Impact of multiple moves on men with complex needs
Monday, 10 September 2018 - 4:43pm
What impact does moving multiple times between services have on men with complex needs?
Coral Westaway, of the University of Hertfordshire, writes of their recent study and explains the key findings.
Last year, we published our research on the impact of multiple moves around homelessness services. We wanted to develop a greater understanding so interviewed six men to learn of their experiences and support the development of good practice. Our study identified four main themes in the experiences of the men; hope, help, identity and intimacy.
The study highlighted the interpersonal nature of hope. Previous research has already shown that a compassionate relationship with someone else helps to facilitate hope and growth.
Our study built on this. It also identified the challenges of holding on to the idea of hope yourself. We found that hope was particularly fragile for these men who had moved within projects. Consequently, staff and services may need to hold onto hope and the belief that things can improve, when this is too challenging for their clients.
The men spoke about the transitional nature of help and the high turnover of staff. They spoke of feeling like a ‘broken record’ as they were required to tell their stories time and time again.
“I’m not like a broken record, I’m not explaining it all again. It’s f*****g awful [when someone new starts]…it means I’ve got to go through it all…you put your trust in people and that and then when they disappear I get really paranoid as well. I mean ... there are so many things like I’ve told drug workers - it’s like really like, heavy stuff.”
This was particularly hard for people who have histories of trauma and loss.
The men spoke of experiences that dehumanised them and felt negative perceptions of others experiencing complex needs influenced the treatment and support they received. Experiences of services as critical contributed to their ‘disengagement’ and to long-term homelessness. However, positive experiences with staff were highlighted as helpful and the re-humanising potential of relationships was stressed.
“Most of them yeah they really, do actually give a shit! Like my key worker, it was his day off and he was home with his kids, he’s phoning from his home on my birthday to wish me happy birthday and to see what I was doing.”
The men interviewed had clear histories of trauma and early relationships which had been unsafe, unreliable and inconsistent. Establishing new relationships and getting close to others was threatening.
“I don’t really get too close to people. You don’t want to be alone, but you don’t wanna get too close… familiarity breeds contempt. There are too many people that might know your soft points… I don’t like people knowing too much about me - if they know your weak points then they can play on it… I don’t like to open up.”
Relationships at the heart
This study proposes that homelessness is a relational issue. As a result, we recommend that relationships between staff and clients are prioritised and interdependence is valued alongside or above independence. Services should promote and build relationships; facilitating connections and fostering community.
Many of the men we interviewed reported positive experiences in projects which offered them more and showed care and support. Their experiences in these projects were in stark contrast to those which provide ‘just the basics’, e.g. just a place where they passed through.
The recommendations from our study strongly fit with the Psychologically-Informed Environments (PIE) framework. We support the view that successful services strive to create secure and containing environments with opportunities for people to safely share life stories and experiences and where they can be supported to develop a positive sense of identity.
These services prioritise the facilitation of trusted relationships and clear and inclusive communication. They thoughtfully manage the beginnings and endings of supportive relationships and help assist with moving forward by breaking things down into small and attainable steps.
“…that person might go out of their way, push that little bit extra, which I do believe happened to me, yeah... And do you know that's made me a different person because I’m getting more support. I feel good and I don’t feel like I want to let them down because they’ve gone out of their way to help me.”
These services can be challenging to work in, so it is also important to consider how best to support staff to create and sustain such environments. Reflective practice and complex case discussions can support teams, increase staff wellbeing and improve outcomes for service users.
Read the full report here.