COVID-19 lockdown: Unlocking mental health services for homeless people

I am a NHS mental health nurse in the newly formed Homeless Mental Health Team (HMHT) provided by Gloucestershire Health and Care NHS Foundation Trust. We work closely with our non-statutory housing partner, P3.  Amongst other services, P3 provides short term accommodation, termed Safe Spaces, to homeless people. The remit of the HMHT is to identify the mental health needs of the people staying in the Safe Space and try to link them into resources available both within and outside of the NHS. We also continue our work with individuals once securely accommodated, this being a time of particular vulnerability.

The work is both challenging and deeply rewarding. People usually present with complex difficulties, multiple past traumas and a distrust of anyone perceived to be in authority. Getting alongside a person can take quiet persistence over a number of weeks. One method that has proved successful is to cook breakfast. The smell of frying bacon, wafting throughout the house, can entice people to the warmth of the kitchen in a way that a direct invitation to talk cannot.

To my mind mental health services are yet to adapt fully to the needs of the transient and often chaotic nature of the lives of the homeless population. Our work therefore involves advocating for services with colleagues who may be less aware of the obstacles and barriers homeless people experience.

With the arrival of lockdown, many of our working methods were stopped in their tracks. The rapid reconfiguration of mental health provision has led to only essential services and urgent face-to-face contacts being offered.

"Homelessness rates are set to rise, along with the pressure on the services that support them. As ever, I take comfort in the determination and compassion of my colleagues. We know that it is our humanity that is our greatest tool."Working from home means text, email or phone calls are the only forms of communication available. Keeping up to date with a person’s latest mobile number is a challenge in itself. Zoom or other video platforms are simply not available. When in-person assessments do take place, the necessity of PPE greatly impedes communication and rapport building.

As a nurse, I understand and accept the need to reduce transmission of the virus. But initially I felt stumped by the prospect of trying to support people without access to non-verbal communication, often the most accurate method of reading a person’s mental state. Having said this, I have been surprised that for a few, a greater degree of openness is possible by telephone or email; with no physical proximity, a sense of safety is increased. Persistence and a degree of detective work are necessary. Making use of the community network helps track down patients. Try as we might, we have lost contact with some.

Housing needs are being met temporarily by local authorities providing accommodation in hotels. However, the well-established services that provided food, clothing and social contact were closed overnight. Although they have quickly been replaced by food deliveries from other sources, these are not a substitute for well-established relationships with volunteers and the safety of being known.

For now, the temporary solutions are in place. The public and local businesses have rallied round in a heartening fashion but what does the future hold?  Homelessness rates are set to rise, along with the pressure on the services that support them. As ever, I take comfort in the determination and compassion of my colleagues. We know that it is our humanity that is our greatest tool.

If you would like to find out more about how the Housing LIN can support you plan strategically to meet the housing and mental health needs of people who are homeless or in insecure accommodation, please email us at: info@housinglin.org.uk