Midterm ERASMUS+ Evaluation Meeting

DIGNITY & WELL-BEING: Exchange for changing

Florence   20 / 02 / 2018   




2.   HEALTH / MENTAL H.    Workshop Tuesday 20/2/2018       Facilitator : Philip TIMMS



1.    Why is mental health a pillar? 

Because a wide range of mental disorders is present in the homeless populations at much higher levels than found in domiciled populations. While disorders such as psychosis, multiple trauma and addictions can commonly cause homelessness others (such as depression and anxiety) seem to be a response to homelessness.


2.    What is the role of mental health interventions?

To collaborate with outreach and support workers as required.


3.    What are the tasks of mental health workers?

         To establish a trusting, helpful relationship with the homeless person

         To address their immediate physical and social needs

         To address any mental health issues.


Specific rights on mental health 

To ensure that the individual has the right to appropriate treatments supports and therapies, even if a mental disorder has compromised their ability to make an informed choice.



It goes without saying that mental health workers participate in any helping networks. The essential thing is that all participants are seen as equals and able to have their views heard.



Going out to meet the client where they are, not expecting them to come to our service, whatever that may be.

Being prepared to be flexible about the number of times you see a client to establish a relationship / reach a diagnosis / make a comprehensive needs assessment.

Being aware of the power imbalance / social distance between the client and service provider

Consider what might be the short-term incentives for the client to be meeting with you .but try to start to formulate a longer-term plan

Establish partnership working with generic street outreach teams

Orient yourself to the clients priorities


Examples of good practice

1. Kiosk de Salud, Lisbon

A small kiosk, with a nurse present for most of the day, where anyone can walk in and have a simple check up. None of the sophistication or the barriers of the clinic.


2. Barcelona

Consultant/senior psychiatrist working on the street. Why a senior psychiatrist? People on the street will often have disorders that have been missed by mainstream services and will often have multiple problems both aspects make assessment more complex and demanding of expertise.


3. Lisbon

A large, open psychotherapy group for people with and without homelessness issues, held in the gymnasium of the mental hospital. Informed by analytical principles, non-directive, varies in size from 20 to 50. Participants can:

  • Feel supported - by hearing other peoples similar experiences, that they are not lone in their difficulties.
  • Learn some ways of coping from others accounts.
  • A sense of hope
  • A sense of inclusion and acceptance both by simply attending, and by having the opportunity to speak and to be listened to.
  • Gain a sense of trust in the service so that they feel more able to engage with services.
  • Gaining a different sense of persepctive on their problems


4. Rome

The way in which mandatory hospital admission is arranged for people on the street with a serious mental illness. After consultation with family , friends, social and supportive network and as part of a long-term plan.


5. London

Experts by experience ex-homeless people employed as user-advocates in an NGO concerned with improving hospital discharge for homeless people and, more generally, improving health services for marginalised and socially excluded groups.


Difficulties in this work

Over-involvement of the service-provider

Infantilisation of the client

Gaps in supportive services and provision

Defences against the demands of the job and the failings of other services paranoia about other services or a retreat into a bureaucratic obstructionism.


Good things about the work

 Highly motivated colleagues

Working in a team enables staff to share both the burdens and successes of the work

Service level agreements

Mutual training with a partner organisation




Staff Support

Opportunities to share feelings (formal or informal)

Informal or facilitated groups

Attention given to individuals professional development

Having the tools to do the job computers that work, phones that can run for a full day on 1 charge

Regular professional supervision

Relationship with team

Any emerging problems

Professional exchanges/ rotation between services.

Pair reflection after meetings with clients

Whole team working in the same room

Flattened team hierarchy so that everyone in the team feels that they can both speak and be heard.


Key Words


Mandatory hospitalisation

Trauma focussed treatment

Psychologically informed environments

Making and sustaining of collaborative relationships




SMES-Europa - Secretary 
  Tel. +32.2.5385887 -    mob. +32.475634710  -   smeseu@smes-europa.org