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Developing a community of practice to support people experiencing homelessness with advanced ill health – Free resources to help you facilitate this

Are you, or any other members of your team interested in creating and running a community of practice in your area, around supporting people experiencing homelessness who have poor health?   

Pathway and Marie Curie, together with experts in the field (and supported by NHSE and the Oak Foundation), have developed a suite of resources to help you set up and lead regular meetings for anyone in your area that is supporting people experiencing homelessness with advanced ill health.

This is an opportunity to bring people together in your local area who are working with this population (e.g. from hostels and other frontline homelessness services, health, social care and addiction services etc.).

They provide videos in which leading experts share tools, resources and tips for supporting people experiencing homelessness with complex ill health in homelessness settings, such as hostels. In these videos you hear from people with lived experience of homelessness, hostel staff, health and social care professionals and from experts in palliative and end of life care. The resources can be used to support the first eight online sessions of your community of practice.

Topics include:

  • links between homelessness
  • health and palliative care
  • complex trauma
  • communication strategies
  • frailty
  • neurodiversity
  • mental capacity
  • care act assessments
  • palliative and end of life care planning & bereavement.

 

The course also provides a detailed facilitator guide to help you support the sessions that you run, with suggested discussion questions and ideas for how to get your groups to come together, support each other and create actions for difficult situations.

If becoming a facilitator sounds like something you would be interested in,  please join one of the virtual information sessions on either Thursday 7th July at 2-3pm or on Tuesday 19th July at 2-3pm to hear more. To sign up to the session, complete this short form. Attending this initial meeting does not commit you to becoming a facilitator!

If you are interested but cannot make either date please email:  homelesspalliativecare@mariecurie.org.uk


How London is Respond-ing to the needs of asylum seekers this World Refugee Day

Dr Olivia Farrant is a member of the University College Hospital (UCLH) Respond team, a community-based service delivering holistic care for asylum seeker communities in London. Olivia is also a Centenary Fellow at the UCLH Hospital for Tropical Diseases.

 

In 2021, 48,540 people claimed asylum in the UK, the highest level since 2003. The majority of these applications were made by people from Iran, Iraq and Syria, aligning closely with conflict in these areas. This rise of almost two-thirds from the previous year, together with the impact of the COVID-19 pandemic on pre-existing delays to the processing of asylum claims, resulted in the placement of many families and individuals in ‘contingency accommodation’ across the UK. Forced migration due to persecution, conflict or natural disaster is not a new phenomenon, and the principles of the 1951 Refugee Convention remain just as relevant 70 years on since its inception.

Bringing health and care into contingency accommodation

Although contingency hotels had been used prior to the pandemic, the scale of their use since then has been unprecedented. Thousands of vulnerable migrants were placed in inner-city areas during a pandemic when health and social care resources were already stretched to their limit. People seeking asylum are known to be commonly affected by complex and inter-generational needs, affecting mental, physical and social health, and may have experienced limited access to prior healthcare. This made it exceptionally challenging to provide an equitable and accessible service for this population, despite the best efforts of frontline staff.

To address these problems, our team from UCLH designed a new integrated, community-based, model of delivering care for asylum seekers called ‘Respond’. This model is designed to overcome barriers in access to healthcare, provide a wrap-around, holistic and trauma-informed service and deliver equitable healthcare for an underserved group.

An integrated and holistic response

Through the Respond model, we support GP registration, screen for a range of physical and mental health needs, including communicable and non-communicable diseases, refer and signpost to key services, and provide a patient-held record of our assessment, as show in Figure 1. We work with expert multidisciplinary input from a range of specialists with expertise in migrant and refugee health. We were commissioned by North Central London Clinical Commissioning Group in July 2021 to deliver services across Barnet, Camden and Islington.

Figure 1. The Respond model

How London is Respond-ing to the needs of asylum seekers this World Refugee Day

We have assessed over 700 people in family groups and as individuals to date. We have learnt the importance of partnership working and the benefits of integrated care across traditional boundaries: primary and secondary care, adult medicine and paediatrics, health and social care. We have learnt the crucial importance of bringing healthcare into the community, of understanding where people live and their experiences in the design of an equitable service. We’ve had to overcome funding shortfalls to continue our work and have learnt the limitations of short-term retrospective funding models when trying to build sustainability into the system.

