Looking back at the last year, “What a privilege to be a part of it all”
John from our Outreach team in Bristol reflects on what has been achieved in the past year. Looking back at the last year, the first words I think of are tiring and exhausting. But also, what a privilege to be part of it all. What we managed to achieve within that year is absolutely amazing. When we first went into lockdown we had to get everyone in, and we had to find the best way to get everybody in. It was that simple. My role is to go onto the streets and reach out to people. To build a relationship. To build trust. Sometimes, I was literally able to chat to someone who was sleeping rough, talk to Bristol City Council, and depending on what was available I could get them into emergency accommodation within 20 minutes. I have to mention other services. I can only talk about my experience but I can’t emphasize enough how much it was a collective thing. The team, St Mungo’s, other homelessness organisations, the emergency services, Bristol City Council – us as a city, we all pulled together. Let’s not forget that most important is the person who is on the street. What we manage to achieve alongside each other. When I think about people who are homeless and how difficult it must have been – one minute they were on a busy street, the next thing they knew the whole city had locked down. How hard that was for people with no homes, for people that needed support or who had alcohol and drug problems. We had to make sure we tailored our support so it was right for their needs. You need to remember how fast everything happened at the beginning. Hotels being opened for people on the streets, supported accommodation project making changes so they could keep going – it all happened very quickly! It’s also important to emphasise how Bristol City Council stepped in to help, and how the government gave funding. It was stressful and exhausting. I remember some nights I’d get home after a day’s work and fall asleep with my tea on my lap. Go straight to bed and then wake up the next morning to do it all again. When we offered people on the streets a hotel room, they couldn’t believe it. Honestly, within a night you could see a difference. An instant stabilisation – being somewhere warm, safe and with a hot meal. Doing the job I do I know how important that is. Imagine how difficult it is on the streets; how hard it is to rest, to find food, to find warm bedding, to find somewhere safe to sleep. And how traumatic that must be for anybody. Of course, Covid has been horrific for everyone. But I do have gratitude for some of the positive things that I’ve seen come out of a bad experience. There were people that we had been engaging with for some time – who might have experienced trauma, difficulties with their mental health, or have had challenging experiences – and we were able to get them in for the first time. And because we could get them into emergency accommodation, we have had so many amazing stories of people moving into their own places. Sometimes I see people that I supported into accommodation and they are walking down the street like a completely different person. Recently, over winter, we’ve activated our severe weather response three times in Bristol. So we’ve got Covid, we’ve got lockdowns starting and stopping, shops opening and closing and then all of a sudden the weather is freezing and it’s all hands on deck again. We’re out from 6 in the morning until midnight, going out to get everyone in from the cold. Even though we achieved what we did in lockdown, sadly there are still people on the street. We can’t lose sight of that. Every single person deserves a home. When I reflect back on the last year – exhaustion, tiredness, not sleeping very well – have I recovered from it? Absolutely not! As a team it’s been hard work. But also, what a lovely thing to be able to do. What a privilege to be part of it. And you know what? I’d do it all again tomorrow.
“Everybody In” – working with vulnerable people sleeping rough during COVID-19
Ed Addison, Manager of St Mungo’s City of London Outreach Team, shares his first-hand experience of supporting people sleeping rough during the outbreak of COVID-19. It was 19 March when the gravity of the situation with COVID-19 hit home for me. I was out on an early shift at around 7am with a colleague and we went to meet George*, a well-informed, articulate man in his 50s who’s been sleeping rough for a couple of years but who is reluctant to accept offers of support for a number of reasons. The City of London had requested that we get everybody indoors due to the potential health risk of COVID-19, which meant us offering to support to anyone, plus we had a duty of care to welfare check and ensure George was safe and well. We find different ways to use our knowledge to encourage people to accept support – such as presenting facts around the dangers of rough sleeping. On this occasion I found myself turning the concern around the virus as a tool to encourage George to take up an offer of accommodation. He countered our initial offer of support stating that it was a choice he was making to live his life on the streets, and that he was prepared to die on the streets. George and I sat and talked, and he revealed his main concern was where he can access food. I told him that we were hearing about the possibility of a lockdown, that the City was likely to become emptier, shops were going to close, food and vital resources would become scarce, with commuter numbers vastly reduced. I listened to his concerns, and felt he was listening to me. I gave George my number and urged him again to consider coming indoors. Working for a homelessness charity it is impossible to distance yourself from the wider housing system. People who end up on the streets can be some of the most disconnected from the system, people who have fallen through a safety net that has become increasingly unsafe. Years of austerity has impacted on the shrinking of local authority budgets and reduced the number of services available to people in need. In a broken system is it any wonder that people are reluctant to trust us? One bad experience of being let down can set the tone for all future relationships. This is exacerbated among those who are sleeping rough who may have, throughout their lives, been let down by people in positions of trust. As outreach workers we are often the first point of contact for people such as George and often met with distrust. As