Nowhere to Go!
By Stephen Wilson, one of our reporters abroad
A recent report by the National Housing Federation in the United Kingdom found that a severe shortage of housing accommodation caused 109,000 days of delayed discharge among psychiatric patients in England from 2023-24. This in turn only exacerbates the lack of access to psychiatric care for those in urgent need of treatment. When some patients do attain treatment, they complain of being 'retraumatized' rather than feeling much better. Many patients are caught up 'in a perfect storm.' They can find neither effective treatment or a roof over their head. They have nowhere to go.
I can never forget this. A patient who clearly had psychiatric problems had phoned the church where the brotherhood who helped the homeless appealed for help. He claimed to be an English man being kept against his will. He asked us whether we could provide him with accommodation. Well I, and Namrud Negashi, visited 'David' in hospital. We found a very pale and sick person who didn't just require psychiatric care but could hardly even walk. He looked very depressed and unhappy. He personified abject misery. I never recall seeing him smile once during our visits. But it was obvious from the start this person was not English. His slight Russian accent and the typical grammar mistake they make with articles gave him away. In any case we did not have the resources or the staff to provide the type of care and accommodation he needed. For some reason he had nowhere to go or any relatives he could rely on. I'm glad the American volunteers were doing a great job visiting him and bringing him at least some comfort.
The medical staff who were looking after them did not conceal anything about him. In fact, they took the trouble to reveal his history to us 'so this patient would not lead us down the garden path' as they put it.
The medical staff were not exactly keeping him against his will. Because his mental and physical condition were bad and he had nowhere to go, he was not discharged. If they discharged him, he would be out on the streets. He had been in their care for years. Nevertheless, the staff would only be too unhappy to discharge him. They even went so far as to ask me “If you want to take care of him you can sign those discharge papers today. We'll bring them to you at this very moment.” I declined. It would have been irresponsible. If I couldn't get stable accommodation for myself, I doubt I or any of us could help the problem of a patient who needed specialist care.
Some months later I got a phone call from someone who never gave me his name but simply said, “It is just to remind you that I still exist.” I guessed it was him.
This case was in Moscow, Russia. But it could just as well have been in Glasgow or Chicago. StreetSense had interviewed a discharged Scottish patient who had no accommodation to go to and published his story which provided an insight into their predicament. Unfortunately, the scenario of patients in limbo who are not being discharged due to accommodation problems has worsened throughout the United Kingdom.
According to a report by the National Housing Federation, thousands of patients who should have been discharged from psychiatric care remain in hospital. The reason for the delay? They have no alternative accommodation to go to. In fact, the lack of supported housing was cited by the report as the biggest reason for delayed discharges from mental health hospitals in England last year. Such a delay is estimated to cost the National Health System 71 million pounds a year. The number of patients stuck in hospital as a result of the housing related question has tripled since 2021.
Unfortunately, the number of young people requesting psychiatric aid continues to relentlessly soar up. The rate of referrals per month for children with psychological problems rose from 40,000 in 2016 to 120,000 in 2024. Many of those children can be on waiting lists for treatment for months and even years. Around an estimated 343,000 children in England are currently waiting for treatment. The British press is full of stories where young people who cannot get urgently-needed treatment commit suicide in despair.
This does not mean patients are not all being discharged. In many cases, they have been prematurely discharged on the basis of simply reaching the age of 18. A report by the Health Services Safety Investigations Body found youngsters who were being discharged from care ended up being housed in caravans, bed and breakfast accommodations, or left with nowhere to go on the streets. One young woman, called Weronika, 21, recalled how she was asked to fend for herself as soon as she reached the age of 18. She recalled, “I went from having a warm, safe nest to being thrown out into the open without even learning to fly.” Weronika now works as a volunteer advocate for the mental health charity Mind.
A representative of Mind, Doctor Sarah Huges stated: 'Mental health problems do not disappear on your 18th birthday, but too often support does. Discharging a vulnerable 18-year-old who may lack life skills to live independently when only a day before they were eligible to receive 24/7 care is unforgiveable. The charity organisation Center Point, whose aim is to help and end youth homelessness, mentions the vulnerable case of Anna, 17, who is homeless on the streets. The appeal reads, “Anna is 17, homeless and terrified. She is scared of strangers looking at her. The sound of footsteps make her feel sick with dread.” And sadly, her fears are not unfounded.
Right now, homeless young people like Anna are at risk of abuse, exploitation and assault on our streets. In fact, 75% of homeless young people say they are anxious for their safety because they have nowhere to stay.
However, even if those children receive treatment, the quality of care can turn out to be dire. A new report from the Centre for Mental Health paints a generally depressing picture of a broken medical care system. The report underlines unsafe levels of bed occupation, chronic staff shortages, and old uncared for Victorian buildings which have seen better days. The quality of treatment can at times be appalling. Coercion, overuse of sedation, and too much restraint are often resorted to when more professional intervention is called for.
Doctor Sarah Huges believes that the British government needs to take bolder action in not only higher investment in care but much better high-quality intervention, planning and care where housing services and hospitals work in unison. She emphasized that “We need a shift in culture, away from coercive approaches to trauma-informed ones, with high quality planning and resourcing to make that possible” {pages 8-9 , “Mental Health,” in Dispatch, Issue 1649,13-19th January 2025, “The Big Issue”}.
In this respect, the connection between poverty and mental distress is a strong one which can't be denied. The charity the Samaritans who maintain an emergency service of volunteers to help people tempted to take their lives found that the poorest 10 % of society are more than likely to die from suicide than the wealthiest 10% of society. Any grasp of the complex problems of mental illness cannot limit their analysis simply to a biological model which stresses inherited genes or the impact of brain damage but should encompass the stress of poverty, deprivation and a situation where people have nowhere to go.