ATHENS   7 - 12  Mai 2018










  Mari 2


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:   
who will listen and hear before intervening?


    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: 
        constellations/relationships, nature of relationships)

-   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

MARI   31y old woman, known to our team since 2008, previously, described in one of our profiles in a workshop in Copenhagen in October  2016.

Removed from parental home at age 5, an lived in children’s care homes till she was placed in a foster family at age 12. After some years living years she was taken back to care homes due to serious conflicts with her foster mother, then moved to supported flats till age 18, when transferred to homeless team.

1- Pre HF  Once 18 and transferred to adult care, referred to homeless team due to her accommodation instability, failing to stay in shared flats for more than a few months, as well as briefly sleeping in the streets.

HF 2016- 2018

2 - PreHF Institutionalized from a young age, her relationships have been “professionalized” and not fully nurtured. Only contact kept with biological family is an uncle meeting on very brief occasions. On few occasions tried to regain contact with a foster mother, but she totally rejects getting in touch with her.( even contacting police when Mari called her).Mari considers the neglect by this foster mother as one of the  most traumatic factors in her live.

Very frail social relationships, and putting herself in risk very often.

HF During this period , looses her appointed SW ( due to change of programme, and during the period her case manager has a sick leave.

3 - PreHF  Always been offered care , that she has accepted, but has had difficulty in the follow up, due to lack of compliance with medication as well as difficulty in living independently.

HF Detreriorization of relationship with the health and social team. Approach is more complicated than in the past.


2.        HEALTH:  physical  and  psychic conditions.
    All additional information on the health situation,  information on hypothetic or declared diagnoses  including:
-  interaction between mental and physical condition; 
   (Comorbidity&mental heath, other health problems     -    Comorbidity &social disadvantage)
-  influence of the health condition on the lifestyle of a person;
-  history of interruptions and resumptions of medical services provided to the person,
-  orientation and opinions  of the medical  players  in respect to the person; 
-  interdependence of psychosocial distress in cases where two people of the same family circle are involved

1 - 2)  PreHFSince  a young age, visited by child and adolescent mental health team, by psychologist, and also on small doses of medication. Probably family history of schizophrenia and drug abuse. No evidence of any other medical condition. Smokes hashish on a social basis.

Diagnosed with Paranoid Schizophrenia

Due to her mental health illness, has great difficulties in adapting to certain settings, her voices and delusions when unwell make her believe, people in the streets are talking about her, hears voices through the walls, has difficulties in concentrating, and difficulties in containing her emotions. On occasions acting on these phenomena, and therefore causing disturbances on the flats she rents, such as braking furniture.

HF Increase in drug intake, and use of other types pf drugs, with an increase I her deterioration.


3) PreHF Whilst referred to our programme, never interrupted contact with us. On occasions would be missing for some weeks but never completely interrupted.

HF more irregular and difficult contact, also lost some of her social relationships

4) PreHF Has a very good engagement with all the professionals working with her.

HFPoor engament with HF team, and deterioration in her relationship with case manager.

5)Not the case


3.   INTERVENTIONS  description  :  presentation and evaluation of the history of interventions with their difficulties, successes, failures, including the circumstances of the person’s first contact with the organized assistance; clarification of the objectives of the intervention in its various stages; description, if needed,  of specific operational solutions; stating the reasons for compulsory sanitary treatment .
(circumstances giving rise to the first contact,clarification of interventions on various stages, compulsory treatment, reason!! Operational sollutions)

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

1),2)PreHF Referred to our team due to severe behavioral problems, and difficulties in the shared flats she was renting, becoming very suspicious with her flat mates, and braking furniture on occasions. Been admitted compulsory to hospital on several occasions, mostly due to periods were not taking the medication properly and increasing the abuse of hashish, and displaying all the symptoms described earlier. 

Referred to a case manager, to individualize her treatment plans.

