What gets called mental disorder or illness, mild or severe, shows itself as a misplaced fear of others. Personal relationships break down, followed by an inability to form and maintain new ones. The sufferer becomes progressively more emotionally and cognitively isolated. Madness results from our failure to constantly update and modify our mental map of the world. If we do not ‘test’ our predictions, beliefs, dreams, thoughts, internal dialogue, fantasies, hypotheses, plans, ideas about how the world is, and what the people within it think and feel, our map becomes rapidly out of date. If we act with an out of date model of the world - we will look mad to others, and they will treat us as mad. If others don’t share a large part of our model of reality we are emotionally and cognitively isolated. We need an accurate map; by sharing we come to have a more complete understanding than we could ever achieve alone. The ability to doubt and live with uncertainty, and hence know that we must constantly test our vision of the world - is sanity. To control and fix our view is the first step on the road to disaster and the way an unchanging outlook is maintained is by isolating oneself from any evidence that might contradict it. An unmodified and out of date model of the world is one where our thoughts and feelings are anchored in the past, hence our predictions of the future may be hopelessly wrong.



Monday 1 November 2010

Homelessness and mental health

Sometimes you just have to be outside.

Those who are homeless and have mental health problems, have different needs from those who don’t. Like other people who are homeless they are highly likely to be users of street drugs and alcohol, they may have been forced from home due to various forms of abuse, relationship breakdown or for economic reasons. Nonetheless their priorities are often different, and almost certainly different from those charged with helping them.

Social workers, social services, the police and more specialised outreach workers often just don’t ‘get’ why someone wouldn’t want even the most basic of accommodation. But that’s not to say they don’t welcome the right kind of help.

Mental distress and a sense of confinement go together. The opportunity to escape, sometimes at a moment’s notice, for longer or shorter periods may be paramount. For some that requires physical space and even an open horizon.

Prior to the current recession the homeless had been becoming less visible than at any time in the last thirty years or more, not simply as a result of economic prosperity, but because of concerted efforts by various authorities to tidy-up social spaces - 24 hours a day. A combination of the police moving the homeless on from town and city centres, plus government and charities providing more hostel beds and more flexible forms of social housing, meant that to be on the streets by choice became more and more difficult. Rough sleepers had to become more discrete. Road and railway cuttings, embankments and bridges - rather than railway stations and town centres. In fields and hedgerows, rather than within the village.

Despite the impression often given in the media, most homeless people/ rough sleepers/ young runaways/ missing people tend to stay within their own territory. And although the population is much more mobile than it once was, it is still the case that a homeless person is likely to remain within a few miles of the home they felt forced to leave. A runaway from a Devon village is quite likely to meet an ex-Royal Marine whilst kipping on a south Devon beach! (Although some younger people undoubtedly do head for the capital, most of London’s rough sleepers are Londoners. At one point people joked that there were more outreach workers at London mainline stations than runaways).

Now the homeless population is growing again - but are they really more conspicuous or less easy to ignore? It is often argued that the general population becomes easily desensitised to their presence. Well, we can block-out all sorts of things, and when we do, that simply forces the rough sleeper to seek out better locations for spot-begging. The portal of an ancient church, which just happens to be en-route for some of the more well-heeled commuters at eight in the morning in my local city - is much favoured. Enterprise is often rewarded. But for others, crowded streets are as much a nightmare as a spacious night shelter may be - too confining by virtue of the company you’re forced to keep. But just to be seen alone is perceived as a threat by some, and a reason for others to impose help. A trusted companion may be welcomed at times, but only for certain things. Physical freedom, in town or country, in order to pursue any activity, unaccompanied or unsupervised, is at an all time low. Space is not free but certain spaces are left vacant at certain times of the day and night. Rough sleepers will commute into towns to beg from commuters and just as purposefully leave again.

