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The Right to Die in the Gutter

Last week Ian Austin, the Under-Secretary of State at the Department for Communities and Local Government, the Minister responsible for homelessness, came out on an evening shift with Thames Reach’s street outreach teams. Together we walked the dank streets of central London, Ian still in his suit and tie having raced over following a late night debate in the House. Even though he was only two miles from Westminster, he must have felt that he had entered a parallel universe. One of the tasks that evening was to seek out a former rough sleeper who is now in a wheel-chair after his prone body, hidden under cardboard and blankets, was run over one morning by a refuge truck, crushing both his ankles. Ian was appalled, shaking his head in horror. He listened attentively, asking thoughtful questions of the rough sleepers he met and the outreach workers sharing the evening with him. We liked him, and having accompanied dozens of politicians on street shifts over the years, I know that close proximity to misery and despair does not necessarily bring out the humanity in our leaders.

This particular evening we met two men with such markedly different background and prospects that I was struck by the absurdity of giving them the same label of ‘rough sleeper’. Daniel is a young man, at almost 19 unusually young for a rough sleeper in London where more than 90% of the street homeless are over 25. He first had contact with an outreach worker just four weeks ago and was initially extremely dubious about our offers of help. Eventually he was persuaded to give us a few details about himself and as a result we were able to find him a place in a shelter in south London.

He chatted cheerfully to us in the van as we drove over to the shelter. Daniel has a small child. He has what he described as ‘personal issues’ to resolve with the mother. He didn’t have a drink or drug problem and told us he intended to ‘get my life sorted and prove to her and the kid and I can be a real father’. My colleague Paul who had spent time with Daniel considered that he had every chance of getting his life on track and predicted that we wouldn’t see Daniel on the street again. I imagined that if I met him in five years time Daniel would shake his head with bemusement as he remembered his brief, traumatic experience of sleeping rough in a shop doorway.

Over in east London we stopped the van to speak to Abdi, a Somalian with limited English who has been on the streets intermittently since 2003. Abdi is extremely withdrawn and suffers from serious mental health problems. The outreach team meets him most nights and he resists all their efforts to encourage him to come off the street. Abdi usually spends his days on the same street, surrounded by his belongings, avoiding all contact, scavenging for food. Occasionally, he goes into hospital. On this night, with the temperature well below zero, Abdi remained obdurately opposed to going into a shelter, bed and breakfast hotel or hospital. He is, beyond question, extremely unwell and at risk of dying on the street.

A brief pavement-based ‘case conference’ ensued and the outreach workers concluded that, protected by the sleeping bag they had left him, Abdi would survive the night but that there was now no other choice but to ask the local Community Mental Health Team to assess him on the street and, if necessary, take Abdi off the street against his will under a mental health ‘section’.

These are momentous decisions that outreach workers have to take, literally of the life and death variety. There is an obvious civil liberties dimension. Abdi was showing little sign that he would be prepared to leave the street of his own free will. Debate about the rights of the homeless is often acrimonious. At the end of 2009, some organisations which support the homeless produced the ‘Rights Guide for Rough Sleepers’. This intriguing guide is primarily aimed at advising people sleeping rough about rights with respect to contact with the police, rather than their rights to access advice, support and accommodation to escape street homelessness. For the outreach workers at Thames Reach this is an odd focus as we work closely with the police, trying to balance the individual needs of rough sleepers with the concerns of local communities who often equate rough sleeping with begging, drug misuse and anti-social behaviour, sometimes justifiably. Page 26 of the guide explains that under section 4 of the Vagrancy Act ‘the police can arrest you for sleeping on the street’. It is a rights guide that clarifies with precision how rough sleepers have no rights.

Before Christmas, with the mercury stuck remorselessly at minus five for night after night, the Thames Reach street teams worked desperately to help people come in from the cold. Over five weeks, more than 250 were helped into shelters, bed and breakfasts, even into the odd Travel Lodge. But on the 19th December we heard of the death on the street of Jan, a rough sleeper from Slovakia. He was well known to the teams and it was devastating news. Subsequently we learnt that he had died of a heart attack, induced by excessive alcohol consumption. We had sought a mental health assessment for Jan a few weeks earlier and, again, the possibility arose of a section if he refused to go to hospital voluntarily. The assessment did not take place as the view prevailed that Jan had made a ‘life-style choice’.

So that’s the dilemma. How can you judge if someone is so mentally unbalanced that you take the decision out of their hands? In my view, nearly all the long-term rough sleepers in London who live on the street like Abdi (in contrast to those like Daniel who make a brief cameo appearance) are in some way extremely unwell, frequently through a mix of mental health, drink and drug problems. And so, naturally, the approach of any outreach worker worth their salt will be to cajole, urge - even pressurise - them to come off of the street for good.

20 years ago I attended the funeral of a rough sleeper called John Hamilton. His son and three daughters were all at the funeral. I remember explaining how difficult it had been to convince their father that he should come off the street. He was obstinate man who I care for deeply I explained and I had to respect his right to stay out. They listened politely, but there was hurt in their eyes and suddenly I could read their thoughts. ‘Yes, but if it had been your father…’ And I knew if it had been my father I would have said ‘stop this sleeping rough nonsense dad, you’re coming home’.


Anonymous said…
"He was obstinate man who I care for deeply I explained and I had to respect his right to stay out"
What you tell here is so touching and reflects a Scratchy Harsh which can make the difference for "the some" who do eventually move beyond Street Homelessness.
My own experience as a Professional informs me without this Honouring of Choice...many indeed would I think "Die alone"
It cannot be easy as a professional when you " Care" only then being positioned to let go and recognise the persons right to self determination.
Unfortunately, I think their are some Workers who just cannot allow this and so get in the way of the process of Recovery.
Thankyou for a very well written account which I suspect reflects the reason ThamesReach is enabling many people to change their lives.

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