Actes   -   Proceedings

Home less  &  Home first  

dignity  &  belonging   -   health  &  well-being

13° European  SEMINAR  SMES     ROMA  6 - 7 - 8  March  2013

 H O M E  PROFILE CONFERENCES ROMA Conf  March 2013 ACTES-PROCEEDINGS RM conf DIGNITY & WELLBEING 2014_GR-&-IT_EU-Pres J O I N  - U S     I T   F R

Acknowledgements: presenting the proceedings of the conference we intend  to thank all those who have enabled and facilitated the realization of this conference: the speakears : Ms Karima Delly: Member of EU Parliement ; Prof. Jose Ornelas: (PhD) ISPA – Instituto Universitário -Lisbon (PT); Dr. Erio Ziglio : WHO - Head Unit of Regional Office for Europe, Venice (IT); Dr. Jean Furtos, psychiatre, Dir. Sc. honoraire Observatoire National des Pratiques en Santé Mentale et Précarité (Lyon, FR);  M. Charles Frazer , Chief Executive, St Mungo's, London, GB;  dr Philip Timms, psyhiatrist - START "a specialist team for homeless mentally ill people" London UK; which were highly appreciated by the participants for their interesting presentations and all those who have contributed to deepen the themes proposed by exchanging experiences, knowledge and thoughts.

A special thanks goes to the Abbé Pierre Foundation, the Foundation of EAPN, the Diocesan Caritas of Rome, who, with their financial support have allowed enabled the realisation of the conference. We thank the President of CNR who graciously made available to the salt. And a final thanks goes to the performers (EN-FR-EN) Technical Agency MPF and to all who have guaranteed safety and communication. A final thank to the members of  Social Coop the Grande Carro, which prepared the catering of these days.  THANK YOU ALL PARTICIPANTS

INTRODUCTION

09:00 - 09:30


 

2013 European Year 

  Justice,  Fundamental Rights  and  Citizenship       
  cf. 
http://europa.eu/citizens-2013/

Homelessne:

  ...is an unacceptable violation of human dignity and represents one of the
  most  extreme forms of poverty and deprivation, and has increased in
  recent  years in several EU Member States  
Resolution (B7-0475/2011)

Dignity and
Well-being:

  Fighting poverty and preserving democracy through social investment

PLENARY SESSION 1

09-30 - 11:00

HOME-less & home-FIRST  -  Right and Access to citizens rights  
discussant:  Charles Frazer ,
Chief Executive, St Mungo's, London, GB

  HOME-first

      Luigi Leonori

audio :   

HOME-first HOME first  -  Right and Access to citizens rights
l’importante non è solo avere un luogo, un ostello, un alloggio ove ripararsi,                                IT
ma soprattutto una casa ove viverci, abitarvi, esserci !

l'important n'est pas d'avoir simplement une place, une auberge, un gîte où s'abriter,  FR
mais surtout une maison où vivre, habiter, où  y être!

Introduction of  Luigi Leonori 






 E N

THURSDAY

7 March 2013
morning

Charles Fraser 

1

Karima Delly: Home-less & Home-first: résolutions of European
                           Parliment concerning  Homelessness 

Download

              AUDIO     Introduction by LL , Mme Karima Delly - Charles Fraser  & Questions
                                     https://www.dropbox.com/home#!/home

José Ornelas: Housing first: an ecologic and collaborative
                           approach to overcome homelessness 

Download

                AUDIO    Intervention of Jose Ornelas - Charles Fraser & Questions 
 
                                  https://www.dropbox.com/home#!/home

THURSDAY

7 March 2013

morning

Philip Timms

2

Erio Ziglio :     Promoting Health and Wellbeing by developing
                           Community Resilience & Salutogenic Conditions

Download

              AUDIO     Intervention of Erio Ziglio__ Philip Timms  &  Questions 
                                    https://www.dropbox.com/home#!/home

Jean Furtos:   To be at home is not to have a house :
                        
clinical and practical approach

Download

               AUDIO   Intervention of Jean Furtos  -  Philip Timms  &  Questions
                                   https://www.dropbox.com/home#!/home

  HOME-less

      Karima Delli

audio :   

HOME-less & home-FIRST  -  Right and Access to citizens rights

Home-less & Home-first: résolutions of European  Parliment concerning  Homelessness 
Introduction of  Luigi Leonori  and 
Intervention of  Mrs Karima Delly  and Questions

   HOUSING FIRST
       
Jose Ornelas
        audio  : 

Housing first : an ecologic and collaborative approach to end homelessness ".  
Prof. Jose Ornelas, (PhD) ISPA – Instituto Universitário -Lisbon (PT)     jornelas@ispa.pt  

Key-Words:    Housing Firstcommunity Integrationmentally ill
  

This presentation describes the quantitative and qualitative results from the two years of the housing first  program in Portugal. This program is aimed to provide permanent, independent and scattered housing, rented from community landlords in mainstream neighbourhoods, to homeless people with severe mental illness in the city of Lisbon, Portugal.  
The evaluation results confirmed the effectiveness of this model on reducing homelessness and the use of emergency services and hospitalizations. Participants reported significant improvements in personal safety, physical and mental health, and a more positive outlook for their future.
As an innovative approach in Portugal, the positive result of the Housing First program validate the applicability and the potential for generalization of this model, and has obtained the recognition from the political authorities, emerging as a favored policy response to homelessness in national contexts.
This presentation will also explore the ecological levels of analysis and the collaborative roles of
community environments in the promotion of the well-being and community integration of program participants.
It will be also emphasized the supports provided by the program professionals focused on strengthening participants’ bonds with neighborhood resources and relationships, in order to maximize their sense of belonging and community participation.
 

PLENARY SESSION 2

11-30 - 13:30

Right and Access to citizens rights :  HEALTH  - mental health  and  well-being
discussant : dr Philip Timms, psyhiatrist - START  "a specialist team for homeless
mentally ill people" London UK

    HEALTH  FIRST:

       Erio Ziglio   :                         audio  :  


PROMOTING HEALTH & WELLBEING by developing Community Resilience and Salutogenic Conditions
by  Dr Erio Ziglio WHO - Head Unit of Regional Office for Europe,  Venice  (IT)  
cf. HEALTH 2020 Europe
                                                               
Glossary :  Health asset ;  Resilience - Salutogenesis <-> “pathogenesis” -  physical, mental and social

 

The presentation will begin  by explaining briefly the concept of assets for health and wellbeing.
Then he will highlight the relevance of strengthening individual and community salutogenic assets.
Thirdly, he will provide a few practical examples of the application of an assets model to address vulnerability and health inequities in today’s fast changing Europe.
To sum up, a salutogenic approach aims to maximise positive assets for health and well-being for communities and individuals.
It can be described as an approach which:
• Focuses on positive health promoting and protecting factors for the creation of health rather than solely on the prevention and management of disease;
• Helps to reconstruct existing knowledge and to assemble new knowledge, resources and tools to facilitate policymakers and practitioners to promote positive approaches to health, wellbeing and development;
• Emphasises a lifecourse approach to understanding the most important key assets at each key life stage;
• Is committed to involving individuals and communities in all aspects of health development process;
• Recognises that many of the key assets for creating health lie within the social context of people’s lives and therefore has  the opportunity to contribute to agendas to reduce health inequities.
 

