Keeping us safer: support for women’s homelessness
Today, 10 December, marks Human Rights Day and brings to a close the 16 days of action against gender-based violence. To mark the day we share how we’re supporting our colleagues, and other staff within the homelessness and women’s sector, to provide the best support for females who are also survivors of domestic abuse and violence. Earlier this year, in partnership with Standing Together, we created our Keeping us Safer guidance. This guidance aims to provide staff within the homelessness and women’s sector with the skills and confidence to be able to support female clients who are also survivors of domestic abuse. The guidance was created in collaboration with 16 women from our services who have experienced homelessness, abuse and violence. As part of the project the women were asked to share what strategies they used to keep themselves safe. One service user explained what she did when she felt unsafe, she said; “if I don’t feel safe, for example at night on the streets, I go to McDonald’s and eat my dinner very late, around 11pm or 12am. There you can stay inside and be warm and you’re okay.” Another client shared what it was like visiting a night shelter which had majority male occupancy, “(Night shelters are) better than the street but I could feel the look of the men on me … I could feel the sexual pressure and I was like, ‘Okay, I have to make a decent decision. I’ll stay here for two hours and then go.’” Some of the other strategies shared included sleeping in hidden locations or public places, constantly keeping on the move, and dressing as a male to avoid harm. Our Keeping us Safer guidance aims to build a strong foundation from which professionals can better support women. The guide encourages you to think about and integrate different approaches which support women’s needs and help to build supportive relationships. The guidance also includes examples of challenges professionals face when supporting women; barriers you may come across within your service; ways to look after your own wellbeing when working with someone with trauma; and suggestions on how to overcome these barriers to best support your female client and create a safe and secure environment. Jillian Thursby, Regional Head and Women and Domestic Abuse Lead, worked on the guidance and said; “We know that women experience homelessness differently from men and it’s our job to improve our support offer to fit their needs. The Keeping us Safer guidance has taken the perspectives of women experiencing homelessness, violence, and abuse and created an approach which encourages staff to consider these experiences in order to improve the support offered. The guidance was piloted in three St Mungo’s Services – an outreach team, mixed gender hostel, and women’s only hostel – and staff fed back that the guidance gave them new ways to discuss violence and safety with both clients and partner agencies.” “I am grateful also to St Mungo’s… they never give up. They are always coming to see me and check if I’m okay which is keeping me in contact with my reality, otherwise I would be lost.” – Service user Ultimately, we hope this approach will contribute to changing attitudes and improve support for women in all their diversity, whether they are rough sleeping, hidden homeless, or living in homelessness support services.
Having difficult conversations about grief and loss
This National Grief Awareness Week, Catherine our Bereavement Support Coordinator explains her role in helping our staff and the people we support through our Bereavement Support Service. Bereavement is cited in the top 10 reasons that contribute to homelessness. This is why it’s so important to be with the people we support as they process their loss as well as ensure that staff are properly equipped to help them with all the difficult emotions that grief can bring up. Our Bereavement Support Service is available across all St Mungo’s services and aims to do just that – provide a range of bereavement support to those in services and the staff supporting them. While each person’s story is unique, there can be factors that can contribute to why people find themselves facing homelessness. Sometimes this is having an unstable environment in childhood or traumatic life experiences such as losing loved ones. In my role as Bereavement Care Coordinator, I offer emotional support to people in St Mungo’s services, with the aim to offer a calm presence in a non-judgemental space for them to discuss their loss and feelings, either face to face or over the phone. People who experience homelessness can face chronic health problems and, the sad reality is that without support, people on the streets face a much shorter life expectancy. This is why my role equally focuses on supporting staff members who work in our services and closely with people who are experiencing homelessness to help them process their feelings of loss if someone they have been supporting passes away. Whether the individual has passed away under tragic circumstances or due to prolonged ill health, staff can often be caught between the need to remain professional but being personally impact by the person’s death. It’s important to offer reassurance and promote the need for self-care and space for them to reflect about what has happened – to try and normalise the grieving process. But this can be hard and there is often an incredible sadness of feeling like a life has been cut short. Cruelly in most cases, staff will have seen the people we support start to make changes, improve drinking habits and get onto a path of recovery but this can’t always be maintained. With time we work with staff about the need to pre-empt the potential outcome of individuals passing away in their services – our Palliative Care Service is crucial in this. But despite coming into their jobs to make a difference and to bring hope in ending homelessness, staff do often say they still need to mentally prepare themselves for seeing people they interact with every day approaching the end of life. Nevertheless, I am always struck by the bond that staff have with the people they support and the ‘family’ type feeling they have for each other. Find out more about National Grief Awareness Week run by the Good Grief Trust here.
