Explainer
Comment
Community
Mental Health
6 min read

The rough sleeper: an icon of injustice

Each rough sleeper is a raw illustration of injustice. On an awareness day for both homelessness and mental health, Jon Kuhrt reflects on the root causes and yet sees hope.

Jon Kuhrt is CEO of Hope into Action, a homelessness charity. He is a former government adviser on how faith groups address rough sleeping.

A black and white close up of the weather-beaten and wrinkled face and beard of a homeless man.
Portrait of a homeless man in Prague.
Ales Dusa on Unsplash.

In 2016, five-year Brooke Blair became an internet sensation after a video of her berating Prime Minister Theresa May went viral. As she put it, she was ‘very angry’: 

“Yesterday night, I was out on the streets, and saw a hundred and a million of homeless people. I saw one with floppy ears, I saw loads. You should be out there, Theresa May. You should be, biscuits! Hot chocolate, sandwiches, you should be building houses. Look, I'm only five-years-old. There's nothing I can do about it. I'm saving up money but there'll never be enough. You've got the pot of money, spend some and help people.” 

The video struck a chord because a young girl was passionately expressing the distress, anger, sympathy and bewilderment that so many feel when seeing people sleep rough in such a wealthy country.   

The image of a rough sleeper is an icon of poverty. And just as religious icons represent the sacred, so does each person sleeping rough. 

Each rough sleeper is a raw illustration of injustice and social breakdown.  The structural issues of poverty and inequality crystalize in the plight of a vulnerable person huddling in a doorway. In them we see an amalgam of both political failure and personal tragedy. 

It's personal because we know that each person has a different story about what led them onto the streets. We will always be moved far more by a person than any statistic.  

The image of a rough sleeper is an icon of poverty. And just as religious icons represent the sacred, so does each person sleeping rough. A precious human of infinite worth, imprinted with the divine, living in destitution. And just as restoring fragile religious icons is a specialist job, so the task of restoring those who have been homeless is often complex and intricate work. 

Today, 10 October, is both World Homeless Day and World Mental Health Day. The two are closely intertwined. It’s a good day to reflect on the nature of homelessness and what we can do in the work of restoration. 

We cannot simply remove the tip of the iceberg without addressing the deeper issues ... The water is getting colder and the iceberg is growing. 

Rough sleeping is just the tip of a far bigger homelessness iceberg. It receives the most attention because it’s visible and visceral. But it is just a small fraction of the total number of people who have no settled home who exist underneath the waterline: those sleeping in temporary shelters, hostels and squats, sofa-surfing or placed in B&Bs. 

It’s the visibility of rough sleeping that gives it political capital.  Whilst in power, Margaret Thatcher, Tony Blair, Theresa May and Boris Johnson all launched high profile initiatives with ambitious targets to reduce or end rough sleeping. 

In 2018, I was seconded from the Christian charity I was working for into the Civil Service as a specialist adviser on rough sleeping. In the four years I spent in this role I worked under four different Prime Ministers and six different homelessness ministers. Despite some significant progress made before and during the pandemic, the numbers of people sleeping rough and those in temporary accommodation are starting to rise again.  

We cannot simply remove the tip of the iceberg without addressing the deeper issues of poverty that it is connected to. The reality is that we have a deep housing crisis in this country. The water is getting colder and the iceberg is growing. 

But the challenge is that rough sleeping and homelessness are genuinely complex problems.  Politics and economics provide some of the answers but not all. After thirty years of working with people who are homeless, these are the key issues which lie behind homelessness. 

Poverty of resources 

The most obvious cause of homelessness is the lack of affordable housing. Housing is a resource which is not distributed fairly, and this inequity creates intense pressure and vulnerability. All of this is compounded by austerity, funding cuts and benefit sanctions which have withdrawn support services for vulnerable groups. 

As London has become an international playground for the uber rich, many new housing developments are simply investment opportunities. Often people sleep rough outside accommodation no one lives in. It is a stark picture of the failure of the housing market. 

This aspect of homelessness is the one that government can do most about. Brooke Blair was fundamentally right – Prime Ministers need to build more houses for those who need them.   

A poverty of relationships 

But homelessness is more than house-lessness.  Homes are more than bricks and mortar: they are places of relationships. 

