Psychiatry at its best

Dr Jenny Drife reflects on the rewards – and rockier moments – of providing mental health support to those who are homeless. 

As consultant psychiatrist in a community mental health team for homeless people, I rarely spend all day in one place. 

Today my day started with a 7am visit to someone’s sleep site in a local park, and then I went along to one of our regular clinics at a day centre for rough sleepers – before going to my office to check in with the team. On the way home, I dropped in at a hostel to see how someone who’d recently come off the streets was settling in to accommodation. Each day is enormously varied, and I’ve got used to navigating the back streets of South London on my trusty bicycle.

A growing issue

Sadly, homelessness is a growing issue across the country. The true extent of the problem is difficult to quantify, but on one night each Autumn there’s a snapshot based on headcounts or estimates across the country. In 2018, the figure was more than 4,600, which is an increase of 165% since 2010. 

People end up on the streets for all sorts of reasons, but it’s hardly ever a lifestyle choice. I’d say that approximately half of those sleeping rough have been formally diagnosed with a mental health problem and similar numbers have either drug or alcohol problems. Many have all three. The reality of living on the streets often makes those problems worse – it can become a vicious circle. And when I talk to my patients it’s often clear that their problems started years and years before they lost their accommodation: many have a history of trauma, often going back to childhood.

Supporting each other

It can be difficult to hear those stories – you feel like someone should have done something to intervene earlier. I struggled with that at first. But it’s great to feel that you are finally helping some of the most vulnerable members of society.

I’m enormously lucky that I work in a team of people who are passionate about what they do, and we work closely with really dedicated colleagues in the third sector who provide outreach and run day centres – it’s hard to feel too pessimistic when you’re surrounded by people who want to make things better.

Battling the elements

We’re coming up to winter now, which is my least favourite time of year: we do outreach in the dark, it’s cold and wet on my bike, and I admit that I often wake up at night worrying about people who I know are outside when the weather’s bad. But sometimes that provides an opportunity to get people in to emergency shelters and then we can do a proper assessment of their needs.

It is not always easy work, and it can be frustrating – more times than I care to remember, I’ve talked to a tent attempting to engage its occupant, only to discover later that there’s no one in there. But the positives more than compensate. It’s not unusual for us to meet people when they’ve been outside for years or even decades, living in sheds or under bushes, with untreated mental health problems. To see them get better, get into stable accommodation, and start enjoying their lives – even sometimes making contact with family they haven’t seen for years – is a real privilege. For me, it’s psychiatry at its best.