H O M E
MANUAL GOOD PRACTICES
Promoting Dignity and Wellbeing to
Homeless People with Mental Illness

   Manual good practices:    EN              PL             IT            SP             GR          PT        DK            FR


        SOCIAL Image associée       HEALTH Image associée       H O U S I N G Image associée      NET-WORKING Image associée       O U T R E A C H  Image associée       R E C O V E R Y Image associée      STAFF CARE Image associée      TECHNICAL FILE


Introduction

 Working with people in a situation of homelessness and mental illness is a demanding job for which no one is well prepared from the start. The multiple issues involved (health, social, housing, recovery, outreach, networking, staff care) make it difficult for a single professional, discipline or service to be prepared for all the challenges and needs at stake. It is very common that professionals starting to work with this population are confronted with their limits and feel the need to go beyond their usual ways and knowledge, developing new skills to become more attentive to peoples special needs and more able to network with others.

A recurrent observation is that what one has learned from regular university and professional curriculum is not enough to face the challenges of the work with this population.

Learning from experience, learning from others experiences, developing a reflective practice that searches for adaptive solutions for unique contexts, rather than copy readymade solutions, is of the utmost importance in this field.

This workbook aims at helping professionals to develop skills to better approach the person in need,  proving a context where future professionals may become more aware of the challenges and dimensions as well as the sound principles of practice when one works with people in the situation of homelessness and mental illness.

Practical approaches to working with homeless people with mental health problems is the result of a three-year project (2017-19) financed by Erasmus+ 

At the origin of this project lies a previous project of SMES-Europa called Dignity and Well-Being  during 2015-16, which promoted workshops where professionals from different countries could meet to discuss case profiles focused on  homeless mentally ill living in poor condition and seeming to refuse help, as well to visit services and share practices and methodologies.  Three workshops took place, in Warsaw, Athens and Copenhagen, after which a qualitative analysis of more than 50 profiles was done and turned into a publication about typical pathways on homelessness and intervention (Fabio Bracci, 2017; SMES-Europa in collaboration with Fondazione Istituto Andrea Devoto).

The Erasmus + project Dignity and Well-Being- exchange for changing used the same methodology developed by SMES-Europa (discussion of case profiles and visit to services)  to achieve  a new aim: the development of a training curriculum and a workbook that could  be useful for the training of future professionals working with homeless people with mental health issues.

The kick-off meeting of the project was held on the 9-10 December 2016, in Brussels. It was time to plan and look into how to reach the goals of the project.

The first workshop was held in Lisbon, on 14-18 March 2017. It was an opportunity for the group to start thinking together about how to give reality to this project. While keeping with the methodology of visits and case profile discussions, we added a new dimension. Each person was asked to reflect on what kind of knowledge and skills they found were in deficit when they began working with the homeless, and what did they learn new in this field. A group discussion was promoted, and an analysis was done to the answers that came up individually and in group.

 At the same time, it was an opportunity to visit many services in Lisbon and to learn how they are currently organised and coordinated under NPISA, a recently created unit for the planning and intervention with homelessness. A SMES conference was held in the last two days of the workshop, bringing together participants from 15 different countries.  The lectures and workshops were focused on the Social, Health, Housing and Employment&Rehabilitation services.

The next workshop was held in Ireland on 25-29 October 2017. The first half of the week took place in Dublin and the second half in Athlone. It gave us an opportunity to visit homeless services in a major city and in a rural area, as well as the chance to listen to a wide range of experts and people with responsibility at the administrative and political level.

Besides the case profile discussions, this workshop also promoted a brainstorm about what are the dimensions considered essential and unavoidable when working with homelessness and mental health. The result was a scheme that guided us through the rest of the project, and that is substantiated in the seven chapters of this workbook: social, health, housing, recovery, outreach, networking and staff care. Once this scheme was established the group was able to start working on the first drafts.

A midterm evaluating meeting was held in Florence, 19-20 February 2018. There we had the opportunity to listen to field experts and academics who helped us to look in a more critical way to our aims and the developing work. In the workshops the group worked towards a more definite sense of what were the critical contents to cover in each section, and this helped to structure and further elaborate a second draft

The next workshop was held in Athens on 7-12 May 2018. There we had the opportunity to visit several key services of Athens and organise an open discussion bringing together service users, stakeholders, local authorities and State representatives concerning the policies and everyday practices regarding homeless people and special groups among them, i.e. refugees and homeless people with mental health problems.