And if you talk with anyone sleeping rough, you are likely to hear of relationships that have gone wrong with partners or with their wider family. Some are fleeing abuse or domestic violence; some have been perpetrators. Relational problems are often a key source of regret and shame; where people carry their deepest scars. 

In our concern for people’s rights to the resources they deserve, we should not lose sight of where humans find true meaning and fulfilment. We all have a deep need to know and be known, to love and to be loved.  We cannot get away from the importance of relationships and a sense of belonging. 

A poverty of identity 

Finally, and most deeply, is the issue of people’s inner identity. The essential relationship that everyone has with themselves.    

The rise in mental health problems are symptoms of a vulnerability of our inner well-being.  For people affected by homelessness, their experiences of exclusion and trauma are both a root cause and an on-going reason for their mental fragility.  

And the addictions to alcohol or drugs which are common to many rough sleepers are deeply connected to these psychological vulnerabilities.  Drugs become a form of self-medication to ameliorate pain.  And however negative, the lifestyle required to maintain addictions can be relatively exciting and can provide each give a day a clear goal. It can be hard to leave such an identity and embark on a demanding journey of recovery.

Homelessness doesn’t just end in a flat. It truly ends in community and connection.

So, in short, homelessness is far more than house-lessness. Houses are a key resource but homes are primarily places of relationships and identity. And the restoration of these cannot be just done by the government. It requires a whole community. 

Thirteen years ago, a Christian couple in Peterborough, Ed and Rachel Walker chose to invest their own inheritance into a house for people who were homeless.  The idea inspired others: it was simple and innovative: encourage people with wealth to invest in homes for those who are poor. And each home was attached to a local church which provides friendship and support and a critical sense of community.  

This is the roots of Hope into Action where I now work. We are now a national charity with 106 homes across the country and last year we housed over 400 people. Our model is a holistic response to the types of poverty I have described.  

Our tenants are provided with the resource of a great house where they feel safe and secure. And this is combined with relationships with housemates and the support of local church volunteers. And our whole focus is to empower our tenants to find a more positive identity: whether through purposeful work, on-going recovery or through exploring faith. Last year, fifty percent of our tenants chose to engage in church activities and six took the step to be baptised. 

Homelessness doesn’t just end in a flat. It truly ends in community and connection. In our work we see justice and generosity in how resources are shared, compassion in the relationships that are formed, and hope on which people can rebuild a positive identity. Just as a lone rough sleeper is an icon of poverty, each of our tenants is a symbol of hope. 

Article
Assisted dying
Care
Comment
Politics
6 min read

Assisted dying’s problems are unsolvable

There’s hollow rhetoric on keeping people safe from coercion.
Members of a parliamentary committee sit at a curving table, in front of which a video screen shows other participants.
A parliamentary committee scrutinises the bill.
Parliament TV.

One in five people given six months to live by an NHS doctor are still alive three years later, data from the Department of Work and Pensions shows. This is good news for these individuals, and bad news for ‘assisted dying’ campaigners. Two ‘assisted dying’ Bills are being considered by UK Parliamentarians at present, one at Westminster and the other at the Scottish Parliament. And both rely on accurate prognosis as a ‘safeguard’ - they seek to cover people with terminal illnesses who are not expected to recover. 

An obvious problem with this approach is the fact, evidenced above, that doctors cannot be sure how a patient’s condition is going to develop. Doctors try their best to gauge how much time a person has left, but they often get prognosis wrong. People can go on to live months and even years longer than estimated. They can even make a complete recovery. This happened to a man I knew who was diagnosed with terminal cancer and told he had six months left but went on to live a further twelve years. Prognosis is far from an exact science. 

All of this raises the disturbing thought that if the UK ‘assisted dying’ Bills become law, people will inevitably end their lives due to well-meaning but incorrect advice from doctors. Patients who believe their condition is going to deteriorate rapidly — that they may soon face very difficult experiences — will choose suicide with the help of a doctor, when in fact they would have gone on to a very different season of life. Perhaps years of invaluable time with loved ones, new births and marriages in their families, and restored relationships. 

Accurate prognosis is far from the only problem inherent to ‘assisted dying’, however, as critics of this practice made clear at the – now concluded – oral evidence sessions held by committees scrutinising UK Bills. Proponents of Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill and Liam McArthur’s Assisted Dying for Terminally Ill Adults (Scotland) Bill have claimed that their proposals will usher in ‘safe’ laws, but statements by experts show this rhetoric to be hollow. These Bills, like others before them, are beset by unsolvable problems. 

