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.

Twenty vibrant years at St Mungo’s

“The enjoyment of it has kept me going for 20 years. It’s a great pleasure. It’s all the people that I meet and talk to, and the work that I see.”

As we celebrate Volunteers’ Week, Jen Burnham, St Mungo’s Creative Arts Volunteer, tells us about what she’s learned through volunteering.

I’ve been a volunteer at St Mungo’s for 20 years. I was one of the first volunteers on a programme called ‘Make It Work’ which I think was the beginning of a formal volunteering programme at St Mungo’s. Now I understand it has something like 900 volunteers a year!

I’m almost 75 years old now. I’ve always had an interest in art but I never did much with it. In 1998, I was at a dead end in my life and I decided to do some art-related volunteering, including an art group at St Mungo’s in Argyle Street, King’s Cross. I was made very welcome there.

A few years later a member of St Mungo’s literacy team produced a booklet of poems by Argyle Street residents and asked if we had some artwork that could be included. The resulting booklet was much admired and one resident Joe asked, ‘why don’t we do this on a regular basis?’ That was the beginning of Homeless Diamonds magazine. It started as a photocopied A5 booklet for art and writing from the King’s Cross area; it’s now a glossy A4 magazine for all of St Mungo’s and a bit beyond (thanks to support from Regional Director David Devoy, who from the start has supported the project).

We produce three editions of Homeless Diamonds per year, each containing the work submitted since the previous issue – no more and no less. Everyone who submits will have something printed. On the suggestion of contributors we have recently set themes for particular editions, but always maintain this submission policy.

Producing Homeless Diamonds is a big, varied job; the hardest (and most rewarding) bit is gaining contacts with residents throughout St Mungo’s and encouraging them to contribute. We are very lucky to have our volunteer designer, Gasan, who has designed most of our editions. When all is gathered, typed, corrected, photographed and laid out for the printers we can look forward to celebrating with a little launch party; then the task is to get our 350 copies distributed, to all the contributors and to as many residents of St Mungo’s as we can,

It’s clear that contributors value the magazine, and that it gives them a great boost to see their work printed in a quality publication. It’s a wonderful way to communicate across boundaries, at a more personal level.

The enjoyment of it has kept me going for 20 years. It’s nice to see contributors as they progress in various ways (including working at St Mungo’s) – many have told us how much their engagement with the magazine has helped them. There is a huge pool of experience, and talent, at St Mungo’s, a resource of great value to society.

Volunteering has helped me a lot. I had lost confidence in myself when I started, and it gave me an experience of being valued that I really needed. And I stumbled upon such interesting people, such remarkable characters! So the feeling was mutual!

I hope Homeless Diamonds will continue, perhaps as part of St Mungo’s Recovery College, when I get too dotty to carry on.

If you have some spare time and would like to make a difference to someone who is experiencing homelessness or a decline in mental health please visit St Mungo’s current volunteering opportunities. You can also email: VolunteerServices@mungos.org or call 020 3856 6160 for more information.

Brick by brick to recovery

Our client, CarrieAnn, shares the story of her love for building work at St Mungo’s Bricks and Mortar project and how learning new skills is helping her to recover from drug misuse.

I was on cocaine for about nine years, and with that came heavy drinking, but that was when I was using. I realised I was spiralling out of control, then I decided that I needed to get help, so I referred myself to a day recovery programme. They referred me here to St Mungo’s Bricks and Mortar project in Euston, London. The project helps people recover from homelessness through social and therapeutic construction skills development.

I’m 34 years old. I have had four years of decorating experience with my step dad. I was a labourer for him and he taught me how to paint. From there I came here and I’ve been here about eight months. I finished my course, which covered bricking, plastering, dry lining, rendering, and now I do wet lining. Since finishing the course, I’ve gone into volunteering.

I’m a very hands on person. I’m dyslexic so I steer away from reading and writing. Actually, St Mungo’s Brick and Mortar Tutor, John Gani, taught me to pick up a newspaper every morning on the way in – so I’m reading a little bit now. I like anything hands on, building things, decorating is my favourite. I find decorating therapeutic. When I have thoughts in my head and I am feeling a bit down I find a paint brush and a wall to paint. It takes me into my own little world.

Coming here has made me realise I now have a future ahead of me, instead of the darkness where I was. I’ve learned more skills. Every morning I look forward to coming here because I know I will learn something new. It gives me a reason to get up.

I was not good at travelling, now I realise I am ok – I used to be terrified of the tube. I live in Battersea, so when I first started I used to take a really long route to get here, not knowing there was a quicker route. Coming here has been really good for my confidence.

People who come here are from different walks of life. When I first started the course I met people here as they were finishing. I don’t know how they were when they first arrived here, but they walked out of here full of confidence. I am more confident in myself. We all get on and know that if there’s a problem, we can talk to the boss – he can have a quiet word to sort out any confusion.

Not only do I get to learn new skills, I am in recovery as well. The tutors are amazing; they’re both in recovery with us. There was an incident a couple of weeks ago. I walked in and one of the tutors knew straight away that something was wrong. I went to walk out and he said, ‘stop’. When I turned around, I completely had a meltdown. I’d had a slight relapse. Because I’m in recovery I stay away from cocaine. But I had used some and it was eating me up inside because I knew it was wrong. The advice my tutor gave me was amazing.

There are a few others in recovery here. The advice we get from tutors helps us stay clean. They share with us what they’ve learned, and with their encouragement we know we can do it.

Set up almost ten years ago, St Mungo’s Bricks and Mortar project offers practical skills in construction, including, plastering, rendering, brickwork and dry lining. The course is accredited so students leave with a basic entry qualification in construction.

St Mungo’s relies on the generosity of the public to run projects like Bricks and Mortar. You can find more information about how you can get involved in supporting us on the website.

‘The greatest journey’

Former St Mungo’s client, Victoria, was recently presented with a Royal Horticultural Society Community Champion Award, which is presented to 15 individuals around Britain who have demonstrated exceptional commitment and dedication to the Britain in Bloom cause in their community. Now in full time employment as a St Mungo’s gardener trainer, she tells us about her “greatest journey.”

I joined St Mungo’s as a client at the end of 2013. I’d just come out of four and a half months treatment for long term addiction in Gloucestershire. So when I came back to my home in London, it felt like being thrown onto this cold world without my usual ‘backup’. I felt I needed an aftercare programme.

With the help of St Mungo’s Recovery College, I put in place things for me to do every day. I was challenging myself, getting to better understand myself and all my likes and dislikes masked through addiction. Through the Recovery College, I was put in touch with the Education Training and Employment service; they connected me to St Mungo’s Putting Down Roots (PDR).

“My interest was doing something in ecology or recycling.”

To begin with, I went on a one day course about inspiring your inner entrepreneur. I always felt I could run a business of my own. My interest was doing something in ecology or recycling.

I joined PDR in spring 2014 – the project helps people to recover from homelessness through social and therapeutic horticulture.

By the end of 2014, I’d been put forward to do a three month paid trainee position. Funnily enough, that was a harder decision compared to going for treatment, because it meant having to come off welfare benefits, that make you feel quite protected and having safety nets or ways of coping with the world that are comfortable. I had to make a decision to risk that comfort to begin a training programme with no definitive job at the end of it. That was a massive decision.

By 2015, I had become a St Mungo’s freelance gardener – that meant I could be sent out independently on jobs and I started to earn an income for myself.

“I’m seen as a bridge between a member of staff and a client”

I have my fingers in many pies at the moment. I am working on two main sites, one in Clapham, London – our main training ground, where we do a lot of our horticulture training with our clients. I also work on our second site at Melior Street, London Bridge, which we manage along with six sites in the surrounding area, on contract with Team London Bridge, the organisation set up to ensure the London Bridge area continues to develop as a centre for enterprise, culture and entertainment. The work here gives clients a flavour of what it’s like to work in gardening.

I think my past experience has helped me connect with clients. I am perfectly happy to tell my story so hopefully I might be seen as the bridge between a member of staff and client, but also as someone who understands what it might be like when you come as a nervous first timer, who might not have a lot of confidence or direction. I am here to show our clients that there is a bridge between where they are and actual living, where you are integrated into society.

On many levels what you’re giving clients is something to get out of bed for and something to show up on time for. They get a sense of responsibility to the team that they are working with or even the seeds they’ve sown. You find that you set a simple task to begin with, they’ll want to come check how they are doing. That’s also where I started to understand the connection between gardening and wellbeing. In my own experience, when I started to nurture something that couldn’t nurture itself, I learnt to nurture my needs and wants and to take care of myself.

What interests me is making my world and the people who surround me happier – making my community brighter.

‘The Award was a complete surprise to me’

The Royal Horticultural Society (RHS) Community Champion Award was a complete surprise to me. Henry Johnstone, from Team London Bridge, the business improvement district, invited me to the Britain in Bloom Award ceremony in Llandudno, Wales. It was an incredible moment. I couldn’t quite believe he was taking me.

I knew that PDR would probably win an award for our work on the local estates around London Bridge – which we did, we got gold. I left the ceremony early to go to bed. Apparently 15 minutes later, I was called up on stage for a Community Champion Award – one of 15 around Britain this year. You can’t get bigger than the RHS for the work I do.

I was absolutely speechless. I am very proud. If you’d asked me on 13 July 2013, the day I took the train to Gloucestershire for treatment, I would never have believed that three and a half years later I would be talking about winning an award for gardening. There aren’t words to describe it. I have travelled the world but this is the greatest journey. It’s very emotional. I could not have done it without Ian Kavanagh and Jeff Morgan at PDR. Martin Calderwood, the PDR project coordinator saw a spark in me and he developed it. He also allowed me to develop myself.

This week I start work as a full time gardener trainer. I plan to have pudding with my team.

We came. We saw. We conquered.

Image: Clients and Staff at St Mungo's climb Mount Snowdon

St Mungo’s client and volunteer, Mandy, has shown incredible strength in her journey to conquer homelessness. Having now also conquered Mount Snowdon, Mandy shares with us her inspirational challenge and her ongoing determination to help others on their road to recovery from homelessness.

From the streets to the mountain top

In June I took on one of the biggest challenges of my life. Along with my friend Claire, also a client at St Mungo’s, we successfully led a team of other clients and staff to the top of Mount Snowdon. Snowdon is the tallest mountain in Wales at 1,085m above sea level, and the highest point in the British Isles outside of Scotland. We were keen to do this for a couple of reasons; to celebrate how we had conquered homelessness and to raise funds and awareness to help give others the same chance.

Your support helped us to the summit, thank you.

Having spent months meticulously planning, we arrived at Snowdon the day before full of excitement and couldn’t wait for challenge day!

The team set out first thing in the morning in great spirits. We could all feel exactly how much the challenge meant to us, and we were so determined to complete it.

We were totally overwhelmed by the number of people who supported us with generous donations and lovely good luck messages in the lead up to the big day. This kept us motivated all the way to the top, we really wanted to do everyone proud.

We came. We saw. We conquered.

We made some truly special memories along the walk which we’ll never forget. Touching the summit of Snowdon was a dream come true. It was a proud and emotional moment for all of us, who had never imagined we could do something like this.

In memory of those who have died while sleeping rough

At the top of Snowdon we dedicated our challenge to those who have died while homeless or sleeping rough. We all knew that could easily have been us.

It was a particularly emotional moment for me as I took the chance to reflect on how far I had come along my journey to recovery. Just two years ago, I was sleeping rough. Today I have a place to call home and have had the chance to rebuild my life. I’ve seen myself grow so much, and I know this wouldn’t have been possible without St Mungo’s and their supporters.

Let’s help everyone conquer homelessness

At the heart of our challenge was our determination to help others who are homeless. Along with the rest of St Mungo’s, we believe that everybody should have a place to call home and can fulfil their hopes and ambitions.

I’ve experienced first-hand how dangerous rough sleeping is and how it can affect mental health. At St Mungo’s having a place to stay, therapy and learning new skills all helped me to recover. We desperately want to give other homeless people the same chance. It would mean the world to so many people if you could give a gift to help us save and change the lives of others.

We cannot thank people enough for supporting us

Thank you so much for your support. Without it, this walk would have been literally that; only a walk. Your support has made it a life changing experience not only for us, but for the homeless people we’re now able to help.

I hope that our challenge will inspire others to think that if Mandy and Claire can climb a mountain, then they can do anything they put their mind to. We’d love to think that someone sleeping rough today could hear about our achievement, feel inspired to conquer their own challenge and make a positive difference to their life or the lives of others.

Thank you all so much for making this possible and supporting us every step of the way.

Save Hostels. Rebuild Lives.

This week, St Mungo’s launched our Save Hostels Rebuild Lives campaign, calling on the government to properly consider the damaging effect changes to funding for supported housing could have on homeless people. Take five minutes to find out why, and what you can do to help.

Many people who are homeless or at risk of homelessness need specialist support.

This expert support is provided by dedicated staff in supported housing – hostels – but these services are at risk.

The Secretary of State for Communities and Local Government, Sajid Javid, and Secretary of State for Work and Pensions, Damian Green, are planning to present proposals to change funding for supported housing to government in a matter of months.

St Mungo’s believes these changes will cause irreparable damage to essential services and may even cause some to close.

A route out of rough sleeping

Full disclosure? We provide supported housing services that could be affected by current proposals, which will compound problems faced by projects already being challenged by a reduction in rent allowance that came into effect in April 2017.

In 2016, St Mungo’s housed 4,120 people, over half of whom have slept rough. Many of our clients have multiple and complex needs, and for them, recovery is more than a roof.

Most funding for supported housing services for single homeless people comes from a combination of housing benefit and local authority budget for support they commission.

Supported housing under threat

The proposals involve reducing people’s benefit entitlement, but they don’t take into account the way support is funded. They will leave supported housing services even more reliant on entirely discretionary funding from already stretched local council budgets.

With no legal requirement to provide vulnerable homeless people with supported housing, many services have lost their funding. Analysis by the National Audit Office shows that between 2010/11 and 2014/15 funding for housing-related support fell by 45% across single-tier and county councils. [1]

There are many reasons to be concerned by this. One argument is that without the right support at the right time, people can get stuck in damaging cycles of homelessness, making recovery all the more difficult. Another is that causing the reduction of available places in supported housing makes no economic sense.

The existing proposals suggest a cap on housing benefits based on local housing allowance rates, which is tied to rent levels in the private sector. This does not take into account the reality that the costs of providing supported housing are similar across the country.

St Mungo’s believes that basing the system purely on Local Housing Allowance rates will provide little incentive to develop supported housing for homeless people in low rent areas. This would create a situation whereby availability of supported housing could be limited in places where it would be easier for residents to find affordable housing when they are ready to move on.

A funding system that does not take into account local demand – or does not ensure that need is properly assessed – not only ruins lives, it is more expensive. Research published by the National Housing Federation found a shortfall of 16,692 places in supported housing for working-aged people in 2015/16. The research estimated that in the last financial year, the shortfall in supported housing places cost the taxpayer £361 million. [2]

The right support for recovery

“Making the service fit the need is really important.” – Rob

Rob told me how he spent 20 years bouncing between sofas and services ill-equipped to help him recover and properly manage his mental health. Finally, he came to a service we run that worked for him. He’s since moved into independent living, is engaged to be married and is working as an advocate for homeless people.

We know that sometimes people find certain environments challenging. Sometimes, people move between services because their support needs have changed or because services close.

Recovery is a process, and moving into supported accommodation after living on the streets can be a difficult transition, but these services save lives.

We are urging the Secretaries of State for Communities and Local Government and for Work and Pensions to:

Develop a sustainable and secure new funding system that helps vulnerable people get off the streets for good
Introduce a legal requirement for local authorities to assess need and plan for appropriate supported housing provision in their area
Ensure that the system is fully transparent and accountable to central government

With the right support at the right time, people can recover and rebuild their lives after being homeless.

Sign our petition to #SaveHostels here

[1] National Audit Office (2014) The impact of funding reductions on local authorities

[2] National Housing Federation (2017) Strengthening the case for supported housing

“Its been the best year of my life”

Image: Kevin Farrell, client of St Mungo's

At the 2017 Skills for Care Accolades St Mungo’s has won Best Employer Support for Apprenticeships. As National Apprenticeships Week draws to a close, Kevin reflects on how his year as an apprentice has changed his life.

