Psychotherapy student, Ari* shares their experience of completing a clinical placement with St Mungo’s Psychotherapy service, LifeWorks

Why did you apply for a placement with St Mungo’s?

This is my first psychotherapy placement but I was intrigued by the opportunity to work with and help clients with complex needs and to support those who may not have the means to refer themselves to local services or community counselling services.

Who are the clients you support?

I support current and previous residents of St Mungo’s and other clients of St Mungo’s support services. Some people have experienced homelessness, others haven’t but have other support needs.

Is your placement remote or in-person?

I started my placement with St. Mungo’s during the pandemic. It was a funny time to start at LifeWorks as they had recently had to change their model from supporting clients in person to working remotely. Now restrictions have lifted, I’m starting to meet client’s in-person at a local hostel. I’m lucky that there is a fantastic hostel located nearby to me as my time is quite limited – it’s a great selling point that there are many hostels ran by St. Mungo’s all over the place, so there’s plenty of options for trainees.

How have you found working in the hostel?

My experience of the hostel has been great! I have a private room for my client sessions, staff are happy for me to reorganise the furniture and as the room is only accessible by staff I know we won’t have any interruptions. It is also reassuring knowing that after our sessions end the hostel staff are there to offer my clients ongoing support.
I love working with my client’s in-person and have found the experience so rewarding.

Have you felt supported during your placement?

My LifeWorks supervisor is so supportive and they make sure I’m comfortable with every client referral I take on. We also have fortnightly clinical supervision which is run in small groups with one or two others and is psychodynamic orienteered. It’s helped my learning having a supervisor who knows the client group very well as I’ve really been able to explore my clients’ issues in depth and get a lot of insight.

Have you had any challenges during your placement?

It can be quite challenging to arrange sessions because of the chaotic nature of the some of the residents’ lives. However, if there was someone who wasn’t turning up repeatedly, my supervisor helped me put boundaries in place so that it wouldn’t go on too long. It didn’t take long for me to build client relationships and I now have three clients who I see regularly.

What do you enjoy most about your St Mungo’s LifeWorks placement?

My placement with St. Mungo’s has allowed me to gain experience with clients with complex needs. I’ve had the same clients since the beginning which is something that I really value about my placement. It’s rare for a placement to be so open-ended so I like that I can work with my supervisor and client to agree when to finish our sessions. Another thing I value is that LifeWorks will support people who are in active addiction. This is unique as a lot of therapy/psychological organisations will only offer help to those who are abstinent.

Would you like to do a clinical placement or gain work experience with St Mungos?

Check out our current volunteering opportunities or get in touch with studentplacements@mungos.org

Supporting people through a lonely time of year

During the winter there’s less opportunity for people to go out and so the people we support can isolate themselves which can have a negative impact on their mental health. Here, Ben, a Housing First Caseworker in Westminster shares how our teams are focusing on arranging activities for the people we support to ensure they don’t feel lonely this time of the year.

Housing First is a service that moves people into accommodation first and then work with them around that to help them support their tenancy. I think it’s really important that we work in this way as I think it’s easy to get someone into accommodation and then to lose them as they’ll get into somewhere and they find themselves isolated and by themselves and they don’t know what to do and they can sometimes develop depression because they’re feeling so alone. It’s not something many people would expect for someone who has just been given their own home but because they’re not used to being on their own all the time it’s difficult for them.

When you’ve housed people who have been living on the streets during the winter time it’s hard to persuade them to come out in the cold and wet weather. So it’s important that we offer them something new, and we try to give them a new experience, whether that’s a museum visit or going out for a Chinese so that they feel part of society and their community.

I was speaking with someone today who had been on the streets for 14 years and now they’re in the flat they can’t give it up for anything, the home is everything they have and since he’s moved into accommodation he has regressed and hidden himself away because he’s never had the opportunity to do that before. It becomes harder during the winter months to keep our clients engaged and to get them out of their houses and taking part in activities. I also recognise the fact that none of us do particularly well during the winter, it’s not a great time of year for most people so there’s definitely a change of mood. It’s making sure that I’m having daily check ins with my clients to see how they’re coping and to make sure they’re ok and what support they need.