     HABITER
        
Jean Furtos : 

                audio  :  


To be  at home is not to have a house : clinical and practical approach 
Habiter'  n'est pas avoir un logement: approche clinique et pratique.   

Dr. Jean Furtos
, psychiatre,   Dir. Sc.  honoraire Observatoire National des Pratiques en Santé
                                Mentale et Précarité (Lyon, FR)

 

Le sujet humain n’est pas une pierre : quand il reçoit un coup, son mouvement n’est pas le résultat mécanique des lois de la cinétique. Le sujet humain, certes un sujet social, participe au mouvement, mais son action (ou sa non action) est le résultat d’une rencontre entre l’environnement, au sens social de ce terme, et sa réactivité personnelle, son activité propre.  C’est pourquoi, lorsque la question de l’exclusion sociale est envisagée, il convient de prendre en compte l’exclusion elle-même, c’est-à-dire l’absence de reconnaissance par le souci de la dignité du sujet humain, la non reconnaissance de ses droits fondamentaux (comme le logement) ; mais il faut aussi prendre en compte la réactivité humaine à cette exclusion, en particulier sous la modalité de l’autoexclusion, qui est une existence paradoxale, une sorte de monde à l’envers.  C’est pourquoi procurer un logement à un sans-abri est différent de lui permettre d’habiter. Le fait d’être at home n’est pas réductible au housing. C’est pourquoi, d’ailleurs, l’accompagnement est généralement inscrit dans l’accèset le maintien au logement des sans-abris, mais pas toujours. La contribution ici proposée consistera en une approche clinique des paradoxes et des contradictions rencontrées dans cet accompagnement. Seront abordées les difficultés concrètes suivantes :

  • ne pas pourvoir habiter son logement, avec la notion de déshabitation de soi-même.

  • habiter la relation d’accompagnement, squatter l’accompagnant, et les effets sur le travail social et le soin.

  • comment l’accompagnant peut rester vivant dans cette conjoncture périlleuse pour lui, et commentil peut héberger provisoirement l’autre en lui-même dans une perspective « thérapeutique ».

  • comment il doit accepter les aberrations et les atypies de l’habiter, et ainsi avoir des conduites à tenir appropriées aux logiques qui président à ces difficultés.

 

WORKSHOPS
PRESENTATION
14:30 - 16-00

 
 G R O U P      A

On the street

Entrenched rough sleepers: what aptitudes are required to facilitate approach to persons and what resources required in order to insure access of homeless to health and social services ?

What is the sense of freedom and compulsory intervention, respect and solidarity concerning people on the street suffering of mental diseases and absolute deprivation? Does partnership, civic co-responsibilities and interdisciplinary work ?  What results can be achieved? And what obstacles must be overcome in this personalised pathway ?

    Franca PEZZONI,


Franca PEZZONI,
Medico Psichiatra Centro Salute Mentale  via Peschiera 10 16122 Genova
                                  franca.pezzoni@asl3.liguria.it   U.O: Salute Mentale ASL 3 Genovese


UN PROGETTO      PER PERSONE SENZA DIMORA IN UN SERVIZIO DI SALUTE MENTALE

organizzazione di un gruppo multidisciplinare per persone senza dimora con disturbi
psichiatrici all’interno   di un Servizio di salute mentale per erogare interventi integrati

Parole chiave:
        persone senza dimora, disturbi psichiatrici, Servizio di Salute Mentale

Idee prioritarie:    Le persone senza dimora a causa della loro condizione hanno difficoltà ad accedere ai Servizi sanitari, specie psichiatrici. D’altra parte la creazione di Servizi ad hoc può avere un effetto ghettizzante.

Una soluzione può essere l’organizzazione di un gruppo multidisciplinare all’interno di un Servizio di Salute Mentale che favorisca l’accesso e la presa in carico Implicazione per la pratica: un gruppo multidisciplinare composto da psichiatri, assistenti sociali e infermieri lavora in rete con tutti i Servizi pubblici e privati del territorio, sostiene la motivazione degli operatori, fa un monitoraggio epidemiologico del fenomeno, elabora specifiche tecniche di intervento

    Alain Mercuel 


Dr Alain Mercuel ,
méd. psychiatre , Hôp. St. Anne , directeur unité SMES, pour l'accès aux soins
                                    psychiatriques pour les plus exclus

Souffrance psychique des sans-abri : vivre ou survivre

                                         
Tout ce que vous avez  toujours voulu faire sans oser :
                                           -   Aller à la rencontre ...

                                           -   Aider à accepter les soins ...
                                           -   Tenir le lien ...

   Ryckmans Pierre 


Conditions de la réinsertion durable pour tous

Ryckmans Pierre,  médecin,  Infirmiers de rue   Bruxelles, (BE): pierre.ryckmans@idr-sv.org


Sujet: Tout le monde peut et devrait aller en logement, pour des raisons de survie, de santé, de dignité, de bien-être.  Mais les conditions de cette réinsertion doivent être étudiées soigneusement pour  rendre cet objectif possible, durable  et éthiquement responsable.


Mots-clés: Réinsertion durable; santé; dignité; réseau; état d’esprit


Idées principales:

la réinsertion durable (une stabilisation durable dans un logement) est possible et souhaitable pour tous
 - les conditions de cette réinsertion sont:
-  l’état d’esprit de l’intervenant et sa connaissance des possibilités dans le contexte dans
    lequel il travaille;
-  l’adaptation des solutions proposées aux besoins, aux envies et aux capacités de la personne;
    la collaboration d’un réseau d’intervenants. Implications pour la pratique:
-  l’état d’esprit de l’intervenant doit être en cohérence avec ses objectifs
-  il est essentiel de consacrer du temps, de façon continue, dans le suivi d’une personne,
    à comprendre et rechercher les besoins,  les envies et les capacités de cette personne.
-  il est essentiel de connaître suffisamment les ressources de l’environnement social dans
    lequel on travaille
-  l’appui d’un réseau d’intervenants qui partagent des objectifs communs est essentiel pour
    la réussite.

Propositions: Que chaque intervenant se pose la question de:

- son état d’esprit (positif, négatif, en cohérence ou non avec les objectifs) face au situations
   rencontrées
- la connaissance en profondeur de la personne (situation, ressources, besoins, envies, rêves,…)
- le réseau fonctionnel autour de la personne.

 
   Márcia David,  and


A health priority:  The absence of answers concerning mental health care

 

Fernanda Lopes, Mental HealthNurse; Médicos do Mundo; fernanda.lopes@medicosdomundo.pt 
Karina Oliveira, Mental HealthNurse; Médicos do Mundo; karina.oliveira@medicosdomundo.pt
Márcia David, Social Educator; Médicos do Mundo; marcia.david@medicosdomundo.pt
Raquel Rebelo, Social EducatorandCoordinatorofthe Project; MdM; raquel.rebelo@medicosdomundo.pt .....

 

Keywords: mental health, primary health care, homelessness, network support.

 

 The report on the integration of mental health into primary care (WHO,2008) refers that the sharing of the human condition is enforcing the universal aspiration for a better life, and to support efforts to achieve a state of complete physical, mental and social wellbeing, and not merely the absence of disease and infirmity.

