Download Home Is Where The Heart Is

Home is where the heart is
Peter Cockersell
Director of Health and Recovery
St Mungo’s
• About 2000 beds: hostels to self-contained flats,
including registered care
• Specialised drug, alcohol, mental health, dual
diagnosis; older, women’s, and sexworkers’ projects
• Street outreach, 2 day centres, employment,
training, substance use, health, and psychotherapy
• London, Reading, Oxford, Oxfordshire, Bath, Bristol,
Hitchin, Welwyn Garden City…
Home is where the heart is
Peter Cockersell
Director of Health and Recovery
What happens if your heart is
broken?
Client perspective
“
Home to me is somewhere that
has a family and everybody in it
5
”
What happens if your family is
broken?
Shattered lives
7
Population
Homeless People
• 1 - 4% schizophrenia
• 16 – 30% schizophrenia
• 5 – 13% personality
disorder
• 50 – 70% personality
disorder
• 11% anxiety disorders
and depression
• 50 – 80% anxiety
disorders and
depression
• 1.3% have attempted
suicide
• 42% have attempted
suicide
Shattered lives: women
• 66% have a mental health problem
• 55% have a substance dependency
• >50% have physical health problems
• >50% have experienced violence or
abuse from family/partner
• 41% rough sleepers have been involved in prostitution
• 45% are mothers
8
Shattered lives: children
• 47% experience of neglect/emotional abuse
• 34% early loss of parents through abandonment,
separation or divorce
• 31% early loss of parents through death (including
murder and suicide)
• 27% sexual abuse
• High levels of parental alcoholism, drug use, and
domestic violence
Behaviours associated with
complex trauma
• Self-harm
• Uncontrolled drug or
alcohol use
• Impulsive, careless
of the consequences
• Withdrawn,
reluctant to engage
• Anti-social
• Isolated
10
• Aggressive
• Lacking daily structure
or routine
• Inability to sustain
work or education
• Bullying, or being a
victim
• Offending
• Unstable relationships
Relationships
• Complex trauma arises from abusive relationships
• Healing relationships need to be managed, and take
care, and time
• Relationships have an impact on both/all parties
• Group dynamics affect individual group members’
relationships
• Sometimes people need specialised help
Seeking help
• 70% had sought help: 11%
got help
• Majority have histories of
compound and complex trauma,
not simple diagnoses
• More people have more than one
condition than have only one
• Almost no access to psychotherapy, only drugs
12
Client perspective
“
I did not access much of mental health services
(they would not let me), but I used up hundreds
of thousands of pounds of other budgets such
as housing, social services and substance misuse
”
13
Psychologically Informed
Environments
•Psychological
Framework
•Social Spaces
•Staff Training and
Support
•Managing
Relationships
•Access to
psychotherapy
14
Client perspective
“
I didn’t want to go initially, thought I didn’t need to see a shrink. I
gave it a go and the first few sessions were very informal, unthreatening. I
grew to trust her, told her things I haven’t told anyone else. A lot of tears
were shed, she didn’t drag it out of me, she listened. I got shit out of my
system that I’d been carrying around a long time. There was an underlying
burden in my heart that she knew what to do with. Everything I said wasn’t
written down and I loved that. It was properly confidential. It was a hard one
but it was a good one and if it wasn’t for her I’d be floating down the Thames
now.
”
15
Psychodynamic psychotherapy
• Based on relational dynamics in the here and now,
while recognising the impact of the past in the
present
• Does not require diagnosis or pathologisation of
clients, and recognises the reality and validity of their
experiences
• Therapy is flexible, client-led and non-directive
• Works on linking thinking and emotions, and the
regulation of affect
• Evidence of effectiveness
Balint
‘Everyone needs to be the sparkle
in someone else’s eye’
The Basic Fault
Client perspective
“
I didn’t believe in myself, but it seems that
other people believed in me; through their
belief I could begin to do things.
It began when I realised – it’s quite sad, where
I’m at...
(former rough sleeper)
18
”
Resolving homelessness
Ending homelessness is about
acknowledging and soothing broken
hearts, enabling relationships, and
holding hope
Further information
• www.homelesshealthcare.org.uk
• www.rebuildingshatteredlives.org
• [email protected]