Recommendations to reduce deaths of homeless people, and support bereaved families, yet to be acted on years later

At least 46 people died while homeless in Dublin last year, according to the Dublin Region Homeless Executive (DRHE). 

That's pretty similar to the number of people who died while homeless in 2020. Even while the number of people who are homeless nearly doubled in those years.

In December 2020, there were 6,022 people who were homeless in Dublin, according to government figures. By December 2025, that figure was 11,782.

But the number of deaths could be lower, if the recommendations of a 2020 report from Dr Austin O’Carroll, an inner-city GP and founder of Safetynet, which provides healthcare to homeless people, had been implemented, says Sinn Féin TD Eoin Ó Broin.

“People are not getting the supports they need for addiction and mental health,” Ó Broin says. “We’re not doing anything differently from what we were doing a few years ago.”

The Housing First programme, which is supposed to provide those supports and lift people out of homelessness too, has stalled, says Ó Broin. 

One of the recommendations of O'Carroll's report was to bring in a system for reviewing the deaths of people in homelessness. 

Work on setting up that review system to gather learning from homeless deaths and issue recommendations is nearing completion, Dr O’Carroll said by phone on Monday. 

Likewise, the DRHE still has not brought in a protocol for homeless services on what to do when someone dies in a hostel. That's something independent Councillor Mannix Flynn asked for in 2023, following the death of a relative.

A spokesperson for DRHE said that it is waiting on sign-off from the HSE and hopes to publish that protocol in the coming weeks. 

Homeless deaths in recent years

DRHE figures for 2025 show that 27 people who were living in hostels run by private companies passed away, as well as 16 people living in charity-run hostels, and three others who were known to the outreach team, meaning they were homeless and had a history of sleeping rough. 

In 2020, a similar number of people died in homeless services, according to Dr O’Carroll’s 2021 report: 48 homeless people died while living in emergency accommodation or rough sleeping.

Counting can get complicated, because definitions of who is homeless, and who is included in these numbers can vary.

The 48 people who died in 2020 don't include an additional 21 people who died while living in long-term accommodation, funded by homeless services.

Likewise, the 46 who died in 2025 don't include people who died while living in long-term accommodation, funded by homeless services. It's unclear how many people that might have been.

"The DRHE does not report on deaths occurring in Long-Term Accommodation (LTA) or any other housing, as individuals residing in LTA are not considered to be homeless,” a DRHE spokesperson said.

The Health Research Board (HRB) also doesn’t count those in long-term accommodation run by homeless charities – but does include others living in very insecure or very substandard accommodation. 

While the death rate appears to be dropping, because the homeless population has increased significantly, Ó Broin says he understands that the cohort of homeless people with very complex needs has not increased significantly.

How are people dying?

A spokesperson for the DRHE didn’t comment on the causes of death.

"The Department of Health commissioned the HRB to collect data on all deaths which occur among people who are homeless nationally,” she said. “To address the need to improve understanding of premature mortality and to provide more complete and accurate national data to inform policy.”

In a report published this year, the Health Research Board examined the causes of death for 124 people (81 percent male) who died while homeless nationally in 2022.

Over a third of deaths (36 percent) were due to poisoning, meaning drug overdose. Methadone was the most common specific drug implicated in poisoning deaths. 

The other deaths were classified as medical (most commonly, cardiovascular conditions), or traumatic (most commonly, falls).

 “Many people take their own lives in homeless services,” says Flynn. He asked the council in 2023 to increase training for staff to intervene in those cases.

The number of deaths among homeless people in Dublin increased during the Covid-19 lockdown period but most were not caused by the virus directly, according to Dr O'Carroll, who told Newstalk he thought there were three or four Covid-19 deaths among that cohort in 2020 and 2021. 

Anti-homelessness campaigner Father Peter McVerry said in late 2020 that many of the support services homeless people rely on, like day centres, which normally provide people with a social outlet were closed during the lockdowns. 

Residential drug treatment centres closed. Some day services for drug users were also not meeting people face-to-face, he said. “Isolation leads to a lot of depression and that has been widely reported,” he said. 

Plans to improve supports

That increase in the death rate during the lockdown prompted calls for the adult safeguarding reviews, a process in place in the UK to gather learnings from the deaths, which could improve services. 

Speaking this week, Dr O’Carroll said he is waiting on sign-off for legal documentation to set up the new review system, for which he will be the clinical lead. 

“I gave the documents to the legal experts, and they took a year or two to sort out,” he says. “It is supposed to come back to me in the next few weeks.”

In the meantime, he has worked with the HSE to provide feedback to some homeless services on a small number of individual cases. 

“Once the process is in place, we can stand over the findings legally, and therefore I can start issuing recommendations on an annual basis,” says O’Carroll. 

In his 2021 report one of his other recommendations was setting up evidence-based initiatives to reduce the risk of death by overdose, such as making naloxone – a drug which can bring people out of an opiate overdose – available in all homeless services. 

He also called for initiatives to reduce long-term homelessness, improve primary care in privately run hostels, and increase mental-health supports, especially for people who have both mental-health difficulties and addictions. 

Naloxone is now available in hostels, O'Carroll says. 

However the other types of supports remain patchy. 

The Review of the Homeless Action Plan 2022 to 2024 found that “wraparound supports are inconsistent or unavailable”, it says. 

“Nearly every group flagged concerns about private emergency accommodation (PEA): the cost of, the standard and need for trauma-informed model of care,” says the report. 

And that remains an issue, according to a DRHE report issued last year

Ó Broin, the Sinn Féin TD, says deaths in homelessness remain high because most of Dr O’Carroll’s recommendations have not been implemented.

There needs to be a renewed focus on those people in homeless services with high support needs, mental health difficulties, trauma, and addiction. 

Because of the focus on homeless families, “the specific needs of those with very complex needs are even more marginalised”, he says. 

Similarly, Flynn, the independent councillor, says that “There is a serious gap when it comes to the most vulnerable."

There is stigma faced by families whose loved ones pass away in emergency accommodation, Flynn says. 

He thinks the council needs a process in place to include families and friends and to remember the person who died, he says.

He would like to see memorials within hostels to acknowledge those who died, he says. “When it comes to having a simple, dignified ritual,” he says.