the severity of the coronavirus public health emergency developed, it quickly became apparent that it was now essential to get everybody off the streets and into an environment where they could self-isolate to protect themselves and others. The UK government had written to every local authority outlining a plan to move all homeless people off the streets within a week. Open access day centres and night shelters were closed due to concerns over lack of ability for people to safely isolate. The situation was changing rapidly, and we knew many of our vulnerable clients would struggle to cope. Yet what we and others have achieved has been remarkable in a short space of time. Since the lockdown measures were announced, the St Mungo’s City outreach team has accommodated more than 100 people in hotel rooms, many of whom were people seen sleeping out for the first time. We have been able to support people to take up offers of accommodation where previously they have been sleeping outside for sometimes as much as 10, 15 or even 20 years. In the first week of the lockdown we were able to accommodate and support 12 people into drug treatment who, between them, have a cumulative rough sleeping history of 70 years. This shows what an unprecedented opportunity this has been to not only reduce the numbers of people who are living on the streets, but crucially to get to know these people, understand their situation and to put in place effective solutions to ideally prevent them from never going back on the streets again – as our No Going Back campaign calls for. This emergency response reinforces the need for a permanent accommodation pathway which is accessible, supportive and helps individuals progress with their lives. Street-based outreach workers continue to work tirelessly to find and support people who are living on the streets to find accommodation. All those who have accepted accommodation in the past few weeks should never have to return to these streets, and in the future our system must improve in its attitude towards the vulnerable. George has remained out as far as we’re aware. We continue to go out to find him to offer our help. People like George and others who remain on the streets of the City, despite the lockdown, remain the most resistant to support and the most traumatised. These are the individuals that need the most focus of our interest, our time and our care. *George’s name has been anonymised for his privacy. This blog was first commissioned by World Habitat, an international charity, which holds Special Consultative Status with the United Nations Economic and Social Council, reflecting its work in support of the goals of UN-HABITAT.
“Hiking brings out the best in people”
In September, a group of St Mungo’s staff, supporters, volunteers and clients are hiking up Ben Nevis. We spoke to two staff members from Haringey Assessment Centre, Geran and Leo, about the hiking challenge and why it can help clients in their road to recovery. How did you hear about Ben Nevis? Geran: I was asked by Leo, to head up a training walk for our service before we head to Ben Nevis. We have two residents from our service with us on the training walk who have overcome significant hurdles to be here. Both clients are on alcohol detox programmes. This is the first training walk they have attended and they will come on the Ben Nevis walk if they are able to reduce their drinking. We are the highest support service in the borough, so we tend to be the first place clients come after moving away from the street. As a service we see the hike as a good opportunity for them to have something to aspire to, something to overcome and a reason to reduce drinking. We have a few other clients who are interested and might attend future training walks. Any clients from our service who want to do it have the opportunity to do so. It is often the ones you don’t expect that have the most interest so it’s a good mix of people. Why are these hikes important? Leo: I have been on a lot trips like this and have seen the beneficial effect it has on everyone. It brings people together in such a way that it brings the best out of people. It is a really uplifting experience. It helps the clients we work with get more motivated to achieve good things in their lives, which is ultimately the purpose. Geran: It takes some of the barriers away from the different levels of management. Clients are able to see the human aspects of the staff who often call the shots in a lot of aspects of their lives. I think it’s a humanising experience that shows we are not that different. Why do you think it is important for clients to take part in this challenge? Leo: There is so much to gain for clients. They can find out more about St Mungo’s from other perspectives. It can also change relationships between service workers and clients as it takes away the power dynamic. Geran: I think it’s inspiring for clients to have something to push themselves to do. Some clients have been struggling on this training walk and it is a good motivator to focus on making improvements. In the case of our two clients it’s an opportunity to reduce something that is having a detrimental effect on their life. Did either of you climb Scafell Pike last year? How was it? Leo: I did. It was an amazing experience seeing so many people get uplifted. I love hiking so to get to do that as part of a wider vision is a really special opportunity. After Scafell Pike, a few clients got onto training courses and some have moved on from St Mungo’s accommodation and got their own places. I know at least two clients who did it last year and are going to climb Ben Nevis this year because they got so much out of the trip last time. Why are you personally looking forward to Ben Nevis? Leo: From a selfish point of view I really love hiking and I know how good it is and how satisfying it is to get to the top of something. To be part of St Mungo’s doing it in their 50th year is special. I am looking forward to the reactions of my colleagues and clients from my service. I am optimistic that it will be pretty amazing and mind blowing, because it always is. Geran: I come from the countryside, I love walking and being out in nature. I want to inspire that passion in other people. In September to mark our 50th year 50 clients, staff members and volunteers join staff from our sponsor Tokio Marine to take on the highest peak in Britain. Find out more about our Ben Nevis hiking challenge.
Should we talk about death?