It was also the opportunity to look at the documents produced so far and to establish a common structure to be used in each chapter. Workshops were dedicated for each topic (seven in total), and within each workshop, a topic was discussed in two subgroups. The results of these discussions generated a document for each sub-group, then synthesised in one paper.

The last workshop was held in Barcelona between 22-26 October 2018. Again, we had the opportunity to visit several services to homeless on the city, to listen and exchange with local experts and also with experts by experience.

It was furthermore the time to collect feedback and discuss together the documents that had been produced so far and that were coming close to the final form.

The final evaluation meeting of the project was held in Brussels, 7-9 March 2019. It was the chance to go over all the things that happened during this project and to look at the intellectual outputs that came from it.

The time to present the outcomes of this project, the Training Curriculum and Workbook, was the 9th of May, 2019, in Warsaw.

It must be said that all workshops were moments of intensive work and an opportunity to invite local experts, local administrators and policymakers, reinforcing the local as well as the european net.

Besides, a lot of work has been done between workshops, at home. Sub-groups were formed for each topic, and a lot of exchanges, back and forward, took place within subgroups, between subgroups and editor and within the total group, making it a very collective work.

The description of how the project developed is necessary to make clear the process that generated this workbook. It represents the distillation of many visits, exchanges, group discussions, individual work and the accumulated experience of the partners.  All of these have been working with the homeless for many years and come from a wide range of professional backgrounds and organisational cultures. Besides, there is the heterogeneity of a group that comes from 8 different countries.

This heterogeneity contributed to a richness of points of view that helped to shape the dynamics and the process of the group working together. Although you can find in this workbook a multiplicity of perspectives and points of view, there is an underlying coherence and unity that is the result of a three-year journey as a group, whose members came to understand and appreciate their differences but also the common ground of values and experiences that unites them. 

This workbook provides seven sections that we could describe as dedicated to four pillars and three beams that hold together the building of a coherent intervention in homelessness:

1.      Social

2.      Health

3.      Housing

4.      Recovery

5.      Outreach

6.      Networking

7.      Staff care

These four pillars are the social, health, housing and recovery aspects involved when working with homelessness towards their dignity and well-being, and the three beams are outreach, networking and staff care that permeate and connect all those aspects.

In each section, you will find an introduction to the theme, the main ideas and concepts, expected difficulties, good practices and a study case or case profile that highlights the issues described. You will also find a glossary and bibliography.

The first section deals with the social aspects since homelessness inserts itself in the social fabric of communities and networks of social relations. Since social factors are as much part of the problem as the solution, this chapter will provide a context for a reflection about the role of social factors, social protection and social work related to homelessness.

Health and mental health needs demand to be addressed when one works with homeless people. So, the second section is dedicated to the challenges that severe health and mental health difficulties pose to intervention. This chapter will help to learn about the role of health interventions in the street, emergency services, hospital admission and discharge, compulsory admissions and good practices of health care to the homeless.

The third section deals with the subject of housing, a crucial aspect in homelessness. This chapter will enable to learn about the importance of housing and the establishment of a home, working from a perspective of housing as a right, the role of emergency and long-term housing and the sound principles of working in housing.

The fourth section is dedicated to the process of recovery. It will help to clarify the specificity of recovery as distinct from treatment, its difficulties and how to manage them, the role of professionals and the good principles of practice that foster recovery.

Intervention in homelessness has generated multiple forms of outreach work that stand as a hallmark of work with this population. The fifth section will focus on outreach practices and will provide a context to learn about outreach as an attentive and respectful attitude, service and model of work, about the phases and professional roles in street outreach, as well as the sound principles of outreach practice.

Working with the homeless requires networking, and the sixth section is dedicated to this subject.  It will help to raise awareness of the importance of networking as a multi-layered approach with structural and operative levels. It will also help to learn about how to build and sustain a network, how to prevent difficulties and to identify good principles of practice in networking.

Finally, it must be said that working with homeless puts professionals in contact with intense forms of human suffering, stigma and inequalities that may affect staffs well- being and ways of working. Thus, the seventh section is dedicated to staff care and training, how to prevent burnout, and how to foster healthier forms of team culture and functioning.

The contents here presented do reflect a journey which has been a great learning experience for those who participated in it, and we only wish that it can be replicated and touch other people in the same way that it did the authors.

        

SMES-Europa      -      Secretary   Tel.  +32.475634710       -        E-mail:     smeseu@smes-europa.org