D-&-WB_profiles-2016

 
H O M E

 Dignity   and   Well-being

Profiles & Study Cases  for Inter-vision

2nd  W.S.  ATHENS 15 March 2016

 

 

When the solution of complex situations seems impossible:   how to listen  for a deepest  understanding  ? 
When the body speaks through his silence and his wounds:  
before intervening, who will listen and hear ?

 

  1. BACKGROUND and environment / context  of  profile of the person in relation to : the condition of ‘dignity’ and 'health' in which these people live.   What kind of interrelation between these dimensions: 
                  -   time
    , in relation to the chronic situation;                 -   abandonment, in relation to the breakdown of any relationship and link;
                  -   refusal
    , in relation to any institutional offer of care and assistance services?


1.  Mr.  Antonio
  Barcellona (SP)

64-year-old man from Galicia referred to our programme, by an ONG “ARRELS” in February 2007. They had been visiting him for years, with the suspicion, that he suffered from a mental disorder; They had only occasional contact due to the lack of engagement in any plans offered to him.               

Visited on a regular basis in the streets, were he could be seen wondering around a specific expensive shopping area in Barcelona. On occasion he was seen talking to himself, or smiling inappropriately  

He would wear odd and dirty clothes, giving him a very eccentric/extravagant  appearance. And with evidence of self neglect. He would only carry a couple of bags were he would keep his sleeping bags, and other clothes.

When approached he was collaborative, with a  warm affect, not elaborating on any subject. There was evidence of lack of initiative as well as motivation. There was no clear  positive psychotic symptomatology.

He had been in the streets for many years, more than 10, and he would feed on what people would give him, and what he found on the dust bins.

He was a well known character in the neighborhood, and people would give him money, and clothes on occasions.

It was known he had relatives that on one occasion some years ago, had come to take him but he refused.

He had also refused any services that were offered to him, like showers, accommodation, etc, but in the past he had contact with social services and had been in hostels.

Not a lot is known from his background , other than he had travelled  around the world and had ended up in Barcelona.

There was no evidence that he abused any drugs or alcohol.

He had a compulsory admission to hospital, with a very long stay, and later discharged to a residential home, but he left it and went back to the same streets of the same area he had always been.

 

  1. HEALTH: physical  and  psychic conditions.  All additional information on the health situation,  information about diagnostic  declared either a hypothesis diagnostic are very useful for discussion, evaluation and proposals.

He had a hospital admission in 2004, from which we don`t have any information other than he was diagnosed of Schizophrenia residual type.

He was compulsory admitted again to hospital in 2013, due to risk behaviors which involved sleeping in the pavement rear very busy streets , with the danger of being run over by the traffic, and to be able to conduct a thorough examination of his physical and mental state.

During his stay in hospital medication was initiated, with very little results, other than being slightly more responsive. There was also evidence of a certain degree of pre frontal cognitive deterioration associated with psychosis.

 

  1. INTERVENTIONS  description  :  presentation and evaluation of the difficulties, successes, failures.

What kind of intervention – in health + social field - success of non success depends of …;
Highlight the correlations between the objectives to be pursued, programmed interventions and outcomes...
–  Innovative practices
Admission to hospital, were he was examined, with results just described.
-  Admitted to a residential home , which he left after 1-2 months.
-  A process of incapacitation was discussed between the teams, but never concluded.

 

  1. WORKERS & NETWORK: what kind of collaboration between public and private sector?

What kind of multidisciplinary performing synergies between social, health services and... others?
What kind of co-working and co-responsibility between Institutions - Associations - Administrations?
There was coordination between a private ONG (Arrels),and social services from the council, as well as coordination with our mental health team.

 

  1. PROPOSALS: What proposals of possible and innovative interventions when the solution of complex situations seem impossible?

What pathways, what specific priorities could be taken for priority recommendations?
The need of a “case manager” or a figure that brings together all the different agencies, and is in charge the action plans are carried out.
-  A higher rate of contact with the person, when so resistant , maybe increasing the frequency of visits can have a successful outcome…

 


When the solution of complex situations seems impossible, how to intervene?

