Opening doors to improved mental health, homelessness services and better outcomes for service users

Many of the homeless people we support have a diagnosed, and often undiagnosed mental health condition. What is increasingly noticeable is that poor mental health contributes directly to the cause of homelessness, as well as being a direct impact of homelessness on vulnerable people.

In 2020, we saw a rise in failed placements in emergency accommodation by New Forest District Council (NFDC) which were intrinsically linked to an increasing number of mental health crises experienced by vulnerable people. With stretched mental health services unable to meet the demands, our Homelessness Officers increasingly needed to become mental health experts with only basic mental health training and a bucket full of empathy in their toolkit.

Unmanaged this situation was having such a negative impact on the health of many of our clients as they cycled round mental health services, homeless services, temporary accommodation, A&E and in patient care, over and over again. This is costly too. In-patient care is extremely expensive. So is temporary accommodation. Staff time needed to manage crises takes its toll on the individuals involved but also has a knock effect for other clients and colleagues.

In discussions with Southern Health NHS Foundation Trust and our local Community Mental Health Team, we agreed this situation was no longer sustainable and we needed to make drastic changes to ensure the mental health and housing needs of our community were met. A partnership was born and with NFDC taking the lead, we submitted a bid to the Government’s Rough Sleeping Initiative (RSI) fund for a specialist worker. We didn’t know it at the time, but we were real innovators. Whilst other Local Authorities had recruited mental health support workers, we found out we were one of the first to recruit a specialist Mental Health Practitioner who had the necessary skills and qualifications to represent mental health services out in the community and refer directly into mental health services.

Since embedding the nurse within the Homelessness Team in November 2021, clients with enduring health conditions have benefited from improved outcomes for treatment, mental health interventions, accommodation and access to services.

Some of the great outcomes include:

• Stronger links with many other services such as Community Mental Health Team (CMHT), Adult Mental Health Team (AMHT), Drug and Alcohol (Inclusion) and Adult Social Care
• Flexible and immediate responses to potential mental health crises of homeless clients, preventing homelessness and reducing hospital admissions
• Informed decision making on appropriate accommodation offers, reducing placements from breaking down

With the professional evidence submitted by our nurse:

• 15 clients have been successfully referred to CMHT, AMHT or Early Intervention in Psychosis (EIP) - All were successfully offered an assessment, review and/or intervention
• 13 clients have been referred to Inclusion
• 16 clients have been referred for a social care needs assessment – all of which have had the assessment and/or ongoing care
• 11 clients have been referred to the Primary Care Network (PCN) or wellbeing support
• 9 hospital admissions have been prevented

Beyond the statistics: “Martin’s” story.

One individual whose life has truly changed for the better is Martin.

Martin approached the Homelessness Team in December 2021 as his landlord could no longer cope with his mental health needs and wanted him to leave. At this time, he was a patient in hospital after trying to end his life. He had suffered sexual abuse as a child and due to this he had deep-rooted trauma and consumed large amounts of alcohol daily. In February 2022, he was admitted to hospital again after being found on a bridge and heavily under the influence of alcohol. We placed him into emergency housing upon his discharge. The next few months were challenging. We were still embedding our new service whilst Martin failed to engage with services. Martin would struggle with his mental health, consume a large amount of alcohol and then openly self-harm. He would then be admitted to hospital and due to the incident, the proprietor of the accommodation would no longer feel comfortable to continue to accommodate him. In the space of 5 weeks, this happened 5 times.

Sadly, Martin could not access a dry/wet house due to living in the New Forest area, where such provision does not exist. Support services were either in the Southampton or Bournemouth area and the caveat to accessing this is having a local connection. In early April, Martin was evicted from our last accommodation option and again ended up in hospital. We made the sad decision that we could no longer continue to accommodate him safely.

Between April and May 2022, there were further incidents of alcohol and self-harming behaviours in the community. We decided we had to try again. We were now confident in our new approach and that it could take on an extreme case like Martin’s. With the support of our nurse and a partnership plan of treatment and support we wouldn’t take no for an answer.

From June through to October 2022, the nurse provided mental health support, validation, assisted Martin to access AA meetings, assisted him to access sexual abuse support, and heavily joint worked with the inclusion service to tackle his alcoholism. From that point forward there were no further crises, hospital admissions, nor evictions and in January 2023, Martin moved into his own long term social housing property.

It is extremely exciting that other Local Authorities are beginning to develop similar innovative projects and it would be wonderful to see many other nurses working side by side with homelessness teams. I have great hope that commissioners and decision makers throughout the country read this blog and just maybe think ‘we can do that too’.

---

If you found this of interest, check out the dedicated mental health and housing resources on the Housing LIN website here.

Lastly, we look forward to featuring this programme and other housing-related services with Southern Health NHS Foundation Trust in our autumn/winter HAPPI Hour series. Attend this FREE webinar on Tuesday 7th November 2023 4pm - 5pm.