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
Care
Comment
Economics
Ethics
4 min read

NHS: How far do we go to feed the sacred system?

Balancing safeguards and economic expediencies after the assisted dying vote.

Callum is a pastor, based on a barge, in London's Docklands.

A patient eye view of six surgeons looking down.
National Cancer Institute via Unsplash.

“Die cheaply, protect the NHS” It sounds extreme, but it could become an unspoken policy. With MPs voting on 29th November to advance the assisted dying bill, Britain stands at a crossroads. Framed as a compassionate choice for the terminally ill, the bill raises profound ethical, societal, and economic concerns. In a nation where the NHS holds near-sacred status, this legislation risks leading us to a grim reality: lives sacrificed to sustain an overstretched healthcare system. 

The passage of this legislation demands vigilance. To avoid human lives being sacrificed at the altar of an insatiable healthcare system, we must confront the potential dangers of assisted dying becoming an economic expedient cloaked in compassion. 

The NHS has been part of British identity since its founding, offering universal care, free at the point of use. To be clear, this is a good thing—extraordinary levels of medical care are accessible to all, regardless of income. When my wife needed medical intervention while in labour, the NHS ensured we were not left with an unpayable bill. 

Yet the NHS is more than a healthcare system; it has become a cultural icon. During the COVID-19 pandemic, it was elevated to near-religious status with weekly clapping, rainbow posters, and public declarations of loyalty. To criticise or call for reform often invites accusations of cruelty or inhumanity. A 2020 Ipsos MORI poll found that 74 per cent of Britons cited the NHS as a source of pride, more than any other institution. 

However, the NHS’s demands continue to grow: waiting lists stretch ever longer, staff are overworked and underpaid, and funding is perpetually under strain. Like any idol, it demands sacrifices to sustain its appetite. In this context, the introduction of assisted dying legislation raises troubling questions about how far society might go to feed this sacred system. 

Supporters of the Assisted Dying Bill argue that it will remain limited to exceptional cases, governed by strict safeguards. However, international evidence suggests otherwise. 

In Belgium, the number of euthanasia cases rose by 267 per cent in less than a decade, with 2,656 cases in 2019 compared to 954 in 2010. Increasingly, these cases involve patients with psychiatric disorders or non-terminal illnesses. Canada has seen similar trends since legalising medical assistance in dying (MAiD) in 2016. By 2021, over 10,000 people had opted for MAiD, with eligibility expanding to include individuals with disabilities, mental health conditions, and even financial hardships. 

The argument for safeguards is hardly reassuring, history shows they are often eroded over time. In Belgium and Canada, assisted dying has evolved from a last resort for the terminally ill to an option offered to the vulnerable and struggling. This raises an urgent question: how do we ensure Britain doesn’t follow this trajectory? 

The NHS is under immense strain. With limited resources and growing demand, the temptation to frame assisted dying as an economic solution is real. While supporters present the legislation as compassionate, the potential for financial incentives to influence its application cannot be ignored. 

Healthcare systems exist to uphold human dignity, not reduce life to an economic equation.

Consider a scenario: you are diagnosed with a complex, long-term, ultimately terminal illness. Option one involves intricate surgery, a lengthy hospital stay, and gruelling physiotherapy. The risks are high, the recovery tough, life not significantly lengthened, and the costs significant. Opting for this could be perceived as selfish—haven’t you heard how overstretched the NHS is? Don’t you care about real emergencies? Option two offers a "dignified" exit: assisted dying. It spares NHS resources and relieves your family of the burden of prolonged care. What starts as a choice may soon feel like an obligation for the vulnerable, elderly, or disabled—those who might already feel they are a financial or emotional burden. 

This economic argument is unspoken but undeniable. When a system is stretched to breaking point, compassion risks becoming a convenient cloak for expedience. 

The Assisted Dying Bill marks a critical moment for Britain. If passed into law, as now seems inevitable, it could redefine not only how we view healthcare but how we value life itself. To prevent this legislation from becoming a slippery slope, we must remain vigilant against the erosion of safeguards and the pressure of economic incentives. 

At the same time, we must reassess our relationship with the NHS. It must no longer occupy a place of unquestioning reverence. Instead, we should view it with a balance of admiration and accountability. Reforming the NHS isn’t about dismantling it but ensuring it serves its true purpose: to protect life, not demand it. 

Healthcare systems exist to uphold human dignity, not reduce life to an economic equation. If we continue to treat the NHS as sacred, the costs—moral, spiritual, and human—will become unbearable. 

This moment requires courage: the courage to confront economic realities without compromising our moral foundations. As a society, we must advocate for policies that prioritise care, defend the vulnerable, and resist the reduction of life to an equation. Sacrifices will always be necessary in a healthcare system, but they must be sacrifices of commitment to care, not lives surrendered to convenience. 

The path forward demands thoughtful reform and a collective reimagining of our values. If we value dignity and compassion, we must ensure that they remain more than rhetoric—they must be the principles that guide our every decision.