The Relationship Between Substance Misuse, Mental Health and Homelessness

The following article appeared in the August 2018 edition of Parity:  Issues of Substance: Substance Dependency and Homelessness. It was written by Nigel Pernu, a member of CHP’s Peer Education and Support Team.

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‘It (addiction) is an attempt to solve the problem of disconnection, alienation and tepid despair, because the problem is ultimately “being human” in an environment that is curiously ill-equipped to deal with the challenges that entails. We are all on the addiction scale.’
— Recovery, Russel Brand

I am writing this from a personal perspective. This is what has happened to me to create my current circumstances. I am at present a member of the Peer Education Support Program (PESP) team at the Council to Homeless Persons (CHP), a program that is run over a two-year period.

When one thinks about homelessness, the image of rough sleeping is the thing that comes to mind. But rough sleeping is only seven per cent of the homeless population. Rooming houses, boarding houses, pubs, motels, couch surfing, unsecured and overcrowded tenancy make up the majority of what is known as homelessness or the risk of homelessness.

While I have done some rough sleeping in the past, this is not a story about that.

I will have to go back more than a few years for this story to make any sense. But hopefully, by the end, the relationship between substance misuse, mental and physical health and homelessness, will make a coherent tale.

At the beginning of 2011 I was working as a chef in Alice Springs. Anyone who knows the cooking lifestyle will understand that it can be quite extreme, with people in the industry often burning the candle at both ends. I was in a position of responsibility and with that came a lot of hours and pressure. So what I am saying is that I was certainly no saint.

One day while on a rare break, I began feeling quite unwell. It felt like all the breath was being sucked out of my body and replaced by a water buffalo sitting on my chest.

I also started having pain shooting up the left side of my body. I was later found out that I was experiencing a heart attack, something that is usually unthinkable for someone only 37 years old. This kept happening on a semi-regular basis for about six weeks with the doctors in Alice Springs and Adelaide baffled as to why this was happening to a relatively healthy man.

What happened next was a long and strenuous process of trying to find out the cause of the heart attacks with plenty of stays in the intensive care unit and three trips down to Adelaide via the Royal Flying Doctor service. It was eventually worked out that I had Cardiac Sarcoidosis, a rare auto immune condition. The doctors were at a loss to explain why this develops and currently do not have an effective plan of how to treat it. As you may or may not know, opioids are used on a regular basis to deal with pain management. As a result, I found myself becoming hooked on morphine and sleeping tablets and medical grade steroids (used for strengthening the effected organs.)

So fast forward a few months and after staying in the Anti-Cancer Council ward and receiving some experimental medication I was declared well enough to be released from hospital. Another blow was that the steroids I was taking made what was a pre-diabetic condition turn into fully blown diabetes 2.

Great, I was now in a city I didn’t really know, hooked on opioids, without a job, without a home, putting on weight at a rapid rate, (because of the steroids) savings rapidly diminishing and without a friend to call. From this you can see how chronic illness can often be a key factor in causing homelessness.

As you may imagine, this was all a huge blow to my mental and physical well-being, and even though I am quite an upbeat and optimistic person, I became quite depressed as well.

The hospital had set me up with a social worker who referred me to a rooming house in an Adelaide suburb. While I was grateful to have a place to lay my head, anyone who has lived at a rooming house knows the pitfalls and adversity one faces on being placed in such a place. Money had begun to get really tight and the Dole (Newstart) barely covered the rent. My personal safety was also in question as there were some highly dubious characters hanging around the rooming house and what little property I had, was stolen. I believe that the combination of depression, stress, boredom, recovery time, anxiety and what I would become to realise was PTSD and the easy availability of heroin led me to start taking it.

Poverty is a key factor when discussing mental health, and of course homelessness, and the fact that I did not have a safe and secure place to call home made my situation particularly hard. At the time the drug was my only comfort. When you look at depression and addiction through the eyes of an addict, one of key factors that needs to be understood is one of lack of connection to the community.

‘Today’s flood of addiction is occurring because our hyper individualistic, frantic, crisis-ridden society makes most people feel socially and chronically isolated.
Chronic isolation causes people to look for relief. They find temporary relief in addiction.’
— Chasing the Scream,
Johan Hari.