Christmas is a bit of a taboo subject as if you’ve had very traumatic experience, Christmas is not a fun loving or pleasant time for them. They see people around them that are off doing their Christmas shopping, meeting with their friends and being able to spend time with their family and loved ones and it can add to the isolation people feel. Just because they’re in their own accommodation it doesn’t get any easier for them and it can sometimes bring up period of their life where they are reflecting on the past and they realise they are alone for Christmas. It’s a real struggle and I think it is a bit of a taboo subject, as the reality of it is that it is a really tough time for a lot of people.

A lot of the things that we do around Housing First, is to make sure all our clients have food hampers over Christmas and we individualise each of our clients Christmas packages as much as we can which I Think makes a real difference. Making sure that our clients are aware of the extra support that is available to them over the winter time. As a team we work for the majority of Christmas and we make sure that staff are available to support clients when they need them and they’ll receive daily check-ins and phone calls and we share the work load a lot as sometimes people do need to be off, we also take on other teams clients when they’re off on leave to make sure that everyone is still supported during the break.

I do go out and buy my clients their very own mini Christmas tree and a few decorations so they have something to look forward to. I think it’s also a nice reminder that if they do start to feel lonely at Christmas and if they are on their own then they can look at the tree and know that someone does care about them and hopefully it will remind them of a happier moment.

I think it’s really important that people show that they care at this time of year, however they do that. There are parts of Christmas that I don’t enjoy and I think sharing these experiences and my own feeling helps my clients to see that they’re not alone, and that not everyone is having a jolly festive time, regardless of their situation.

I’ve been working with someone with very complex mental health. At the beginning the only way he would feel comfortable talking to me was if he was in his bed under a duvet. He wouldn’t come out to see me and he wasn’t looking after himself very well. Six months later, we now meet up three times a week and get a cup of coffee at a local café and he’s beginning to trust me which is amazing. He’s now on a mental health pathway within St Mungo’s and is moving to additional support, he said “I can’t believe you’ve listened to me and you’ve made it happen”. He was so happy. I think it goes to show that there isn’t a perfect scenario for people experiencing homelessness and your options are always limited when you’re in the system, but being able to find him a space that’s more calming environment and less chaotic is really great for me. To see the growth in someone is the reason why I do this job.

Find out more about our Housing First service here.

Experiencing homelessness at Christmas

Nathaniel is a former client and a member of our Client Involvement Working Group. Here, he shares his experiences of homelessness at Christmas and the message he wants people to know.

I was adopted from birth and grew up with my family in Bounds Green, North London. I used to spend Christmas at home and celebrate with my mother and our extended family but since I became homeless I’m on my own.

I became homeless after I started to experience voices in my head which was mentally and physically debilitating. I was in dire straits and my mum didn’t understand what was happening and couldn’t look after me.

I spent my first Christmas in supported accommodation and it was very lonely. We didn’t have any festivities and, at the time, I was experiencing negative voices which also caused me pain and physical manifestations. It really affected my mental health and I was physically and mentally debilitated. I couldn’t do anything so I spend Christmas day alone in bed drinking soup, trying to fight my way out of something that was really dark and difficult to get out of. It was a really tough time.

Since then I’ve taken part in a lot of client involvement projects with St Mungo’s and I volunteered at the StreetLink service. At StreetLink they were really supportive and gave me my role responsibilities in stages, to make sure I had jobs that I felt comfortable in doing. My first role was inputting information into the computer and then, as my confidence grew, I worked up to taking phone calls and assisting people in that way. I felt happy, content and valued for the work I was doing and I felt that I was part of the team.

I also joined the Outside In network and started to get involved in some client involvement projects. The work I’ve been doing has definitely been life changing for me. Being able to do things and support with activities has definitely helped me keep my mind free and I’ve been able to talk to other people who have experienced homelessness and hear their stories which has been really educational.

This Christmas I would like people to open their hearts and minds and be able to connect to others and to the issues and plights of people around them. Homelessness is something that is so common that we don’t really see it anymore. Homelessness has been around since recorded history and I want to encourage people to educate themselves about homelessness and to open up the dialog that will bring about action, understanding, and education and will hopefully inspire people to change the systems and policies in place. Homelessness is something that together, in unity with organisations, the public and policy makers we need to eradicate.