It is through integrated primary health care that can reduce the considerable global burden of mental disorders untreated, thereby improving the quality of life of hundreds of millions of patients and their families. Having the situation in Portugal as background, when we talk about people with mental disorders who are in a situation of homelessness, we are faced with a serious problem at the level of first-line answers to these situations.

The existing network of primary health care and that should also address situations first-rate mental health, has a serious gap, since it does not include in its parameters, effective responses to level ground structures or teams that make the bridge between the person with mental illness who are in the street and the access to primary health care. In Portugal, the National Mental Health (2008), is distant from the real needs of the Portuguese population and does not meet the financial and cultural dimension Portuguese. Existing data show reveal the prevalence of mental health problems in vulnerable groups - women, poor and elderly - then we encounter another major problem after diagnosis of the situation of severe mental disorder: network scarce resources for continuity of care.

Taking as an example the usual situation: A person with severe mental disorder without rear family, socially and economically dependent, the answers are insufficient for the prevalence of situations and distanced from the real needs of the population, which means that the person encounters a situation of homelessness. People with mental disorders should see all their rights respected, including the right to adequate health care, residence and employment / economic support, as well as protection against all types of discrimination. Despite the current economic conjecture, should be a priority in health efforts at inclusion of mental health at the level of primary health care, according to WHO guidelines.
 

 

G R O U P      B

Emergency shelter and temporary housing:  How to prevent that emergency condition becoming in chronic situation ? In almost all European metropolis on the winter municipalities launched an emergency plan. Who and how accompanying measures to prevent that at the end of emergency program the people find himself again back on the street

Emergency shelter and temporary housing

   Klyueva Nadezda
    Marina Perminova


Resocialization through creativity: a place that will stay with you forever
Author(s)
Klyueva NAdezda; Psychologist -
Organisation:
CARITAS OF MOTHER OF GOD ARCHDIOCESE IN MOSCOW
Email:
nadia.klueva@gmail.com

            
Project "City of Dream" - ashelter and temporary housing:  
 an organization of training for homeless people, that
live in shelters in Moscow.

The goal:  to build a model of the city of Dreams and consider steps to translate the desires of each participant in the reality.

Keywords: Homeless, resocialization, life perspective, psychological work with homeless


Priority Ideas:

   -   Homeless people have a lot of problems:  the loneliness, loss of vision life perspective
       (or inability to build it), Low self-esteem,  Lack of self-expression, lack of close social ties,
       emotional stress

   -   Psychological problems of homeless people: the degradation of motivational and sense
        structures,  acceptance of the social role of "homeless person" and following this role

 

The goal of this project:  allocation of its homeless life perspective, building a life plan, improving personal relationships, increased self-esteem and emergence of motivation to resolve personal problems

 

Implications for practice : The project lasted for 5 months, 1 day a week for 4 hours.
The project involved 56 homeless people and volunteers. Two psychologists, volunteers and homeless people took part in each group. 
Steps of each group:

   -   Everyone had built the house in which he would like to live, work, relax, device of the city.
        They also discussed the rules of collective life.

   -   Each participant work with a psychologist. We had individual discussion of  choosing such
        a home, creating the story of person who live in this home, opportunities and ways to
        implement the "game" model into a real one

   -    Completing membership card

   -    Adding to the list of City memorial

   -    Each participant at the end of the group told the story of his house and resident

 

Results:

   -        Minimum of 4 people found a real home.

   -        It  was a project where people are most open over 7 years of work

   -        everyone who participated received relaxation, stress relief

   -       Even if a person has taken part in only one session - he left his mark in the city's history

   -        People plan what will be built, think about the project outside of the group

   -        City gained importance for the participants and leave pleasant memories.
             It has been over three years, but the members still remember about it.

 

Concluding proposals:

This project can be a good start for the long-term psychological and psychotherapeutic work with a homeless man.

The "City of Dream" does not require a lot of material costs and a special artistic skills - it can be realized by conventional social workers or volunteers

I would like to do this project international - to display a movement , social network  “Place that will stay with you forever”, and a platform for the unification and solidarity would become the Internet.
 

 

 

 

G R O U P      C

Support & personalised help to ensure that people do not return to the streets".

- belonging...,   avoid the risk of segregation (ghetto) and discrimination
- promoting  deinstitutionalization at all levels, social: shelters and emergency centres
   and at health level : psychiatric institutions ? "

Moving from homelessness to home

    


Inclusion as a socio-political and therapeutically process
by 
Christian Reumschüssel– Wienert Referat Psychiatrie/Queere Lebensweisen Kollwitzstraße  ;   mail  : reumschuessel@paritaet-berlin.de

Since the German unification 1990 especially in the centre of the German capital berlin a lot of processes had taken place which could be described as „gentrification“.

One effect of gentrification is an increasing exclusion of people, who are poor, without work and mental handicapped.

More and more they become displaced in the „poor” districts at the urban periphery or become houseless.
In spite of this Situation (not only) the psychiatric maintenance- and help organisations in berlin developed activities and plans, which can be described as a multi – dimensional strategy on several levels of interest:

• On the political level they try to get influence on social programms especially for housing
• On the local level they try to get create a „social community“ in two functions:
         o As „social“ brokersandmanagers
         o As „social“ entrepreneurs, developers and construction companies

On the therapeutically level the try to implement programms in order to reach people living in the streets and to motivate them
to develop their skills in using „normal“ social and psychiatric assistance or support.

The lecture will outline this activities
 

 

    

Observatoire de la santé et du social,                                                   
Commission communautaire commune de Bruxelles-Capitale,
Une expérience en Région bruxelloise « Vivre sans chez soi»     
 

by  Annette Perdaens  e-mail   aperdaens@ccc.irisnet.be
                              

A la demande du Parlement bruxellois, la Région bruxelloise a adopté en 1991 une loi (dite ordonnance ») instaurant l’élaboration bisannuelle d’un rapport bruxellois sur l’état de la pauvreté.

Ce rapport est rédigé en 5 partie : un baromètre social contenant des indicateurs de pauvreté, un cahier thématique sur un public particulier, des contributions d’organismes fédérateurs de lutte contre la pauvreté, un Plan d’action bruxellois de lutte contre la pauvreté (instrument politique) et un débat public.

Dans le cadre du rapport bruxellois sur l’état de la pauvreté 2010, le cahier thématique a été consacré à la problématique « Vivre sans chez soi à Bruxelles ». 

En concertation avec des acteurs de terrain, des pistes de travail ont été proposées aux pouvoirs politiques compétents. En voici quelques-unes.

  • Prévenir les situations de rupture:
    Tous les dispositifs de prévention doivent être activés pour éviter que les personnes ne se trouvent sans logement. C’est pourquoi l’accès aux droits sociaux fondamentaux et leur maintien est crucial, de même que l’accès aux services d’aide et de soins. L’action des services sociaux généralistes y trouve une place indispensable. En cas d’expulsion, le travail social exerce une fonction de détection, de prévention, de suivi et d’alarme. C’est ainsi que le CPAS de St Gilles a mis en place un dispositif d’accompagnement des personnes tout au long de la procédure d’expulsion pour trouver des solutions soit en termes de maintien dans le logement, soit en termes de recherche de nouveau logement
     

  • Soutenir les personnes les plus vulnérables dans leur milieu de vie quel qu’il soit
    Le logement est indispensable mais n’est pas suffisant pour stabiliser les personnes vulnérables. Il y a lieu de dépasser l'urgence et d’investir dans le long terme, en développant l’accompagnement social dans le milieu de vie des personnes, quel qu’il soit, et surtout reconnaître et valoriser ce travail, qui façonne une nouvelle approche (outreach) dans la conception du travail social.  L’accompagnement social n’est pas un facteur qui augmente la dépendance, mais qui favorise au contraire l’autonomie.