Lived experience of dual diagnosis
David, shares his experience of homelessness as well as overcoming alcohol abuse and mental health struggles. I’ve had depression, anxiety and OCD intrusive thoughts since I was around 9 years old. It was pretty scary at that age, as I had no idea of what was going on. I remember feeling apart or different from everyone else, and had a feeling that something was just ‘not right’. On the outside I was quite a happy outgoing friendly kid, but on the inside I was very unhappy and lonely. I first discovered alcohol at around the same age 9-10. I vividly remember the effect of alcohol leaving me calm and relaxed, and feeling ‘normal’, whatever normal means? It was a very addictive feeling. The only problem was once the alcohol wore off, the mental health problems came back. I didn’t realise it then, but I had learnt to self-medicate. I did try to reach out to my family and GP in my late teens and early twenties, but they didn’t understand what was going on. That left me feeling ashamed, stigmatised and misunderstood for many years. I remember telling myself ‘I’ll just get on with it myself ‘and ‘drink my way through it’. I was alcohol dependent by the time I was around 23. I was now caught in a trap, I couldn’t stop drinking because I would get withdrawals, and was also afraid to stop due to being mentally unwell. I continued to drink daily for many years, and ended up park drinking and street drinking. I developed alcoholic hepatitis which was really painful and was told by Doctors I had a year to live. But I was more afraid of stopping drinking than dying. I have no idea why I stopped drinking, but looking back it was a combination of a lot of factors. The main one being able to talk to someone in MH services openly about my MH issues without feeling judged for the first time. This was a very freeing experience. Stopping drinking was really hard, as my MH problems worsened instantly without the alcohol. I can’t explain how hard it was to go through it, especially as I knew one drink would take it all away. But I didn’t drink and threw myself straight into recovery. I started taking medication for my MH problems, I engaged with local MH services, had therapy, attend fellowship meetings, went back into education and volunteered at various local services. It hasn’t been easy in recovery, I was made homeless early on and that was a pretty hard time. I have SHP to thank for helping to rehouse me. I now believe I’ve come full circle working for St Mungo’s, and feel privileged to be able to help those who going through the same issues I once had. I still have to look after my mental health, but I’m doing well. Recovery has been a life changing experience it’s been incredible, and I haven’t a drink or drug now for over 12 ½ years.
A Mental Health Act that works for vulnerable people
This week we submitted our views to the public consultation on reforming the Mental Health Act. Emma Cookson, our Senior Policy and Public Affairs Officer, outlines what we want the legislation to remember about people who are homeless experiencing mental ill health. How many people who are homeless do you think suffer from mental ill health? From October to December 2020 our data showed that 72% of people accessing St Mungo’s housing-related support services had a mental health support need. The Mental Health Foundation (2015) found that depression rates are more than 10 times higher in the homeless population, and Office for National Statistics data for 2019 shows suicide rates 14 times higher than among the general population. But all too frequently people tell us they can only access help when they reach crisis point. And then even once they receive help, they can often be disempowered and not treated with dignity and respect. The role of complex needs and multiple layers of disadvantage – like homelessness – in people’s mental health and access to mainstream services is also completely under-acknowledged. Research carried out by St Mungo’s in 2016, for example, revealed that 68% of areas where 10 or more people sleep rough on any one night do not commission any mental health services actively targeting people sleeping rough. There has been some positive progress with the £30m in NHS funding to enable specialist homeless mental health services to be set up in some parts of the country. However, there is still plenty more to do. It’s been two years since the Independent Review of the Mental Health Act, led by Professor Sir Simon Wessely, which recognised the need to give people more say in their own treatment; to require stronger, transparent justification for using compulsory powers; and to improve services. It also highlighted the huge race inequality in the use of the Act: black people, for instance, are more than eight times more likely to be subjected to Community Treatment Orders than white people. In response, the Government has now published its long-awaited White Paper on reforming the Mental Health Act and held a public consultation on it. This is a huge opportunity to reflect the needs of St Mungo’s clients and ensure that people who are homeless are not forgotten in the reforms. Here are the main points we put forward in our submission: We need more focus on prevention, rather than only being able to access help once someone has reached crisis point. Many homeless people are not engaged with statutory mental health services (for reasons including a lack of trust in services and barriers in access). This lets problems escalate. Specialist homeless mental health services