 

Fictitious name

  ANTONIO

Codex D&W:

Gender

M

F

male

Age

known:  64

hypothetic:

Permanence time on the streets (in months)

known:

hypothetic: more than 10 years

Permanence time on the shelters (in months)

known:

hypothetic:  unknown

Hygienic conditions

Acceptable

bad  

very bad

Health conditions 

acceptable 

bad 

very bad

diagnosis declared:    rectal prolapse

diagnosis hypothesized:

Mental Health Conditions

diagnosis declared: Residual Schizophrenia

diagnosis hypothesized:

Causes / factors of loss

housing: unknown, declines

health:

In charge of 

social services: ONG visits on regular basis/ social services thinking of disengaging

health services

mental health services : we continue visiting  him in the streets

Collaboration of people  

with a request:

collaborative

indifferent: he tolerates the company , and accepts having a coffee with us

oppositional:

Interventions   

net-working:  Mental health/ ONG / social services with regular meetings

individualists:

complementary: gets help from citizens from the area, shops..

occasional:

sustainable: mental health and the ONG

Pathways

alternative:

possible: being there on a regular basis ,to respond to any detected needs

 

 

 

 

 

 

 


 


2.  Mr.  X 
  of Midlands (IRL)
 

  1. BACKGROUND and environment / context  of  profile of the person in relation to : the condition of ‘dignity’ and 'health' in which these people live.   What kind of interrelation between these dimensions: 
                  -   time
    , in relation to the chronic situation;                 -   abandonment, in relation to the breakdown of any relationship and link;
                  -   refusal
    , in relation to any institutional offer of care and assistance services?

The Midlands Simon Community deliver services across four counties in Ireland, namely Laois, Longford, Offaly and Westmeath. It is a predominately rural area where the main towns have a population of 20,000 people. The region scores below the national Irish average on indicators such as gross disposal income and the numbers of people attending third level education. Yet, despite these indicators of poverty and social exclusion, the social networks and social supports are good; as to be expected in a rural community. However, homeless services are in the early stages of development and only 1.5% of the Irish Governments total spend on homelessness is given to homeless services in the Midlands. (This is the lowest amount of any region in the Midlands.)

 

  1. HEALTH:  physical  and  psychic conditions.  All additional information on the health situation,  information about diagnostic  declared either a hypothesis diagnostic are very useful for discussion, evaluation and proposals.

The person in this case study has a diagnosis of schizophrenia and is also addicted to heroin. Prior to being referred to the Midlands Simon Community he had numerous convictions and had spent time in prisons for repeat offenses. The people in the community would know him and his reputation for being involved in anti-social behaviour, which would mean that people would not want to engage with him. It was very difficult on his release from prison to get a Community Doctor (GP) to accept him into his practice. There was also a very long delay on his release from prison to get admission into addiction treatment and support services. 

 

  1. INTERVENTIONS  description  :  presentation and evaluation of the difficulties, successes, failures.
    What kind of intervention – in health + social field - success of non success depends of …;

Highlight the correlations between the objectives to be pursued, programmed interventions and outcomes...
Innovative practices

The first intervention was to admit the Service User (SU) into our emergency accommodation service.
This service consists of six emergency units of accommodation. The service responds to the crisis housing needs of service users and rough sleepers. Each SU has their own room and own bathroom. This allows us to engage with SU`s and offer a safe, homely and effective service. From here the SU was accepted into a community treatment programme. He progressed well and attained a considerable degree of stability. The SU spent 18 months in this service.

Then the SU moved into an apartment that was leased to him by our organisation. In doing so, our services were aiming to implement a “Housing First” intervention. The SU spent four months in this accommodation but at the end of the fourth month there was a relapse in his addiction. He committed a minor offence and because of his previous convictions he was returned to prison.