A Mental Health Act that works for vulnerable people

This week we submitted our views to the public consultation on reforming the Mental Health Act. Emma Cookson, our Senior Policy and Public Affairs Officer, outlines what we want the legislation to remember about people who are homeless experiencing mental ill health.

How many people who are homeless do you think suffer from mental ill health?

From October to December 2020 our data showed that 72% of people accessing St Mungo’s housing-related support services had a mental health support need.

The Mental Health Foundation (2015) found that depression rates are more than 10 times higher in the homeless population, and Office for National Statistics data for 2019 shows suicide rates 14 times higher than among the general population.

But all too frequently people tell us they can only access help when they reach crisis point. And then even once they receive help, they can often be disempowered and not treated with dignity and respect.

The role of complex needs and multiple layers of disadvantage – like homelessness – in people’s mental health and access to mainstream services is also completely under-acknowledged. Research carried out by St Mungo’s in 2016, for example, revealed that 68% of areas where 10 or more people sleep rough on any one night do not commission any mental health services actively targeting people sleeping rough. There has been some positive progress with the £30m in NHS funding to enable specialist homeless mental health services to be set up in some parts of the country. However, there is still plenty more to do.

It’s been two years since the Independent Review of the Mental Health Act, led by Professor Sir Simon Wessely, which recognised the need to give people more say in their own treatment; to require stronger, transparent justification for using compulsory powers; and to improve services.

It also highlighted the huge race inequality in the use of the Act: black people, for instance, are more than eight times more likely to be subjected to Community Treatment Orders than white people.

In response, the Government has now published its long-awaited White Paper on reforming the Mental Health Act and held a public consultation on it. This is a huge opportunity to reflect the needs of St Mungo’s clients and ensure that people who are homeless are not forgotten in the reforms.

Here are the main points we put forward in our submission:

We need more focus on prevention, rather than only being able to access help once someone has reached crisis point. Many homeless people are not engaged with statutory mental health services (for reasons including a lack of trust in services and barriers in access). This lets problems escalate. Specialist homeless mental health services are an invaluable means of overcoming the inaccessibility of mainstream health services. But these teams have been subject to major funding cuts during the past decade.
Wherever possible, successful community-based interventions are much more preferable to the situation where people are held in a secure, medicalised setting with other people who are also very unwell, with huge restrictions on their choices and freedoms, and where treatment may be administered against their will. Sometimes detention is necessary – but we want it to be a last resort.
Housing needs are too often forgotten in both prevention and recovery from mental ill health. Homelessness is toxic to mental wellbeing. To stop a cycle of discharge, re-admittance and worsening mental health, we need more Supported Housing and Housing First which can play a big part in improving mental ill health.
People who are homeless face significant stigma, including from ‘professionals’ in positions of responsibility. We need to make sure that there are checks and balances in place to prevent this. We also need more awareness of complex needs amongst mental health professionals to understand the complexities of being homeless with mental health needs.
Many people who are homeless with mental ill health have complex trauma. It’s crucial that detention – and other responses to mental ill health — do not re-traumatise the individual, exacerbating mental ill health and creating more difficulties in addressing other, intertwined problems – such as homelessness, substance use, chronic physical, health problems and crime.
Even though there is National Institute for Health and Care Excellence (NICE) guidance in place to prevent it, people are frequently pushed into individual treatment pathways. Mental health, homelessness, and drugs and alcohol services are all designed and funded as if people fit into one box, rather than the reality that people’s problems are complex and interwoven. They cannot be addressed one-by-one but need to be approached holistically.

It’s so important to have a Mental Health Act which works for vulnerable people – like our clients — who find it difficult to engage in mainstream services and who need person-centred care which takes into account their complex needs.

Just changing the law won’t be a magic switch. Money is needed for chronically underfunded mental health services and we need attitudes towards mental ill health to shift, although there’s been some good progress. Overhauling the Mental Health Act 1983 is a good place to start.

The power of peer mentoring

In this challenging time, it is more important than ever to look after your own mental health, as well as look out for the people around you. Here, we are highlighting the incredible work of our volunteers. During lockdown they have adapted how they work to carry on supporting our vulnerable clients with their mental health.

