References in relation to
homelessness and (mental) health
Kelly M. Doran
and Adam Tinson, Homelessness
and Public Health: Lessons
Learned from the COVID-19
Joana A. Miler
Miler, Hannah Carver , Wendy
Masterton, Tessa Parkes,
Michelle Maden, Lisa Jones,
2021, What treatment and
services are effective for
people who are homeless and use
drugs? A systematic ‘review of
and services are effective for
people who are homeless and use
drugs? A systematic ‘review of
reviews’ | PLOS ONE
THE IMPACT OF
COVID-19 ON HOMELESS PEOPLE AND
Gill Leng (s.d.),
The impact of homelessness on
health. A guide for local
authorities, Local Government
22.7 HEALTH AND
Gallardo, Diane Santa Maria,
Sarah Narendorf, Christine M.
Markham, Michael D. Swartz,
Charles M. Batiste, Access to
healthcare among youth
Perspectives from healthcare and
social service providers,
Children and Youth Services
Review, Volume 115, 2020,
105094, ISSN 0190-7409,
Sylvestre, J., Aubry, T. et
al. Predictors of Mental
Health Recovery in Homeless
Adults with Mental Illness. Community
Ment Health J 55,
people prefer to sleep on the streets
rather than in night shelter ?"
Anton Van Dijck
(Article in Sociaal.Net - Feb 5, 2023 –
translated from Dutch trough DeepL.com)
Why don't some street dwellers use
It is a question that has long
preoccupied policymakers and social
A recent survey in Antwerp probed
street residents themselves.
Failure as a society
November 5, 2021.
Flanders awoke to the harrowing
that two men died that night in the
underground bicycle shed at Antwerp
Central Station. Mike and Wesley did not
know each other, but were both homeless.
The deaths of Mike and Wesley brought a
lot of swell, sadness and helplessness.
Not only among family and friends, but
also among many social workers. Seeing
people die on the streets made us
realise in a painful way that we as a
society sometimes fail.
'Why don't the places in
the night shelter all get filled?'
That realisation sparked a lot of
conversations, between care providers
among themselves but also with those
responsible from the city government.
What could be improved in the care of
street residents? One question to which
no clear answer was found for the time
being: why is it that so many people
spend the night on the streets? In other
words: why don't all the places in the
night shelters get filled?
To gain insight into how street
residents view this, student Amber Van
Wijngaarden (Thomas More Hogeschool
Antwerp) conducted a field study as her
final internship. For three months, she
sought contact with street residents.
Central question: why don't you use the
This study has no
scientific pretensions. Nevertheless,
give a unique insight into the
motivations of a group of people who are
usually difficult for researchers to
Who was interviewed?
The student spoke to 34 street dwellers,
including six women. Their average age
is between 45 and 50, which is
considerably older than the average age
of homeless people. Over two-thirds use
an intoxicant, often alcohol.
About one in three had a 'temporary
shelter' at the time of the
conversation. Specifically, this often
involved shelter for that night. For
people who are homeless, 'temporary
residence' is a relative term. Only for
a few does it indicate a slightly more
stable living situation. For most, it
means a daily search for a place to
sleep that can range from on other
people's seats, across car parks, metro,
sleeping in a park to night shelters.
'For people who are
homeless, "temporary residence" is a
very relative term.'
Five people reported spending the night
exclusively in the public domain.
Fourteen were staying in night shelters
at the time of the interview. A few
stayed in a squat or occupied a couch
with friends and acquaintances at night.
Why don't all these people sleep in the
night shelter? What are stumbling
blocks? Most of the barriers cited can
be divided into five categories:
practical objections, rules, sanctions,
privacy and mental problems.
"First my dog and then the rest. I would
even rather be without dope than not
feed my dog," said one man. A lot of
street dwellers have a pet. Pets are
important: they show affection, provide
companionship and warmth. Sometimes
people also talked about an instrumental
utility. Begging with dog brings more
Except that homeless people with dogs
have nowhere to go. In every night
shelter, there is a ban on pets.
Consequence? People choose not to take
advantage of the shelter offer.
'I'd rather be without
dope than not feed my dog.'
Another frequently cited practical
argument is the non-existent or too
limited space to safely store personal
belongings. Virtually everyone who
brought this up had been robbed at the
night shelter. A lot of street dwellers
suggested that free large lockers,
somewhere in the city, would solve a lot
Another barrier of night shelters are
the fixed opening and leaving hours.
Quite a few people experience this as
patronising, even humiliating. Some show
understanding, but find the time slots
too limited. In particular, the fact
that people have to go out into the
street every morning seems to be the
biggest pain point. "Why can't we just
stay there, it's empty anyway?"
For 40 per cent, the price of overnight
accommodation is sometimes an obstacle.
That cost proved not always feasible,
even if it was a few euros. But cost was
certainly not the biggest barrier.
Formal requirements, rules and
procedures are other major barriers for
street dwellers. There are those who
clash with these but do not object to
them in principle. A few people were
even positive about some administrative
But for another group of street
dwellers, it goes directly against their
aspiration to go where and when they
want. They are categorical in their
rejection of the night shelter: "If I
wanted to, I could sleep in the shelter
every night. But so I don't want that.
Why do you think? You are treated like a
child there. Besides, they themselves
don't know why they have so many rules.