Most helpers want to put back together that which is perceived as having fallen apart. Most obviously in the case of children there is the insistence on returning them to the source of their distress after they have taken the constructive step of removing themselves from perceived danger - which often leads to worsened circumstances. But the same thinking is applied to adults too, albeit through ‘expert’ advice rather than the force of the law. People make themselves homeless when there is ‘nowhere else to go, and no one left to turn to’. But when life at ‘home’ becomes impossible and individuals feel forced to leave, family and professional helpers do conspire - made possible by the distressed person’s inability to explaining themselves to others.

It’s more difficult to jump trains (fare-dodge) than ever before. And of course it was never possible to be a ‘hobo’ on the UK rail network (jump freight cars and be a seasonal agricultural labourer - outside, and on the move). Equally the ancient art of hitching lifts on roads has died-out, unless you are clearly identifiable as a fellow member of a very small number of occupational groups. Railways however have a traditional, although dwindling connection with homelessness in the UK. And that connection is linked inevitably with the number of suicides that have occurred on or around railways. I’ve written elsewhere on this blog about suicidal thoughts and actions, but there is one exception to the views I’ve already expressed and that is what has become known as ‘suicide by train’. My sympathy goes out-the-window when someone attempts or succeeds through such a method. If you are determined to make life as unpleasant as possible for the largest number of people by your voluntary death, then suicide by train is the way to do it.

Choosing suicide by train in the mistaken belief that death is both instantaneous and easy; the track-walker, platform or bridge-jumper, when successful, dismembers themselves and leaves the greatest possible mess for others. And when the British Transport Police, for it is their formal responsibility to clean up, euphemistically refer to the ‘torso’, they simply mean the biggest bit they can find. Of the many people potentially traumatised by such an act, the train driver often suffers the particular experience of witnessing the before, during and after of an act in which they are both involved but powerless. There have been some initiatives in the UK to provide counselling for drivers, and training for station staff in suicide prevention. However the modest amount of research into suicide by train has principally been undertaken in Canada and Sweden.

But what is really missing is an appreciation that homelessness is not just a precursor to suicide for many with mental health problems, but a process in which an individual my progressively loose their adaptability to modern living and revert to more fundamental and natural behaviour. For although suicide may be unnatural, choosing the time and place of one’s own death may not be. The suicidal person often expresses the belief that they have become useless to their nearest and dearest, that those they care about most, would be better-off without them. They cut themselves off, mental and sometimes physically, becoming outsiders to their own group. In this way someone, whatever their age, may in their thoughts and actions come to resemble the elderly. Equally, there may be parallels with our ancient ancestors. In modern Christian mythology, death is about ‘crossing the river’. In a hunter-gatherer ‘form of life’, a natural lifespan comes to an end when you can no longer cross the river without endangering the lives of your family and group. I’ll end therefore with a quote from Jacob Bronowski in The Ascent of Man, reflecting on an incident recorded whilst filming the nomadic and pastoral Bakhtiari of northern Iran in 1970.

‘Who knows, in any one year, whether the old when they have crossed the passes will be able to face the final test: the crossing of the Bazuft River? Three months of melt-water have swollen the river. The tribesmen, the women, the pack animals and the flocks are all exhausted. It will take a day to manhandle the flocks across the river. But this, here, now is the testing day. Today is the day on which the young become men, because the survival of the herd and the family depends on their strength. Crossing the Bazuft River is like crossing the Jordan; it is the baptism to manhood. For the young man, life for a moment comes alive now. And for the old - for the old, it dies.

..What happens to the old when they cannot cross the last river? Nothing. They stay behind to die. Only the dog is puzzled to see a man abandoned. The man accepts the nomad custom; he has come to the end of his journey, and there is no place at the end.’


Support Railway Children http://www.railwaychildren.org.uk/?lpos=fromtheweb - a charity started by UK railway workers, which raises funds for projects principally in India, East Africa and the UK. Includes help-lines, outreach work, family support, education programmes, the recruiting of former street children as peer supporters, plus in the last few years, research. For the Off The Radar (2009) report, 100 experienced UK child rough sleepers were interviewed; 2 out of 3 experienced violence on the streets, 1 in 10 had been sexually abused at home, 2 out of 3 had mental health problems, and almost all had been excluded from school.

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