Physical or mental health problems can be both a cause and consequence of homelessness. At St Mungo’s we take a holistic approach to mental and physical health, addressing these issues alongside each other. We run mental health dedicated services in Bath and our Building Bridges to Wellbeing programme empowers people to use their experience of managing their mental health to help others.

Building Bridges to Wellbeing has a peer mentoring service where volunteers use their own experience of living with mental health challenges to help and support clients to improve their wellbeing, confidence and mental health. These volunteers, known as Peer Mentors, work on a one-to-one basis with their clients. They support them to explore how to make small changes, look at their interests and options available, hopefully enabling them to link with their community by joining groups or courses, planning and supporting them to make small steps towards this goal. Mentors use their own experience of living with mental health challenges to build this relationship and share useful tools and resources.

However, due to safety guidance and Government restrictions relating to Covid-19 pandemic, this was no longer possible. Our peer mentors have adapted quickly to the Government’s measures and put in place a new way to support clients remotely. Our clients are now being supported by regular wellbeing phone conversations with their peer mentor, some have even started using video link calls, to share resources and encourage positivity in regards to exploring things they can engage with. We are working with local partners, to distribute wellbeing packs that include activities, puzzles and techniques to help with any mental health difficulties arising during lockdown.

What is it like being a part of the programme?

Two of our mentors, Zoe and Dena share why they got involved with the Building Bridges to Wellbeing programme and what it means to them.

Mentoring has given me back a purpose.

Zoe wanted to get involved with peer mentoring following her own personal battle with mental illness after the breakdown of her marriage and working long hours at a job in social care. Through various drug treatments, Cognitive Behavioural Therapy and the support of her family and friends, she’s been feeling stronger and felt that she wanted to give something back.

I absolutely love what I do and I like to think I’m making a difference to those during the various stages of their journeys.

After weeks of training, Zoe was matched with first mentee and has since been a peer mentor for five different people, supporting them with their own stories. She feels lucky to be able to support those in need during this difficult time, especially through uncertainty and loneliness in isolation. She hopes that her mentoring will lead to permanent position in a mental health setting.

In these current times, everyone is prone to be feeling unsettled, scared and, at times, lonely, and this particularly true for vulnerable and isolated people.

Dena, a fellow peer mentor wanted to help because she believes that mentoring and helping others is one of the key wellness techniques.

I think the real power of peer mentoring is empathy.

Following access to excellent resources and training through St Mungo’s, Zoe works with our clients, having a weekly a non-judgemental chat and providing support and information on the different kinds of self-care methods available that could make a difference to the client’s mental health.

People can gain such reassurance and peace from simply hearing “I understand” from someone that they know really does.

Mental Health Awareness Week

Hosted by the Mental Health Foundation, Mental Health Awareness Week takes place from 10-16 May 2021. The theme is Connect with Nature.

The new NHS plan for mental health services has a clear offer for people sleeping rough

For organisations who have campaigned for many years on homeless health, the NHS Mental Health Implementation Plan is a cause for celebration. Beatrice Orchard, St Mungo’s Head of Policy, Campaigns and Research, explains why the plan must deliver on its ambition to make sure everyone sleeping rough can access the mental health support they need.

When the Government’s Rough Sleeping Strategy was published exactly one year ago by MHCLG, there were some positive signs that other government departments would also be doing their bit to reverse the dramatic rise in the number of people sleeping rough in England.

One of the most solid commitments was in relation to improving mental health support for people who are sleeping on the streets. Last month, the details of this commitment became clearer when the NHS Mental Health Implementation Plan was published.

The plan is clear that by 2023-24, 20 areas with high levels of rough sleeping will have established new specialist mental health provision for people sleeping rough, which will be made possible with £30m of central NHS funding invested for this specific purpose.

This is a fantastic result for St Mungo’s Stop the Scandal campaign and our continued efforts to press the Government for investment in specialist mental health services to ensure people sleeping rough can access the support they need.

Sleeping rough and mental health – the links

It is fairly easy to understand that sleeping rough has a negative impact on a person’s mental health and wellbeing, as well as their physical health.