     

  • Les formes que prend cet accompagnement social varient selon les dispositifs :
         -  le « post-hébergement », un travail réalisé par les travailleurs de l’hébergement après celui-ci ;

         -  l’habitat accompagné, réalisé par une équipe spécifique, quel que soit le type de logement (AIS, logement social,
             logement groupé, occupation précaire, voire logement privé ou même squat). Les travailleurs se rendent au lieu de vie
             des personnes et les accompagnent ou les forment dans leurs démarches sociales et administratives ;
          -  l’habitat solidaire, logement accueillant des catégories mixtes de populations, en partenariat avec une (ou des) équipe(s)
             qui assure(nt) l’accompagnement social individuel ET le suivi collectif pour assurer le bien vivre ensemble
     

  • Organiser ou valoriser les concertations entre travailleurs sociaux et responsables politiques de différents niveaux de pouvoir.  En Belgique et particulièrement en région bruxelloise, le fractionnement des services, accompagné d’un effet de transferts, est un frein important à la prise en compte de l’ensemble des besoins sociaux des personnes les plus vulnérables. C’est le cas par exemple de personnes handicapées, de personnes atteintes de troubles mentaux ou d’addictions, de demandeurs d’asile ou d’autres groupes de migrants refusés dans des structures spécifiques.  Ces personnes cumulent souvent plusieurs problématiques
     

  • Différents lieux de concertation existent à différents niveaux : Conférences interministérielles fédérales et/ou régionales et communautaires, Conseils consultatifs (CCC-COCOF et VGC), Centres d'appui et diverses concertations régionales telles que la Concertation en matière de politique d’aide au secteur sans-abri ou la Concertation de l’aide aux détenus... A l’exception des Conférences interministérielles, les concertations rassemblent les travailleurs de terrain et les responsables politiques, mais aussi selon leur forme des experts (scientifiques) et des personnes défavorisées
     

  • Dans le cadre du plan d’action bruxellois de lutte contre la pauvreté, ces instances de concertation sont consultées pour alimenter l’outil politique, le plan d’action bruxellois de lutte contre la pauvreté. Les Autorités politiques tiennent compte des remarques et propositions formulées.

 

 
    


Paula Domingos, 
Social Worker/Social Adviser;  pauladomingos@dgs.pt

Organisation : National Program for Mental Health, Directorate - General of Health, Ministry of Health; Portugal
 

“Tackling Homelessness at local level: The responsive Portuguese model”

Portugal has a National Mental Health Plan 2007-2016, and one of the major objectives is to guarantee to all persons with mental health problems access to quality care, including vulnerable groups such as homeless people.
Regarding this particular objective, in 2010 the Ministry for Health’s through the National Program implemented a pilot project to provide homeless treatment.
It is the State’s responsibility, particularly the National Program to ensure equity in accessing health care for all the population in general, as well as homeless with mental illness.

The Project is addressed to those homeless who suffer severe mental diseases and to who have not psychiatric follow-up, disregarding the geographical area where the homeless might live and the time out in the streets.
The Scope is to ensure the access of homeless people to mental health care services, at local level – Lisbon City. And, the aims are: 1) ensure psychiatric and psychological follow-up of homeless people coming from the referral of case managers, coach teams and other institutions that provide support.2) help the training of professionals health care staff as well as the social professionals in managing real situations based on “Case Management”.
This project was preceded from a survey of mental health needs carried out with the Homeless, technical experts, scholars and professionals from mental health and social services of public and private organisations.
In fact, this mental health project is regulated by a protocol of cooperation between the National Program and the single Psychiatric Hospital (out of the existing three) that has technical and institutional experience in the area of the Homeless clinical follow-up.

The Protocol is based upon the model of intervention and follow-up built together in a partnership among ministries proceeding from the Mental Health Policy within the National Plan for Mental Health and Social Policy in the context of Portuguese Strategy for the Integration of the Homeless that has been launched on the 14Th march 2009 and was adopted for 2009 to 2015.
The model of intervention adopted consists of the following procedures: a) the identification and the forwarding of the situations are carried out by case managers from the outreach teams and emergency centers; b) The referral of the homeless to mental health services is made by filling a unique form; and c) Entrance/access by homeless to the hospital occurs through the mental health team.

In this context mental health care comprises: a) direct access to a therapeutic group; b) individual medical appointment and the medication costs are covered by the national health care system.
In conclusion, this model holds on a rights-based approach, and it requires working in the three levels of public intervention – local, regional and national ones; and closely with homeless people, non-governmental entities from mental health and social sector in listening the health needs.



 

 
    


AUTORE  : Dott. PAOLO  LONGO,   Maggiore  Esercito della Salvezza     :   
paololongo@esercitodellasalvezza.org



Una questione che ci sfida e ci invita a riflettere per un'idea forte e concretizzabile è il tema della  cronicità dei senza fissa dimora nei centri sociali di seconda accoglienza.
In base alla nostra esperienza, vediamo l'urgenza di porre rimedio allo “stop” di percorsi di vita che avvengono nel nostro centro e non solo.
Progettare un programma di uscita in stretta collaborazione con tutti gli enti e istituzioni, per ottemperare a quella che è la legislazione vigente in materia socio-culturale (regionali e nazionali, una su tutte: la legge Basaglia).
 

Concertazione progettuale con i servizi, cooperative sociali, istituzioni pubbliche e di privato sociale, enti ecclesiastici.

Educare e stimolare le competenze socio cognitive dell'utenza assistita e facilitare l'orientamento e la fruizione delle opportunità offerte dal territorio.

Spazi diurni all'interno della struttura come tassello aggiuntivo nel percorso di promozione umana e socio-esistenziale.
 

PROPOSTE

Social housing in base al percorso condiviso con l'utente e le istituzioni.
Gruppi di appartamento e di co-housing con soggetti provenienti dal bacino di utenza del disagio sociale con le relative serie di passaggi con i servizi, da una seconda accoglienza a quella che di fatto è una terza.
Soluzioni abitative ad hoc, di gruppo o individuali, non più concepite come “parcheggio” ma una dignitosa realizzazione della persona nel suo percorso di vita.
A tal fine va prevista adeguata istruzione socio-educativa dell'utente attraverso analisi delle leve riabilitative e social skill con relativo supporto e monitoraggio nelle varie fasi del processo di inserimento nelle nuove realtà, luoghi progettati per uscire dalla marginalità sociale.

 

 

G R O U P      D

Homelessness prevention : at the streets (no two nights in a row on the street...) at the shelters and at home regarding especial risk people: migrants European & extra EU, and without documents, elderly people abandoned in their solitude and women and children. In what manner "clinics solidarity 'can become the important preventive services at social and health levels, whether in connection with social and health public services ?  "

Homelessness prevention

    

“PROJECTO MENSANUS” – Reabilitação, Reintegração e Redução de Riscos
 MdM Portugal


Resumo: O projecto Mensanus, teve o seu início de implementação em Abril de 2009, sendo um projecto único e inovador a nível Nacional (Portugal), inseridona Organização Médicos do Mundo- Representação Porto. Tem como área de intervenção a Reabilitação, Redução de danos e Reinserção, na região do Grande Porto e termina em Março de 2013.

