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
Comment
Justice
5 min read

Will clinicians and carers objecting to assisted death be treated as nuisances?

The risk and mental cost of forcing someone to act against their conscience.
A tired-looking doctor sits at a desk dealing with paperwork.
Francisco Venâncio on Unsplash.

After a formal introduction to the House of Commons next Wednesday, MP’s will debate a draft Bill to change UK legislation on Assisted Dying. Previously, a draft Bill was introduced in the Scottish Parliament in March 2024, and is currently at committee stage. Meanwhile, in the House of Lords, a Private Member’s Bill was introduced by Lord Falconer in July and currently awaits its second reading. These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who wish to recuse themselves from carrying out a patient’s end of life wishes on grounds of Conscientious Objection.  

There are various reasons why someone might want to conscientiously object. The most commonly cited are faith or religious commitments. This is not to say that all people of faith are against a change in the law – there are some high-profile religious advocates for the legalisation of Assisted Dying, including both Rabbi Dr Jonathan Romain and Lord Carey, the former Archbishop of Canterbury. Even so, there will be many adherents to various faith traditions who find themselves unable to take part in hastening the end of someone’s life because they feel it conflicts with their views on God and what it means to be human. 

However, there are also Conscientious Objectors who are not religious, or not formally so. Some people, perhaps many, simply feel unsure of the rights and wrongs of the matter. The coming debates will no doubt feature discussion of how changing the law for those who are terminally ill in the Netherlands and Canada has to lead to subsequent changes in the law to include those who are not terminally, but instead chronically ill. The widening of the eligibility criteria has reached a point where, in the Netherlands, one in every 20 people now ends their life by euthanasia. This troubling statistic includes many who are neurodivergent, who suffer from depression or are disabled. It is reasonable that, even if a Conscientious Objector does not adhere to a particular religion, they can be allowed to object if they feel uneasy about the social message that Assisted Dying seems to send to vulnerable people.  

“You will often find that legislation that provides a right to conscientious objection is interpreted by judges these days in a way that seems to treat conscientious objectors as nuisances” 

Mehmet Ciftci

  Conscientious Objection clauses can themselves send a social message. A response to the Scottish Bill produced by the Law Society of Scotland notes concern over the wording of the Conscientious Objection clause, as it appears to be more prescriptive in the draft Bill than in previous Acts such as the Abortion Act of 1967. In the case of any legal proceedings that arise from a clinician’s refusal to cooperate, the current wording places the burden of proof onto the Conscientious Objector, stating (at 18.2):  

In any legal proceedings the burden of proof of conscientious objection is to rest on the person claiming to rely on it.  

The Bill provides no indication of what is admissible as ‘proof’. Evidence of membership of a Church, Synagogue, Mosque or similar might be the obvious starting point. But where does that leave those described above, who object on grounds of personal conscience alone? How does one meaningfully evidence an inner sense of unease?  

The wording of the Private Member’s Bill, currently awaiting its second reading in the House of Lords, provides even less clarity, stating only (at 5.0): 

A person is not under any duty (whether by contract or arising from any statutory or other legal requirement) to participate in anything authorised by  this Act to which that person has a conscientious objection. 

Whilst this indicates that there is no duty to participate in assisting someone to end their life, there remains a wider duty of care that healthcare professionals cannot ignore. Thus, a general feature in the interpretation of such conscience clauses in medicine is that that the conscientious objector is under an obligation to refer the case to a professional who does not share the same objection. This can be seen in practice looking at abortion law, where ideas around conscientious objection are more developed and have been tried in the courts. In the case of an abortion, a clinician can refuse to take part in the procedure, but they must still find an alternative clinician who is willing to perform their role, and they must still carry out ancillary care and related administrative tasks.  

Placing such obligations onto clinicians could be seen as diminishing rather than respecting their objection. Dr Mehmet Ciftci, a Researcher at the McDonald Centre for Theology, Ethics and Public Life at the University of Oxford comments:  

You will often find that legislation that provides a right to conscientious objection is interpreted by judges these days in a way that seems to treat conscientious objectors as nuisances who are just preventing the efficient delivery of services. They are forced to refer patients on to those who will perform whatever procedure they are objecting to, which involves a certain cooperation or facilitation with the act. 

This touches everyone, even those who (if the Bill becomes law) will still choose to conscientiously object. Therefore, it is important to consider that the human conscience is a very real phenomenon, which means that facilitating an act that feels morally wrong can give rise to feelings of guilt or shame, even if one has not been a direct participant.  

Psychologists observe that when feelings of guilt are not addressed, if they are treated dismissively or internalised, this can significantly erode self-confidence and increase the likelihood of depressive symptoms. But even before modern psychology could speak to the effects of guilt, biblical writers already had much to say on the painful consequences of living with a troubled conscience. In the Psalms, more than one ancient poet pours out their heart to God, saying that living with guilt has caused their bones to feel weak, or their heart to feel heavy, or their world to feel desolate and lonely.   

If the Conscientious Objection clauses of the new Bill being proposed on Wednesday are not significantly more robust than those in the draft Bills proposed thus far, then perhaps that is something to which we should all conscientiously object? There is much to discuss about the potential rights and wrongs of legalising Assisted Dying, but there is much to discuss about the rights and wrongs of forcing people to act against their consciences too.