Evidence shows people sleeping rough are 17 times more likely to be victims of violence compared to the general population. News reports describe horrifying attacks and abuse on people sleeping rough and our clients tell us about their experiences of feeling lonely, frightened and even suicidal.

Furthermore, we mustn’t overlook the fact that some people sleeping rough have already been through many traumatic experiences in their lives, including violence and abuse from a young age.

All of these experiences can cause mental health problems to develop or worsen, but also impact on the type of mental health support people need and how easy they find services to access.

New avenues into support

The new, NHS-funded, specialist services will make sure that people sleeping rough can access to clinical mental health support by integrating with existing homeless outreach, accommodation and physical healthcare services.

They will be required to adopt a trauma-informed approach, known to help improve the psychological and emotional wellbeing of people with complex needs. We also expect the new services to help people who have drug and alcohol problems and are currently excluded from some mainstream mental health services as a result.

This specialist support breaks down all of the barriers people sleeping rough often face when trying to get help to improve their mental health. Really effective specialist teams can also influence mainstream health services in their local area, encouraging them to become more knowledgeable and understanding of the needs of people who are sleeping rough.

So far, so good. But what about people sleeping rough in other areas not in receipt of this new funding?

A welcome step forward

Research shows 4 in 10 people sleeping rough in England have an identified mental health problem. The latest data from the CHAIN reports on rough sleeping in London shows 50% of people sleeping rough in the capital in 2018-19 had a mental health support need.

It is welcome, therefore, that the new plan for mental health requires all areas of the country to complete a mental health needs assessment for people sleeping rough and take action to increase access to mental health services for this group.

This new approach to mental health for people sleeping rough is a real step forward.

Specialist mental health services have been tried in the past. We know they can make a dramatic difference to individuals’ lives, and help to reduce rough sleeping by supporting people to move on from homelessness for good.

Better still, it doesn’t stop with specialist services this time. Instead all NHS services will need to think about how people sleeping rough can access the healthcare they need in order to rebuild their lives.

St Mungo’s will be watching closely and encouraging all areas to ensure the plan delivers.

Tackling homelessness in Lisbon

In summer 2018 Ed Addison, Case Coordinator for St Mungo’s project Street Impact London, took part in a two week long cultural exchange programme in the USA. Since then he has also been to Portugal to see how they approach street homelessness. Ed explains more about what he learned from Crescer, an organisation which has homeless and substance use outreach services in Lisbon.

In my work in London, I see on a daily basis how the cycle of homelessness and drug use can be very hard for people to break out of. Using drugs can make people very sick and hard for them to address some basic needs, including housing. I wanted to see if I could learn a different way to support people who are using drugs and facing homelessness, and was fortunate to be able to spend three days with Crescer, which has staff offering substance misuse and homeless outreach services in Portugal’s capital, Lisbon.

Minimising harm

Throughout the 1990s Portugal had high rates of HIV and opiate related death, affecting all levels of society. Many people in Portugal knew a close friend or family member who was affected.

In 2001 the government decriminalised the use of drugs and gave organisations like Crescer a platform to use a harm minimisation approach to address the issue. This kind of approach recognises that sometimes people will not be ready to make changes such as stopping their drinking or drug use completely, and helps people to minimise the risks to themselves and others.

On my first day at Crescer I went out with the ‘E Uma Rua’ service in the east of the city. The team was made up of three psychologists, a nurse, a social worker and a psychiatrist. I watched as they talked to people on the streets, offering harm reduction advice, distributing kits meaning people could use drugs more safely and collecting used needles in a needle disposal bin. I was moved to see how the outreach workers offered support to individuals where they were, regardless of their situation. Those they spoke to seemed to hold them in high esteem and were willing to talk about their issues.

Crescer work in cooperation with other services including a methadone van. Once people are registered, they are able to access a mobile service to receive their methadone prescriptions from a van. This serves the city seven days a week distributing methadone to 1,200 people at four locations throughout the day and is thought to be behind a reduction seen in drug related antisocial behaviour.

The harm reduction approach means in Portugal, whilst there hasn’t necessarily been a decrease in the number of drug users, there has been a massive drop in cases of HIV, other blood born viruses and opiate related death.

