Christine: When You’re Homeless, Malnutrition Often Follows

When I found myself in the homeless hostel system for a period in 2017, I never gave much thought to nutrition. My mind was totally taken up with other concerns. Who will I be sharing with tonight? If I get no rest how will I stay awake out on the streets all day?

It didn’t take long, no more than a week, before I stopped paying attention. That is how quickly homelessness can wear a person down. I would subsist on whatever odds and ends I could get my hands on.

Store-made salads, sandwiches, some grapes for me and the ducks. I couldn’t bear the dinners at the hostels, and there were strict rules around cooking facilities. I was once berated for making a poached egg late at night. That was the last time I tried to cook for myself there.

By the time I was upgraded to a 24-hour hostel I was mired in depression, living off donuts donated to the shelter. Because of a medical condition, I’m regularly required to give bloods.

As it happened, during my stay in that hostel my bi-annual bloods came back to my GP. The look on his face said it all. He told me I would need two months of post-surgical liquids to build my system back up. My nutrition was all over the place.

My case – which was resolved after six months, when I finally found a place to live – pales in comparison to the levels of malnourishment which go hand in hand with long-term homelessness, particularly with regards to those who sleep rough.

Unpublished research suggests that malnutrition among those who are homeless could be 10 times higher than among those who are housed, the director of the medical charity Safetynet, Dr Fiona O’Reilly, has said.

They need high-protein, high-calorie meals to sustain them through the hardships of homelessness, with the unexpectedness of day-to-day life, and the chaos of night shelters, she says.

Malnourishment, more medical issues and higher rates of morbidity mean more stays in hospitals. Homeless individuals who are ill, who may be recovering from an operation or receiving consultantive treatment, are being released from hospitals back on to the streets.

Dr Austin O’Carroll, who also works with Safetynet, says the malnutrition he sees can be extreme. “It’s not just malnutrition because of weight: it also has to do with a low protein diet with vitamin depletion. So you have a range of different scenarios. But the most common is just not enough food.”

O’Carroll says there is much well-intentioned work done for those who sleep rough, but said it can be counterintuitive. “A lot of people go out on soup runs and they do fantastic work. They’re thinking of giving healthy food to people. Soup and sandwiches sound healthy, but really they need nutrition, and high calorific foods.”

I noticed, when sharing rooms and hostels with others, the severe psychological toll that homelessness takes, and how hostels can brutalise and institutionalise.

Within a few weeks of being in such a system, which was never designed for the strains of our current housing crisis, a whole myriad of wild brain activity – in my case, learning to act and react appropriately in an alien, often hostile environment – can in turn lead to depression, serious anxiety, unmanageable stress levels. It’s different for different people.

But homelessness is a trauma. In the face of such trauma, mental health suffers. With minds overwhelmed, one thing that seems to unite many people at the coalface of the homeless system is the deprioritisation of food.

Other factors play into poor nutrition, says O’Carroll. “With associated conditions like alcoholism and drug addiction, there’s lack of access to treatment. I have many people waiting three to six months for treatment for heroin addiction, and because they’re addicted they have to prioritise their addiction, or they’ll go into withdrawal. So they don’t have the money or prioritisation to emphasise their diet.”

When people go into treatment, their weights generally go up within three or four weeks, he says. “Nutritionally they improve. So it’s not just drug addiction; it’s lack of access to treatment for that drug addiction that also contributes.”

Malnutrition can have knock-on effects. It reduces immunity, he said. It can lead to infections if you’re sleeping rough and homeless. “It’s one thing to get out of homelessness, but if you’re nutritionally deprived, then you need the energy to get out of homelessness and you haven’t got the energy that needs to be required to get out of homelessness, so it’s a vicious circle,” he says.

The health ramifications don’t stop there. With protein depletion comes muscle loss. With vitamin depletion comes skin infections. “So you start to see various skin complaints because of conditions such as vitamin C depletion. Which we have never seen in the settled population but we have certainly seen in the homeless population,” he said.

Vitamin D loss affects the bones too, he said. Overall, vitamin depletion leads to lower rates of life expectancy. In a speech at the 2018 Safetynet symposium, O’Carroll described the shockingly low life expectancies among the homeless in Ireland: 47 years of age for men, and 43 for women.

Food is the most basic of our needs as human beings. But the value of good food goes way beyond its nutritional benefits. When we share a meal with someone, when we cook for a friend or a partner or parent or child, we share something unique in the constitutive capacity of what it means to be human in and of itself.

It is a means of care-giving and care-accepting. It is socially bonding. It brings us together, in its myriad, multiple ways. But the homeless populations don’t get that.

What’s to be done? O’Carroll cuts straight to the point. “The basic answer to what we need to do is that we need to address the housing crisis. We need to increase social housing. It’s political. So if you really want to make a difference, use your vote for housing.”

When you’re homeless, you start to feel like a second-class citizen. The government’s homeless network of institutions and hostels certainly create the conditions for that.

It impacts diet and nutrition in a very significant way, for homelessness is, in its truest sense, destabilising and dehumanising.

That all comes sharply into focus when you see homeless individuals’ exclusion from a luxury that many so often take for granted: nutritious food.