Looking ahead

Moving forwards, from a clinical perspective we will be upscaling, strengthening our partnerships and bringing in peer advocates to work with us in the implementation of our service. From an academic perspective we will be developing one of the largest clinical datasets to date describing the health needs of asylum seekers in the UK, conducting in-depth qualitative work and economic evaluation to assess for acceptability and cost-effectiveness. We will be sharing the results of an interim service evaluation of the first 12 months shortly and will be seeking feedback from key collaborators across the region and from patient advocates.

How London is Respond-ing to the needs of asylum seekers this World Refugee Day

Our work is designed to address health inequalities through equitable service delivery, partnership across traditional system divides, digital innovation and cutting-edge research for an underserved group. We remain at a pilot stage and welcome feedback from collaborators and other stakeholders as we move forward.

Further reading

Farrant O, Eisen S, van Tulleken C, Ward A, Longley N. Why asylum seekers deserve better healthcare, and how we can give it to them BMJ 2022; 376 :n3069 doi:10.1136/bmj.n3069

Contact

Find out more about the Respond service here: https://www.uclh.nhs.uk/our-services/find-service/tropical-and-infectious-diseases/respond-integrated-refugee-health-service

Or email the team via: uclh.respondadmin@nhs.net

 

World Refugee Day is an international day designated by the United Nations to honour refugees around the globe and takes place annually on 20 June. Learn more about HLP’s work to support people experiencing homelessness and other inclusion health groups.


Homeless health podcasts and webinars

Find podcasts and webinars produced by HLP’s Homeless Health programme team and partners in London, sharing insights and the latest work developments in homeless health from colleagues across health, housing and the third-sector.

Find more content on our homeless health learning and resources page.

London Health Podcast episodes on homelessness

The HLP Homeless Health team is hosting a new podcast series for the London Health Podcast to help debunk myths about homelessness and homeless health through minimal jargon and honest conversations.

This series is open to all: for health and care workers who don’t always work with people experiencing homelessness, individuals and teams providing homelessness support, and for anyone else out there who wants to learn a bit more about homeless health.

Public Health Voices Webinar Series

The UCL Health of the Public team hosted a webinar series themed around public health voices. In the ‘Everyone In: Citizen Voice in Inclusion Health’ webinar, inclusion health experts discussed the importance and value of involving people with lived experience of social exclusion and how this is key to designing effective interventions and solutions.

Homeless Link online training and webinars

Homeless Link’s national, regional and online training and events are an opportunity to network with other homelessness professionals – share knowledge and experience, find solutions and develop expertise within the sector.

Local Government Association webinars

As part of the Out of Hospital Care (OOHC) Models Programme, the Local Government Association (LGA) are holding webinars around OOHC and housing every fortnight until the end of January.

Homeless health learning and resources

Presentations from previous webinars are linked below.

Housing and accommodation: maximising local opportunities and resources (30 November)

Engagement through and with emergency department Teams: what works well? (16 November)

Step-down and onwards accommodation: good practice models and resources (14 December)

Developing the evidence base (11 January)

Discharge from acute mental health settings (25 January)

 

Feedback

We welcome feedback on the resource and will update it from time to time. If you have any comments please the Homeless Health team.

Back to Homeless Health


Navigating homelessness and loneliness day to day

Navigating homelessness and loneliness day to day

The START team is a Community Mental Health Team for people sleeping rough in Southwark, Lambeth and Croydon. Dr Jenny Drife has been the Consultant Psychiatrist in the team since 2016.

Loneliness makes everything harder

In our community mental health team (CMHT) for people sleeping rough, loneliness is something we see every day. The woman whose paranoia has led her to abandon her hometown, and who hopes setting up camp in a South London park will keep her safe. The man who has travelled from his war-torn country plagued by symptoms of Post-Traumatic Stress Disorder, unable to speak English or explain his distress. The teenager who has suffered abuse and neglect from childhood and drifted into a life of drug use and self-harm. Often, it can seem that the one thing our clients have in common is that they are alone.

Unfortunately, being alone makes everything harder. Asking for help, even when surrounded by a loving family or friends, can be difficult. Struggles with mental health and substance misuse can make reaching out even more tough. Left alone, it’s much easier to listen to the internal voices, withdraw into a depressive episode, or seek solace in drugs or alcohol.

Reconnecting people can have lasting impact

A lot of our work centres around relationship-building. We meet our clients on the streets and do what we can to establish a connection, gradually building up trust by trying to help meet their individual needs – be that with a cup of coffee, helping with benefits paperwork, or with medication. It can be slow and tedious work. If we get up at 6am to go on outreach, we know that there’s a high chance we won’t find the person we’re looking for, or that we’ll be told to go away. We persevere and are lucky to have a psychologist on our team who works with people from the earliest stages of their homelessness experience with us, to help them address their trauma.

