3 of 13 Over Medicalisation of Mental Health Issues

“That’s just what I need. More pills and someone to talk to about why I feel crazy. You would too if you slept in a tiny room next to someone screaming all night.”

Significant numbers of people talked of being prescribed drugs for depression, anxiety or bipolar disorders, when in reality, their emotional distress was related to their homelessness, isolation and abuse from people around them.

Many people were referred to mental health services and community psychiatric teams due to behaviour that was later identified as post-traumatic stress. Suicidal thoughts or attempts were often a result of events in the past or their circumstances – for example, living in unsuitable housing where they were intimidated or didn’t feel safe.

Many people became defined by their ‘mental health’ diagnosis. This acted as a barrier to moving from their homeless situation and led them to be institutionalised into the system.

We took action

In many situations, we changed the focus of our conversations to ask ‘what happened to you?’ not ‘what’s wrong with you?’. We aim to identify whether mental health issues and emotional distress are the reasons why people are homeless or if they are a symptom of their situation. This allows support to be tailored to the individual and informs whether solutions are medical or whether alternative options are more appropriate.

The PTS provides a range of options, choices and information to promote healthy, mental and emotional wellbeing

2 of 13 Right Intervention at the Right Time

“Right now isn’t a good time for me to start my healthy eating plan. Right now I’m trying to get my kids back, so this pizza will do just fine.”

People told us that often, the help available to them wasn’t what they needed at that point in time. Instead of being able to access what they knew would really help, they ended up attending key working sessions that focused on box ticking rather than what was really going on in their lives and what they felt they needed. The interventions were not ‘ real world’.

Having to engage in activities that didn’t reflect their interests, spending months on waiting lists and undertaking tasks and courses to prove that they were ready to move out of the homelessness sector was often further proof of how far they had failed in life.

We took action

We threw out needs and risk assessments and the use of paperwork in front of people and replaced it all with real world, advantaged conversations.

Our focus was on listening and hearing people, then providing what they needed to make whatever difference they wanted to make in their life. Often, this didn’t involve providing a service but was instead providing an opportunity. We gave everyone access to small personal budgets and bonds so they could shape their own markets and drive supply based on what they knew they needed at the times they needed it.

Providing the right opportunity at the right time also meant that the PTS doesn’t just operate 9am to 5pm.

The PTS embeds personalisation through the approach, personal budgets, talent bonds and transition grants that finance the services, activities and opportunities that individuals need, when they need them.

1 of 13 More than Fixing

“What I need isn’t just to come off drugs, quit alcohol and to get a job. I need to feel I’m worth something, then I might want to do those things.”

People told us about the focus of the services they received. They felt that the aim was to find out what the problems were and then set about trying to fix them without understanding that they weren’t ready to give up the things that were helping them cope. Many used drugs, alcohol or self-harming as ways to cope with traumatic experience. Some did so to keep in with their friends, forget about their situation or just get through the night. Without finding more positive things to replace them, they needed something to help them get through.

Often, it is difficult for people to move on positively from a place of shame, feelings of failure or where their experiences aren’t validated by someone significant in their lives.

We took action

We researched further and found that this is common. There was a body of evidence that identified that, by maintaining people in their area of weakness (their needs), minimal impact would be achieved. By harnessing people’s strengths, evidencing their previous successes, exploring what they can do and validating their experiences, people build on their own abilities and move toward more positive, sustainable life changes. Training staff on how people use coping strategies is a key part of this.

An Introduction to Wisdom from the Street

In 2011, we conducted a qualitative review of over 100 people inside and outside Mayday Trust. We wanted to know what people thought of the services designed to support their move out of homelessness and toward independence.

Their feedback, and our own reflections, uncovered the systematic institutionalisation of people accessing homelessness services. The ‘traditional’ focus on needs kept people in their area of weakness, leaving them unable to create sustained, positive change for themselves.

The results were so powerful that they demanded a need for radical change. Change not only in how we delivered support, but in how our entire organisation thought, acted and responded to make sure the individual was at the heart of every decision we made and every action we took.

A whole cultural change was needed. So that’s what we did. We took a blank piece of paper and created the  Person-led, Transitional, Strength-based Response (PTS).

Wisdom From The Street illustrates the key issues highlighted to us during this review. What we learned informed a completely new way of working so that homelessness and tough times can become what they should be; a temporary transition.