Housing First

Crescer also offers a Housing First service – ‘E Uma Casa’ – which provides people who have slept rough for long periods, and also have mental and physical health needs, with a home. Their approach is multi-disciplinary, meaning lots of different agencies work together to provide support. The team currently supports 36 people and is made up of psychologists, a social worker, a nurse, a psychiatrist and a peer advocate.

The team establishes a relationship with a person living on the street over a number of months and offers them a house. Once they have a home, the team put support plans in place, conducting home visits and offering psychological support, to help manage their drug use, mental health needs and encourage development of independent living skills.

The team also works to empower the local community to offer support to those housed in the project. For example, I saw people from a local convenience store looking after a person with mental health needs and dispensing their daily medication.

The challenge of ending rough sleeping

I would like to say a big thank you to Crescer for hosting me for three days and giving me a fantastic insight in to the amazing work they are doing in Lisbon.

In London I cycle up to 100 miles a week as part of my job, finding and working with people who are sleeping rough. That equates to a lot of thinking time!

I’ve been inspired by some of the innovations I saw, particularly those which take specialists to the streets to meet people where they are. In Portugal, working together in an interdisciplinary way is reducing harm, and linking people who are using drugs on the street with other services that could help them leave homelessness behind such as sorting out benefit claims and mental health support.

What I have seen in Portugal convinced me that treating the issue of drug use as a matter of public health is effective. I believe it is time for the UK to follow suit and recognise the severe health crisis that is occurring on our streets, in our communities and in our prisons, often due to drug dependency and other complex interrelated factors such as trauma, and mental health issues.

We are starting to see more funding for multi-disciplinary approaches to supporting people who are homeless. I believe introducing innovative ideas could improve health outcomes for people who are sleeping rough and using drugs, helping to reduce drug related antisocial behaviour, the number of people needing ambulance services and the number of drug related deaths.

Find out more about our service models, including Housing First and Social Impact Bonds.

Why the budget 2018 is a missed opportunity for ending rough sleeping

Following the announcement of the autumn 2018 budget, Rory Weal, Senior Policy and Public Affairs Officer, analyses what the Government’s plans mean for those sleeping rough or at risk of homelessness.

Amongst talk of an ‘end of austerity’ budget, the Chancellor yesterday delivered one that was really a missed opportunity from the perspective of homelessness.

It had been a positive summer, with the Government listening to the homelessness sector and deciding to keep funding for supported housing in the welfare system, as well as publishing a rough sleeping strategy which contained a variety of interventions to stop the scandalous rise in the number of people sleeping rough across the country.

However, the Budget failed to build on these developments, and did not contain measures which will deliver on the Government’s commitment to halve rough sleeping by 2022, and end it all together by 2027.

There were bits of positive news to be found which – if delivered with homelessness in mind – could contribute to helping people off the streets.

A new mental health crisis service

On mental health, there was the news that a new mental health crisis service will be developed, as part of the NHS Long Term Plan. Given the scale of the mental health crisis on the streets and the difficulty many have accessing support, this is particularly welcome.

The service will include comprehensive mental health support in every major A&E, more mental health specialist ambulances, and more crisis cafes. We want to see this service work with people sleeping rough who have mental health problems, providing support on the street if necessary.

More money for the NHS

However, we know that prevention is always better than cure. We want to see fewer people getting to crisis point and helped much earlier before conditions worsen.

People sleeping rough have much higher rates not only of mental illness, but of physical health problems too, and shockingly high levels of mortality. So the cash injection for the NHS – £20bn over the next five years – is desperately needed and clearly welcome. But we know that without a clear plan, these kinds of funding injections often don’t make their way through to helping the most vulnerable. That is why we want the upcoming NHS Long Term Plan to earmark some of these funds for specialist services for people sleeping rough, to ensure their needs are not forgotten.

Funding to address problems in Universal Credit roll-out

Universal Credit roll-out has had a particularly damaging impact on people sleeping rough, which is why the £1bn announced in the budget to address problems with roll-out is welcome. These problems include large deductions being taken from Universal Credit awards to repay Advance Payments and other debts such as rent arrears. We are also seeing increases in arrears for service charge in supported housing, as Universal Credit no longer allows claimants living in supported housing to request direct payments to their landlord for the likes of gas and electricity.

