Achieving Continuity Across Agency Boundaries Revolving Doors Expert Seminar: Improving Front Line Service Responses 14 th November 2011 King’s College London, London Michelle Cornes, Louise Joly, Jill Manthorpe & Sue O’Halloran with Cumbria Action for Social Support, Look Ahead and Calderdale Smartmove

Seminar Aims How can we achieve continuity across homelessness, mental health and drug and alcohol services? What are the current objectives of inter- disciplinary support? Are these right ones?

Research Project Aims To explore how different agencies and professionals work together to support people with experience of multiple exclusion homelessness – focussing on workforce development and improving practice

Methods Fieldwork in Cumbria, Calderdale and Inner London Interviews (n=48) and focus groups (n=17) with stakeholders from a wide range of agencies across health, housing, criminal justice and social care including housing support workers/hostel staff Interviews with people with direct experience of MEH (‘Experts by Experience’) following their journeys through the ‘system’ over a six month period (32 first interviews and 22 follow-up interviews) Partnership working with local partner agencies to develop findings for practice

‘The basic idea is that treatment and aftercare must be integrated to sustain the individual in the recovery process, and for this to happen there must be a shared recovery approach among provider agencies in delivering coherent packages of support’ Best et al. 2010

Engage to change St Mungo's adopted the recovery approach as our guiding ethos five years ago…The recovery approach is about enabling people [with mulitple and complex problems] to live to their full potential... It is about transformation and change. Change can be facilitated but it comes from within. [Accessed ]

Support Planning “Stick to my meths, get to do something and move on to the flats… that’s it basically” Johnny, Hostel Resident, Age 24

Assessing Motivation and Engagement [Discussing his drug worker] If you mess her about she’ll come down hard on you. When I first got in, I messed her about a lot coz I was still using. She said “I’ve signed you off for 6 months come back in six months” and I was like “no way” and I begged with her and pleaded with her and I said I am telling you now mate this is me changing now, honestly you put me back on my script and when I’m back for [drug] testing I’ll be clean (Phillip, Supported Accommodation, Age 30)

Exclusion… Being In or Out of Recovery ‘The problem of limited resources permeates the system. All services have to determine who has access to limited staff time’ (Anderson, 2011 p24) “Not heard from Sam for a while and there appears little motivation to meet with me at the moment. As such I am going to close him” (Sam’s Key Worker)

The Revolving Door 6 months4 months6 months7 months311 months29 months Eviction December 2009 Hostel and Other Temporary Accommodation Rough Sleeping & Sofa Surfing. October 2005… Johnny Leaves Home Permanent Accommodation Hostel Support Plan: “Stick to my meths, get to do something and move on to the flats… that’s it basically” Johnny Age 24 Recovery Approach 2 years

Second Chances ‘[Service providers] should house people who are on drugs but some of them can’t be [housed] at that time… they just have to catch them the next time…’ (Phillip, Supported Housing Resident)

“The System” “Getting Sorted” Recovery Approach “The tenancy is for two years … Thankfully it’s a long way off. I certainly don’t want to move out now as I have just started to get things sorted… The health things alone might be enough for them to say [at the end of the tenancy] well you’re not well enough to go back into that system, back through the whole process… hopefully they will recommend I keep the flat” (Peter, Former Hostel Resident, Age 47) “I am nothing, I am a nobody” (Johnny, Hostel Resident Age 24) Hitting Rock Bottom

“ I’ve witnessed people dying in the street with starvation, that’s the truth … you know people in sleeping bags … I’ve witnessed people actually wakening them up and they’re dead because they’ve had nothing to eat or nothing to drink… “ Jennifer, Hostel Resident, Age 32

Reframed Objectives for Cross Disciplinary Support: Independence, Well-being and Choice “Housing First” Recovery and Change Outcomes Maintenance & Prevention Outcomes Personalisation and Continuity of Support People Determining Their Own Outcomes Stop Drinkin g Provide a hot meal Independence Well-being and Choice

The real issue… The recovery model (‘revolving door’) enables us to manage capacity by keeping only so many people in system at any one time. Ending rough sleeping and providing support to everyone who needs it will depend ultimately on finding new ways to manage increasing capacity and demand amid shrinking resources Any suggestions?

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