Coercion 

Take, for example, the issue of coercion. People who understand coercive control know that it is an insidious crime that’s hard to detect. Consequently, there are few prosecutions. Doctors are not trained to identify foul play and even if they were, these busy professionals with dozens if not hundreds of patients could hardly be counted on to spot every case. People would fall through the cracks. The CEO of Hourglass, a charity that works to prevent the abuse of older people, told MPs on the committee overseeing Kim Leadbeater’s Bill that "coercion is underplayed significantly" in cases, and stressed that it takes place behind closed doors. 

There is also nothing in either UK Bill that would rule out people acting on internal pressure to opt for assisted death. In evidence to the Scottish Parliament’s Health, Social Care and Sport Committee last month, Dr Gordon MacDonald, CEO of Care Not Killing, said: “You also have to consider the autonomy of other people who might feel pressured into assisted dying or feel burdensome. Having the option available would add to that burden and pressure.” 

What legal clause could possibly remove this threat? Some people would feel an obligation to ‘make way’ in order to avoid inheritance money being spent on personal care. Some would die due to the emotional strain they feel they are putting on their loved ones. Should our society really legislate for this situation? As campaigners have noted, it is likely that a ‘right to die’ will be seen as a ‘duty to die’ by some. Paving the way for this would surely be a moral failure. 

Inequality 

Even parliamentarians who support assisted suicide in principle ought to recognise that people will not approach the option of an ‘assisted death’ on an equal footing. This is another unsolvable problem. A middle-class citizen who has a strong family support network and enough savings to pay for care may view assisted death as needless, or a ‘last resort’. A person grappling with poverty, social isolation, and insufficient healthcare or disability support would approach it very differently. This person’s ‘choice’ would be by a dearth of support. 

As Disability Studies Scholar Dr Miro Griffiths told the Scottish Parliament committee last month, “many communities facing injustice will be presented with this as a choice, but it will seem like a path they have to go down due to the inequalities they face”. Assisted suicide will compound existing disparities in the worst way: people will remove themselves from society after losing hope that society will remove the inequalities they face. 

Politicians should also assess the claim that assisted deaths are “compassionate”. The rhetoric of campaigners vying for a change in the law have led many to believe that it is a “good death” — a “gentle goodnight”, compared to the agony of a prolonged natural death from terminal illness. However, senior palliative medics underline the fact that assisted deaths are accompanied by distressing complications. They can also take wildly different amounts of time: one hour; several hours; even days. Many people would not consider a prolonged death by drug overdose as anguished family members watch on to be compassionate. 

Suicide prevention 

 It is very important to consider the moral danger involved with changing our societal approach to suicide. Assisted suicide violates the fundamental principle behind suicide prevention — that every life is inherently valuable, equal in value, and deserving of protection. It creates a two-tier society where some lives are seen as not worth living, and the value of human life is seen as merely extrinsic and conditional. This approach offers a much lower view of human dignity than the one we have ascribed to historically, which has benefited our society so much.  

Professor Allan House, a psychiatrist who appeared before the Westminster Committee that’s considering Kim Leadbeater’s Bill, described the danger of taking this step well: “We’d have to change our national suicide prevention strategy, because at the moment it includes identifying suicidal thoughts in people with severe physical illness as something that merits intervention – and that intervention is not an intervention to help people proceed to suicide.” 

 Professor House expressed concern that this would “change both the medical and societal approach to suicide prevention in general”, adding: “There is no evidence that introducing this sort of legislation reduces what we might call ‘unassisted suicide’.” He also noted that in the last ten years in the State of Oregon – a jurisdiction often held up as a model by ‘assisted dying’ campaigners – “the number of people going through the assisted dying programme has gone up five hundred percent, and the number of suicides have gone up twenty per cent”. 

The evidence of various experts demonstrates that problems associated with assisted suicide are unsolvable. And this practice does not provide a true recognition of human dignity. Instead of changing the law, UK politicians must double down on existing, life-affirming responses to the suffering that accompanies serious illness. The progress we have made in areas like palliative medicine, and the talent and technology available to us in 2025, makes another path forwards available to leaders if they choose to take it. I pray they will. 

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