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Theme

Mental health and wellbeing

This theme explores the issues surrounding mental health and wellbeing for women who are homeless or at risk of homelessness, and is being led by Expert Group member Sophie Corlett, Director of External Relations at Mind. Read the theme round up here

In her blog, Sophie writes: “The link between mental health and homelessness is reciprocal. Women with mental health problems are more vulnerable to becoming homeless and being homeless can exacerbate or lead to poor mental health.

“For these reasons, mental health and wellbeing has been chosen as one of the themes of the Rebuilding Shattered Lives campaign, and I am delighted to come on board as the Expert Group lead for this theme.

“Looking in detail at this area will allow us to find answers to some important questions. Does stigma affect women and men in the same way? Do women who are homeless and facing mental health problems need different services to men? How do we get the right help at the right time to women at risk of homelessness?”

How do we make sure women get the right help, at the right time? We want to hear from practitioners on the ground and from women using services themselves, about what works and what support is missing, in particular:

In particular, we want to hear about:

Specialist mental health or wellbeing services for women

• Self harm and eating disorder support services

• Partnerships between mental health and homelessness services that are working well for women

• Move on options and support in the community for women with mental health issues

• Provision for women whose mental wellbeing is affected by domestic violence, prostitution and separation from children

Please also submit any relevant research so we can gather this together to improve the support out there for women.

If you have already joined the campaign, please log in to submit evidence. If you are not already a member, please click here to register. Send us your contributions on this theme by 30 June 2013.

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Theme started on: 13 May 2013

21 Submissions

  1. Faye Mooney

    During Mental Health Week 2013, there was a debate held in the House of Commons on “Mental Health” (16th May). Below are extracts relating to women and to homelessness:

    Dr Sarah Wollaston (Totnes) (Con):
    I want to talk about social exclusion and the role of mental health services in social exclusion. If a person is homeless, they are far more likely to suffer from mental health problems. Equally, if a person has mental health problems, they are very much more likely to end up homeless and on the streets. In my area of Totnes, we tragically have suffered some deaths among our homeless population. We know from those who provide help to the homeless in south Devon the level of dual diagnosis—the number of people who have both mental illness and, for example, addiction problems. I would very much like to hear from the Minister in her summing-up what work will be done to improve access to dual diagnosis. I pay tribute to Mark Hatch and the work that he has been doing, alongside very many dedicated volunteers, with the Revival Life Ministries and with Shekinah, providing an outstanding service to our local community.
    I want to raise a point about access to GP services for the socially excluded and homeless. In coming months, there will be much focus on how we reduce health tourism. If, in reducing health tourism, we require people to bring a passport to their GP in order to be registered, very many people who are socially excluded will not be registered because they simply do not have access to identification. I ask the Minister, in addressing an important problem of great concern, to be particularly careful to avoid making it even harder for the socially excluded to obtain help with their problems. That would be a real avoidable tragedy.

    Jeremy Corbyn (Islington) (Lab)
    Voluntary Sector & Female Mental Health
    In an earlier speech, I made an intervention about the role of the voluntary sector in dealing with mental health conditions. As I have pointed out, my borough has considerable problems in dealing with mental health, but we have a number of very good local organisations that often deal with mental health issues in an innovative and supportive way, and are often very successful. Nafsiyat, an intercultural therapy centre based in Finsbury Park which was founded by the late Jafar Kareem, was groundbreaking in its ideas of looking at the cultural background and ensuring culturally appropriate treatment of people with mental illness, for example by making sure there are people who speak the necessary languages and understand something of the specific cultural background. The Maya Centre, which particularly relates to women, does much of the same work… We also have the Refugee Therapy Centre and the Women’s Therapy Centre, which also provide therapy on a culturally sensitive basis.

    Jane Ellison (Battersea) (Con)
    Female Genital Mutilation
    A study cited by the World Health Organisation in the mid-2000s examined the effects of FGM on the mental health of women. The researchers concluded that FGM is “likely to cause various emotional disturbances, forging the way to psychiatric disorders,” especially post-traumatic stress disorder, possible memory dysfunction and other problems associated with trauma.
    The BMA’s 2011 guidance acknowledged that little is documented about the psycho-sexual and psychological effects of FGM, but it does say: “Long term consequences might also include behavioural disturbances as a result of the childhood trauma and possible loss of trust and confidence in carers who have permitted, or been involved in, a painful and distressing procedure” and that “women may have feelings of incompleteness, anxiety and depression, and suffer chronic irritability, frigidity, marital conflicts, or even psychosis.”
    The point that I want to make is that there is a significant mental health aspect to FGM, but that it is not well documented. Not many of our front-line professionals have it at the front of their minds when trying to explain other problems. I just want to put that on the record so that the Minister and the Department of Health can reflect on it and so that it starts to become a normal thing for mental health professionals to talk about and think about, particularly when they see people from communities that practice FGM and who might have suffered it.