are an invaluable means of overcoming the inaccessibility of mainstream health services. But these teams have been subject to major funding cuts during the past decade. Wherever possible, successful community-based interventions are much more preferable to the situation where people are held in a secure, medicalised setting with other people who are also very unwell, with huge restrictions on their choices and freedoms, and where treatment may be administered against their will. Sometimes detention is necessary – but we want it to be a last resort. Housing needs are too often forgotten in both prevention and recovery from mental ill health. Homelessness is toxic to mental wellbeing. To stop a cycle of discharge, re-admittance and worsening mental health, we need more Supported Housing and Housing First which can play a big part in improving mental ill health. People who are homeless face significant stigma, including from ‘professionals’ in positions of responsibility. We need to make sure that there are checks and balances in place to prevent this. We also need more awareness of complex needs amongst mental health professionals to understand the complexities of being homeless with mental health needs. Many people who are homeless with mental ill health have complex trauma. It’s crucial that detention – and other responses to mental ill health — do not re-traumatise the individual, exacerbating mental ill health and creating more difficulties in addressing other, intertwined problems – such as homelessness, substance use, chronic physical, health problems and crime. Even though there is National Institute for Health and Care Excellence (NICE) guidance in place to prevent it, people are frequently pushed into individual treatment pathways. Mental health, homelessness, and drugs and alcohol services are all designed and funded as if people fit into one box, rather than the reality that people’s problems are complex and interwoven. They cannot be addressed one-by-one but need to be approached holistically. It’s so important to have a Mental Health Act which works for vulnerable people – like our clients — who find it difficult to engage in mainstream services and who need person-centred care which takes into account their complex needs. Just changing the law won’t be a magic switch. Money is needed for chronically underfunded mental health services and we need attitudes towards mental ill health to shift, although there’s been some good progress. Overhauling the Mental Health Act 1983 is a good place to start.
World Social Work Day: “I am because we are”
Today (16 March 2021) is World Social Work Day, which recognises the hard work and dedication of social workers, as well as celebrating best practices in social work. This year, the theme of World Social Work Day is “Ubuntu”. Here, Toni-Lea John-Baptiste, a student social worker on placement with St Mungo’s, discusses the concept of Ubuntu and how it applies to the work we do with our clients. I have recently been working as a student social worker with the St. Mungo’s Wellbeing Team in Westminster. While working with the team, I have gained invaluable transferable skills that I will use in my future practice, and I have gained a deeper understanding of the importance of creativity in social work, as well as how social workers can use these skills to think outside of the box when working with service users. Due to the current climate of COVID-19, I have had to adapt to remote working. This situation enabled me to draw upon my creativity to engage service users and promote digital literacy in a time where we heavily rely on technology. Upon reflection, I have realised how important creativity is as a social worker, to be able to adapt and work in any environment. The idea of Ubuntu is all about humanism. It is the belief that your sense of self is shaped by the relationships you have with other people ‘I am, only because we are’, and this was a key theme throughout my placement at St Mungo’s. As an example, we used this philosophy as the basis to create a postcard project which involved members of the Westminster community sending ‘messages of hope’ and discussing things that have helped them during this time, to residents within the different projects of the Westminster Wellbeing Pathway. At the heart of this project was a sense of community and helping one another, through encouragement, regardless of who the person is or if they even knew them. This was ubuntu in its purest form, as the project was all about helping one another as humans and extending love and hope to echo the philosophy that as a human ‘I am’ ONLY ‘because we are’. It was a truly beautiful project that I am grateful to have been a part of. My placement has encouraged my creativity as a student social worker, which has played a big part in me developing projects to engage clients. I found that when working remotely, using a person-centred approach to develop tailor-made projects for clients was the best way to engage and support them. An example of this would be my work with a client, in which I used a strengths-based approach to create a project based on their artwork. This then led to working on an intensive 1-1 basis, to create a virtual art exhibit with this client, to not only showcase their artwork, but also potentially create a social enterprise opportunity. Throughout all of this, particularly because of COVID-19, I’ve realised that you can’t limit social work to a building or a particular place. It’s about treating people as humans, with respect and dignity.