 

  1. WORKERS & NETWORK: what kind of collaboration between public and private sector?
    What kind of multidisciplinary performing synergies between social, health services and... others?
    what kind of co-working and co-responsibility between Institutions - Associations - Administrations?

Our service worked very hard to advocate for the SU to be admitted into a range of community services and there was resistance and a lack of consistency in their responses and interventions. In particular a lack of consistent and effective services from the mental health services and the addictions services. The response was not fast enough to prevent him from a full scale relapse into his addiction. The mental health services had no community aspect to their intervention and it only consisted of dispensing his depot injection once a fortnight in their centre.

 

  1. PROPOSALS: What proposals of possible and innovative interventions when the solution of complex situations seem impossible?   What pathways, what specific priorities could be taken for priority recommendations?

The Midlands Simon Community believes that if the state fully funded a “Housing First” team who could implement intensive case management; where  there was  resources to provide a suite of addiction, mental health, housing and other supports, this SU would still be in his own home. This would be better for the SU in terms of quality of life but it would also be more cost effective. The cost of keeping one prisoner in prison for a year in Ireland is €68,959 (Source: Irish Penal Reform Trust 2013). The Midlands Simon Community estimates that a fully functioning Housing First team with all the necessary disciplines in that team would cost €15,000 a year. So from a value for money and/or a quality of life perspective a “Housing First” funded intervention would make a significant difference.
 

 

Fictitious name

Michael Thomas

Codex D&W:

Gender

M

F

Male

Age

known:  40

hypothetic:

Permanence time on the streets (in months)

known:  2-3 years

hypothetic:

Permanence time on the shelters (in months)

known:

hypothetic:

Hygienic conditions

Acceptable

bad

very bad

Health conditions 

acceptable 

bad 

very bad

diagnosis declared:  Addiction to Heroin

diagnosis hypothesized:

Mental Health Conditions

diagnosis declared: Schizophrenia

diagnosis hypothesized:

Causes / factors of loss

housing: Repeat public order offences

health: non payment of rent

In charge of 

social services:

health services

mental health services

Collaboration of people  

with a request: Yes willing to engage

collaborative

indifferent:

oppositional:

Interventions   

net-working: 

individualists:

complementary:

occasional:

sustainable:

Pathways

alternative:  A Fully Funded “Housing First” team could meet his needs

possible: 

 


 

 


3.  Mr.  K 
 
64  age  -  Athens. (GR)
 

  1. BACKGROUND and environment / context  of  profile of the person in relation to : the condition of ‘dignity’ and 'health' in which these people live.   What kind of interrelation between these dimensions: 
                  -   time
    , in relation to the chronic situation;                 -   abandonment, in relation to the breakdown of any relationship and link;
                  -   refusal
    , in relation to any institutional offer of care and assistance services?

Mr. Κ is 64 years old male who was born and raised in Athens. During our first meeting he mentioned that he was living in a room at the basement of a block of flats. The condition of his room was bad since he was lacking the basics, such as electric supply  and heating. In his effort to make his living condition better he was forced to reconnect irregularly by himself the electric supply. Concerning his nourishment, he was getting his food from the church and constantly trying to get information about the daily rations of the municipality of Athens. In addition to the above, he was receiving daily phone calls from several banks concerning his loans, which ended up in a very serious threat for the foreclosure of his house. As a result there were many days that he was staying at home having no place to go.

As Mr. X is saying “I have never been in this situation before, i don’ t know how to live like that.”

A few words about his background:

 He has graduated from high school, he got married and became a father  of a daughter while he was working in a publishing house. Later on he became involved in a trading business as he was the owner of a small paper company. He was in a good financial condition  enjoying the general prosperity of the Greek society during the 80s and the 90s. From 2010 and onwards in accordance with the general socioeconomic crisis his personal story of loss has just began. At the same time his second wife and his sister passed away due to a serious form of cancer (his was also a widower from his first wife).  At that moment his business is starting to have serious losses. A little later his small business shuts down permanently and Mr. K is losing all the feedback that maintain his sense of identity. Now he is being tested by two serious losses having absolutely no income to support himself. This is the first time that he refers to the network of social services. The matter of survival is coming forward for the first time and this particular fact leads him to despair. When i questioned him about his relationship with his daughter, the only bond that seems to be present in his life and whether she is supportive, he answers the following: “I don’ t want to ask anything from her, i don’ t want to be a burden for her although she is scolding me”

 

  1. HEALTH:  physical  and  psychic conditions.  All additional information on the health situation,  information about diagnostic  declared either a hypothesis diagnostic are very useful for discussion, evaluation and proposals.

