In 2018, Ipswich Borough Council received funding from MHCLG (Ministry of Housing Communities and Local Government) to provide services for rough sleepers. Part of the funding was used to commission a single mental health practitioner from the local mental health trust, with the post integrated into homelessness services.
I started this role in July 2018. This has been a truly pioneering role, although since I started there have been a number of other people start in similar roles, funded in a similar way.
Case study of practice
M had struggled with long term mental health issues throughout his life, due to the extensive psychological trauma he had suffered growing up. M had previously worked, but at the time of this case study had lost his job due to mental illness, and then had lost his accommodation. M then subsequently become involved in, and was exploited by a gang. This led to him being arrested, and gaining a police tag. However, he had subsequently escaped the gang, and had gained some stability when he moved into a hostel. Apart from one short period of a couple of weeks when he became suicidal, he managed to start to rebuild his life in the hostel. At the time of the case study he had been in the hostel a year.
However, I received a call from the hostel manager, saying they just evicted M for using cannabis in his room on several occasions (despite a number of warnings). Although the manager was evicting him, she was also quite concerned about his mental health and wanted to ensure he had support wherever he went.
Having previously had contact with him, I called him immediately, and quickly realised he was feeling hopeless and suicidal due to having lost everything he had worked so hard to get. He stated he felt that there was nothing left to live for. I was very concerned about his overall vulnerability and suicide risk, but he said he would not go to hospital. At that point M had no access to food (as the hostel had provided his meals), no money, no access to his mental health medication, clothes that were all old and ripped, and also reported health issues that his GP was not helping with.
I spoke to Housing Options, and raised my concerns. They agreed to pay for him to go into a budget hotel in the short term. I then signposted him to the Soup Kitchen who provided him with food for that night. I then arranged an appointment for him at the homelessness advice centre the next morning. They helped re-sort out his benefits, gave him a food parcel, and accessed him for some funding for some new clothes. Speaking to M that afternoon he already felt so much better, because he felt there were people on his side that cared about him. He was however stressed and anxious about how long he could stay in the hotel, and what would happen next.
I discussed him in the weekly multiagency rough sleeper meeting, and as a result he was referred to a supported housing provider by his Housing Options worker. I then also arranged an appointment for him at the Health Outreach Service, who made contact with his GP requesting further investigations. I also wrote to his GP surgery, and requested a repeat prescription of his past mental health medication. After he restarted his medication, his sleep improved, his anxiety reduced. and he felt more in control of his mood.
Next, we discussed options for the future. M realised he had taken a lot of steps backwards, but was keen to be referred to an employment support service, and this was done. He was then taken shopping with the funding for clothing, so he could dress smarter and feel less embarrassed about attending housing appointments and potential job interviews.
M was interviewed, and accepted by the supported housing provider who offered a room in a shared house in another town. He was really pleased about this as he wanted to make a new start. His housing options worker provided funding for some new furniture. I supported him to register with a new GP, and wrote to them regarding his medication. His new support worker then helped him set up relevant benefits, and mechanisms for paying his bills etc. We also liaised with his probation worker to make them aware of the move.
Summary and reflection
There was a real risk of M killing himself the day he was evicted, but he actually didn’t even spend one night on the street.
Obviously in a future circumstance an ideal scenario would be to avoid such an eviction. However, this eviction led to M improving his circumstances, which was a huge achievement. Last time I spoke to M he was feeling very supported, and was very happy with his new place, and the other people in his house. He was having contact with the employment support service, and was hoping to get back into working in the near future. He stated his mental health was good, he was sleeping better, he was quite happy and felt extremely appreciative for all the help he had been given.
Since starting this role, I have gradually adapted and developed the service through working out what is effective, what is not, and getting feedback from service users and clinicians in the homelessness services. I have also completed a research study and service evaluation focussed on the impact of the role which I am happy to share.
My key message is that I could certainly not have done any of this on my own. It was only possible by multiple services using their expertise to work in a complementary and integrated way, with as few barriers as possible. We have shared information as appropriate with consent, and have all worked together to achieve a shared goal using a similar ethos. I feel privileged to work in Ipswich where so many amazing services work so hard together to improve the lives of this marginalised and vulnerable population.
Jonathan Dickson
Senior Homelessness Mental Health Practitioner/ Non-Medical Prescriber
Rough Sleeper Team East Suffolk, Suffolk Access and Assessment Team
jonathan.dickson@nsft.nhs.uk
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