Sunday, 18 July 2010

Lifestyle choice or mental health issue?

Entrenched rough sleeping is a difficult and often sensitive issue. These clients have been on the streets for so long and yet seem to be coping well in so many ways. But at what point do we take a step back and say it is a lifestyle choice or delve deeper? Are there underlying mental health issues, that are preventing them from accepting accommodation?


  1. Given the individual circumstances of each rough sleeper, I think that it is extremely difficult to categorise the cause of entrenched rough sleeping.

    To those people who have limited front line experience and are fortunate enough to have a home and a secure network of family and friends, the idea of sleeping rough as a lifestyle choice is absurd.

    This does not, however, mean that rough sleeping cannot be a lifestyle choice. Once a person is living on the street, which will often result from mistreated/diagnosed mental health problems, I can see how rough sleeping could develop into a lifestyle choice. As humans we are capable of quickly adapting to a change in circumstances and feel comfortable with the certainty of everyday routine. Therefore, no matter how strange it may seem to the wider population, someone may select rough sleeping as a lifestyle choice as it represents a way of life that they feel both familiar and comfortable with. It has nothing to do with their mental state. On the other hand, to anyone with limited experience of rough sleepers, the decision by an individual to choose to sleep rough as a lifestyle choice provides clear evidence of mental health problems.

    It’s impossible to categorise the cause of entrenched rough sleeping. It will be a mental health issue for some but a lifestyle choice for others - each case has to be assessed on its merits and the appropriate strategy adopted to achieve the best results for the individual in question. However, to achieve this adequate resources need to be made available to those working with rough sleepers. Given the current economic climate I think that unfortunately this is unlikely.

  2. I am an outreach worker in the East of England. I have personal experience of being homeless and entrenched rough sleeping. I found it very easy to become entrenched because being homeless is a fairly easy life. You dont have to worry about anything or anyone apart from your self so to move into accommodation means to start having to worry about bills and the like. I dont believe that people choose to rough sleep for long periods but that you just get used to it, and once entrenched cant see there is another option.
    I had lived in my car for about 11/2 years so the move to street homelessness was quite easy and I was entrenched before I had spent one night on a pavement. In my mind substance misuse issues are usually the culprit with mental health issues being the bi-product of abuse. We may think that there are issues there but if you remove the substance usually motivation and self respect return......this is my personal experience

  3. I have followed a few cases of long term street homeless into their own accommodation. I think the above points are all well made. I knew one man who seemed to be sane who had been rough sleeping in a shop doorway. He was insistent that he would not move indoors, but ended up in a flat where he recently died. He refused to stop drinking or have anything to do with anyone who ever raised the subject.

    A man who had been in the cemetery has had his own flat for over a year now, and has kept 5 consecutive appointments to get back into work. He has always accepted help and despite acute arthritis insists on contributing himself.

    Another man was neqrly 10 years outdoors, and was like a role model to a lot of people in housing need who wanted to be as independent as him. Although he has no formal diagnosis, his fear of mainstream society and his past make it a certainty that PTSD and paranoia would figure. But why intervene if he is not a danger or at risk? He can be non communicative for months at a time, but agin he holds down a tenancy in a very isolated but central council flat. I work with the council to ensure they realise that his timescales are longer than most peoples'. So far it works.

    I don't think any of these men benefited from sleeping out. They all benefit from having a secure home. I reckon even the one who died would have had a good few less months alive and his death would most likely have been less dignified if he didn't have a roof over his head. But the decision to 'come in' had to come from them.

  4. A lifestyle choice is "A way of life or style of living that reflects the attitudes and values of a person or group". I have never really been convinced that a person chooses to be homeless, it is a by product of life events. Once they are homeless and have been for a number of years, I can see how they would rather maintain this than make some very scary and difficult changes. The fear of loosing everything again must undermine many positive aspects of change. The reason I don't agree that it can be a life style choice is that people become stuck, and the overall impact of this life has such damaging effects on a body (the reason why average life expectancy of a rough sleeper is approx 55 and rest of the country would be approx 80).

  5. Some people choose to sleep rough for no other reason that it is positive for them. We favour home due to the excluded intimacy that it provides us with. In essence we fear the lack of ability to exclude. However if you have spent a long stint in an institution where you have exclude intimacy has been a pejorative, then you will favour the lack of ability to exclude. I would not categorise it as a mental health issues rather a diss association with the mundane and familiar therefore the included dynamic provides the same comfort for these people that home provides for us.