Mental health is one of the key elements of homelessness because it can be both the cause and the consequence of living on the street. Access to quality support and treatment is therefore essential for the sustainable reintegration of homeless patients with psychological or psychiatric disorders.
Untreated mental disorders fuel homelessness
The street is now the largest psychiatric hospital in Brussels. In the field, Streetnurses’ teams are increasingly confronted with homeless people presenting mental health issues. Around 70% of our patients suffer from mental disorders, with at least 25% suffering from psychiatric disorders such as psychosis, schizophrenia or neuroses.
This prevalence can be explained by, among other things, the closure of many beds in psychiatric institutions, the lack of community services, the shortage of low-rent housing, and the presence of homeless people in exile who are at increased risk of post-traumatic syndrome.
With no structural solutions available, our teams have to adapt. Pierre Ryckmans, medical coordinator at Streetnurses, explains: "We refer our homeless patients to specialized mental health services. You have to make an appointment, get around, and respect strict time schedules... It's simple for you and me, but much more complicated when you live in the street. We must listen to them, reassure them and support them throughout the process, but we also have to mediate with the services."
Psychological follow-up is also important for people leaving the street
For many of our patients, the return to housing alleviates the mental problems associated with street life, and helps to identify underlying problems where they exist. Pierre: "Once the stress of street survival has been eliminated, we can identify the underlying mental health problems. It can be post-traumatic stress, mental disability, neurosis..."
Rehoused people, like people living on the street, have to comply with the mental health care framework. Pierre: "Sometimes we have trouble bringing them to see a psychiatrist at the right time. We have to compromise, negotiate and do it over several times. It's not easy, but we manage."
Faced with the system requirements, the field teams struggle to find solutions for the most difficult cases. As a result, the people who most need mental health care have the most difficulty accessing it. "We are serving as a crutch in a care coverage that could be shorter and more appropriate. It's frustrating and paradoxical for us," concludes Pierre.
No end to homelessness without access to mental health care
Ending homelessness is a political choice! In order to provide high-quality support for homeless and rehoused people in Brussels, the government must increase the funding and capacity of all care services:
• Outpatient services such as nursing homes and mental health services
• Sufficiently low-threshold psychiatric institutions
• Specialised institutions for sustainable rehousing of homeless people with mental health problems