Dr Suzanne Elliott 2018 Suzanne elliottleicspart nhs uk

* Dr Suzanne Elliott 2018 Suzanne. elliott@leicspart. nhs. uk

*overview of the work in Leicester * the Homeless Mental Health Service (and it’s development) * Clinical Psychology provision *Developing innovations: * City-wide PIE * Street Outreach *

* Founded in 1990 * Dedicated Clinical Psychology provision for people who are homeless since 2000 * Team currently comprises: * 3 RMN * 1 Support, Time and Recovery worker * 1 Consultant psychiatrist 1 day a week * 1 junior psychiatrist ½ day per week * 1 clinical psychologist, 4 days per week * 1 trainee clinical psychologist 3 days per week * Team secretary 2. 5 days per week *

*Psychological assessment *Cognitive assessments *Brief psychological therapies *

*Psychological consultancy *Formulation & Care planning as part of MDT *Training & Supervision *Research & evaluation *Service development *

*The psychologically informed service… Is a service run according to the ‘emotional and psychological needs of service-users’ Enables service-users to make changes (eg in relationships/behaviour/emotions) Will reduce ‘chaotic behaviour’, evictions and hospital admissions Will increase service-users’ engagement with staff Also… * Could reduce referrals to mental health services? 9

*5 key areas 10 1. 2. Developing a psychological framework 3. 4. 5. Staff training and support The physical environment and social spaces Managing relationships Evaluation of outcomes

*2010 - invited to contribute to PIE guidelines *2012 - PIE guidelines published *2012 - Presentation to hostel managers across the sector in Leicester *

* 2012 - Develop 3 day training programme * 2013 - Pilot training followed by reflective practice with one team *

* 2014 - Roll out 4 day training across sector (training available to NHS staff in homeless sector, hostel staff, outreach workers, refuge workers, day centre staff and intensive floating support teams) * 2015 - initiate reflective practice groups at 3 other sites *

*Attachment theory / the impact of adverse childhood experiences / trauma informed practice *Narrative Approaches *Community Psychology *Active listening skills including boundaries and self-care *Emotional literacy and reflective practice *Outcomes and evaluation *Endings *

* Response-based approaches (based on Alan Wade’s work) Homelessness and brain injury * Understanding Dual diagnosis * Understanding ‘Psychosis’? * Failure conversations (based on Michael White’s work) * Homelessness and gender diversity * Understanding ‘personality disorder’? * Homelessness and Motivational interviewing * Understanding ‘PTSD’? * The impact of trauma on parenting *

*In collaboration with University of Leicester *Monthly reflective practice groups offered to 5 organisations *Facilitated by a qualified clinical psychologist alongside a second year trainee clinical psychologist or two final year clinical psychology trainees *Monthly supervision for trainees *

*University of Leicester facilitates supervision for qualified clinical psychologists offering reflective practice *University also hosts EMids Reflective Practice Research Network- pooling data across reflective practice groups *

EMERGING EVALUATION *positive use of staff time *relevant to the day to day experience of staff members *quality of the training and the knowledge and skills of the individuals presenting the training were high *knowledge increased significantly for each individual training session *Fostered curiosity and reflection *

POSSIBLE IMPROVEMENTS *Private, undisturbed venues away from clinical contact and day-to-day responsibilities should be considered *Employing a variety of tasks that support different learning styles and preferences, including more practical tasks *Ensure IT resources are working adequately *

CHALLENGES *existing research relating to the implementation of PIE principles focuses on a single centre service (eg Westway, Nolte & Brown, 2017) *Services running on skeleton staff who work shifts *Culture clashes: can reflective practice be done anywhere? Do we have to sit in a circle? *

CHALLENGES *spread of services / funding bodies means that achieving a consistent approach to providing services to people who are homeless is very challenging *Embedding PIE into service strategic planning, policies and procedures *

*Just PR? *gaining entry into the rough sleeping community *making mental health conversations possible and acknowledging trauma *demystifying and raising awareness of mental health services *starting conversations about aspirations, values and what is important to people rough sleeping. *

*Based on model developed by Ma. C-UK * taking psychology to the streets * having conversations that are therapeutic * * Who is this person? * What are their ethics for living? * What are they passionate about? * What do they give value to in life? * What are their dreams?

*Also, importantly, it has brought our two teams closer which has had very positive outcomes, from my perspective anyway, for service users and for us as co-workers. My hope is that we can find a way of continuing with it despite all the nonsense that goes on in our organisations. *

SERVICE USER FEEDBACK *Referrals *Myths about mental health services were dispelled *Increased understanding of a psychological approach *

OUTREACH WORKERS FEEDBACK *We need more *improved knowledge/awareness of mental health which invited outreach workers to have confidence in sharing with rough sleepers *Increased awareness of barriers to accessing support *Increased awareness of psychologists of ‘real world’ circumstances of people who sleep rough *

PSYCHOLOGISTS FEEDBACK *Increased awareness of psychologists of ‘real world’ circumstances of people who sleep rough *Stepping out of therapy room *The potential for research/evaluation *Bringing the street community together *

* Suzanne. elliott@leicspart. nhs. uk