Our Palliative Care Coordinator Andy Knee poses this important question and highlights the innovative ways our Palliative Care Service is supporting clients who are at risk of death or in need of bereavement support. Should we talk about death? In St Mungo’s Palliative Care team, we think the simple answer to this question is yes. Death is something that affects us all, that does not discriminate against gender, race, sexuality, culture, or religion. Many of us are fortunate to talk about death and our wishes with loved ones. But what if you don’t have a home? And what if you don’t have family or loved ones to have these conversations with? This is a sad reality for lots of people who experience homelessness. A reality where many of their deaths will be preventable, undignified and untimely, with no planning for their wishes, and sadly many will be forgotten. In 2017 there were an estimated 597 deaths of homeless people in England and Wales, which represents a 24% increase since 2013. The NHS has recently reported a rise in homeless patients returning to the streets with many observing a surge in serious illnesses in the past decade such as respiratory conditions, liver disease, and cancer. Without someone to be their voice and their advocate, many individuals will be trapped in a harmful cycle of being admitted to hospital and discharged to the streets. This is something we can change. Dying Matters Week 2019 ‘Are we ready?’ is the poignant theme of this year’s Dying Matters Week, which helps to raise awareness around this issue. At the end of 2018 we responded to the increase in homeless deaths and continue to pave the way in making change for people experiencing homelessness. We know the importance of providing end of life care and support to our clients, and we are using creative and innovative new ways to provide this service. Our Palliative Care Service To mark Dying Matters Week, we’re shining a light on our Palliative Care Service. This service is the only one of its kind in the homelessness sector and has benefited from dedicated funders over the last five years. The purpose of the Palliative Care Service is to coordinate a flexible and responsive care pathway to support clients who have a terminal prognosis or acute and potentially fatal health conditions, and to provide them with options that protect their quality of life. The service works to ensure that our clients can access healthcare and that we provide appropriate support to help them approach the end of their life with dignity and respect. We meet with local health services, lead change with research, and continue to develop tools and support structures for St Mungo’s. We’re also here to support staff across St Mungo’s to feel empowered and discuss death as openly as possible. Our aim is to ensure that everyone experiences a ‘good death’. We are also working to destigmatise this term, which holds so much power and importance. New Befriending Service This year the service has expanded to include our Palliative Care Volunteer Coordinator, and in June 2019, St Mungo’s will launch a new Befriending Service. The Befriending Service will serve to support clients that are at risk of death, or clients who need bereavement support for a recent or historical loss. In addition, the Befriending Service will support colleagues and teams around loss and bereavement, reinforcing our message: “you are not alone”. In response to the theme of Dying Matters Week – “Are we ready?” – St Mungo’s can proudly say “We are, and will continue to be.” Find our more about our Palliative Care Service.
The value of apprentices at St Mungo’s
In this blog to mark the end of National Apprenticeship Week, our Head of Volunteering, Apprenticeships and Placements, Iver Morgan, reflects on the value and skills that apprentices bring to St Mungo’s and a new Social Work Apprenticeship launching later this year. More than 200 people have successfully completed St Mungo’s award winning Apprenticeship Scheme, since it began more than a decade ago. With National Apprenticeship Week drawing to a close, I have been reflecting on the last ten years and thinking ahead to the launch of a new Apprenticeship later this year. Our Apprenticeship Scheme is for people who have lived experience of using support services. This could be that you have slept rough or have lived in a hostel, or you might have suffered from mental health issues or spent time in custody. Our Apprenticeships are 15 months long, where you work in placements across the organisation for five days a week. While 20% of your time will be geared towards learning, giving you time to train and study for qualifications. Our Apprenticeships are currently in either adult social care or business administration The scheme is a perfect opportunity to learn practical skills in the workplace whilst gaining a qualification and boosting your confidence. The qualifications are offered by Opps Development, a training provider, which tailors the support they offer to ensure it meets the needs and ambitions of our apprentices. Many of our apprentices have had a complex past and their own individual battles. Through our Apprenticeship Scheme, people are able to use their own lived experience to support others to achieve their goals. One of our current Social Care apprentices is Jack. Before he started he thought: “given my past I never thought I would ever be able to do the role I do.” Now, coming to the end of his qualification, Jack says: “I love the fact that I’m helping people get their life back on track. I wish I did this years ago!” When I look across the organisation, I see former apprentices throughout our services and central departments. Some are now deputy managers or managers, it gives me an immense sense of pride to see the journey they have been on. All of our apprentices bring huge value to our work, not just to clients but also to us as their colleagues. The best apprentices are the ones who ask questions. It helps create a learning cycle, so that staff can assess their work and continue to improve the positive impact our service can have for clients. That learning is important: supporting professionals and those in the wider community to understand the causes and consequences of homelessness is vital in helping our clients to recover. Another way of improving this understanding among professionals is through our student placement scheme, which involves 250 social work and nursing students every year working with our clients. These placements are a fantastic opportunity for students to gain first-hand experience of working with people with a mix of strengths, vulnerabilities and needs. The involvement of social workers at St Mungo’s can only ever be a positive. That’s why I am delighted that the Apprenticeship Standard for Social Work has been approved and we will be offering our first St Mungo’s Social Work Apprenticeship later this year. These three year Apprenticeships will be open to our staff who at the end will achieve an honours degree in social work. It will help our staff develop new skills and understanding but, more importantly, we know that these skills and expertise will help our clients to move on from homelessness and live fulfilling lives. Find out more about our Apprenticeship Scheme and how you can apply.
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.
