DR AUSTIN O’CARROLL was a youth worker in inner city Dublin in the 1980s.

Out of one group of 15 young people he worked with at the time, seven later died as a result of drugs.

“It just shows you how bad drug addiction was in the inner city then … there are some families who have lost four kids out of five,” O’Carroll said.

He was speaking at the AGM of the Irish College of General Practitioners (ICGP), which took place in Dublin yesterday and today.

O’Carroll is a GP based at Mountjoy Street Family Practice in Dublin city. He’s the programme director at the North Dublin City GP Training Scheme and founded Safetynet Primary Care – a medical charity that delivers care to homeless people, drug users and migrants.

O’Carroll noted that there is a higher incidence of several conditions among homeless people, compared with the general population, such as HIV, diabetes, Chronic Obstructive Pulmonary Disease (a lung condition known as COPD) and mental health issues.

“The health statistics for homeless people are just appalling,” he said.

O’Carroll told the conference that the life expectancy for a female rough sleeper is 45 years, while it’s 46 for male rough sleepers.

Reluctant to seek healthcare

O’Carroll said many homeless people are reluctant to seek medical treatment, for a number of reasons.

The fear of discrimination is one such reason. O’Carroll recalled a story about a homeless man and woman who went to an emergency department in Dublin when the man started to develop hypothermia.

The man and woman were addicted to alcohol, cocaine and heroin. They said the doctor told them ‘it’s disgusting the state you’ve got yourselves in’. After this incident, both swore they’d never go back to a hospital.

O’Carroll said some of the reasons homeless people tell him they don’t want to go to a doctor is because they’ve previously been “treated like dirt”.

“As soon as you give them your name, you know what way you’re going to be treated,” one person said.

Other people have said embarrassment about their appearance or smell makes them reluctant to sit in a waiting room.

O’Carroll said some people are in denial about how bad their health really is, while others are put off by the application process to get a medical card – even though they’re entitled to one.

Sexual assault

O’Carroll said some homeless people don’t seek help because they have lost all hope.

“I don’t care about my life, I can see death in me … I think it’s going to be very soon,” one person told him.

O’Carroll said some people are failed by the system. He used the example of a woman who was addicted to drugs but could not access methadone in her local area so moved to Dublin.

She was homeless and, when staying in a hostel one night, was raped. The woman died of a drug overdose shortly after this happened, leaving behind a four-year-old daughter.

Two-thirds (67%) of homeless women have been sexually assaulted, he noted.

O’Carroll said he has been told many lies from people trying to get a prescription for benzodiazepines or benzos, medication which has a sedative effect.

Some people pretend to be dealing with a bereavement or illness, he noted. Over time he has developed methods to handle this and aims to be “assertive but positive”, trying to help the patient in other ways such as through counselling and detox programmes.

Scenarios such as this are why it’s vital for GPs to be trained in how best to help homeless people with complex medical needs, he noted.

O’Carroll said he approaches treating homeless people and people who are experiencing poverty in the same way.

He describes homelessness as “the far end of poverty”, when people go “over the cliff”, something thousands of people are experiencing in Ireland – for many reasons.

More information about Safetynet can be read here, while more details about the North Dublin City GP Training are available here.

The HSE’s Drugs and Alcohol Helpline can be reached from 9.30am to 5.30pm, Monday to Friday, on 1800 459 459 or via helpline@hse.ie.