1. Older, wiser … and homeless Counselling older adults experiencing homelessness Emerging priorities in mental health and addictions: the virtual world, ageing and migration 3 rd June 2016, University of St. Andrews Presented by Derek Dempsey Andrea Koenigstorfer

2. Agenda Introduction to the Dublin Simon Community Context to our research Presenting issues Barriers to treatment Our focus with this client group Questions

3. The Simon Communities in Ireland is an affiliation of local Communities in Cork, Dublin, Dundalk, Galway, the Midlands, the South East, the North West and the Mid West. The Simon Community across the country provide support and services to over 7500 individuals and families experiencing or at risk of homelessness every year. Together, with people who are homeless, Simon tackles the root causes, promotes innovative responses and urges the government to fulfil their commitments. About Dublin Simon Community

4. Our services for all stages  Rough Sleeper Team (Regional Contact & Outreach Service)  Soup Run  Social Club  Needle Exchange Programme  Emergency Shelter (Supported Temporary Accommodation)  High Support Housing  Medium Support Housing  Stabilisation/Respite Unit  Detox Service  Rehabilitation Service  Aftercare Services  Counselling Service  Support to Live Independently  Visiting Tenancy Support  Tenancy Advice Service  Wicklow, Kildare & Meath Support Services  Learning & Development  Client Involvement  Health & Wellbeing Emergency & Outreach Housing Services Treatment & Recovery Preventing Homelessness Personal Development

5. Our Mission: Empower people to access and retain a home, by providing housing, prevention and targeted interventions through advocacy and partnership. First ever Soup Run in 1969. Provide services to people who are homeless or at risk of homelessness, from emergency accommodation to treatment and supported housing, enabling people to move to a place they can call home. Today Dublin Simon Community over 24 services across Dublin, Kildare, Wicklow and Meath. We work with over 217 part-time and 53 full-time volunteers. Approximately 210 full-time and part-time staff.

6. Homelessness Dublin Simon work with over 3,000 people a year in Dublin, Kildare, Wicklow and Meath  There are now over 4,300 people in temporary emergency accommodation nightly across the greater Dublin region  Currently there are over 790 families with 1,616 children living in emergency accommodation in the greater Dublin region. This is an increase of 110% since this time last year  NATIONALLY: 5,811 people in emergency accommodation; 2,706 adults with no dependents and 912 families made up of 1,224 adults with 1,881 children. 49% increase nationally since the same week in February 2015 and 1.6% from January 2016.

7. Context Higher prevalence of Mental Health issues among older homeless adults compared to their younger counterparts More complex issues compared to general population – alcohol & substance use, past trauma, isolation from family, limited opportunities Complications in assessment of MH issues - issues are considered a part of ageing

8. Presenting issues – general population Losses & loneliness, bereavement, survivor guilt Lack of interaction with others Health problems, disabilities Dementia Loss of independence – wish to be cared for vs needing to be in control of their life

9. Presenting issues – specific to older homeless adults Past trauma – Impact on sense of self, sense of safety and control, ability to self-regulate, and interpersonal relationships Failing health, disability Reduced social engagement Alcohol and substance use Lack of financial resources, life skills, and social support Safety – living without a stable home can be particularly challenging in later life/violence in shelters and on the streets

10. This leads to: Depression Feelings of inadequacy, worthlessness, shame Fear Vulnerability Anger Fear of abandonment Helplessness

11. Issues in accessing traditional Counselling Services – general population Mobility Faltering concentration/memory issues Hearing problems Physical illness Lack of understanding of what counselling is Difficulties sharing problems with a stranger Issues “not suitable” for counselling Frequently focus on pharmacological treatment and “encouragement” to “go out and socialise more”

12. Issues in accessing traditional Counselling Services – older homeless adults History of trauma and psychological issues linked with homelessness  Multifaceted needs require access to specialised services not available in shelters

13. Treatment – age specific issues Deal with negative emotions Come to terms with loss Meaning-making Clients provide a narrative of their lives – the role they played in it – find new meaning/purpose in life – acceptance and ability to live in the present Stress independence – don’t let them become infantilised (shelters!) Maintain self-esteem – support and build on coping strategies Stress and build on their resilience

14. Our focus with this client group Incorporate an understanding of trauma into our work – Build physical and emotional safety – Emphasise importance of choice – Rebuild self-efficacy and control over their lives Focus on strengths rather than deficits Understand drivers

15. Meet the client where they’re at and go where they need to go Be open and non-judgemental Provide the service where they are – shelters, supported housing, mobile health clinic, treatment services Drop-in clinics to provide information Reminders for appointments Adapt session length to client’s physical and mental capacity on a particular day

16. LISTEN – VALIDATE – BUILD A RELATIONSHIP OF TRUST FIND VALUE IN WHAT WE ARE DOING SUCCESS MIGHT NOT COME IN HUGE LEAPS AND BOUNDS “PLANTING A SEED”

17. QUESTIONS?

18. The presenters have no conflict of interest to declare.