For Street Nurses, homelessness in Belgium is not only about housing. The link between precarity and mental health often shapes whether recovery is possible. This account focuses on mental health among homeless people and what steady, street-based support can change over time
Mental disorders and social exclusion: a life on the streets marked by breakdowns in care
We were first made aware of this gentleman in 2021, but it was not until January 2023 that he actually came under our care. His journey has already been a long one, marked by dissociative identity disorder associated with psychosis. For years, his life on the streets has been punctuated by periods of observation, hospitalisations and repeated interruptions to his treatment.
Despite his morbid awareness and the lucidity with which he can discuss his condition, the treatments he has received so far have often been difficult to tolerate. It has therefore been difficult to maintain his medication: the side effects prevent him from functioning in daily life, exhaust him and discourage him. Treatments are stopped, then resumed elsewhere, in a different way.
Added to this is a critical shortage of places in psychiatric care services. The lack of a framework for testing and adjusting treatments, finding the right medication, the right dosage, is a major obstacle to effective support. These limitations of the system regularly lead to gaps in care.
Between one period of care and the next, we have to start all over again: re-explain his history, piece together a case file, track down records of hospitalisation, medical reports, ‘proof’ of what he is going through. We sometimes spend a considerable amount of time chasing after these documents, as if we were constantly having to prove the reality of his suffering.
What strikes us in these moments is the courage it requires: to tell his story all over again, to relive fragments of his history in the hope of accessing the help he needs.
In our support work, we move forward with him step by step. Often, we have to cope with shortages: a lack of places in psychiatric care, a lack of opportunities to trial treatment in a stable setting, a lack of time to properly adjust medication. So we make do with what we have. We try to maintain the connection, to support the process, and to seek solutions where they still exist.
Psychosocial support for homeless people: a field psychologist, trust and relapse prevention
In this work, Manon’s contribution, as a psychologist, has also been invaluable. She has already met the gentleman and shared her observations and understanding of the situation with the team during clinical meetings. Although the follow-up may take place via referral, we work as a team: at every meeting, we try to embody the approach we have built together.
Over time, something is built. After nearly three years of meetings, discussions and sometimes simple moments shared, trust has been established. A trust that is sometimes fragile, but real. We listen to one another, we try again, we search together for help that might suit him.
It is in this context that he recently agreed to start treatment with injections. This choice is by no means trivial: it is the result of a long journey marked by trials, doubts and discussions.
The follow-up remains fragile, particularly in the absence of a psychiatrist to oversee this treatment. But this step forward speaks volumes: the perseverance of a man who, despite setbacks, obstacles and discouragement, continues to seek help and to accept that we walk alongside him for a while.
In these journeys marked by precarity and illness, progress is sometimes subtle. Yet it carries within it something profoundly human: the encounter between a person who, despite everything, chooses to trust, and professionals who strive, with the resources available, not to let that trust go unanswered.
Clémence, social worker