Being without a home is a major personal problem that brings many other difficulties in its wake, writes Patrick Burke
It's a typical workday morning routine. En route to the office, you drop by the coffee shop. Pleasantries are exchanged with the staff. There's no need to place your order, such is the regularity of your request. Your loyalty card is stamped and off you go.
Next stop, the newsagents. You pick up a paper, scan the sweet counter and decide against any additional purchases. After all, you have the exact change ready.
During the few minutes remaining to the office, you see the same people, all walking fast and carrying takeaway coffee. There's a man in a doorway. He's sitting on cardboard. You see him every day. As they file past, some people look the other way. Some drop small change into the paper cup by his side. The same person always gives him a hot drink and sandwich.
Weeks pass and your morning routine changes very little: same coffee, same people, same route to work. Then you notice the man in the doorway is no longer there. You're not quite sure when it was you last noticed him.
Days go by and he's still not there. What might have happened to him? You hope the man has found a place in transitional accommodation, where he will be offered a range of supports to help him out of the cycle of homelessness.
After some months or a few years, he might be back on his feet and secure independent move-on accommodation.
But the fate of homeless people is not always hopeful. Last year, 55 people who used the services of the Simon Communities met untimely deaths. Their average age was just 42. The mortality average for an Irish person is 78.
The cycle of homelessness usually begins with a personal crisis: a relationship breakdown, bereavement or violence in the home.
Poverty is also an underlying cause, as are the systematic failures that result in people in institutional care being released into homelessness.
Health problems - physical and mental - are often the first to manifest themselves. After a sustained period of homelessness, mental health problems affect many people.
In the most significant health profiling of homeless people undertaken, the National Advisory Committee on Drugs (2005) found that 90 per cent of people experiencing homelessness had a physical health complaint.
Almost half of those profiled reported a psychiatric health problem. The majority indicated that they had a problem with alcohol or drugs.
The extreme circumstance of being without a home obviously precipitates health problems. However, the lack of access to appropriate healthcare means these problems are accentuated.
Because of a lack of a permanent address, people experiencing homelessness are in a vacuum. They have no entitlement to a medical card and, without a reasonable income, they cannot afford to attend their GP.
The Simon Communities realise that the job of addressing the high mortality rates of people experiencing homelessness is more than just a matter of extending medical card provision. Because of their multiple health needs, they require a range of care interventions that are outside the scope of a GP. As well as medical interventions to address physical health complaints, psychiatric care and addiction treatment are regularly required.
In Cork, the Health Service Executive (HSE) has worked in partnership with Simon to establish a multi-disciplinary health service for people experiencing homelessness. This model has proven highly effective and is affecting people's transition from homelessness positively.
The solution to the poor health of people experiencing homelessness lies in the extension of similar models of healthcare services nationally.
In some areas of the country, people who are homeless simply have nowhere to go when they fall ill, and this means that preventable health complaints become chronic illnesses which, too often, prove fatal.
The 55 people who died last year meant a lot to Simon's staff, volunteers and fellow residents. Many of them were known to us for years. Their untimely demise should not be in vain.
While much responsibility lies with the HSE in ensuring that budgets for homeless healthcare services are ring-fenced in every region for 2008, other policy measures are also required to address and prevent homelessness.
The quality and availability of emergency services needs to be addressed to ensure that all services conform to best practice standards.
Investment is required in social housing and sufficient move-on accommodation for people to progress out of homelessness. Even with the Government Budget commitment to deliver 9,000 social housing units in 2008, those who will have to shout the loudest for a place are those that are homeless.
It is also important to recognise that social housing is not appropriate for everyone and that further long-term supported accommodation is required for those with high-support needs.
Our welfare system also needs reform to ensure that, once accommodation is secured, the tenant can keep up with rent payments. Finally, initiatives should be developed to address barriers to education, training and employment for people who are homeless.
The target of ending homelessness by 2010 is still realistic, but requires an accelerated effort by central and local government - as well as the HSE - as we inch closer to the deadline.
Patrick Burke is chief executive of the Simon Communities of Ireland, which today launches its 2006 Annual Review. Simon operates in Cork, Dublin, Dundalk, Galway, the midlands, southeast, northwest and midwest. Further details from www.simoncommunity.com