Trata-se, inclusivamente de um projecto co-financiado pelo Alto Comissariado da Saúde - Portugal. O projecto Mensanus surge da necessidade de uma intervenção mais específica e direccionada na área da saúde mental com população vulnerável e em exclusão social pois muitas pessoas com perturbações mentais graves são ostracizadas pela sociedade, caem na pobreza e ficam sem abrigo ao não receberem tratamento e cuidados de que precisam a nível de saúde. Os utilizadores deste projecto em gestão de caso têm na sua maioria consumos de substâncias psicoactivas (álcool e drogas) e problemas neuropsiquiátricos. São na sua maioria utilizadores do sexo masculino, com idades compreendidas entre os 20 e os 65 anos.

O projecto Mensanus é constituído por uma equipa multidisciplinar: Coordenadora; Educadora Social; Duas Enfermeiras de Saúde Mental e Psiquiatria. O contexto de desenvolvimento do projecto incide na abordagem multicontextual, podendo serno: gabinete, rua, domicílios/pensões. As estratégias utilizadas neste projecto passam por intervenção em situação de crise, treino de assertividade, motivação para a mudança, capacitação, articulação interinstitucional, envolvimento da família/prestadores de cuidados e inserção social. A presente comunicação tem como objectivo apresentar o projecto Mensanus, evidenciando os ganhos em saúde mental já obtidos no decorrer do desenvolvimento do mesmo. Os ganhos em Saúde são entendidos como resultados positivos em indicadores da saúde e incluem referências sobre a respectiva evolução.

 

 
    

Author : Nikos Gkionakis,   Director of Babel ,  Psychological Center for Migrants  - Athens  (GR) 

Titolo: Networks vs crisis – Nobody alone in the crisis!

Keywords: crisis management, urban settings, networking, comprehensive intervention

The crisis that Greece (but not only this country) is going through during the last years is a complex phenomenon and as such it should be approached by who is wishing to plan and implement interventions in favour of crisis “victims” and their multiple needs.

A slogan that is heard in Athens is “Nobody alone in the crisis”. The Day Centre Babel interdisciplinary team in Athens works with people living crisis on the edge: mainly migrants and asylum seekers or sans papiers who left their countries because of a crisis there, have reached, searching for relief, a European country that is facing the devastating consequences of an economic crisis at all levels: societal, institutional, social,  state etc. Not to be alone in this crisis becomes of high priority.

People live their own crisis without any help or care by state agencies. Quite no services are provided to them, even for the more basic needs. No guarantee is provided for elementary human rights.

To fulfill this gap, Day Centre Babel team works in order to meet the needs people have, connect people with each other and with existing services (coming mainly by non “official” initiatives), mobilize community resources and create support grids that are able to answer to the basic needs: food, clothing, shelter, employment, education, integration. This work is done by building networks with other agencies, volunteer organisations, other collective initiatives.

Our proposal is the same with what the slogan says: Nobody should be left alone in the crisis. To do so, services should not operate alone either!



 

 
    

Preventing homelessness

AUTHOR  : Hans Dubois,  Research Officer, Hans.Dubois@eurofound.europa.eu

Organisation : Eurofound


While it is important to provide services to homeless to prevent deterioration of their situation, ideally homelessness itself is prevented in the first place. While there are many pathways into homelessness, one that risks to be particularly on the rise is the inability to pay one’s rent or mortgage anymore. Recent results from the European Quality of Life Survey[1] show that the proportion of Europeans who find it quite or very likely they will need to leave their accommodation within the next six months because they can no longer afford it, has risen from around 4% in 2007 to almost 6% in 2011 . The proportion of people with arrears on rent and mortgage payments have risen from 8% to 11% in the same period, and arrears in utility payments have risen even more sharply from 14% to 17%. Furthermore, 8% of Europeans have been unable to pay as scheduled informal loans to friends and relatives.

A Eurofound project[2],[3] has looked into how such problems, related to household over-indebtedness, can be best dealt with. It points toward policy action against over-indebtedness which is a combination of prevention, alleviation and rehabilitation. In preventing homelessness among people who are experiencing over-indebtedness, quality debt advisory service provision can play an important role. By providing a helping hand and a listening ear, they can help avoid the situation from escalating even further, with all the social and economic cost for the individual and for society. Mutual referral by social services and early warning systems can be of particular benefit to provide support at an early stage, when it is most effective.

Case studies from debt advice service providers in several EU Member States highlight ways in which these ideas can work in practice. Experiences include a proactive system in the municipality of Amsterdam where debt advisors pro-actively approach people who miss payments with their social housing or utility companies. Causes and consequences of over-indebtedness are often interlinked. Furthermore, over-indebtedness is a heterogeneous problem, with different responses required for different groups. Often, though, straightforward administrative debt settlement procedures are not enough. Longer-term solutions would require deeper causes to be addressed. Integrated social service provision is crucial here. Measures to enhance quality of debt advice can include establishment of self-help groups (an example can be found at AGIR HOJE in Portugal), and manuals and training programmes for debt advisors (an example can be found at Money Advice and Budgeting Service in Ireland).

Overall, the proposal is to stimulate timely access to debt advisory services, to enhance the quality of such services and to provide a sound institutional context. In each of these categories specific actions can be taken, which are described in the following 2-page executive summary:

http://www.eurofound.europa.eu/pubdocs/2011/891/en/1/EF11891EN.pdf


[1] Eurofound (2012) Third European Quality of Life Survey - Quality of life in Europe: Impacts of the crisis, Publications Office of the European Union, Luxembourg. http://www.eurofound.europa.eu/publications/htmlfiles/ef1264.htm

[2] Eurofound (2011) Managing household debts: Social service provision in the EU, http://www.eurofound.europa.eu/pubdocs/2010/70/en/2/EF1070EN.pdf

[3] Eurofound (2012) Household debt advisory services in the European Union, http://www.eurofound.europa.eu/publications/htmlfiles/ef1189.htm

 

 

G R O U P      E

Dignity & Well-being and project elaboration How will be possible working together (mental health and social services of public and private Organisations) for a very difficult situation, when the solution seems very IMPOSSIBLE? cf. "Dignity & Well-being project"  What it's similar and different in European Metropolis concerning this specific situations ? Very important are the exchanges, to implement innovative practices based on the concepts of respect of suffering and abandoned people, of sharing responsibility in co-working and to formulate concrete proposals. !"

Dignity & Well-being

    


 

Un gruppo di intervento integrato per SFD con  gravi disturbi psichiatrici e non-collaborativi

Parole  chiave : Psicosi; non-collaborazione; processo; interventi integrati; Salute Mentale.

Autore : Pino Riefolo, psichiatra RME

Idea base :  integrazione degli interventi


PRESENTAZIONE: 
Pazienti psichiatrici in situazioni di grave disagio sociale, più in particolare soggetti senza fissa dimora, incontrano spesso gravi difficoltà nella presa in carico da parte dei servizi preposti e tali servizi esprimo difficoltà ad intervenire in maniera coordinata, integrata ed efficace tanto che, puntualmente, gli interventi sono solo episodici ed i pazienti si mantengono per lunghi periodi in condizioni dove è impossibile siano aiutati sia da un punto di vista medico, che psichiatrico che sociale.