Referred on several occasions to different professional training skills programme, but unsuccessful. On occasions, it was a need detected by professionals, but not her choice, and when her choice she would leave when  felt overwhelmed

An appointed social worker with a very good engagement

HF Been accepted to the housing first project, with new professionals working with her.  Had to leave previous SW.

Moved from several houses due to neighbor complaints about her disruptive behavior, braking furniture and shouting in the middle of the night, as well as slamming the doors. And in one occasion her flat was squatted.  During the time her flat was squatted the only option offered was to go to a shelter home, which she refused.

Difficult to follow up due to her unstable mental state and her chaotic way of living. There is always evidence of a degree of residual negative symptomatology present.

The objectives of the mental health team and the HF team were not allways in the same direction.

( perspectives of how to carry out her follow up, whilst in the housing first project, is slightly different between the mental health team, and the housing first team. The HFT  are carrying out a very paternalistic approach, in the way that for them the housing is not the aim, but the means to carry out a rehab scheme).

Currently been discharged from HF programme,  and waiting for a SW to be assigned.

Mari is currently in hospital



One or many actors?      -      Does the networking and cooperation between actors exist or not?
-   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?

What are the institutional and legal barriers and limitations to providing adequate assistance (cumbersome, poorly
     defined procedures, “vicious circles”; resources and financing).
-   What obstacles could be overcome by “creativity” of the operators in the face of the unhelpful of confusing legislation?

1)PreHF, Many actors involved , trying to work in a joint way

HF More actors and more difficulties in networking

2)PreHF The mental health team is from a service provider paid by the Catalan health department, ”, and the social worker is still from a different service provider paid, by the town hall.

HF The professionals from the housing fist team are from the same service provider as the mental health team,  but from a different “Branch”.

3)PreHF Joint meetings of SW mental health team an d mari predominantly in SS office, except case manager visiting at home or  in community. , and in these meetings agree on how we would distribute the different responsibilities between all the professionals, making sure that Mari had a saying in all of this. We agreed on the frequency of visits, and the tasks we had to carry out.

HF Same as before but predominantly at her flat or surroundings

4)PreHF  Co- responsibility between different agencies according to actions taken

HF Same as before.

5)PreHF When she lost a room in  a flat, social services would pay for a hostel, and on occasion that could give rise to economical problems , because lack of resources

HF When the house was occupied the programme did not contemplate an adequate response., leaving her un supported


   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?
Make the proposals as concrete as possible and  avoid generalities.

1) Rethink the follow up model, Team/individual follow up. When a team member is ¨¨of¨ another known team member con continue.

2) Revise housing first project, The procedures in the Housing first project (Barcelona) are not properly defined since it is a very new project, and some of the allocated professionals are nor experienced enough, all of this giving rise to on occasions doubling actions, poorly defined responsibilities, and badly addressed solution to problems that arise.
Wider  spectrum of solutions to concrete problems E.G when house is squatted, possibility of transferal to another location


Personal factors influencing the launching and continuation of assistance process:
        (stigma, prejudice,  orientation towards person,cultural aspects)

-  possible stigmatization of person taking charge or applying for assistance;
-  sources of stress and burn-out for assistance workers;
-  changes in staff during assistance process; clashing cultural aspects.

Among some of the professionals of HF Project there was evidence of judgmental opinions.

House being seen as a rehab instrument, that can be applied to overcome the needs assessed by the professional , rather than a right in the process of recovery and dignity.

Problems regarding changes of staff, were observed.



7.      Overall assessment of the case: strengths and weaknesses of the support net and/or
         interventions provided;

-  synthetic judgment: the person's condition has improved/worsened or remained unchanged?
    (in relation to the assumed objectives relevant ethical issues related to the work;
-   final thoughts, free. 

ERASMUS +    ANNEX II - KA2     Ag. Nb.:  2016-1-PT01-KA202-022970

SMES-Europa - Secretary   Tel. / fax: (+) 32.2.5385887 -    mob; +32.475634710       -   E-mail: