Golden Key – Understanding the Barriers for People with Multiple and Complex Needs

What is Golden Key and who is involved?

Golden Key is an eight-year programme, funded to the tune of £10 million by the Big Lottery Fund, aiming to change the way Bristol services respond to people with multiple and complex needs. Our definition of MCNs is a person that has experienced at least three out of four of the following issues – mental health, criminal justice involvement, substance misuse and homelessness. www.goldenkeybristol.org.uk

How does it work? Each Golden Key client will have a service coordinator to pull together relevant services and act as an advocate on their behalf. They will also have a peer mentor to offer support. We will identify and tackle blocks and barriers to make the system work better and create lasting change for Bristol services.

Golden Key agencies have promised to say ‘yes’ to people who have struggled to access services. Together we will find new ways of working to create lasting change for Bristol. ll www.goldenkeybristol.org.uk

Why does Bristol need Golden Key?

A survey called Tackling Homelessness and Exclusion: Understanding complex lives’ by Joseph Rowntree Foundation was completed in November 2012 on current service delivery, it showed that agencies were in contact with people with multiple needs, of whom 94% had two out of the four need areas and 69% with three out of the four need areas. Agencies also said they had noticed a change in their client population with 61% reporting that clients appeared to have more complex needs than previous years, with 90% saying they had seen the numbers of clients with complex needs increase. Additionally, 80% of agencies said they see people who fail to engage or have limited social abilities.

One agency stated: ‘needs are far more multiple and complex’ and ‘although we are funded to provide low-medium support we are finding increasingly that referrals are for people with complex needs – drugs, alcohol, mental health, personality disorders and homelessness combined’.

Bristol continues to have deprivation ‘hot spots’ which are amongst some of the most deprived areas in the country, yet these are adjacent to some of the least deprived areas in the country. Bristol has 32 areas in the most deprived 10% in England Of these 32 there are 14 in the most deprived 5% and 1 in the most deprived 1%. Within Bristol there is evidence that many individuals are facing complex needs, some of whom are experiencing all four of the target need areas.

Who do we work with?

Golden Key will work with up to 300 people in Bristol who are the most excluded with multiple and complex needs relating to homelessness, offending, mental health and drug and alcohol abuse. People who have been excluded or evicted from services, who are part of the ‘revolving door’ population, and who are disengaged or not using services effectively. By working with a network of partners across Bristol we aim to learn about how services can work better for this group and bring about system wide change, and a lasting impact. Led by Second Step, this 8 year strategic programme funded by BLF is overseen by a Partnership Board with representatives from the key statutory and voluntary sector agencies, and people who are experts by experience

What have we learned so far?

Block and barrier review process Developed by Golden Key Partnership representatives at the Operational Group April 2015 Tiers represent current and potential avenues for block and barrier resolution Blocks and Barriers: May be fed in via IF group, partnership board and subgroups, GK partnership, clients, Service coordinator team and any other avenue which offers a viable block or barrier. Tier 1 Barrier may be resolvable through specific client-led intervention such as mediation Tier 2 Barrier may be resolvable between front-line staff members through client-focussed sensitive partnership working. Tier 3 Barrier may be resolvable between staff managers through solution-focussed, positive partnership working. Tier 4 Barrier may be resolvable if presented to Operational group Tier 5 Barrier may be resolvable if presented at Commissioners sub-group. Tier 6 Barrier may be resolvable if presented at Partnership Board Tier 7 Barrier requires national/policy related intervention – No pathway identified for this area.

Long term coordinated support works Transitions across accommodation types and from secure settings are not managed well Complex clients often have their issues managed by the wrong services e.g. MH issues being dealt with through CJ processes or MH dealt with through substance misuse services The most reported issues from staff relate to mental health and housing services The housing pathway doesn’t work for lots of our clients Complex clients often don’t offer achievable outcomes to services and so working with them is not a priority

Extra issues our clients face Domestic abuse / in controlling relationships (e.g. with their dealers / sexual abuse / sex work / experience of children being removed due to safeguarding issues / self-harm / overdose / attempted suicide / learning difficulties / institutionalisation / malnutrition / poor health / debts/ history of being bullied / behavioural issues Extra issues our clients face

What’s next?

Golden Key project wants to identify how it can find more ‘hidden clients’, i.e. people who have multiple and complex needs and are not accessing services to support them. Golden Key already works with a lot of clients who are well known to local services but have not been well supported by them, but it wants to explore how it can find people who are not well known to other services but who would benefit from GK’s approach

Hidden clients are people - who are in need but do not currently access any services. who have fallen or been locked out of services due to requirements set by service organisations. members of specific communities or demographic groups who are currently believed to be underrepresented in service use. accessing crisis, acute need, and/or emergency services who do not receive support to address their long term underlying needs.

Next steps Go through the list of people to consider targeting, and for each one identify whether Golden Key has already worked with any clients in this group, and secondly whether you want to target this group. This will provide greater clarity for the staff and selection panel on how to prioritise cases. Go through the list of potential referral sources and identify whether Golden Key has good contact with these people already, and what actions could be taken to improve relationships and increase the likelihood of referrals of people furthest from services.

Thank you