Little by little, the beginnings of change emerge. Sometimes the outcomes are well beyond our hopes. Clients who have seemed the most entrenched in homelessness have made it off the streets and found peace. Perhaps the most satisfying part of the work is when we have been able to reconnect people with family they lost touch with, years or decades before.

 

We can do more by working together

These days it can feel as though the battles we are helping our clients to fight are getting harder. Systems are under pressure, hospital admissions are increasingly harder to achieve, waiting lists for CMHT support are long, and accommodation is in short supply so when it is offered it may be far away – meaning the networks our clients have started to form are lost.

This is a population that is extraordinarily vulnerable. In 2020-2021, 44 per cent of people sleeping rough reported a mental health support need, 29 per cent needed support around alcohol use, and 31 per cent around drugs. There is a huge burden of physical ill-health, and the average age of death for a man sleeping rough is, incredibly, just 45. Mental health awareness week is not something that will enter the minds of many of our patients; they are too busy trying to survive, and may not even understand their struggles as part of a mental health issue.

However, as a society we need to be aware of this marginalised group and recognise that many will avoid or push people away because of the distress they have been subjected to by others. We need to remain hopeful that trust can grow again when people start to feel safe. We need to be aware of the extent to which mental ill-health both causes and is caused by homelessness, so that we ensure that the network of housing, health, and community organisations continue to work together to provide expert support to the most isolated.

If you would like to learn more about the work we do on the START outreach team, check out NHS South London and Maudsley website here: https://slam.nhs.uk/search/service/homeless-outreach-team-start-lambeth-southwark-and-croydon-171

For more useful information on homeless health and resources to help improve homeless health services, look at our resources page.

 

 

 

 


Homeless Health clinical leads update – April 2022

Co-Clinical Leads Dr Jasmin Malik and Dr Caroline Shulman joined HLP’s Homeless Health programme in September 2021. Jasmin and Caroline bring valuable skill sets to their joint leadership role having worked with inclusion health groups in primary care across London for a number of years.

Working within the homeless health network, their combined knowledge, experience and understanding of the homeless population, frontline practitioners and the commissioning landscape, enables Caroline and Jasmin to bring their joint clinical voice into the development of pan-London homeless services.

Jasmin’s background includes being a clinical lead for homelessness and mental health in Camden/NCL since 2017. This role has involved working with commissioners at a local level supporting the development of local homeless services, bringing together local networks of clinicians and frontline staff, and providing training and support to local hostels prior to and during the pandemic.

Caroline is a clinician, researcher and trainer and has led a number of projects in homeless and inclusion health. She was also a clinical lead for a multidisciplinary hospital Pathway team for a number of years. Her projects include highlighting unmet palliative care needs and high levels of frailty within the homeless population, and development of interventions to advocate for – and improve access of – high-quality services. She is also developing training resources for inter-professional learning to support localised communities of practice to better address the needs of people with multiple and complex needs.

Through their joint role for the HLP Homeless Health programme, they are supporting a number of areas and contribute to the Homeless Health Leadership Group and ICS meetings. Their work includes building upon and chairing the Homeless Health Clinical Leads Group which is an open forum for clinicians and other frontline practitioners working in homeless services, ensuring the clinical voice is heard. Members can share experiences, discuss problems and potential solutions – where necessary escalating to commissioners and other appropriate bodies, and learn from regular speakers sharing their expertise.

Jasmin has been working with ICSs to conduct a mapping of homelessness provisions across boroughs, and has convened a new steering group to take forward the Primary Care workstream. Jasmin has also Caroline is supporting the out of hospital programme and led rapid surveys capturing a snapshot of COVID cases across London between December 2021-January 2022, and a subsequent winter snapshot audit to capture a more in-depth picture of hospital inpatients’ needs, helping to identify difficulties in facilitating timely and safe discharges and any gaps in step-down accommodations. Caroline is also working on developing a survey with St Mungos to explore the unmet needs of people with care and support needs living within homeless hostels.

Caroline and Jasmin are also involved in work addressing the health needs of the most vulnerable rough sleepers in London as part of the T1000 project. They are also bringing their clinical voice into the mental health and substance misuse workstreams, as well as highlighting the needs raised by experts and frontline practitioners regarding other areas of need such as women rough sleepers, homeless children and families, and the transitional years between the ages of 16-25.

 

Click here to read related content from the London Homeless Health Partner April 2022 newsletter.