At this point Mr. K  is committing his first attempt of suicide. He is being hospitalized in psychiatric clinic for 45 days under the diagnosis of depressive disorder. His anti-depressive medication  has positive results but his recovery has many fluctuations which ended to a second suicidal attempt.
 


  1. INTERVENTIONS  description  :  presentation and evaluation of the difficulties, successes, failures.
    What kind of intervention – in health + social field - success of non success depends of …;
    Highlight the correlations between the objectives to be pursued, programmed interventions and outcomes...

    Innovative practices

During his hospitalization Mr. K. manages to maintain a strong bond of trust with his psychiatrist at the public hospital which seemed to function in a very positive way for him keeping  him away from his suicidal tendency.

Mr K. visited the Community Daycenter of Mental Health in order to start psychotherapeutic sessions and to enter a psychotherapeutic group. At the same time he visited the job counselling service of the Hellenic Community of psychosocial rehabilitation and employment reinstatement for people with mental health disorders in order to be trained in certain tools that would make him more effective in the job seeking process. All the above interventions seemed ineffective since they offer no answer to his basic need and request. After a short period of time Mr. K abandoned his effort stating that: “I went there three times, they are good people but i left because they couldn’ t offer me anything”.

Soon it became clear that the basic need of Mr. K was to become productive in the social environment, to form again a social identity and through his work to regain his autonomy outside of the mental health sector. Up to the point that our interventions targeted to the fulfilment of the basic needs of his survival, the efforts of Mr. K would end up meaningless. At this point we thought that it would be a very fruitful idea to enrol Mr. K to Housing and Rehabilitation Program. The structure of the particular program is targeting homeless people and has to do not only with a financial support for the housing but also the funding of employers in order to hire the participants of the program. Precisely, our  intervention was aiming to Mr K employment reinstatement through the Social Cooperative of limited liability of the Association of Social Psychiatry and Mental health in the city of Amfissa. The transition of Mr. K from one city to the other was a factor that we had to take under serious consideration.
 


  1. WORKERS & NETWORK: what kind of collaboration between public and private sector?
    What kind of multidisciplinary performing synergies between social, health services and... others?
    what kind of co-working and co-responsibility between Institutions - Associations - Administrations?

The particular intervention became feasible through the cooperation of the Social Cooperative of limited liability of the Association of Social Psychiatry and Mental health which hired Mr. K, the Day Centre for Homeless people of NGO Praksis, which implements the particular program  and the National Institute of Human Resources which is a part of the Ministry of Employment (public sector). The whole fund comes from the Ministry of Employment by using the tax surplus of the year 2013 that the Greek government used for the relief of the homeless people.

The cooperation between the  Day Centre for Homeless people of NGO Praksis with the Social Cooperative of limited liability of the Association of Social Psychiatry and Mental health is very important since the reinstatement of Mr. K in the labour market  became possible through the facilitation of a therapeutic structure. The form of the particular employment reinstatement manages to overcome many of the limitations such as age, high unemployment rate and the frustrations that Mr. K would possibly experience once again.