  2. Jennifer Holly

    Between 2010 and 2013, AVA’s Stella Project delivered a three-year action research project with selected domestic and sexual organisations, substance use and mental health agencies to develop, implement and evaluate a model of integrated partnership working to address the combined issues of domestic and sexual violence, substance use and psychological distress.

    Based in Bristol, Nottinghamshire and the London Borough of Hounslow, the project focused on:

    Policy and procedure development, training and partnership working with six agencies in each of the three pilot sites.
    Good practice guidance. Following the completion of the action research, good practice was developed.
    Online training course addressing the overlapping issues was also created.

    The project was independently evaluated by a team of researchers from the University of Middlesex, led by Dr Miranda Horvath.

    Key resources from the project can be downloaded including a full project outline, ‘Evaluation reports – interim and final report’, ‘”Treat me like a human being” – survivor consultation report (June 2012)’, and ‘Promising practices: Mental Health Trust responses to domestic violence’ (October 2012).

    The toolkit and e-learning can be accessed from the AVA website: http://www.avaproject.org.uk/our-projects/stella-project/stella-project-mental-health-initiative.aspx

  3. Kate Moss

    Women Rough Sleepers is an EU DAPHNE-funded project which aims to increase the knowledge base related to domestic abuse suffered by Women Rough Sleepers. As part of the research, in the UK, we found that mental health issues for female rough sleepers were very prominent and all those we interviewed were effected, ranging from depression to more serious mental illnesses such as bi polarity and also permanent mental health issues arising out of long term drug and alcohol abuse. Many were or had been self harmers.

    To find out more about this project see: http://www.womenroughsleepers.eu/ and also our new website and follow up project on women’s homelessness at: http://www.womenroughsleepers2.eu

  4. Laura Smith 81

    http://www.thefword.org.uk/blog/2013/06/20130618_GL_Wild

    This is an interesting article written by someone working in a supported housing project for people with mental health conditions. It raises questions about gender, freedom and autonomy and whether clients are treated as active or passive agents.

    “Approaches to behavioural choices can be very different. Sexual activity in women is often approached as a signifier of a deterioration in mental health. In one case a 9 p.m. curfew has been imposed in order to protect a client from engaging in ‘risky’ behaviour. Where relationships or friendships have a negative impact on both parties, for example where people have a tendency to encourage people to drink to excess, it is generally assumed to be the man driving this negative behaviour, the woman engaging purely as a passenger.”

  5. OIWG

    One woman resident’s view:

    Support services and people in general are not very aware about self harm. People have said to me that I am doing it for attention, or that I am a sadomasochist and enjoy the pain.

    The same goes for eating disorders. In one homelessness service I needed an urgent referral related to my eating disorder and they just gave me details of a website to look at to follow up myself. Because homelessness service mainly cater for men I think they are not well equipped or knowledgeable on this area. Sometimes the men say they have an eating disorder but actually they are not eating because they are on drugs. Staff assume that eating issues are to do with alcohol or drugs. One alcohol service told me I didn’t have an eating disorder and it was just because I was drinking, even though I was diagnosed previously.

    Dual diagnosis is another difficult area because professionals on both sides think you are being awkward. They say that issues you have are just a product of something else, either the substances or the mental health, not recognising it is possible for them to occur at the same time.

  6. Gabrielle Brown

    “As a psychotherapist for St Mungo’s Life Works Team, some of the most horrifying stories I have heard from residents have been from women. These are often the granddaughters of women who have had adverse life experiences and it’s gone from generation to generation.”

    “Sexual and other forms of abuse in childhood are so common that one almost is surprised if somebody says that that wasn’t their experience. It’s not only what was done but the environment, where other family members knew and nothing was done, which has had such a traumatic effect.”

    “One of the very common experiences is women who were expected to take care of the rest of the family in a parental role from a very young age but not necessarily doing it very well. One of the hostels worked so beautifully because it had a lovely maternal manager. It took a lot of burden off the women to be mother to the men and it allowed them to be mothered a bit themselves.”

