Mental Health and Homelessness

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Mental Health and Homelessness

• Peter CockersellDirector of Health and Recovery

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St Mungos statistics

• 30 - 35 of rough sleepers have classic mental
  illnesses
• 60 of hostel entrants meet the criteria for
  diagnosis of personality disorder
• 61 are drug/alcohol dependent
• 34 have mental health problems, physical health
  problems, and are drug/alcohol dependent

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Why worry?

• Poor mental health is the
• motor that keeps the
• revolving door
• revolving

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Down and Out?

• Transitions
• Dual diagnosis/ complex needs
• Lack of accountability
• Limited housing options

• Over 90 respondents
• Significant agreement
• Except for DH
• Available on St Mungos website

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Recommendations

• Government leadership and accountability
• Department of Health recognition of gaps in
  services and leadership in finding
  cross-departmental solutions
• Improved commissioning and joint working
  locally, and specialist commissioning
• Bigger role for provision of mental health care
  and support in primary care

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Happiness Matters

• 103 interviewees
• 30 women,25 from BME backgrounds
• 85 had some form of mental health problem
• 65 took drink/drugs as easier to cope
• Low levels of formal diagnosis
• 9 with personality disorder (actual diagnosis)
  
• 59 with personality disorder (Southampton
  University study, 2004)

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Recommendations

• Training in mental health for all frontline
  staff
• Stop approaching drink, drugs and mental health
  as separate issues
• Not just medication more talking therapies
• Urgent and prolonged engagement
• Holistic responses
• Better coordination of services
• Mainstreaming through GPs

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Effective services

• Dual diagnosis project
• Intensive engagement
• 1 1s with specialist substance use worker
• Individual psychotherapy for clients Reflective
  practice for the staff
• No rehospitalisations 17 of 18 moves were into
  less supported accommodation

• Lifeworks psychotherapy
• Individual sessions of psychodynamic
  psychotherapy at 8 different sites
• 100 improvement on Outcomes Star axes
• 75 improvement on Wellbeing Impact Assessment
  Measure
• 3x more likely to move from pre-contemplation to
  active on Cycle of Change

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Client perspective

• I didnt want to go initially, thought I didnt
  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 havent told anyone else. A lot of tears
  were shed, she didnt drag it out of me, she
  listened. I got shit out of my system that Id
  been carrying around a long time. There was an
  underlying burden in my heart that she knew what
  to do with. Everything I said wasnt written down
  and I loved that. It was properly confidential.
  It was a hard one but it was a good one and if it
  wasnt for her Id be floating down the Thames
  now.

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Peter Cockersell
Peter.cockersell_at_mungos.org