Co-producing recommendations on mental health services and homelessness
On Friday August 30, we hosted an event to present the findings from our recent report on homelessness and primary mental health services in Westminster and co-produce further recommendations with residents, service users, and community professionals.
On the day, we were joined by representatives from Westminster-based organisations providing support to homeless people in the borough – The Marylebone Project, Turning Point -, service users with lived experience of homelessness, and representatives from CNWL NHS Trust Adult Mental Health services.
A key takeaway from our report was that individuals who are living with a “dual diagnosis” - that is, a severe mental illness combined with misuse of substances – find it more difficult to access primary mental health care. To elaborate on the topic, we invited professionals from Turning Point, an organisation providing support to individuals struggling with substance misuse in Westminster, Kensington & Chelsea, and Hammersmith & Fulham, to deliver a presentation on the services they offer. Many of the clients accessing Turning Point services are homeless and experiencing mental health issues, but professionals remarked that they often struggle with putting a mental health referral through to medical professionals.
In our ensuing discussion, we invited participants to share what could be changed to make accessing services easier, how to tailor services to the unique needs of homeless people, and ways to improve long-term care.
What could be changed to make accessing mental health services easier?
We discussed with the event participants ways to improve access to primary mental health care for people experiencing homeless.
Amongst the factors hindering access, facing long waiting times to access mental health services is often a big barrier for people experiencing homelessness. A service user remarked that in their experience, the poor quality of services offering housing to homeless people deterred them from accessing mental health care. They also highlighted how the services they used struggled with funding and contract management, calling for more transparency in management.
During our conversation, participants stressed the importance of targeted outreach and tailored communications, as well as the quality of related support services. To improve awareness of support services available, using simple posters, publications, and other media outlets could help promote and disseminate information regarding mental health services, particularly for individuals who are homeless or speak limited English.
Connecting independent primary care services with community outreach services - such as drop-in clinics - to ensure seamless referrals, was also advocated by participants. This is in addition to involving police and other public institutions, such as libraries and train stations, to better assist homeless people.
Do services for homeless people currently take mental health needs into account? How could this be improved?
During our discussion, the question of whether services for homeless individuals adequately consider their mental health needs came up. According to participants, some services providing support to homeless people, such as hostels or supported housing, often fail to address behavioural issues stemming from undiagnosed or undisclosed mental health conditions. This lack of understanding can result in the expulsion of individuals from these facilities, exacerbating their vulnerability.
Moreover, the presence of "organisational boundaries" between different services complicates communication and coordination, making it difficult to create seamless care pathways for those in a mental health crisis. To address these challenges, participants suggested to develop collaborative care plans that integrate mental health services with homelessness support, alongside enhanced staff training to better recognise and respond to the specific mental health needs of homeless populations.
Improving these aspects of homelessness outreach could foster a more supportive approach to tackling both mental health challenges.
How could services provide better long-term care?
Improving long-term care for individuals experiencing homelessness and mental health challenges requires a multifaceted approach that covers different aspects of care provision.
Participants suggested improving the quality of primary assessments when initially diagnosing psychiatric conditions, ensuring accurate and effective treatment plans. In the experience of one service user, inconsistencies in the delivery of psychiatric care following their initial diagnosis had a negative effect on their overall wellbeing.
Transparency in fund allocation from local authorities to community organisations was also deemed essential, to ensure resources are effectively utilised and services are delivered appropriately.
In the experiences of service users and professionals alike, social isolation was an issue that severely impacted the mental wellbeing of those experiencing homelessness. Tackling isolation by strengthening and acknowledging the informal support networks around clients, especially for those estranged from their families, could, in this case, improve health outcomes. Involving service users in assessing mental health system accessibility from their perspective can provide valuable insights for improving care delivery.
Professionals noted that it was at times difficult for different organisations providing support to come together and discuss ways to improve mental health amongst their service users: building a professional network for practitioners working in homelessness support could enhance the sharing of best practices.
Ensuring continuity of healthcare providers, such as a regular GP, is crucial for managing long-term health issues, as it fosters trust and comprehensive care. Finally, providing staff with comprehensive training is essential to ensure they are equipped to address the unique challenges faced by vulnerable groups.
