Ireland’s inflexible healthcare system excludes homeless from mental health services, reports new study
5 June 2025
Ireland’s homeless are being routinely excluded from mental health services due to a rigid and inflexible healthcare system, according to a new report.
A significant issue identified is the exclusion of individuals with dual diagnoses, those with both a mental health condition and substance use disorder.
This exclusion leads to a cycle where individuals with substance use disorders are denied psychiatric care because of their addiction, and their mental health continues to deteriorate.
This is according to (opens in a new window)Dr John Gilmore, UCD School of Nursing, Midwifery and Health Systems, lead author on ‘Review of Crisis Mental Health Support within Inclusion Health’.
Revealing systemic and structural barriers preventing people experiencing homelessness in Ireland from accessing timely and appropriate mental health care, the new report is based on in-depth interviews with frontline clinicians and service leaders working in homeless healthcare.
A key issue raised was the fragmentation of services, where housing, healthcare, mental health, and addiction services operate in silos rather than providing integrated care.
Interviewees noted that the current system places unrealistic expectations on service users to navigate multiple layers of bureaucracy, which can be overwhelming and unachievable for people experiencing homelessness.
“Clients go all around the city to get a wound dressed here, meds there, and methadone over there. It would be impossible for somebody who’s housed, working, and fully educated to keep up with that level of access to care,” said one service provider.
“Homeless services are stuck between a rock and a hard place. We don’t provide mental health care; we’re not funded to provide mental health care. Yet, the vast majority of our clients have mental health needs and some kind of mental health diagnosis,” reported another.
Other significant barriers identified include restrictive eligibility criteria, poor service coordination, long waiting lists, and the transient nature of homelessness itself.
Highlighted were the issue of catchment areas, which prevent homeless individuals from accessing mental health services unless they have a registered address in the area.
“The mental health system’s strict reliance on catchment areas makes it incredibly difficult to access care. Homeless people don’t fit into these boundaries, and as a result, many don’t receive any support,” reported one hospital consultant.
Conducted in collaboration with (opens in a new window)SafetyNet Primary Care, the report identifies eight key recommendations including the integration of mental health, addiction, and housing services, the expansion of trauma-informed training, and the need to reform the Mental Health Act to enable earlier intervention before individuals reach crisis point.
“We are immensely grateful to the clinicians, service leaders, and members of our expert advisory group who generously shared their time and expertise,” said Dr Gilmore.
“Their insights were invaluable in shaping the report’s findings and recommendations.
“I would also like to thank the Irish Research Council, now Research Ireland, for funding this work. Their support made it possible to foreground the voices of those working on the frontline of Ireland’s homelessness and mental health systems.”
Speaking on the launch of the report, SafetyNet CEO Nicola Perry said it “lays bare the systemic barriers that too often prevent people experiencing homelessness from accessing the mental health care they urgently need”.
“It echoes what our clinicians see every day, compassionate, effective support is possible, but only if services are flexible, trauma-informed, and truly integrated.”
By: David Kearns, Digital Journalist / Media Officer, UCD University Relations
To contact the UCD News & Content Team, email: newsdesk@ucd.ie