The complexity of the new system means that many struggle to navigate it and make a claim without support. The cumulative effect of this is to make it even harder for people to move on from homelessness.

We want this new funding used to address these serious problems. However, in order to stop vulnerable claimants being pushed further into destitution, we still want to see a pause in the roll-out to give time for the process to be fixed.

But not enough to end rough sleeping…

Despite these positive notes, the overall feeling is that this was a missed opportunity. With no funding measures on rough sleeping specifically, and no plans to tackle the key drivers of homelessness, there is still much more to do to get close to the Government ambition to ending rough sleeping by 2027.

We need to see further commitments to increase social housing, strengthen private renting and funding for homelessness services for people to find, and keep, a home for good. We will be working to build support for these changes in the months ahead. With the numbers sleeping rough continuing to rise, we cannot afford to delay.

Our Home for Good campaign is calling on the government to put an end to rough sleeping by ensuring that everyone gets the long-term housing and support they need to rebuild their lives. Sign Kevin’s open letter to the Secretary of State for Housing, Communities and Local Government.

We must not let fatalism set in

Rory Weal, Senior Policy and Public Affairs Officer at St Mungo’s, explains why we’re calling on Government to enact urgent measures to stop the scandal of people dying on the streets

One week ago marked the first anniversary of the Grenfell Tower disaster. It was a time to reflect not only on the lives that were lost on that day, but also on how we all respond when faced with a human disaster on that scale.

This week St Mungo’s has been highlighting another human disaster: the rising number of people dying on the streets. It is less visible, more dispersed and slower moving. But it is a disaster nonetheless, when so many people are dying in circumstances that are preventable and shockingly premature.

Data suggests that, in London, someone dies on the streets every fortnight. In the rest of the UK, as many as two people are now dying every week, a rate twice as high as five years ago. The average age of someone who dies sleeping rough is 47 for a man and just 43 for a woman.

What is worse is that these figures are likely to be an underestimate, given that recording deaths is infrequent and not done systematically.

Our new report Dying on the Streets: the case for moving quickly to end rough sleeping looks into these figures in more detail. We found that mental health support needs among people who have died has increased dramatically, from 29% in 2010 to 80% last year.

To find out more about what is going on the ground, we also carried out a national survey of street outreach services earlier this year. The picture that emerged is one in which the number of rough sleepers is growing, at the same time as access to vital service is getting harder. This is creating a perfect storm to which the most vulnerable homeless people are falling victims.

Some of the findings were shocking. 70% of respondents said access to mental health services for people sleeping rough had got harder compared to five years ago, and 64% said this was true for emergency accommodation. The majority of respondents had experienced a death in their area, but only one-quarter of those had any experience of a review being carried out.

In short: there is less help available, people are dying, and these deaths are going ignored.

But statistics don’t capture the most tragic consequence: the sense of acceptance and inevitability which increasingly meets the death of someone sleeping rough. As such tragedies become more commonplace, we come to expect, and sadly, accept them.

We must not let fatalism set in. Dying on the streets should be unthinkable. It is certainly preventable. There are ways to stop this scandal from continuing, but only if the determination and political will is there.

To achieve that end, earlier this week we held a roundtable discussion in Parliament. This was attended by the Minister for Mental Health, MPs, and experts in the field, who all recognised the gravity of the issue and resolved to stop the scandal of deaths on the streets. With the Government’s rough sleeping strategy due for publication next month, now is the time to turn those warm words into firm action.

We are calling for a package of measures to ensure rapid relief from rough sleeping, to get people off the streets and prevent future deaths. This includes access to specialist mental health services, an expansion of emergency accommodation, and full reviews to learn the lessons from every single death that occurs on our streets.

Without such interventions, I fear current trends will worsen, lives will be cut short, and our claims to being a compassionate society will be left in tatters. We hope the Government uses its upcoming rough sleeping strategy to avoid this fate. The price of failure is too high.

On a typical day…

“For me, if I can go home knowing I have helped at least one person away from the streets, or just one person away from the distress of mental health illness, I feel blessed.” St Mungo’s Mental Health Practitioner, Fatima, shares her experience of working in Outreach, helping people sleeping rough in the Tower Hamlets area.