No, just leave me alone, I will make my
'You are treated like a
Many street residents also fall out over
conditions linked to the night shelter.
For instance, people who frequent it are
expected to take steps to put their
status in order. As a result, people
drop out, it sounds. Some spoke of
Some of the interviewees do not have
valid residence or identity documents.
As a result, they can only access the
additional winter accommodation. Outside
the winter months, there is no
alternative for them. This is hard to
Antwerp night shelters use sanctions to
manage problems, for example for people
whose behaviour interferes with group
behaviour. Among those who had
experience of it, the sanctions policy
raised a fierce fuss.
'Sanctions policy raises
Some call the rules or sanctions
inconsistent and arbitrary. For
instance, you would not be allowed to
drink in certain places, but are
sometimes allowed to do so with a blind
eye. Others talked about how sanctions
seem to depend on employees' moods.
Also, some people are allowed more than
Sanctions often amount to denying people
access to the night shelter for one or
more nights. Incomprehensible, four
street dwellers think: "The staff show
no pity, while they do not know what it
is like not to have a warm bed."
Moreover, people then often become
aggressive and start shouting outside.
So sanctions sometimes make the problem
bigger for everyone."
Lack of privacy
The lack of privacy is the most cited
objection. "You are not alone for a
second, there is always noise and you
have to constantly watch out that they
are not stealing. It drives me nuts."
'Many street dwellers
also feel a sense of insecurity in the
The dormitories where people sleep six
to 10 people in one room are also an
eyesore for many. Besides the fact that
you are never alone there, it causes
annoyances such as being too crowded,
too noisy, irritation at the behaviour
of others and a lack of hygiene.
Many street residents also feel a sense
of insecurity in the night shelter. They
refer not only to thefts, but also to
conflicts brought to the night shelter
from the streets. One young woman
mentioned that she is constantly on her
guard, for fear of being part of a group
with a majority of men.
We suspect that the need for privacy
explains a lot of the behaviour of some
street dwellers: always being alone,
staying invisible as much as possible,
not using shelter facilities and
sleeping in a place in the public space
that you anxiously keep secret. With
them, more privacy and freedom always
wins out over a bed.
This kind of avoidance
drive, contrary to popular belief, is
mostly rational behaviour,
according to Scottish researcher Lynne
It is a thoughtful response to living in
extreme stress. The more shelter
accommodation is of poor quality,
large-scale and collective, this
avoidance urge would play a stronger
role, according to McMordie.
Particularly many street residents
struggle with mental vulnerability.
Mental problems can be a barrier to
using night shelters.
For example, two people with
post-traumatic stress told us that
because of their disorder, they have the
greatest difficulty being part of a
group. They referred to the crowds and
noise that makes staying in the night
shelter unbearable for them.
'Many street dwellers
struggle with mental vulnerability.'
Observation and conversations with
social workers and street residents
revealed that there is sometimes a lack
of understanding or expertise about
mental health problems. This
occasionally leads to conflicts and
misunderstandings, for example when
behaviour is labelled as aggressive by
the group or staff. The result is often
that the person concerned has to leave
It is important to note that there can
be both a cause-and-effect relationship
between homelessness and mental health
problems. Uncertainty, stress and coping
strategies associated with living on the
streets are important factors in
developing depression and anxiety
Five people reported that they never
felt safe anywhere, neither outside nor
inside. One woman, who can only enter
the shelter in winter, slept in a tent
the rest of the year. However, this
attracted too much attention, so she
tried to hide better. The constant
alertness leads to chronic sleep
deprivation and saps her mind, she told
Among the street dwellers we spoke to,
alcohol was the most common intoxicant,
whether combined with other drugs or
not. Antwerp has a night shelter that
also accommodates users of illegal
substances: De Biekorf. Substance use is
tolerated there. It is a unique approach
While shelters for homeless drug users
undoubtedly offer advantages,
coexistence with other centres that have
zero tolerance policies for alcohol and
drugs leads to strange situations.
Discussions with street dwellers reveal
'Antwerp has a night
shelter that accommodates users of
For instance, a homeless man, by his own
account, had to spend four weeks at The
Biekorf for observation after a drunken
aggression incident. As he had no
alcohol addiction, this was a very
negative experience. Someone else said
that when drugs are used, the regular
night shelter not infrequently calls in
the police. "Kafkaesque and excessive,"
the person felt. Some street residents
who use illegal substances and want to
stop doing so find it unfeasible at The
Biekorf, but have nowhere else to go.
Based on the suggestions of street
residents, we formulated recommendations
to lower the thresholds for the night
shelter. These include extended opening
hours, a night shelter where people can
take their pets, specific attention to
the needs of female street residents and
individual sleeping places as an
alternative to dormitories.
With these proposals and
the research report in hand, we went to
the night shelters and the office of Tom
Meeuws, the competent Antwerp alderman
for social affairs. They were fruitful
discussions. Among other things, the
idea of larger lockers in public places,
as in Ghent,
is under consideration. There will also
be discussions about a later leaving
hour in De Biekorf.
There are also plans for a new building
for night shelters.
The topics of pets
and smaller rooms are on the table, as
well as safe rooms for women.
in Sociaal.Net - Feb 5, 2023
translated from Dutch trough DeepL.com