Nursing studies

The plight of those with no place to call home

A nursing student describes how working with a homeless healthcare charity opened her eyes to the difficulties faced by those with mental health issues who do not have proper shelter

A nursing student describes how working with a homeless healthcare charity opened her eyes to the difficulties faced by those with mental health issues who do not have proper shelter


Picture: iStock

In the first year of our mental health nursing degree we are asked to either research or work alongside an organisation we feel would enhance our nursing practice and provide us with experience in an area we may not necessarily be exposed to during clinical placements.

I decided to spend a week with Pathway, a homeless healthcare charity. Set up in 2009, the charity offers care and support to homeless people and rough sleepers who come into contact with the healthcare system.

According to research published last November by housing charity Shelter, at least 320,000 people are homeless in England, Wales and Scotland. Earlier this year, an investigation by the British Medical Association (BMA) found that the number of visits by homeless people to emergency departments (EDs) in England has more than trebled since 2011.

Most vulnerable and disadvantaged

Pathway helps hospitals to create multi-agency homeless healthcare teams that include a GP, specialist nurses, social workers, drug and alcohol teams and housing experts. Some hospitals also have Pathway care navigators – care co-ordinators who have experienced homelessness themselves.

To date the charity has supported 11 hospitals across the country – including in London, Manchester, Brighton and Leeds – helping more than 3,500 patients every year.

Homeless people are one of the most vulnerable and disadvantaged patient groups. When a homeless person arrives at the ED in need of medical attention, staff can notify the Pathway team based at the hospital. The team then support the individual, helping with their discharge and putting long-term care plans in place to help keep them off the streets and avoid the need for further hospital treatment.

What Pathway offers patients

The charity Pathway says it aims to transform health outcomes for homeless people. It offers support including:

  • Housing and benefits advice
  • Help to recover important documents such as birth certificates and passports
  • Links to community services
  • Support and collaboration with other clinicians such as advice on drug interactions
  • Complex care planning and discharge liaison
  • Referral for addictions support
  • Help with GP registration
  • Clothes, shoes and other basics, such as when these have been destroyed because of infection or infestation
  • Help to reconnect with loved ones

Improving care for  vulnerable patients

Pathway teams can also help with issues such as housing and benefits advice, addiction support and reconnecting with loved ones (see box).

The team I worked alongside was based at a hospital in London. I attended a ward round to see how the patients were and if any new information was available to help with their discharge and care planning. Multidisciplinary team meetings then took place to decide how best to work with the patients in future.

‘Spending time with the Pathway team and the mental health liaison team at the hospital highlighted the importance of effective communication’

I also attended a mental health liaison team handover to discuss patients who had been admitted to hospital, several of whom were homeless and being looked after through Pathway. It was interesting to see how the teams worked together to help improve care for these vulnerable patients.


Picture: iStock

Mental health issues

One of the patients we visited had taken an overdose the week before. She had recently been made homeless and a friend had expressed concern about her behaviour as she was displaying suicidal ideation.

When we talked to the patient she said she was looking forward to starting a course she had been accepted on to and had plans for the future. She said there had been a misunderstanding about her expression of suicidal thoughts.

‘As nurses, it is vital we act as advocates for this patient group, providing them with the information they need to feel more empowered, reducing risk of relapse or finding themselves in vulnerable situations’

After spending time with the patient and consulting with a family member, the mental health specialist did not think it necessary to put her under a section of the Mental Health Act, which he had been considering previously. The Pathway team informed the patient that they would visit her again to talk about her options, reassuring her that she wouldn’t just be left to go back onto the streets.

Health screening days

The next day I went to a local hostel to see how Pathway supports people in this setting. Many of the clients have complex mental and physical health problems, and the hostel’s multi-agency team includes a psychiatrist, a community mental health nurse, a sexual health outreach team, intervention for ex-offenders and representatives from Housing First, a scheme to help clients out of homelessness and hostels and into their own accommodation.

Each member of the team is allocated clients and offers help and advice on issues such as managing finances, enrolling with a GP, and managing substance and alcohol misuse. They can also accompany the clients to hospital appointments and help them to apply for benefits and housing. Physical health screening days are also held on-site.


Picture: iStock

Unable to live independently

I spoke with one of the clients in the hostel to gain a better understanding of why he was living there and what his experience was like. The client had a history of schizophrenia and was unable to live independently due to his illness. He said he had a part-time job and although he didn’t like living in the hostel as he missed his friends, he appreciated the support from his key worker, who helped him to budget and apply for benefits and housing support, which he said was very useful.

‘Working with Pathway opened my eyes to the difficulties faced by those with mental health issues who do not have a place to call home’

Before my week working with Pathway I was unaware what help and support, if any, was available to homeless people. Spending time with the Pathway team and the mental health liaison team at the hospital highlighted the importance of effective communication and helped broaden my understanding of the services they provide.

Dealt a bad hand in life

Homeless people have often been dealt a bad hand in life and have not been offered the support or guidance they need to get out of the revolving door dilemma they find themselves in.

As nurses, it is vital that we act as advocates for this patient group, providing them with the knowledge and information they need to feel more empowered, reducing the risk of them relapsing or finding themselves in vulnerable situations.

Working with Pathway also opened my eyes to the difficulties faced by those with mental health issues who do not have proper shelter or a place to call home, and I also learned how important it is not to judge people and to treat everybody with the dignity and respect they deserve.


Debbie Zeffman is a second-year mental health nursing student at the University of Greenwich

 

 

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