I’ve been a mental health nurse for 18 years. In 2011, I became and an approved mental health professional, which incorporates social work. I will work typical outreach shift in terms of going out early in the mornings and staying out late in the evening, as late as two or three in the morning, speaking to clients who are sleeping rough to try to form therapeutic relationships with them to help them move away from a life on the streets.

‘Blinded to homelessness’

I was one of those people who was blinded to homelessness. I could walk past a homeless person or rough sleeper and not really see them to understand what they’re going through. It’s been an eye opener for me and I’ve fortunately been able to influence others to see homelessness through what I do at St Mungo’s.

It can take a week or months to be build a relationship with a person. Sometimes they are in denial – they have no insight about what is happening to them so I try and to slowly educate them. I take decisions out of people’s hands when they’re experiencing mental distress.

I enjoy my work. I can get people registered with a GP surgery, then get them to start medication, stabilise their mental health illness and then help into accommodation whilst we support them. Many people may have been de-registered and have been turned away from Accident and Emergency (A&E) wards. They can go through those revolving doors three or four times a month, back and forth from A&E.

I also work with the clients to ensure they engage with the process of recovering from homelessness. You cannot take someone off the streets and expect them to turn up for every appointment. I have to build that relationship, that rapport and that routine of them coming to see me to talk about their mental health, the medication and the side effects.

‘Long days full of drama’

My days can be very long and full of drama. Sometimes I get abused, which can be quite stressful. But my job is also fun and flexible. For me, if I can go home knowing I have helped at least one person away from the streets, or just one person away from the distress of mental health illness, I feel blessed.

It’s brilliant to see someone who has been sleeping on the streets for five or six years leave that life behind. The kerb becomes their family so getting them into accommodation is not easy. When you put them in a room in a hostel it can be very lonely. The silence can be deafening for them because people out on the streets give them money and say hello – some people get to know them as they walk past them on their commutes. So they run back onto the street and people wonder why because they have accommodation.

‘Everybody is unique, everybody has a journey.’

A lot of clients can lose their accommodation in hostels because of poor mental health – some people cannot understand their journey. Everybody is unique, everybody has a journey. How you hold their hands to support that journey is what makes a difference. People might think, ‘go to housing and get a property, get off the road and get your benefits’, it’s a much longer journey, however.

Different clients talk about their living conditions. Finances are a problem. People have not been used to managing money and paying bills. Universal Credit has also caused a lot of problems for our clients.

I have one client, for example, who believes he has all his money invested in stocks and shares. He says when his investments mature, he’ll pay his rent. He has a diagnosis of schizophrenia with delusional disorder. I ask for my colleagues to work with him in terms of hand-holding to ensure he does not get evicted from his hostel.

I’m working with this lady that I’ve known since I was a student nurse. Up to now she will not allow anyone else to work with her. She was sleeping in a bin shed. She became mentally unwell, and started using drugs to self-medicate the voices she was hearing. Her children were taken into foster care when they were young. I worked with her and got her a place in a hostel. He son got in touch after 15 years and they’re building a relationship again.

‘You cannot be judgemental’

Because of the nature of the people we work with, many with chaotic life styles, who are extremely marginalised, it’s very difficult to get through to the NHS. Even though I am that link between the NHS and homelessness services. Sometimes the nurses have no understanding or knowledge of homelessness. They’ll say, ‘he needs to go, he might bring drugs in here’. It’s a big challenge to get my clients treatment because of the way they look, or dress and their circumstances.

Working in outreach, you cannot be lazy. I have gotten used walking everywhere. You must be able to multitask as you’re dealing with more than one client, sometimes up to seven a day, who are in crisis. I’ve jumped over six feet walls and walked along canals to help people – it’s part of what we do. You must have people skills, respect humanity, and you cannot be judgemental at all. It takes a lot of character to try and support people who are not ready to receive help.

It’s a nice feeling to know you’ve helped someone from being a hermit to re-engage back into society and to be part of a community. I think that’s what has been missing in [conversations about] homelessness. Our country has forgotten how to be a community. To me, it feels like in London everyone is in a rush, so in that mad rush, we are blinded to homelessness.

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Category: Mental health