Peraltro, la difficoltà di intervento è dovuta al fatto che in molti casi la patologia non presenta elementi di particolare acuzie e puo’ essere mascherata da quadri di scarsa cura della persona,  marginalità sociale e alcolismo.

In tali situazioni, proprio per l’assenza di una rete fra i vari servizi, si assiste puntualmente ad un rimvio sterile di responsabilità fra le diverse istituzioni coinvolte con l’esito di estremo dispendio di energie, e di sostanziale abbandono del paziente in una «terra di nessuno» che il paziente può abitare anche per lunghi anni in condizioni di salute psico-fisica estremamente precaria e pericolosa. 

Pertanto, da circa due anni, con il coordinamento del Centro di Salute Mentale del XX municipio della ASL Roma.E, si è costituito un gruppo integrato di lavoro al fine di realizzare un‘equipe multidisciplinare costituita dai diversi servizi coinvolti che, in questo caso, possano funzionare in rete organizzando una collaborazione piuttosto che rinviarsi faticosamente le responsabilità e la sostanziale presa in carico del paziente.

Il gruppo si occupa solo dipazienti che, per evidente patologia psichiatrica, non sono in grado e persino rifiutano attivamente, ogni forma di aiuto sanitario e sociale. E’ stato stilato un protocollo di intervento che prevede il contatto in loco del paziente mediato dai soggetti e dalle istituzioni con i quali negli anni ha stabilito contatti e, attraverso questi contatti, fare in modo che il paziente possa accettare cure finalizzate - prima che alla soluzione definitiva della condizione di SFD - al miglioramento delle capacità di critica e di scelta da parte del paziente. In alcuni casi è stato possibile stabilire una relazione di ordine terapeutico ambulatoriale coordinata con gli interventi delle associazioni di volontariato.

In alcuni casi che potremmo definire «estremi» è stato necessario coordinare un percorso che iniziasse dall’inevitabile TSO presso un reparto psichiatrico ospedaliero per poi continuare attraverso strutture cliniche intermedie e il passaggio presso istituti residenziali transitori gestiti da volontariato religioso. L’intervento in rete, che organizzi la collaborazione delle diverse istituzioni, permette di coordinare le risorse in campo senza bisogno di risorse economiche aggiuntive e con maggiori esiti rispetto al recupero di soggetti da lunghi anni tenuti in una condizione di sostanziale abbandono e migliori esiti anche per quanto concerne le motivazioni degli operatori coinvolti.

Sul piano operativo, il gruppo di lavoro ha una breve riunione mensile presso il Centro di Salute Mentale di via A. Di Giorgio e, soprattutto, mantiene e cura i contatti operativi attraverso una mailing list a cui accedono tutti i partecipanti.


 

 
    

 

Dignité et bien-être des sans abri chronicisés en rue - Samusocial de Bruxelles

Bruno Rochet, Laurence Bourguignon; psychologues au Samusocial de Bruxelles 

La question qui sous-tendra cet atelier sera sans doute celle du questionnement des services psycho-médico-sociaux autour de la qualité de vie du public sans abri désinséré.

En effet, comment aborder un individu qui a brisé depuis longtemps les liens avec les institutions et la réalité sociale?

Devons-nous le laisser venir vers nos services au risque de ne jamais le rencontrer, ou devons nous aller à sa rencontre (aller vers) sur son lieu de vie au risque d'infiltrer son intimité.

Que nous dit ce SDF en s'éloignant ainsi des institutions, en rompant le lien avec la société, quelles sont ses demandes et comment nous, travailleurs de terrain les entendons-nous?

Comment pouvons nous aider cette personne en respectant sa dignité, en tenant compte de la complexité de sa situation, de sa vulnérabilité psychique. De quels moyens disposons nous pour répondre aux attentes et aux besoins de soins. Force est de constater que le logement privé, les maisons communautaires, les structures thérapeutiques, les hôpitaux psychiatriques, etc...ne répondent pas forcément aux besoins et aux attentes de ces personnes précarisées en grande souffrance psychique.

Enfin, nous nous interrogeons sur nos limites d'intervention et des conséquences d'une non-intervention.

Pouvons- nous accompagner quelqu'un qui ne souhaite pas être aider ? et dans les situations les plus extrêmes et de crise, avons nous le devoir/le pouvoir de le contraindre à se soigner. Qu'en est il de la question de sa dignité? Partons d'exemples concrets, de vécus cliniques rencontrés, d'échecs et de petites réussites et réfléchissons ensemble.
 

 
    



TITOLO: Between Marginality and foolness. The question of consent. Between consent and taking charge AUTHOR  : Lorenzo Toresini TOPIC: (?)

KEYWORDS : clochard, reason, culture, consent, deinstitutionalization, taking charge, homeless There are two types of homeless people. Either they have became homeless as they are crazy, or they get mad once they are pushed into the street. The question is that of the experience of resulting invisible. The basic need for mankind is: to feel wanted. Mother Theresia from Calcutta.

The Deinstitutionalizzation has brought freedom and liberated the fools. Meanwhile it brought freedom to the cooperators for Mental Health as well as to the whole society. I do liberate myself in the meantime that I'm liberating you. Reason is no longer submitted to repression, instead today it has become a partner for mediation. In a similar way to subjects arriving from far countries, who are bearing the cultures of their own countries, fools are bearing their own culture .At the end of the day, unreason as such doesn't exist, there just exists the subjective reason of each one.

The french law of 1838 about Psychiatry has been denied by the italian law 180 – 833 of 1978.

The statement that Deinstitutionalization has included some mistakes, among which the new establishement of homeless people, seems an oversimplifiation, if we just consider that the homeless people did exist even before the closure of lunatic Asylums. In France the mental hospitals have never been touched, on the opposite way they have recently been reinforced by Sarkozy, nevertheless the clochards do exist even in that Country, and always did exist. The question of consent in this sphere appears crucial, as long as it is regarded in an excessiveely rigid way. Either it is there, and afterwords the take in charge becomes a relatively simply question, or it is not there, and there exist in every Country the legal tools in order to overtake such an obstacle. The problem of consent to the take in charge of the abandoned person has not to be seen as a linear fact, but inside of a circular dynamic. The beaurocratic coolness of a service has to be substituted by the affectiveness of the relation.

In 1978 N.Y. was crowded of fools, who had been released by the psychiatric institutes and abandoned in the undergrounds. In 2003 the WAPR world meeting in NY shoowed how there had taken place meanwhile a relevant engagement of ressources, determined by the republican governor of the State of N.Y., Rudolph Giuliani, that made possible the creation of shelters, structures and mobile as well as fixed services ambulanti e stanziali, up to the point that the homeless people dropped down in a considerable amount. The epense for Mentel health per inhabitant had increaed to higher level than that in Italy. The Health services have to be intagrated to the social ones. Tha fracture between the two networks of resources has always represented a problem and an unefficiency, rather than a real rationalization.

Basic ideas: The question of the experience of being invisible.