Concerning Mr. K employment reinstatement, he  was hired in September of the previous year. The helping stuff of  the Association of Social Psychiatry and Mental health was very supportive and helped him in an emotional and practical (coverage of practical needs for his new apartment) way in order to make his transition. At the beginning Mr. K faced a lot of difficulties regarding his incorporation to the social life of his new city. Although, in his working environment he was very willing to learn anything new that comes up and offer his knowledge in order to accomplish more tasks and help his co-workers. His professional experience which was related with the field of trading was very important and useful. From the perspective of  the Social Cooperative of limited liability the continuity of the cooperation with Mr. K is of a great importance and for that reason we are more than willing to find a formula for Mr. K in order to become a permanent member of the Social Cooperative of limited liability.


  1. PROPOSALS: What proposals of possible and innovative interventions when the solution of complex situations seem impossible?  What pathways, what specific priorities could be taken for priority recommendations?

Complex situations require person centered interventions that do not pose a particular methodology that could be followed in all cases. Solutions are hard to find, however the priority should always be the high lightening of subjectivity and the hard effort from our side in order to facilitate on the recreation of each person’s social identity.

Our intervention was based on the above approach which has to do with the job placement through a therapeutic establishment that would help him to feel productive and a member of the social whole, a situation that seemed to be the core answer to his personal need.

 

 

Fictitious name

Mr. K

Codex D&W:

Gender

ü  M

F

 

Age

known: 64

hypothetic:

Permanence time on the streets (in months)

known:

hypothetic:

Permanence time on the shelters (in months)

known:

hypothetic:

Hygienic conditions

ü  Acceptable 

bad 

very bad

Health conditions 

ü  acceptable 

bad 

very bad

diagnosis declared:

diagnosis hypothesized:

Mental Health Conditions

diagnosis declared:  Major Depressive Disorder

diagnosis hypothesized:

Causes / factors of loss

housing:  Bankruptcy of his business company/ loans in many banks

health: loss of his wife and sister

In charge of 

social services: Day Centre for homeless people NGO Praksis

health services :

mental health services: Aiginitio Psychiatric Clinic

Collaboration of people  

with a request:

Collaborative: Social Cooperative of limited liability

indifferent: family and friend relationships

oppositional: lack of funding- financial crisis / Community of Amfissa

Interventions   

net-working:  Day Centre for homeless people NGO Praksis & Social Cooperative of limited liability of the Association of Social Psychiatry and Mental health

individualists: Psychiatrist in the public Psychiatric Clinic

complementary:

occasional: Community Daycenter of Mental Health & Job Counselling service of the Hellenic Community of psychosocial rehabilitation and employment reinstatement for people with mental health disorders

sustainable: Therapist of  the Association of Social Psychiatry and Mental health who facilitate his adjustment in the new environment.

Pathways

alternative: disability benefit

possible:  frequent relapses and long term hospitalization

 


 

 

4.  GEORGI  ST  man 61  age  - Caritas  Burgas  (BG)
 

  1. Background and environment

Georgi  is 61  years old.  He is homeless for around 15 years.   Georgi has white  hair and beard and looks like Santa Claus. Its hair is full with leeches. No matter which period from the year is, he always is clothed with many  jackets and coats. Every day he can be seen on the biggest market in the city. George always carries his entire baggage with itself.  Often he can be heard to speak to himself and doesn’t communicate with strangers. Every day he consumes large amount of alcohol. Then he becomes aggressive, curses and shouts. He collects old iron from the trash and so gains some funds He has been married but his wife has died twenty years ago. He lost the family home after her death. Our mobile team met him three years ago in distributing (sharing) of the food for homeless people.

  1. Health

He has diagnosis schizophrenia but there isn't data that he has  been hospitalized. When he has lived with his wife, she supported him to accept medicines and to visit psychiatrist. He disturbs sacred treatment, starts to live on the street and to drink much alcohol after her death. By the first meeting with our mobile team, we observed psychotic symtomps.  For his behavior, they do not accept him in the municipal shelter.

  1. Intervention

The main difficulty of the intervention  were being for us to induce him to be cooperative. Every day he was coming  to our  minivan  and was only consuming his food. He did not want other contact with us. After few weeks he took from us clean clothes and that was the first step. The second step was to come to our center and to took a shower. We succeeded to persuade it that him is fine he is being checked by a psychiatrist. So he was accepted in a center for a mental health and cured for one month. He had not been drinking alcohol at the time of his stay. After his releasment  the diagnose was changed – schizophrenia and personality disorder. It was recommended to visit regulary psychiatrist who to give him in the beginning free medicines.