People experiencing homelessness are some of the most isolated people in society, both from a social and financial point of view, so it makes sense that many turn to substances to ease their pain.

So I was hooked on heroin, a drug that at the time was readily available in Adelaide. What was I to do?

Of course my situation had the potential to become even more dire. At the time, my lack of friends was something that actually worked for me. I withdrew to my room and decided on giving up the junk; going cold turkey as I was unaware of the various pharmacotherapies available for the treatment of addiction to opioids.

As a result, I was strung out and desperate for some connection and so I called my mother with whom my relationship at the time was quite fraught. After some tense conversations she offered me her spare room in country Victoria.

My mother at the time did not understand the seriousness of my condition as my illness does not really manifest itself in a physical way. So all she saw was a lazy, angry man who would eat anything that came his way. Being a 37-year old man being reduced to living in my mother’s spare room also affected my pride.

This was another stressful time that only ended with me making the decision to move back to Melbourne, a place I had not lived in for almost a decade. Luckily, I had maintained a few connections and was able to call upon a friend for a place to crash. Couchsurfing is a common part of homelessness and again I was grateful to have a place to crash. However, the situation was not ideal with people in the house all having their own substance issues. I spent a few months on the couch until a room became available at that house.

While this is by no means the end of my story, I believe that this snapshot of my life shows how physical health, mental well-being and substance dependence all have the potential to intersect.

While the will to change has to be present before any change takes place, relapse is inevitable if appropriates supports are not in place or the place where you are living provides little safety or security.

The added impact and trauma that comes with homelessness makes giving up something that is the only form of comfort, a particularly hard task.

What can be done for those experiencing homelessness and addiction? Well for me what worked initially was the kindness of various support and alcohol and other drug (AOD) workers. This support is important when dealing with people who have experienced trauma as there is little space in their lives for trust, and where their connections to the wider community are often frayed or non- existent. This support can help establish a relationship that can help the workers develop individual goals and life skills with the client.

On a more societal level what I believe needs to happen is a systemic change in our ideas and attitudes when we consider homelessness and substance misuse.

One of the key problems is with the so called ‘war on drugs’. This punitive approach can turn people who have been convicted of relatively minor charges into hardened criminals. It also adds to a problem of homelessness as people released from prison with few supports in place often find themselves at risk of being homeless and as a result, the pull of drugs is often alluring. This punitive approach is also hugely expensive. Even some conservative thinkers are now looking at the costs of this approach and finding the results of this ‘war’ are ineffective and fiscally irresponsible.

How will this change occur? A necessary start will be raising consciousness around these issues to combat the stigma surrounding homelessness, addiction and mental health. Advocacy is an important part of the work done by CHP. Trying to influence policy at a government level is also important because without this change we will end up digging a bigger hole that is even harder to escape.

Portugal is a prime example of where they decriminalised a certain amount of personal drug use. Now people are given interventions and counselling instead of incarceration. Drug use has actually decreased and the prisons are no longer heaving with inmates.

So what if we introduced this idea in Australia? Well it will certainly not happen with the current thinking on the issue. The mainstream media and the hysteria surrounding the issues tend to make people panic when discussing drug use and homelessness. It would be great if evidence-based journalism and policy was more evident.

However, to give the state and local government credit, some of the recent changes in policy have resulted in a Police Force that seems to have a better understanding of the relationship between homelessness and substance misuse. The Victorian Police force is showing a great deal more empathy when dealing with people with a lived experience of homelessness. The Federal Government on the other hand has totally dropped the ball when it comes to issues of homelessness.

The safe injecting facility in Richmond which is currently a trial is also a step in the right direction.

I hope that sharing this story will help challenge some of the stigma that surrounds homelessness and substance use and show that homelessness can happen to anyone.

As John Kenny (a graduate of the PESP team) has said: ‘Homeless people are just people without homes.’


This article appeared in the August 2018 edition of Parity:  Issues of Substance: Substance Dependency and Homelessness. It was written by Nigel Pernu, a member of CHP’s Peer Education and Support Team.

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