting unique challenges warranting an enhanced programme of care. Additionally, from the period between March 2020 to January 2023, there was a 72% increase in young adults residing in emergency accommodation services across the country.
Responding to this need, Dublin Simon Community developed a service enhancement project to design and implement a mental health support programme tailored to young adults experiencing homelessness. The project featured a 15-month project led by Research & Policy Manager Michelle Connolly to co-design a support in collaboration with researchers from UCD, a staff counsellor and members of this 18-24 year-old cohort.
The findings of this project, published in the ‘Co-designing a Mental Health Support Programme with Young Adults Experiencing Homelessness’ report, revealed several unique requirements to consider in the provision of services to young people experiencing homelessness with mental health issues. These included an age-appropriate counsellor, light activity offerings, the location of sessions in informal social settings and holistic, trauma-informed approach.
Speaking about the project, Young Adult Counsellor Sinéad Casey said:
“Each young adult experiencing homelessness is unique. Their experiences are varied, and the approach to developing mental health support for these young clients should be tailored to their specific needs.
“We believe that young adults should have a say in how their supports are structured and implemented. We used a co-design model to create the programme and ensure it is accessible and appropriate for young people. This resulted in strong engagement and improved outcomes for young adults and boosted our effectiveness as a counselling service. We hope that the programme can become a permanent offering from Dublin Simon, and that its benefits can be shared far and wide.
Exploring Factors Affecting Adherence to HIV Medication
One of the key insights raised at the symposium was the impact of HIV diagnosis experience on future treatment engagement among homeless clients with addiction issues.
The research study “The lived experience of adherence to HIV medication in the context of homelessness and addiction” carried out by Eavanna Maloney, Senior Manager for Clinical Services at Dublin Simon Community, revealed that feelings of being stigmatised, devalued or dismissed by Healthcare Professionals at the point of diagnosis had a negative impact on patients’ adherence to and engagement with treatment throughout their lives.
The study, which involved qualitative research among six participants (three male, three female), presenting with homelessness, addiction and a HIV diagnosis, explored several factors affecting medication and treatment adherence among this group. The study identified the conditions of homelessness including lack of privacy, routine, agency and exposure to other drug users in homeless settings as having an adverse effect on adherence to medication.
The study also shed light on the impact of shame and guilt on perceptions of HIV transmission as participants deployed transmission narratives to protect themselves from the social stigma driving these emotions. Recounts of transmission were markedly gendered, with males reporting transmission from sex, women reporting transmission from drug use and all narratives featuring a “villain” character. Patients also exhibit a desire to demonstrate moral worth by reporting strong adherence to medication.
In concluding the study, Maloney made several recommendations relating to practice, policy and further research:
“While this study clearly illustrates a need for further research, what is clear at this point is that the harmful and long-lasting impact of a negative diagnosis interaction warrants attention. Healthcare Professionals need to ensure stigma and fear is not perpetuated at this point and may require specific communication training to guarantee this. There also needs to be an established support network in place to provide patients with the wraparound supports necessitated by the nature of such a diagnosis.”
“In addition, housing policy must consider the needs of people who use substances and who wish to begin to or sustain recovery from addiction. Housing and healthcare policy needs to reflect the principles of integrated care to a greater extent in order to facilitate more cohesive support for those living with HIV who are homeless and who have substance use support needs.”
Improving Responses to Suicidality & Self-Harm
There were almost six hundred incidents of self-harm and suicidality recorded among homeless service-users over a three-year period. Of the 587 reported incidents, frontline services called either an ambulance or the Gardaí, or both, on just over two-fifths, or 42.7%, of occasions. A substantial number of clients had more than one incident within a given year, and often within a relatively short timeframe of weeks or months.
The objective of this collaborative research project, funded by the HSE National Office of Suicide Prevention under the Grant Scheme for Collaborative Research Projects on Connecting for Life ‘Priority Groups’ in Ireland, was to support further development of Dublin Simon’s approach to addressing suicidality and self-harm amongst clients.
Dublin Simon’s framework for suicide prevention/response has been evolving over the years and comprises a number of elements, including services and interventions provided by a dedicated mental health counselling team (Sure Steps), training for frontline staff, and incident reporting systems to support organisational risk-management processes.
The findings of the study illustrate the complexities for frontline services in balancing risk-management with the provision of optimal mental health support. One aspect of interest was the potential role of guidance developed by the Sure Steps counselling service based on the Collaborative Assessment and Management of Suicidality (CAMS) model.
Dublin Simon is preparing to implement a number of the recommendations from the research project.
Evaluating Recovery Pathways
In a study mapping outcomes of Dublin Simon Recovery Services carried out by Trinity College Dublin, it was found that the wellbeing of service users in Dublin Simon Recovery Services was generally better than similar clients in other community services. Client health and wellbeing was found to have improved over time. However, the complexity of undergoing recovery in the context of homelessness disadvantaged participants by presenting unique challenges relating to the pressures of securing available housing.
The study, “The Recovery Pathway: Mapping outcomes of existing processes of the Dublin Simon Community” involved comprehensive research to explore the enablers and the challenges of the three-stage recovery pathway, from the perspective of the wider governance structures, client, staff and leadership in light of its key mission and in line with the value systems of the organisation.
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Notes to Editors
Co-Designing a Mental Health Support Programme for Young Adults Experiencing Homelessness
Connolly, Sinead Casey, Éilís Conroy, Derek Dempsey, Assoc Prof. Kate Frazer (UCD), Prof. Thilo Kroll (UCD), Rachael McDonnell Murray, Patricia Walshe.
The research will be available on /dubsimon/healthsymposium2023 from 4pm on March 20th
The Lived Experience of Adherence to HIV Medication in the Context of Homelessness and Addiction.
Team: Eavanna Maloney
The research will be available on /dubsimon/healthsymposium2023 from 4pm on March 20th
Suicidality and self-harm incidents amongst Dublin Simon Community clients; an analysis of the frontline service response and how it can be better supported.
Team: Kevin Cullen and Tim Creedon
The Recovery Pathway: mapping outcomes and existing processes of the Dublin Simon Community.
Team: Catherine Comiskey, Prakashini Banka, Debra O’Neill, Ruby Walsh, David McDonagh.
About Dublin Simon Community
Dublin Simon Community provides services to over 6,000 people in Louth, Cavan, Monaghan, Dublin, Kildare, Wicklow and Meath, who are homeless or at risk of homelessness. Services range from:
- Outreach support to people who are rough sleeping
- Emergency accommodation for those with nowhere else to go
- Treatment, counselling & recovery services for people experiencing homelessness with addiction issues
- Long-term supported accommodation for those who need support
- Independent housing units for people able to live independently
- Tenancy support & homelessness prevention services to prevent falling into homelessness
- Resettlement services for people moving out of homelessness and into a home of their own
- Education & employability services for people who wish to build their skillset and find stable employment