 

  1. Workers and network

With the cooperation by the multicipal social  services and the psychiatric hospital, Georgi was accepted in a shelter, where he becomes social and psychological assistance.

 

 

 


 
VASILE 

 

1.   Rumenia à Italy à Rumenia


Vasile is a young man, who came in Italy roughly five years ago and, since three years, settled down in the northern banlieu of Rome, using mainly gestures to communicate with people in the neighborhood.

We know that once he has been married and has a son that is now fifteen years old; Vasile has previously  been in Turkey, where he worked as a baker and, later in our country, he worked as a laborer.

For what concerne his health’s condition, he was perhaps hospitalized in Romania, for mental health problems, where his medical records registered the abuse of heavy neuroleptic drugs. Three years ago, he was hospitalized for a TBC problem, in Rome.

The most critical issue that brought this case to the attention of our interdisciplinary team for “homeless”, was his stubborn silence and the complete rejection of any kind of concrete help, once that he became unable to handle his daily life, due to a severe alcoholic addicition and an occured inability in walking.

As Vasile persistently refused to be hospitalized and because of the insufferance of the inhabitants of the area, our team decided to intervene with a mandatory sanitary treatment in the psychiatric department of S. Filippo Neri Hospital in Rome.

After a week, Vasile was transferred in a Psychiatric Clinic, where his psychiatric, motoric and internal conditions have been rehabilitated.

 

2.   EPILOGUE

 Since a couple of months Vasile is back, among his family in Romania. The way back has been very difficult, due to the snow clad roads that lead in his village between the mountains, in the eastern area of Romania, called Vrancea,  a very poor country, between Bucarest and Bacau.

While hospitalized, it was possible to get him in touch with the family, the mother and some sisters, who invited him to go back home.

Because of his physical and psychological improvement and due to the fact that he reached the time limit  to be hosted in the Clinic (two months), Vasile was going to be dismissed, with a high risk to go back in the street, drinking.

Our team, composed of the Social Operating Room – S.O.S – of the Municipality of Rome, some Volounteers Associations and the Public Mental Health Service, stressed Vasile’s decision to go back in Romania.

The Social Operating Room together with the Romanian Consulate, payed for his flight ticket, but nobody guaranteed the accompaniment on board and from the airport to his village, which is at three hours by car.

Therefore a lady, who took care as a volounteer of Vasile since when he was in the street, accompained him the way home, at her own expense, bringing to the family some money that we collected, as a gift from the Italian experience. After a three days journey, once back, this lady described the  very poor life conditions in which Vasile’s family goes through.

The welcome at home was not very warm, some sisters blamed our volounteer for her initiative to accompany Vasile back home, whereas the mother with a daughter and a son in law, were glad to reacquire him.

Once back from Romania, this lady remained in touch with Vasile and his family. Vasile met his fifteen years old son, that he didn’t see since years, and, up to now, he neither has started drinking again, nor attempted to return in Italy; nevertheless he’s very much depressed, presenting some suicidal thoughts, maybe because of his withdrawal symptom and his return in Romania.

The volounteer lady, that still remains in a daily touch with this family, feels very guilty and responsible for the matter, she sent some money to them and she urges the whole group to participate in collecting money, medicines and food to be brought in Romania.

We, as a team, are all envolved in supporting this lady, who feels now very angry for her agreement and cooperation to this project; we are trying to protect her from excessive identification with Vasile’s condition and to make her accept the limits of any sanitary or social intervention, wheras the responsability for life choices, still remains under the patient jurisdiction.

 

3.   KEY POINTS

 SOCIAL ASSISTANCE

Italian Public Insititutions  intervene only for the expulsion from Italy, they do not rehab patients in order to make the reentry in their own country more gradual.