The basic need of every human being: to feel wanted. Mother Teresa from Calcutta Prioritary messages: The content has to be seen as a dynamical and a dialectical fact, rather than as something given a priori. There are two kinds of asylums: the total institution, on the one side, and the abandonement on the other. The latter is equaly totalitarian as the first.



 

 
    

 

A health priority: The absence of answers concerning mental health care

by   Fernanda Lopes, Karina Oliveira, Márcia David, Raquel Rebelo

KEYWORDS: Mental health, primary health care, homelessness, network supportThe report on the integration of mental health into primary care (WHO,2008) refers that the sharing of the human condition is enforcing the universal aspiration for a better life, and to support efforts to achieve a state of complete physical, mental and social wellbeing, and not merely the absence of disease and infirmity. It is through integrated primary health care that can reduce the considerable global burden of mental disorders untreated, thereby improving the quality of life of hundreds of millions of patients and their families.

Having the situation in Portugal as background, when we talk about people with mental disorders who are in a situation of homelessness, we are faced with a serious problem at the level of first-line answers to these situations. The existing network of primary health care and that should also address situations first-rate mental health, has a serious gap, since it does not include in its parameters, effective responses to level ground structures or teams that make the bridge between the person with mental illness who are in the street and the access to primary health care. In Portugal, the National Mental Health (2008), is distant from the real needs of the Portuguese population and does not meet the financial and cultural dimension Portuguese.

Existing data show reveal the prevalence of mental health problems in vulnerable groups - women, poor and elderly - then we encounter another major problem after diagnosis of the situation of severe mental disorder: network scarce resources for continuity of care. Taking as an example the usual situation: A person with severe mental disorder without rear family, socially and economically dependent, the answers are insufficient for the prevalence of situations and distanced from the real needs of the population, which means that the person encounters a situation of homelessness.

People with mental disorders should see all their rights respected, including the right to adequate health care, residence and employment / economic support, as well as protection against all types of discrimination. Despite the current economic conjecture, should be a priority in health efforts at inclusion of mental health at the level of primary health care, according to WHO guidelines.
 

 
  Maria MOUDANOU

      Athens  (GR)

Providing the fundamentally basics: sharing the experience of PRAKSIS’s
“Syn Sto Plyn” project

Topic: Dignity and Well–being and project elaboration:
             From intervention to prevention, from the street to the house

Key words: day centre, social housing, shelter, homeless, PRAKSIS, case study, active case finding, interaction Syn Sto Plyn Plus to minus project was “born” out of the steadily changing reality of recession Greece was facing-and still is-over the past five years.

Austerity measures applying mostly to low-middle income people has affected dramatically their capacity to cope with daily and inelastic expenses such as paying the rent or utility bills. Increased unemployment has increased uncertainty of what tomorrow will bring. Those who already were living at the edge have completely dropped off while the welfare system is still undergoing structural adjustments and is unable to meet the increased demand.

Priority ideas Syn Sto Plyn project is based on two axes: Prevention: via the Social Housing project, families with under-aged children that are at risk of homelessness can retain their home and autonomy via financial support, financial literature where needed, psychosocial support, employment counselling. A multidisciplinary team consisted by social workers-psychologists, administrator, financial, employment and legal counsellors is working together with the families in order to set up concrete goals and a plan. Individual approach helped not only to understand concretely the needs of the family in terms of potentially provided support, but also to formulate the response to these needs in such a participatory manner that has allowed including more families than initially planned. We have received more than 1500 calls and managed to include 680 families in Athens and Thessaloniki. Initial target was set at 200 families. Intervention: via the Day centre project that aims at providing relief to those who are already sleeping rough or living into precarious conditions (overcrowded houses, shelters, homes with no utilities such as electricity, heating, water). Relief includes personal hygiene services like shower and laundry, psychosocial support, primary health care services, employment counselling and referrals to a wide community network in order to meet other needs expressed. The challenge is to enforce people’s choices and identify via interaction realistic options. Outreach activities (Street work) are used as a tool to approach and inform those in need of these services, but also to register the phenomenon of homelessness and its dynamic changes. From May 2012 to January 2013 we have registered 1999 persons out of which 54% is living in the streets. Families and children mostly foreigners were a surprisingly important portion of those served at the day centre (836).

Implications for practice In both projects major issue is the fact that the referral system capacity is decreasing: Community mental health services, public health system is under structural adjustments and has suffered horizontal cuts regardless needs and capacity to response. Issues of concern are the lack of human resources that leads to increased waiting list, lack of drugs and material at hospitals and so on.

Concluding proposals - Synergies between different stakeholders are a necessity to meet the increased demands and not simply an instrumental choice - Definition of a minimum adequate income is essential to maintain safety valves for those in mostly at risk - Solutions are at individual holistic approach and understanding basis. Presentation will be based on case studies from both day centres and social housing programs
 

    

Deinstitutionalization. 
Author (s) Louise Christensen, social anthropologist. Copenhage  (DK)
Keywords; mental health, housing, social care, empowerment

 

Deinstitutionalization has been keyword in the psychiatric system in Denmark since the 1950’s but some institutions still remain and from a specific case in Denmark, it seems the process of deinstitutionalization need to be upheld continuously and that the process of deinstitutionalization not only is secured through closing large institutions but also a continuous effort in the social care.

On the basis of a study of the moving process from a sheltered residence (institution) for people with mental illness to their own home with social care several problems of deinstitutionalization can be highlighted.

In a municipality in a suburb to Copenhagen a large institution for people with mental illness is being closed. The institution comprised of 1-room apartments (some with toilet/bath) and a shared dining room, shared garden etc. After a political debate and demand for economic cutbacks the municipality decided to close the institution and instead make a so-called “living environment” with 11 houses where some of the mentally ill from the sheltered living institution could live. The caretakers approach and work with the residents was also changed.

The resident’s life in the new surroundings was evaluated by me circa half a year after they had moved to their own homes. The caretakers in the new living environment (most knew the residents from the former institution) and most of the residents were interviewed.

The study showed that residents experienced an increased standard of living and influence on their life. Most caretakers were surprised at how much residents actually managed on their own and some residents, whom the caretakers thought might not manage living on their own and would have to be moved back to a sheltered living institution, managed very well.

Besides a change in living environment, the caretakers expressed a need for a significant change in their work towards the residents in order to secure a proper deinstitutionalization. In order to enable the mentally ill to a life in their own home the caretakers tried to a larger extend to involve the residents in the daily chores and challenges in their life. The caretakers expressed a need to continuously remind themselves about not doing the daily routines for the residents but doing it with them and letting the residents decide when, and if, it was to be done. The social caretakers were used to a different work method and expressed the new work as a need to continuously “sit on their hands” in order not to direct the life of the residents.

All in all, the residents were grateful about having their own home, however some expressed a continuous need for the old institutions for certain residents, and residents and caretakers named new problems such as; loneliness, difficulties in adapting to the practical challenges in their own home after many years in an institution and problems in finding a balance between giving the residents the opportunity to live a life totally on their own conditions but also make sure that no residents were neglected in their homes.
 

 
    

 

Situation de M.D.T

Monsieur D.T, 56 ans, nous est signalé par la Police Municipale d’un village de la côte. Monsieur vit dans un tombeau depuis plusieurs mois.

Nous nous déplaçons dans un premier temps pour faire une évaluation et lui proposer s’il accepte un lieu un hébergement.