The Independent Review on Drugs is an opportunity for bold change
Today, St Mungo’s put forward a written submission to the Independent Review on Drugs by Dame Carol Black. Here Emma Cookson, Senior Policy and Public Affairs Officer at St Mungo’s explains what this review means and the primary calls St Mungo’s is making towards it. This is the second part of the review which is examining drug prevention, treatment and recovery (the findings of the first part were published in February this year).This is a huge opportunity to reflect the needs of St Mungo’s clients, and the many other hundreds of thousands who are homeless and face multiple layers of disadvantage. Sadly, as we are all too aware, there is a significant relationship between homelessness and drug and alcohol problems, which becomes even more pronounced amongst people sleeping rough. Data from the Combined Homelessness and Information Network (CHAIN), a multi-agency database recording information about people sleeping rough in London, shows that 62% of people sleeping rough had a recorded drug or alcohol need in 2018-19. And it’s not just that people who are sleeping rough have a higher likelihood of drug use – they are also more likely to die from it. The Office for National Statistics (ONS) data shows that in 2018, 726 people died while rough sleeping, with a staggering 40% of all those deaths related to drug poisoning. And it’s getting worse. The St Mungo’s Knocked Back report earlier this year showed that the number of deaths caused by drug poisoning increased by 135% between 2013 and 2018 and by 55% in just one year in 2018. This is an alarming increase. For many of our clients, drug use, alcohol use, poor mental health and homelessness are interlocking and mutually reinforcing problems. CHAIN data shows that over half of all people with a recorded drug and alcohol problem have a co-occurring mental health problem. These problems create a vicious cycle from which it is hard to escape. If you just address one of these without tackling the other, you are unlikely to be successful. But this is all too often what the current system does. A St Mungo’s Manager set out the disjoint between systems: Someone goes into prison and whilst they’re in prison they’re detoxed. But then they’re released and told to go to housing department who say they’re not priority need. They’re then picked up by an outreach team and the only place available is a hostel where there are lots of drug users. This isn’t going to help them in their recovery. The vicious circle continues. Health, homelessness, and drugs and alcohol services are all designed and funded as if people fit into one box, rather than the reality that people’s problems are complex and interwoven. They cannot be addressed one-by-one but need to be approached holistically. This is why in our written submission to the Black Review we’re calling for the following: Integrated, person centred and holistic services. To best support people we need integrated support and housing pathways, with a treatment package arranged for them in a way which works for them in that particular point in their recovery journey. One of the best ways to do this is through increasing joint commissioning and explore longer contracts. This would help health, homelessness and drug and alcohol services to work better together and encourage them to treat clients holistically rather than providing insular support related only to one need, whilst clients are caught in the gaps in between services. Longer contracts provide the time to build practice and culture change. Access to affordable and appropriate housing. Access to affordable and appropriate housing can act as both prevention and cure for drug misuse. Therefore we want the Government to improve access to truly affordable housing by increasing investment to build 90,000 homes for social rent every year for 15 years, and improving security for tenants in the private rented sector by, for instance, re-aligning Local Housing Allowance Rates to cover the 50th percentile of local rents. There also needs to be an expansion in Housing First services (backed by sufficient funding) and an increase in supported housing provision. This would help prevent individuals from becoming homeless, and rapidly relieve their homelessness if they are forced to sleep rough. Further funding for drug support services. There needs to be more funding for services which are interlinked with drug misuse, such as homelessness support services, to support an integrated approach which looks at the whole system and situations which both cause and exacerbate drug misuse. Previous research from St Mungo’s has shown that £1 billion less is being spent on housing related support services per year (which help many people with complex needs, such as drug misuse, gain and retain accommodation) than a decade ago. We are therefore recommending that the Government invest an extra £1 billion a year in services that prevent homelessness and end rough sleeping. This money should be ring-fenced so it can’t be spent on anything else. This echoes our calls in our Home for Good campaign. This review is timely. In the midst of this global pandemic, the health inequalities suffered by those who are homeless have become even starker. This is a chance to put forward bold solutions, which recognise the need to see drug prevention and recovery as interwoven with other systems and services. People aren’t boxes — they have messy, complex lives. We need a whole systems approach which recognises this, so that we can effectively help people.
