Home is where the heart is Peter Cockersell Director of Health and Recovery

St Mungo’s About 2000 beds: hostels to self-contained flats, including registered care Specialised drug, alcohol, mental health, dual diagnosis; older, women’s, and sexworkers’ projects Street outreach, 2 day centres, employment, training, substance use, health, and psychotherapy London, Reading, Oxford, Oxfordshire, Bath, Bristol, Hitchin, Welwyn Garden City…

Home is where the heart is Peter Cockersell Director of Health and Recovery

What happens if your heart is broken?

5 Client perspective Home to me is somewhere that has a family and everybody in it “ ”

What happens if your family is broken?

7 Shattered lives Population 1 - 4% schizophrenia 5 – 13% personality disorder 11% anxiety disorders and depression 1.3% have attempted suicide Homeless People 16 – 30% schizophrenia 50 – 70% personality disorder 50 – 80% anxiety disorders and depression 42% have attempted suicide

8 Shattered lives: women 66% have a mental health problem 55% have a substance dependency >50% have physical health problems >50% have experienced violence or abuse from family/partner 41% rough sleepers have been involved in prostitution 45% are mothers

Shattered lives: children 47% experience of neglect/emotional abuse 34% early loss of parents through abandonment, separation or divorce 31% early loss of parents through death (including murder and suicide) 27% sexual abuse High levels of parental alcoholism, drug use, and domestic violence

10 Behaviours associated with complex trauma Self-harm Uncontrolled drug or alcohol use Impulsive, careless of the consequences Withdrawn, reluctant to engage Anti-social Isolated Aggressive Lacking daily structure or routine Inability to sustain work or education Bullying, or being a victim Offending Unstable relationships

Relationships Complex trauma arises from abusive relationships Healing relationships need to be managed, and take care, and time Relationships have an impact on both/all parties Group dynamics affect individual group members’ relationships Sometimes people need specialised help

12 Seeking help 70% had sought help: 11% got help Majority have histories of compound and complex trauma, not simple diagnoses More people have more than one condition than have only one Almost no access to psychotherapy, only drugs

13 Client perspective I did not access much of mental health services (they would not let me), but I used up hundreds of thousands of pounds of other budgets such as housing, social services and substance misuse “ ”

14 Psychologically Informed Environments Psychological Framework Social Spaces Staff Training and Support Managing Relationships Access to psychotherapy

15 Client perspective I didn’t want to go initially, thought I didn’t need to see a shrink. I gave it a go and the first few sessions were very informal, unthreatening. I grew to trust her, told her things I haven’t told anyone else. A lot of tears were shed, she didn’t drag it out of me, she listened. I got shit out of my system that I’d been carrying around a long time. There was an underlying burden in my heart that she knew what to do with. Everything I said wasn’t written down and I loved that. It was properly confidential. It was a hard one but it was a good one and if it wasn’t for her I’d be floating down the Thames now. “ ”

Psychodynamic psychotherapy Based on relational dynamics in the here and now, while recognising the impact of the past in the present Does not require diagnosis or pathologisation of clients, and recognises the reality and validity of their experiences Therapy is flexible, client-led and non-directive Works on linking thinking and emotions, and the regulation of affect Evidence of effectiveness

Balint ‘Everyone needs to be the sparkle in someone else’s eye’ The Basic Fault

18 Client perspective I didn’t believe in myself, but it seems that other people believed in me; through their belief I could begin to do things. It began when I realised – it’s quite sad, where I’m at... (former rough sleeper) “ ”

Resolving homelessness Ending homelessness is about acknowledging and soothing broken hearts, enabling relationships, and holding hope

Further information