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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with complex trauma • Self-harm • Uncontrolled drug or alcohol use • Impulsive, careless of the consequences • Withdrawn, reluctant to engage • Anti-social • Isolated 10 • Aggressive • Lacking daily structure or routine • Inability to sustain work or education • Bullying, or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]