The power of peer mentoring
In this challenging time, it is more important than ever to look after your own mental health, as well as look out for the people around you. Here, we are highlighting the incredible work of our volunteers. During lockdown they have adapted how they work to carry on supporting our vulnerable clients with their mental health. Physical or mental health problems can be both a cause and consequence of homelessness. At St Mungo’s we take a holistic approach to mental and physical health, addressing these issues alongside each other. We run mental health dedicated services in Bath and our Building Bridges to Wellbeing programme empowers people to use their experience of managing their mental health to help others. Building Bridges to Wellbeing has a peer mentoring service where volunteers use their own experience of living with mental health challenges to help and support clients to improve their wellbeing, confidence and mental health. These volunteers, known as Peer Mentors, work on a one-to-one basis with their clients. They support them to explore how to make small changes, look at their interests and options available, hopefully enabling them to link with their community by joining groups or courses, planning and supporting them to make small steps towards this goal. Mentors use their own experience of living with mental health challenges to build this relationship and share useful tools and resources. However, due to safety guidance and Government restrictions relating to Covid-19 pandemic, this was no longer possible. Our peer mentors have adapted quickly to the Government’s measures and put in place a new way to support clients remotely. Our clients are now being supported by regular wellbeing phone conversations with their peer mentor, some have even started using video link calls, to share resources and encourage positivity in regards to exploring things they can engage with. We are working with local partners, to distribute wellbeing packs that include activities, puzzles and techniques to help with any mental health difficulties arising during lockdown. What is it like being a part of the programme? Two of our mentors, Zoe and Dena share why they got involved with the Building Bridges to Wellbeing programme and what it means to them. Mentoring has given me back a purpose. Zoe wanted to get involved with peer mentoring following her own personal battle with mental illness after the breakdown of her marriage and working long hours at a job in social care. Through various drug treatments, Cognitive Behavioural Therapy and the support of her family and friends, she’s been feeling stronger and felt that she wanted to give something back. I absolutely love what I do and I like to think I’m making a difference to those during the various stages of their journeys. After weeks of training, Zoe was matched with first mentee and has since been a peer mentor for five different people, supporting them with their own stories. She feels lucky to be able to support those in need during this difficult time, especially through uncertainty and loneliness in isolation. She hopes that her mentoring will lead to permanent position in a mental health setting. In these current times, everyone is prone to be feeling unsettled, scared and, at times, lonely, and this particularly true for vulnerable and isolated people. Dena, a fellow peer mentor wanted to help because she believes that mentoring and helping others is one of the key wellness techniques. I think the real power of peer mentoring is empathy. Following access to excellent resources and training through St Mungo’s, Zoe works with our clients, having a weekly a non-judgemental chat and providing support and information on the different kinds of self-care methods available that could make a difference to the client’s mental health. People can gain such reassurance and peace from simply hearing “I understand” from someone that they know really does. Mental Health Awareness Week Hosted by the Mental Health Foundation, Mental Health Awareness Week takes place from 10-16 May 2021. The theme is Connect with Nature.
Knocked Back: A tragic loss of human potential
Our Knocked Back report revealed that at least 12,000 people who are homeless are missing out on potentially life-saving drug and alcohol treatment. Oliver Standing, Director of Collective Voice, reflects on the report’s findings. Collective Voice is the national alliance of drug and alcohol treatment charities, whose members collectively support 200,000 people every year. A substantial proportion of these people will not only be dealing with a substance misuse problem but with other areas of severe and multiple disadvantage, including homelessness. For this reason, we welcome the publication of St Mungo’s latest report, Knocked Back, highlighting the growing prevalence of drug and alcohol use by people sleeping rough, and its increasingly tragic consequences. It will be sadly unsurprising to many in our sector to read that drugs and alcohol caused the deaths of 380 people sleeping rough in 2018 (over half the total number of people who died). But we must remain shocked and appalled at this growing public health crisis, and stay resolute in our ambition to reach the huge numbers sleeping rough who desperately need treatment but at present are not getting it – 12,000 people according to the St Mungo’s report. Every year people in the substance misuse treatment sector anticipate with sickening dread the latest drug death statistics. And with every year in recent times bringing more bad news, the dread only increases. In 2018, we know that hundreds of people sleeping rough died as a result of drugs or alcohol. The total number of drug related deaths are even higher, at 4,359. That’s the largest amount since we started counting in 1993 and a 16% leap from 2017’s figures. Those statistics alone make for disturbing reading. But what’s really disturbing are the human stories behind the statistics. Our communities have lost fathers, mothers, brothers, sisters, sons and daughters, who will no longer fulfil the promise their parents saw in their bright