home is where the heart is peter cockersell director of health and recovery
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Home is where the heart is
Peter CockersellDirector of Health and Recovery
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St Mungo’s
• About 2000 beds: hostels to self-contained flats, including registered care
• Specialised drug, alcohol, mental health, dual diagnosis; older, women’s, and sexworkers’ projects
• Street outreach, 2 day centres, employment, training, substance use, health, and psychotherapy
• London, Reading, Oxford, Oxfordshire, Bath, Bristol, Hitchin, Welwyn Garden City…
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Home is where the heart is
Peter CockersellDirector of Health and Recovery
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What happens if your heart is broken?
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Client perspective
Home to me is somewhere that has a family and everybody in it “
”
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What happens if your family is broken?
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Shattered lives
Population
• 1 - 4% schizophrenia
• 5 – 13% personality disorder
• 11% anxiety disorders and depression
• 1.3% have attempted suicide
Homeless People
• 16 – 30% schizophrenia
• 50 – 70% personality disorder
• 50 – 80% anxiety disorders and depression
• 42% have attempted suicide
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Shattered lives: women
• 66% have a mental health problem
• 55% have a substance dependency
• >50% have physical health problems
• >50% have experienced violence or abuse from family/partner
• 41% rough sleepers have been involved in prostitution
• 45% are mothers
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Shattered lives: children
• 47% experience of neglect/emotional abuse• 34% early loss of parents through abandonment,
separation or divorce• 31% early loss of parents through death (including
murder and suicide)• 27% sexual abuse• High levels of parental alcoholism, drug use, and
domestic violence
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Behaviours associated with complex trauma
• Self-harm• Uncontrolled drug or
alcohol use• Impulsive, careless
of the consequences• Withdrawn,
reluctant to engage• Anti-social• Isolated
• Aggressive• Lacking daily structure or routine• Inability to sustain work or education• Bullying, or being a victim• Offending• Unstable relationships
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Relationships
• Complex trauma arises from abusive relationships• Healing relationships need to be managed, and take
care, and time• Relationships have an impact on both/all parties• Group dynamics affect individual group members’
relationships• Sometimes people need specialised help
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Seeking help
• 70% had sought help: 11%got help
• Majority have histories of compound and complex trauma, not simple diagnoses
• More people have more than onecondition than have only one
• Almost no access to psychotherapy, only drugs
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Client perspective
I did not access much of mental health services (they would not let me), but I used up hundreds of thousands of pounds of other budgets such as housing, social services and substance misuse
“
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Psychologically Informed Environments
•Psychological Framework•Social Spaces•Staff Training and Support•Managing Relationships•Access to psychotherapy
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Client perspective
I didn’t want to go initially, thought I didn’t need to see a shrink. I gave it a go and the first few sessions were very informal, unthreatening. I grew to trust her, told her things I haven’t told anyone else. A lot of tears were shed, she didn’t drag it out of me, she listened. I got shit out of my system that I’d been carrying around a long time. There was an underlying burden in my heart that she knew what to do with. Everything I said wasn’t written down and I loved that. It was properly confidential. It was a hard one but it was a good one and if it wasn’t for her I’d be floating down the Thames now.
“
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Psychodynamic psychotherapy• Based on relational dynamics in the here and now,
while recognising the impact of the past in the present
• Does not require diagnosis or pathologisation of clients, and recognises the reality and validity of their experiences
• Therapy is flexible, client-led and non-directive• Works on linking thinking and emotions, and the
regulation of affect• Evidence of effectiveness
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Balint
‘Everyone needs to be the sparkle in someone else’s eye’
The Basic Fault
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Client perspective
I didn’t believe in myself, but it seems that other people believed in me; through their
belief I could begin to do things.
It began when I realised – it’s quite sad, where I’m at...
(former rough sleeper)
“
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Resolving homelessness
Ending homelessness is about acknowledging and soothing broken hearts, enabling relationships, and
holding hope
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Further information
• www.homelesshealthcare.org.uk
• www.rebuildingshatteredlives.org