Tools and guidance on assessing the risks associated with rough sleeping, use of the Mental Capacity Act, use of the Mental Health Act, developing a hospital admission plan, and raising safeguarding adults alerts - developed by Lambeth Council in partnership with South London and Maudsley NHS Foundation Trust, Thames Reach and the Greater London Authority. The three forms in Word can be downloaded and completed electronically by frontline workers.
Saving Lives: supporting people with mental illness to leave the street
Between 2008 and 2014 I worked as a street outreach worker in London. It was a job I had wanted to do for many years and one I loved. Getting to know the individuals who often wouldn't or couldn't engage with other services, building their trust and supporting them to move away from the street was a role I felt privileged to have.
Most people just needed someone to support them to make that journey. In some cases it was merely a case of signposting or referring into services, for others they needed a little more support, encouragement and patience.
But there were a small handful of individuals whose sometimes obvious, sometimes not so apparent, mental illness was preventing them from engaging with services and keeping them stuck on the street. They were not making a 'lifestyle choice'. They lacked the capacity to decide whether leaving or remaining on the street was the right thing for them.
Take Jim* who, well-liked by the community and well known to services, had slept rough for 35 years when I met him. A lovely man who regaled everyone with his stories but refused all offers of support. The outreach team had been unable to support Jim to access statutory mental health services despite serious concerns that the stories he told were in fact delusional beliefs; unsubstantiated and evident of an underlying and long-term psychotic illness.
Many attempts were made to encourage the local mental health team to take our requests for support and intervention seriously. Jim was deemed to be making an active and informed decision to remain on the street and because he was using local facilities to eat and keep relatively clean it was decided he had access to all the support he needed. It was incredibly frustrating to watch Jim deteriorate, having got to know and care about him and understanding the complexities of his situation.
In 2010 another person with mental illness died on the streets in Lambeth. It sparked a serious case review and a year long project which aimed to improve access to mental health services for people like Jim. A toolkit was created and outreach teams across London were trained to identify less obvious symptoms of mental illness, to understand the legislation that was there to protect people in these situations and how to frame the information in a way which could be understood and acted upon by mental health services.
Those working with Jim received the training and for the first time were able to clearly explain that his presentation was not that of the typical street homeless person. We argued that his suspected psychosis impacted his capacity to make a decision to accept accommodation and made recommendations for potential intervention and the ongoing support we could offer.
After 35 years Jim was taken into hospital and given treatment. It was a difficult time for us all. We hoped that it would work and that Jim could continue his life in a safe and stable home. Over the coming weeks the medication started to work and Jim's delusions lessened. He became more actively engaged in decisions about his future and moved from the hospital into accommodation.
Roll on two years and I'm at Homeless Link working on the street counts and estimates work. I speak to people up and down the country who tell me about their 'famous faces' who have 'been there for years', seem 'happy enough' and 'just don't want anything'. Individuals who 'keep themselves to themselves'. Alarm bells ring and Jim comes to mind.
I am delighted that the original team that trained me and worked on the Saving Lives project are now working with Homeless Link to offer this training across England. I hope you will participate and make use of the toolkit. Nobody should have to live or die on the street, not least for reasons in which they can access support. People have a right to treatment as much as a right to choice.
You should never worry about advocating on their behalf. In most cases nobody else will.
* - name changed