Should we talk about death?

Our Palliative Care Coordinator Andy Knee poses this important question and highlights the innovative ways our Palliative Care Service is supporting clients who are at risk of death or in need of bereavement support.

Should we talk about death? In St Mungo’s Palliative Care team, we think the simple answer to this question is yes.

Death is something that affects us all, that does not discriminate against gender, race, sexuality, culture, or religion. Many of us are fortunate to talk about death and our wishes with loved ones. But what if you don’t have a home? And what if you don’t have family or loved ones to have these conversations with?

This is a sad reality for lots of people who experience homelessness. A reality where many of their deaths will be preventable, undignified and untimely, with no planning for their wishes, and sadly many will be forgotten.

In 2017 there were an estimated 597 deaths of homeless people in England and Wales, which represents a 24% increase since 2013. The NHS has recently reported a rise in homeless patients returning to the streets with many observing a surge in serious illnesses in the past decade such as respiratory conditions, liver disease, and cancer. Without someone to be their voice and their advocate, many individuals will be trapped in a harmful cycle of being admitted to hospital and discharged to the streets. This is something we can change.

Dying Matters Week 2019

‘Are we ready?’ is the poignant theme of this year’s Dying Matters Week, which helps to raise awareness around this issue. At the end of 2018 we responded to the increase in homeless deaths and continue to pave the way in making change for people experiencing homelessness. We know the importance of providing end of life care and support to our clients, and we are using creative and innovative new ways to provide this service.

Our Palliative Care Service

To mark Dying Matters Week, we’re shining a light on our Palliative Care Service. This service is the only one of its kind in the homelessness sector and has benefited from dedicated funders over the last five years.

The purpose of the Palliative Care Service is to coordinate a flexible and responsive care pathway to support clients who have a terminal prognosis or acute and potentially fatal health conditions, and to provide them with options that protect their quality of life. The service works to ensure that our clients can access healthcare and that we provide appropriate support to help them approach the end of their life with dignity and respect.

We meet with local health services, lead change with research, and continue to develop tools and support structures for St Mungo’s. We’re also here to support staff across St Mungo’s to feel empowered and discuss death as openly as possible.

Our aim is to ensure that everyone experiences a ‘good death’. We are also working to destigmatise this term, which holds so much power and importance.

New Befriending Service

This year the service has expanded to include our Palliative Care Volunteer Coordinator, and in June 2019, St Mungo’s will launch a new Befriending Service.

The Befriending Service will serve to support clients that are at risk of death, or clients who need bereavement support for a recent or historical loss. In addition, the Befriending Service will support colleagues and teams around loss and bereavement, reinforcing our message: “you are not alone”.

In response to the theme of Dying Matters Week – “Are we ready?” – St Mungo’s can proudly say “We are, and will continue to be.”

Find our more about our Palliative Care Service.

Five ‘giant evils’ of 1940s still exist for today’s homeless

The welfare state was established to fight the five ‘giant evils’ Lord Beveridge identified in his 1942 report. 70 years on, is the welfare state just as spritely when it comes to vanquishing those giant evils? Denis, from St Mungo’s client representative group Outside In, doesn’t think so: “The five evils are still evils in today’s society. They still continue.” Tanya English, St Mungo’s Executive Director of Communications, examines some client perspectives and considers our response…

Giant evil #1: Squalor

Beveridge wanted to break the cycle of poverty, where health problems caused by inadequate housing restricted people’s ability to work. Today, thousands of people still end up sleeping on the streets each year:

“On many occasions I woke up and I’ve been covered in snow” Mark, 37

“When I woke up sometimes, my foot would be so frozen that I wouldn’t move it until it proper thaws out because it felt like I had frost bites and my hands were hurting because it was so cold” Michael, 31

Giant evil #2: Ignorance

Beveridge thought that higher social classes were ignorant of the problems affecting communities. Our clients still experience this prejudice:

“[Homeless people are] treated bad. Low life, dirty junkie, prostitutes, worthless dogs, but we’re not. We haven’t committed a crime; we’ve just had a bit of bad luck and made a terrible mistake, you know?” Linda, 52

“I think people who have problems with the homeless…whatever problems they’ve had, however they end up that way; I personally think [people] should consider them a bit more. Whether you’re homeless or not you’re still human beings at the end of the day. We are all still human beings.” Leon, 36

Giant evil #3: Want

Beveridge was concerned with ensuring everyone in society had what they needed to survive. Unfortunately, many people who are homeless feel they have to resort to crime just to be able to eat:

“[Homelessness] actually turned me to crime and…I’m a bit ashamed because I’ve caused a lot of damage to properties having to steal lead and that was just to survive… when you get your dole money if it doesn’t last or you get robbed, you’re going to find it very, very, very hard. I found that very, very difficult to, you know, to get a meal most days.” Stuart, 44

Giant evil #4: Idleness

Beveridge called for training and work centres to be set up across the country to help everyone find a job. Although many people who are homeless would prefer to work, many still struggle with overcoming bureaucratic hurdles:

“[When] you do go for a new job you say, ‘I’ve been homeless; this is why I’ve been out of work’, they just say, ‘What have you been doing?’” Michael, 30

“I was at the job centre. Loads and loads of work, but it was the same answer every time I picked the phone up, ‘We need proof of your address in London’” Jason, 39

Giant evil #5: Disease

Beveridge believed that tackling health issues was central to helping people out of poverty. Health is a significant barrier to work for a number of people who we help:

“I’ve nearly been killed three times doing [prostitution]. I’ve been raped doing it. I’ve… as a result of that I got HIV doing it.” Angela, 38

“Some people don’t understand [depression]… A lot of the time I have kept myself to myself. It’s only recently I’ve started to push myself out there a bit more. But even still there’s stigma. Any hint that you’ve got this, especially when I’ve been in the mental hospital, people think straight away strait jackets; nutjob.” Michael, 30

At a time of great financial uncertainty, Britain’s welfare system was set up to direct limited resources towards those who needed them most. Now in the middle of another financial crisis 70 years later, those who are most vulnerable are still tumbling through the gaps in the safety net to the streets below. Our response must be to strengthen the net, not cut more holes.

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