Home is where the heart is Peter Cockersell Director of Health and Recovery

Home is where the heart is

Peter CockersellDirector of Health and Recovery

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…

Home is where the heart is

Peter CockersellDirector of Health and Recovery

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 “

”

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

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of the consequences• Withdrawn,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

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.

“

”

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

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

Further information

• www.homelesshealthcare.org.uk

• www.rebuildingshatteredlives.org

• Peter.cockersell@mungos.org