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 people’s 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 other’s 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
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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 staff’s 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. |