·     It is not foreseen any entourage on board or at home;

·     It has been impossible to get in touch with any social service in Romania, to give an assistance to our patient, once he arrived in his country (not even SMES could get in touch with any helping institution in Romania).

 MENTAL HEALTH

 Once the time limit of two months of hospitalization in our psychiatric clinic has been reached, the patient may only go back in his country or in the street; the social services may intervene only on patient’s request;

·      There are no funds to organize any project of recovery and return in the country of origin;

·      In our country, whatever follows the discharge of a homeless, does not refer to any welfare and health program: any personal assistance  and care is on charge of the volounteers’ associations, that don’t have any available or dedicate public funds.

 CITIZENSHIP PARTICIPATION

 Volounteers’ participation can be extremely risky, as in this case, due to a overwhelming deep emotional involvement.

If unprotected, the volounteers may feel the entire responsabilty of the project and may refuse the limits of the intervention, considering themselfes guilty about negative outcomes.

Actually, we always registered that, with different intensity,  an exaggerate involvement of the volounteers in cases’ handling, occurs.

At the very beginning, this may be useful in order to keep the case in our mind and in our agenda. However, in the long term, if the team doesn’t support these persons, they may personally incur severe depressive disorders.

In a kind of almighty feeling, they may concretely impede  that the patient may follow his way and destiny.

According with our experience, the presence of a large working team avoid that these volounteers may fall into a condition of deep emotional and concrete isolation.

 

  


 

An interdisciplinary approach on Human Rights in Mental Health

 

Renia Pournara

Attorney at Law, MfA - Member of the Hellenic League for Human Rights -

Advocate at the Hellenic Advocacy Office in Mental Health

________________________________________


Mental Health is an extremely wide term and often a misinterpreted one. The wide range of the term covers mental health problems of various degrees of severity, from stress and panic attacks, to diagnosed psychiatric illnesses. And this is not only a methodological clarification, but also an important breaking down of the myth which relates mental health only to psychiatric cases.

Mental Health and its extreme, mental illness, are not detached from the sociopolitic and economic factors of our societies. In the contrary, they are closely related to them, affected by them and growing into them.

Our western societies currently experience the most significant example of the above connection: economic crisis, political and social destabilization, human isolation are only some of the factors which push the most vulnerable groups of people to their edges. And homeless population is one of the first to experience this violence.

According to researches taking place in Europe between 1970-2006, mental health problems were appearing to unemployed people in the percentage of 34%, while at the same time employed people were appearing mental health problems in a percentage of 16%. The same researches revealed that for every 1% of unemployment’s increase there was 0,8% increase of suicides at the ages under 65 years old.

Numbers are tough, as it is reality itself. Homeless population is by definition a vulnerable population, an isolated one and a most easily exposed to mental health problems, due to its circumstances of living and its social and economic state into society. Working in the Hellenic Advocacy Office in Mental Health, where law and clinic scientists we came together for the first time in order to promote and secure human rights in mental health in Greek reality, we came across different and perplexed situations of people with mental health problems belonging to different social classes. Of course, homeless people were among them.

During the operation of the Hellenic Advocacy Office, we had the opportunity to get in touch and cooperate with the organization of the Greek Street Journal of the Homeless “SHEDIA”. It was one of our partners’ organization, through which we came into contact with homeless people working for the Journal “SHEDIA” and we had the opportunity to inform them about the advocacy services and most of all, about the Human Rights, their meaning and essence.

Human rights have no differentiation between people. Mental health is just a field where human rights are specified only to emphasize the need of protecting the people who are more likely to experience violation of their enacted rights.

To this extend, our human rights which are undoubtly recognized to homeless people as well as to all of us, are indicatively:  The right of personal freedom, the right of personality, the right of work and social insurance, the right of a dignified life, the right of a proper and suitable treatment, the right of judicial protection.