I see myself as a holistic therapeutic practitioner. I love art and yoga, I enjoy photography. I enjoy getting involved in projects, working in collaboration with other organisations and charities. I’ve done stuff with Café Art and HAGA.

I’m a people person, I enjoy seeing people move forward with their recovery. I am a person with lived experience of homelessness. Great fulfilment for me is when I see people climbing up the ladder and moving forward with their lives.

‘Surviving by any means possible’

Life was very chaotic for me from a young age. I come from a large Irish family. I lost my mum to cancer when I was 12. From then I was out of control.

I didn’t really have any discipline, I have five older brothers who were no angels. I wasn’t living in a good environment. It was not uncommon for a 12 year-old to smoke cannabis. That was just the environment we came from.

We weren’t a rich family but we survived by any means possible. I’m not proud of the things I did. I know a lot of it was done in survival mode. I never intentionally went out to hurt anyone, and I never did. I sold drugs for a number of years. I got caught and I did a prison sentence. I’m not ashamed of my past.

When I came out of prison in 2009, I was housed at a St Mungo’s hostel in Central London. I was there for six months.

I was not abstinent, still messing about in illegal activities. From there, I was rehoused through St Mungo’s rent deposit scheme.

‘Living in the fast lane’

I held it together for a couple of years. I went back to work in the catering field. I again became dependent on alcohol and started to use Class A drugs. Then I went to rehab again.

I used to work in management in the catering field. That kind of environment is fast paced. People tend to get involved in a lot of activities with drink and drugs. That’s just the way it was for me, for many, many years.

I’d been at it for quite a number of years in the fast lane, working for a high end catering company and working sometimes 60 or 70 hours a week. It took its toll. My only means [of coping] was indulging in bad behaviour, which had an impact on my mental health – not surprisingly.

‘Out of the darkness’

In 2012 I came out of the darkness. I’ve not had a drink or drug since. I remain abstinent.

When the opportunity for the Apprenticeship came up, I was told by the people I was volunteering for, “Kevin, it’s about time you got a job. You’ve done everything you need to do now”. I’d done a lot of volunteering for St Mungo’s for two years, in hostels and as the lead service user representative. I had completed a psychology qualification, Cognitive Behavioural Therapy and Smart Facilitative training. I’d also had a number of years of sobriety under my belt.

I was really primed, I came for the interview and it happened all in a flash. Then I was offered the role.

Being an apprentice gave me an opportunity to gain experience in the drug and alcohol recovery field, which is what I’m specialising in. Over the year, I was running groups and holding one to one sessions with clients. I held a client caseload of up to 15 people, it’s been really full on.

‘More than I expected’

The St Mungo’s Apprentice Scheme is the best thing to have ever happened to me. It’s been a lot more than I expected. The amount of support I received from St Mungo’s is massive. Massive!

I work with other people in the same field from other organisations, they don’t get the same level of support. Here you get line managed very well.

As an apprentice, you attend ‘Reflective Practice’ – an opportunity for a group of apprentices to get together, sometimes with a therapist, to ‘offload’.

You get rid of the good, the bad and the ugly in a confidential environment. It is an opportunity to soak and air views, especially when I had been struggling and needed help.

In the early days I was struggling with some of the IT. I took that to reflective practice and some of the apprentices helped me out. They pointed out that I was not silly.

‘I’ve had a positive impact’

I’ve not reverted back to my old life because of connecting to people; socially, spiritually and physically. I started a relationship with my partner, which is very special to me.

There’s also fear – fear of going back because I know where it took me – to a really dark place but I know my biggest asset is my lived experience.

I use that experience to empower other people that I work with. I couldn’t envisage going back to that life again. I enjoy being me. I enjoy my life too much now.

I feel a lot of serenity around my life now. I still have my bad days, don’t get me wrong. I still swear and bark every now and again but in general I try to lead a peaceful life and empower people.

I’ve just finished the year’s apprenticeship with St Mungo’s Haringey Recovery Service. It’s been the best year of my life. I’ve had a positive impact. Now I’m going to help run Shine, a social enterprise in Haringey.

To find out more about St Mungo’s apprenticeship scheme click here.

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