I love a big city get away. The energy, architecture, great food, art galleries, the zingy mix of languages, the cultural melting pot. But there are down sides: the crowds, high prices, and the sharp, sharp contrast between those who have and those who haven’t a roof over their heads. On a recent trip to Sydney, I was reminded of living in London years ago. I became desensitised to the homeless dotting the pavement because they were just part of my daily landscape. But that was before…
It feels very different now. Homelessness is often the collateral damage of poorly managed mental illness. Back when we lived in London I had no knowledge of such things. My Bipolar Disorder was still dormant, waiting for the birth of my first child to trigger an illness that viciously distorts how I feel, speak, and behave, when it strikes.
How can mental illness lead to homelessness? Firstly, it’s easy to lose your job if you come down with one. The symptoms will interfere with your ability to perform to the same standard as you do when you’re healthy. A lack of motivation, poor concentration skills, poor short-term memory, irritability, do no one’s performance review any favours. And that’s if it’s something common like depression or anxiety. If you’re dealing with anything that is accompanied by delusional or psychotic symptoms, your behaviour might turn seriously inappropriate, appalling, even dangerous. Grounds for immediate dismissal.
You might ask: ‘Well, why doesn’t the person with the mental illness just get some help?’ Fair enough. If the sufferer has the insight or an insightful family member to get help before their illness wreaks irreparable damage on their career – then yes that is ideal. However, if it’s a first episode, often there is no insight. And by the end of the episode the damage is done.
Then there’s the pesky business of what ‘help ‘entails. If you can’t afford private health insurance, in this country, the public mental health system often goes nowhere near providing an adequate standard of care. So even if someone tries to get help, they may not access what they need to get better.
There is also the huge matter of stigma. Because psychiatric symptoms can adversely affect behaviour they are often thought to be under the sufferers control. So wrong. Employees may be reluctant to tell their boss they have a mental illness, because stigma gets in the way. So, they struggle in silence, possibly thinking they can push through it. They can no more push through it without appropriate treatment than someone with cancer can push through their illness unaided.
Many employers struggle with the concept that their mentally ill employee may need an unknown amount of time off to get better. Running a business and not knowing how long an employee will need off is a logistical nightmare. Many other illnesses’ treatment and recovery have a defined end point. Even if they need lengthy sick leave, someone who has a broken leg or needs chemotherapy will be able to tell their employer when they are likely to be able to return to work. Mental illness is different. Even a highly trained psychiatrist can’t tell their patient when they will be better. They can give a rough guideline, but that’s all. And mental illness almost never gets better in the 10 days of annual sick leave most employees are entitled to. So, then what?
Someone suffering a mental illness can be fired or convinced to resign relatively easily. Not so much because there is no legislation to prevent this – there may well be – but because while the employee is unwell they have no spare energy to fight for their rights. They are often battling feelings of guilt or shame (either as primary symptoms, or secondary to underperforming at work or having to take time off). By the time they are well enough to consider what they are entitled to, it’s often too late. If that employee is the sole wage earner in the household and they don’t have sympathetic family or friends to support them while they are unwell (for as long as it takes) – then who will pay their mortgage or rent? Suddenly there is nowhere but the footpath in a big city to call home.
Then there’s alcohol and/or drug abuse. It’s expensive and makes it even harder to stay in paid employment. Unfortunately, while mental illness and (ironically) seeking help for these illnesses remain shrouded in stigma, and as long as our public mental health system fails to provide the care needed, those most vulnerable will self-medicate with the very substances that can exacerbate their symptoms or even trigger a latent mental illness.
I used to throw coins in hats to assuage the mix of sadness and embarrassment at seeing people living on the pavement. But that’s not the answer. Especially not if you walk away without thinking about this issue further. For me now, I am acutely aware that I could become homeless because of my illness. All it would take is a change in my circumstances, something as simple as no longer being able to afford private health insurance, and this illness could swoop in and take everything from me.
So, when my sheltered children first encountered homeless people in numbers last week, I explained the link between homelessness and mental illness, and that the first step towards a solution is to shred the stigma surrounding it. Rather than teaching our children to avert their eyes from what we might not want them to see. Let’s lead by a better example and open their eyes. To all of it. Even the ugly stuff.