 

Case Study: Through our cooperation with the Street Journal “SHEDIA”, some of the homeless employees used the services of the Hellenic Advocacy Office. Miss K. was one of them. Miss K. lost her job 5 years ago, and as a consequence she also lost her house, her property and every material belonging she owned. She is currently occupied by selling the street journal “SHEDIA”. Miss K. had taken a 20.000 euros loan from a bank while she was diagnosed with psychotic syndrome and she came to the Advocacy Office in order to find a proper regulation to her paying back problem.

After we explained her the legal status for the poor citizens in Greece who cannot pay back loans up to 20.000 euros and the possibility to succeed judicial cancelation of their debt according to the Greek Law 3869/2010, we advised her to use the Legal Aid service of the Greek Legal Associations, which offers free legal support to poor citizens, in order to succeed the judicial abolishment of her debt. We also proposed that she should follow a therapeutic monitoring at a specified Mental Health Centre. Miss K. followed our advice and her case is currently leading to an extrication.

The offered services to miss K. were interdisciplinary: we offered legal information, advice and guidance, as well as clinic reference aiming at a holistic dealing of her case. According to this, the final aim of our advocacy services is getting into shape: this shape is nothing else but the passage from advocacy to self-advocacy, from paternalism to effective treatment and social reintegration, from isolation to connection.

Because homeless people are not only the result of socioeconomic crises. They are just a symptom of our intolerant societies, who are gradually losing a collective point of reference and resistance. And this is the target that us, the people who work in mental health or relative social/humanitarian fields, we should aim at first. In order to redefine the main problematic of human rights: from the claiming to the self-evident of human rights.

 


 

Some ideas taken from the profiles

 

In reference to the Warsaw conference, (Oct 15) a lot of ideas and questions about how we work were expressed, and many similarities about the people we see, were discussed.

I would like to underline some issues, which I think appear in our day-to-day practice, and were reflected in some of the profiles.

In order to do this, I will propose them in the form of questions or short phrases, divided in areas.                   

 

1.      Profile similarities.

From the profiles described during the Warsaw workshop, it was clear, that there were a lot of similarity between them. These could be summarized in challenges that we are faced with such as:

-          Long-term homelessness.

-          Difficulties in engagement.

-          Refusal of care plans and services.

-          Social / police/ public alarm.

-          Difficulties in obtaining background information, personal/ medical/ etc…

-          Use of public space.

-          Difficulties in carrying out proper medical examinations when required.

 

2.      Interventions.

Constantly we are faced with difficulties in our daily work, and the resources that we have to offer, as well as how we “do things”. Here are some examples to think about:

-          Compulsory admissions into hospital (with defined protocols)

-          Frequency of visits.

-          Service provisions, service accessibility, what can we offer; a place to eat, shower, sleep….

-          Setting of the interventions, in the street, in the office, in the hostels…

 

3.      Workers and network.

All of our actions are carried out by people, professionals (being our main investment) and how we organize ourselves is a key issue, especially regarding action plans, and areas of organizational structure, here are some points that would need some reflection.

-          Team members: nurse, psychiatrist, social worker psychologist….???

-          The figure of a  case manager

-          Multidisciplinary /multiagency teams (teams with different service providers).

-          Need for consensus between different agents (main actors), including local police and neighbour associations, were formal coordination with joint care plans can be discussed.

  

4.      Ethical issues.

This is a very important point that should always be taken into account, especially due to fact, that this vulnerable population has been destituted of many basic rights. Here are some examples of special situations: 

-    People’s right to refuse treatment.

-    When do we carry out a compulsory admission?

-    How much time do we leave the person without psychiatric treatment?

-    If unwell, but stabilized and without evidence of suffering do we intervene??

As we see from the points I have mentioned briefly, there are several areas, and aspects, that are well worth looking at and that are of crucial importance when working with people living in the streets, with a severe mental illness,

Victor Soto

Parc Sanitari Sant Joan de Deu

  

SMES-Europa - Secretary Tel.  (+) 32.2.5385887 -  mob; +32.475634710  -   E-mail: smeseu@smes-europa.org