Un temps d’apprivoisement mais monsieur veut bien une structure si nous sommes présents. Nous lui expliquons notre travail et notre lien avec le CHRS, mais monsieur refuse.

Nous revenons une deuxième fois. M.D.T met plus d’un quart d’heure pour se « lever  et sortir de son tombeau ». Après un temps d’échange, nous lui proposons de rejoindre la collation chaude au sein d’une nouvelle structure sur Perpignan. Puis  nous lui proposons de visiter l’Hôtel Social. S’il souhaite être hébergé, il peut rester. Nous nous sommes également engagés à le ramener dans son tombeau, s’il le souhaitait ;

Pendant le trajet, monsieur nous raconte son parcours professionnel d’usineur de pièces. Il aimait son métier et a gravi les échelons. Un conflit familial important a conduit Monsieur à partir en errance. Il nous dit avoir beaucoup souffert et subit des trahisons. Nous arrivons sur le lieu de la collation, monsieur est accueilli chaleureusement, réticent au départ il passera plus de deux heures avec les accueillants. Nous lui proposons la visite de l’Hôtel social. Monsieur demande s’il peut se doucher. Il y restera un bon moment sous la douche, puis après avoir visité les lieux et la chambre, il nous demande de la raccompagner.

Nous remarquerons pendant le trajet de retour une grande fatigue. Tous ces déplacements, ce retour au monde, avaient été difficiles et quasi violents. Dans la voiture, il ne cessera de nous remercier de cette journée vécue. Il nous récitera des poèmes et entonnera quelques chants. Nous le déposons devant son tombeau et lui donnons rendez vous, la semaine d’après.

A ce jour, monsieur est toujours dans son tombeau mais la confiance s’établit et nous ne désespérons pas de son retour dans le monde des vivants !

Nous le revoyons régulièrement. Il sort de son tombeau et accepte de s’asseoir autour d’un café.

A ce jour notre amitié suffit, il nous demande de rester dans cette relation amicale. C’est le seul contrat qu’il nous propose. Nous le prenons. Nous avons compris que c’est dans ce respect que nous pouvons maintenir la relation.  Nous apprenons beaucoup de toutes ces observations auditives et visuelles qu’il mène depuis le tombeau et dans son cimetière.

Quelques pistes de réflexions :

La porte qui claque, lorsque ce monsieur rentre dans le tombeau portant le « nom de dieu », juron, protection du Ciel ?

D.T vivant enfermé dans un tombeau, que nous renvoie-t –il de nos propres vies de mort ou de vivant. Est-il vivant ou mort dans son illusion de la société. ?

Que pouvons- nous lui proposer : un retour dans la société, quoi, comment, pourquoi et pour quoi ?est ce la limite du tolérable pour nous travailleurs sociaux, soignants ?

 

 
    


CLINIQUE MODERNE LANGAGE SPATIAL TRANSFORMATION DU MENTAL             
Author : LECCIA JEAN,  PROF. ADJ. PSYCHIATRE    Email: jdl@jeando Leccia.com
Organisation :  Mc GILL UNIVERSITY MONTREAL HEX 4 E2 Qc CANADA

Clinique spatiale de l’itinérance  L’itinérant substitue au mot à mot de l’histoire son dangereux pas à pas aux limites de la survie. L’histoire de Suzanne une patiente itinérante va nous servir de modèle, pour proposer une approche géomentale de cette nouvelle réalité clinique.

Dans un premier temps l'évaluation de l’état mental du sujet va prendre en compte le niveau de sa désorganisation spatiale qui témoigne de l’ampleur de sa détresse et de son désarroi.

Dans un deuxième temps le choix thérapeutique va inclure un réapprentissage spatial du patient en utilisant nos accueils, et nos services comme des espaces intermédiaires de recomposition.

Enfin dans un troisième temps nous verrons comment l’itinérance est le symptôme de bouleversement spatiaux qui nous affecte tous même si certains son plus vulnérables Ce que nous souhaitons mettre à jour c'est l’actualité d’une lecture spatiale du mental, sur une planète mondialisée et en péril, qui génère de manières inédites de vivre et de penser, mais aussi de réagir et de souffrir

 

DAILY PRACTICES
07-03-2013
afternoon 1

    PRESENTATION OF DAILY PRACTICES

 

ROUND TABLE 1
DAILY PRACTICES and
20 Years of SMES-Europa
08-03-2013   morning 1

   Complement on Daily practices and  SMES-Europa  20 years after,
       with  intervention of  Alain Mercuel (FR) ; Preben Brandt (DK); Maria Fe  Bravo (ES) ;
       Patrizia Di Tolla (DE) ; Andrew Czarnisky  (PL); Antonio Bento  (PT) 

  https://www.dropbox.com/home#!/home   cf. 05-cnr_8-3-2013_mattina_1 (1).mp3

 

ROUND TABLE 2

EUROPEAN NET
08-03-2013

     SMES-Europa & European Organisations,  with Participation of :
          EUROPEAN  COMMISSION -Emploi ;  PICUM ;  FEANTSA;  CARITAS ;
          MHE_SME;  MHE-Presentation on SMES Conference.ppt

    https://www.dropbox.com/home#!/home   cf. 06-cnr_8-3-2013_mattina_2.mp3

 

CONCLUSIONS  &
PROPOSALS
08-03-2013

PRIORITIES RECOMMENDED

  • RESTORE HOPE : sustain hope with a realistic optimism; we really can innovate and change step after step

  • EXTREME SOCIAL & HEALTH PRECARIOUSNESS: this people abandoned in the street in severe and chronical precariousness conditions are permanent recall and denounce of structural failures of our society and of our democratie.

  • RIGHT – JUSTICE – FREEDOM : charitable assistance, emergency interventions plan (winter plans etc .) are the most useful aptitude & action for homeless people. To provide home is not one charitable gesture, it is one act of justice, an act of protection of a fundamental human right, the right to dignity and of a decent life.. (Nelson Mandela)

  • Prevention : primary and secondary is so important in order
    to have not lost time,

  • RESPONSIBILITIES o and co-responsibilities
    (social policy strategies and programs) Antinomy between:
    to share responsibility and dismission of responsibility,
    delegating “assistance” to private sectors.

  • Co-working at all level (public and private, health and social) and in pluridisciplinary way is  the garantie of success in all initiatives and projects in favour of  homeless people.

  • Attention to the permanent temptation of public authorities to remove subtly (raising the benches,  making it difficult to access ...) and/or forced way (with the patrols of so-called social assistence services ...) this obscene view from squares, from the gardens,  from places of high people concentration with with the excuse that disturb bystanders and businesses and the estetic of city centre.

  • ANSWER THE HOLISTIC / INTEGRATED and networking, are more likely to be effective in dealing with certain responses homeless people who otherwise would be considered as simply the rejection and refusal.

  • To address a special attention to workers in this field by organizing authority and the responsibles of services, especial with training and more adapted working conditions.

    Exchanges for mutual learning and for realise synergies in lobbying and advocay

 

 

N.B. :  in this   'https://www.dropbox.com/home#!/home'   web page  you can  find  all the audio of interventions  in Conference of Rome       

CONTACT :  SMES-Europa ,  Tel./fax : +32.2.5385887 - mob. +32.475634710
Mail :
smeseu@smes-europa.org 
    web : www.smes-europa.org