eyes as children, will no longer laugh or love. These are not just numbers, but a tragic loss of human potential. It can sometimes seem hard to determine the real-world impact of public policy making. But surely the seemingly unstoppable increase of this particular type of death marks a clear and significant failure of the public policy and political leadership necessary to protect a very vulnerable group of people. When it comes to people who use drugs and sleep rough we can’t ignore stigma as a factor. When people are dying on our streets from conditions we know how to treat we must ask ourselves the question — what is different about this group of people that allows this to happen well into 21st century Britain? The most frustrating aspect of this? That the evidence on what works is so very clear. We have a world class compendium of evidence in our “Orange Book” and multiple NICE guidelines. We have a substance use workforce not short of ambition, compassion and expertise. It’s welcome to see St Mungo’s Knocked Back report make clear the link between homelessness and drug related deaths. It demonstrates how some substance use outreach services, so vital in reaching people sleeping rough, have been lost in the blizzard of local authority cuts. While in 2013, local government was handed the responsibility for commissioning life-saving substance misuse treatment services, but it was asked to do so with one hand tied behind its back. In the eight years to 2020 local government has lost 60 pence in every pound it received from national government. It’s welcome to see the report stress the importance of close partnership work across the domains of severe and multiple disadvantage. People’s challenges simply do not resolve into the neat concepts such as ‘substance use’ or ‘mental ill health’ we use to think about the delivery of public services. On the frontline, practitioners have of course always known that partnership working across those boundaries is essential. The same can be said for service-managers, commissioners and Chief Executives. National programmes such as Fulfilling Lives and MEAM are making robust coordinated attempts to bring together these services at the local level. These are all to be welcomed. In the sector, we have the compassion, ambition and expertise to meet the needs of a great proportion of the people we support — we just lack the resource. The government’s new addictions strategy and monitoring unit should both be unveiled this year and will provide important opportunities to drive much needed change. I implore the government to set out an ambitious plan for preventing further deaths through the delivery of adequately funded evidence-based services — and I know that effective partnership between the substance use and homeless sectors will be essential in supporting the delivery of such a plan. Read our Knocked Back research. Find out more about Collective Voice.
What must be done to prevent homeless deaths
Following the news of an increase in deaths among people who are sleeping rough or in emergency accommodation, Rory Weal, Senior Policy and Public Affairs Officer for St Mungo’s, discusses what must be done to combat this rising trend. Today we heard the news that 726 people died while sleeping rough or in emergency accommodation last year. This is a 22% increase compared to 2017, the highest year to year increase since the Office for National Statistics (ONS) started publishing these figures six years ago. These figures should shock and shame all of us. The figure of 726 means that someone dies while homeless every 12 hours – that’s the equivalent of two people a day. Moreover, these deaths are overwhelmingly premature and entirely preventable – the mean age of death was 45 for men, and 43 for women. To have so many people die in this way, in such discomfort and distress, failed by so many is nothing short of a national tragedy. But this is not the sort of tragedy where we simply pause, pay our respects, then move on, bemoaning the wretched luck of a particularly unfortunate group of people. It is the product of collective choices and decisions, and should be regarded as a national emergency, one which needs urgent action. The context to these figures is that rough sleeping has risen by 165% since 2010, the result of years of funding cuts which have devastated crucial services and the unavailability of genuinely affordable housing. More people are sleeping rough, which exposes them to a greater range of harms – a premature death being the greatest. To stop people dying on the streets we have to stop them living on the streets. We need to build homes, to make the welfare system truly work for the most vulnerable and to fund homelessness services to help people find a way off the streets, and out of danger, for good. And we must also tackle the direct causes of death – the figures show the majority of deaths are so-called ‘deaths of despair’, the result of drugs, alcohol or suicide. Drug related deaths in particular have soared in recent years, and account almost entirely for the increase we’ve seen last year. Just as housing and homelessness services have become harder to access, so too have drug and alcohol services, leaving many people languishing with serious drug and alcohol problems and going without the support they desperately need. We still have a situation where most of these deaths will never result in a Safeguarding Adults Review, the legal review process for deaths which have occurred due to abuse or neglect. As a result vital lessons are going unlearned. We now need a new national system to review each and every death. As we consider what we need to do to tackle this emergency, we must remember each and every life that has been prematurely lost in recent years. At St Mungo’s, to commemorate those people who died while homeless, our clients, alongside staff and supporters, have together hand made hundreds of origami flowers, in tribute to lives needlessly lost. The most fitting tribute of all, however, would be meaningful government action to prevent future tragedies.
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.
