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Orwell Prize

Compassion and understanding for people who experience homelessness

Jeannette Ward

This is an extract from an essay, submitted for the Orwell Prize for Reporting Homelessness, in which Jeannette Ward draws on her professional background working with children within mental health services and as an adult therapist, and of her own childhood experiences of homelessness 

Leaving institutions such as care for younger people and prison for older people (Centre for Homelessness Impact, 2022) are significant factors in homelessness.  Certainly, when I volunteered at a foodbank, apart from people who had their benefits sanctioned, leaving an institution was the most frequent reason given for requiring the food donation and being homeless. I recall that for a couple of people this situation of becoming homeless again, meant there was little motivation to remain out of prison. One of the reasons why I support Centrepoint is my awareness of the number of young people leaving care who experience homelessness. I have worked professionally with a lot of children in the care system over the years. 

An excellent review of the literature for a doctoral thesis by Gallagher (2023) suggests that the prevalence of ADHD in the homeless population is around four times the prevalence in the general population (32 % versus 5 to 8%). I have no doubt from my professional experience in the NHS that young people, but also older adults affected by a neurodiversity such as ADHD will be at higher risk of homelessness. People affected by neuro-diversities have organisation skill deficits, concentration difficulties, low threshold for boredom, problems with time management and impulsivity. These difficulties have been shown in research to impact education and work, managing finances and relationships. I have close relatives with ADHD, and they require support at times to cope with day-to-day life. I have seen many young people with ADHD develop comorbid psychiatric problems such as depression and extreme low self-esteem. These young people have often struggled to achieve in school and in the workplace and may have additional neuro-developmental difficulties with dyslexia, dyspraxia, dyscalculia, and Autistic Spectrum Disorders. 

A great concern and challenge professionally and within my relatives and friends is the paucity of assessment and treatment services, a shortage which should be rectified as a priority. There has been a recent sensationalist Panorama programme (2023) highlighting problems with some private ADHD services stepping in to fill the gaps in the NHS provision (ADHD Foundation). The ADHD foundation charity helpfully points out the missed opportunity to speak to people experiencing ADHD about their struggles to get the appropriate help from the NHS. (ADHD foundation, 2022). I have seen young people resort to substance use as a form of self-medication. 

For various reasons children and adolescents are vulnerable to becoming involved in gangs as a way of belonging as they are often excluded from mainstream school.

There is a higher prevalence of children with ADHD being in the care system, possibly at least in part due to their parents having often untreated ADHD, but as always it is much more complex than that. There is research to show that mothers of children with ADHD have an increased risk of depression (Cheung et al,2018) due to the additional pressures. I believe that our industrialised society presents many more challenges for people affected by ADHD and on the Autistic spectrum (Homeless link 2015) 

Referring to my point about the structural / individual causes differentiation and whether it is helpful or even valid, I would argue there are structural as well as individual factors at play here. I mention the severe shortage of trauma informed therapies and services for children affected by adverse childhood experiences. The same applies to adults affected by neuro-developmental disorders. There are very few services available to help them with their neuro-disability. That is a structural as well as individual cause but would be at risk of being officially documented as ‘individual,’ negating the requirement to prioritise important service developments. 

I also believe that for the person experiencing homelessness and affected by these health issues, and society in general, being told a cause is individual rather than structural feels it is blaming and stigmatising of the person. Potentially it risks an abnegation of responsibility and reinforces a lack of compassion. Using the metaphor of the garden, it is like neglecting to use sticks or a trellis to support plants which need to climb or be held up. The plants become crushed and buried under the ivy, equivalent to being crushed by the misrepresentation and wilful ignorance of the real state of a lack of much help and support for the difficulties I have discussed here.

This is an extract from an essay by Jeannette Ward.

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