    “Psychotherapy as a profession has considered that the sort of people who might end up in St Mungo’s homeless hostels would not be suitable for psychotherapy. That’s not been our experience at all. People are able to make use of the therapy to build a relationship, even if they are still drinking, still using drugs, still what we would call acting out. Sometimes they have just changed their level of happiness. And sometimes people have changed their behaviours significantly.”

    “We are seeing women who are trying to use their bodies in all sorts of ways, like drugs and alcohol, to cut off their memories. I think getting pregnant works in that way. When they have had very poor childhoods, many women may attempt to rewrite the story and have a child in order to be a very different mother. It’s an absolutely devastating sense of failure when it doesn’t work.”

    “My team has a view that people become homeless because of a lot of psychological factors. And that homelessness itself creates a lot of psychological trauma, some of which repeats early experiences. And that both of those things need to be treated before people can settle and get back to a regular life.”

    Taken from an interview for http://www.wherefromwherenow.org/ women’s homelessness photography project by Georgina Cranston donated to St Mungo’s.

  7. Penny Bennett

    Established in 1987, Wish is the only national, user-led charity working with women with mental health needs in prison, hospital and the community. It provides independent advocacy, emotional support and practical guidance at all stages of a woman’s journey through the Mental Health and Criminal Justice Systems. Wish acts to increase women’s participation in the services they receive, and campaigns to get their voice heard at a policy level. It is unique in its long-term commitment to each individual, as they move through hospitals, prison and the community.

    Community Link provides extended support to women in Greater London as they move from prison or secure hospital into the community. Its wraparound services equip women with the skills, security and self-esteem necessary for successful resettlement, through:

    · Pathways tailored to each individual’s needs and aims, to ensure long-term and meaningful change
    · Support to engage with services and attend court dates
    · Links into statutory and voluntary services
    · Support with housing and accommodation issues
    · Financial assistance and benefits guidance
    · One-to-one support whenever and as often as each woman needs
    · Social contact and peer support

    For more information see: http://www.womenatwish.org.uk/

  8. Lyndsey Lloyd

    Imagine independence has established itself as a leading mental health charity. Our accommodation schemes provide quality housing and support for people who experience mental health problems.Our services have grown to meet the changing needs of our service users and will embrace government initiatives and support time for change.

    Imagine Independence supports women who have been in secure services for a long time and have complex needs including personality disorders, offending behaviors, mental illness and maladaptive coping strategies. Years in service can also leave life skills under developed. We introduce the women to self management in a very supportive way and their path to recovery is planned with them at their pace. Supported by CPA management they become introduced to budgeting and license/ property management in a very informative manner whilst encouraged to feel cared for with a promotion of independence. Referrals to this service are from secure services only. Imagine have a range of accommodation and have created a lot of opportunities for our service users. Others services include accommodation, floating support, life opportunities, mainstream and outreach services. Service user involvement map the delivery of our service to ensure collaborative working. Imagine are also proud to introduce the peer support worker, this staff group are people with lived experience who are trained to use their lived experience in a therapeutic manor.

    Imagine continue to strive to ensure people are socially included and peoples life’s are rebuilt to optimum recovery and we support our service users to their full potential.

  9. Nicola Saunders

    From working in counselling and psychotherapy services in substance use and primary care prior to my joining St Mungos, a significant number of women attending psychotherapy had experienced sexual abuse in childhood, and were or had in the past experienced abusive relationships as an adult. Over the 16 years I worked in a substance use counselling services, I only encountered two men who did not have an alcohol or drug problem who continued to live with women who were substance users. While many more women stayed with their male partners who were using and/or drinking, often experiencing family violence, having very little money and being left with the responsibility for caring for children.

    Many women who have experienced early childhood trauma, such as sexual abuse, neglect or being in the care system, often get diagnosed with Borderline Personality Disorder. Many more women than men are given this diagnosis, & such a diagnosis can give the impression that there is something intrinsically wrong with the personalities of these women, which doesn’t takes into account the effects of their traumatic experiences. When women are unable to look after their children because of past trauma, mental health, substance use or domestic violence, this goes against the social norm of motherhood and they face harsher judgement than men in the same circumstance. Women are much more likely to sell sex for drugs, whilst men tend to deal to buy their own drugs.

    I have encountered far more cases of self harm and eating disorders in women. On a social level women’s bodies are objectified and reflected back to them as how they ought to be and rather than how they are. This can lead to some women developing a problematic relationship to their own body – many women often say they do not like their body. Food is also a way to control emotions, to purge, binge or deprive themselves of food, this is similar with self harm too. Men act anger out in a different way and can be more likely to fight externally than against themselves.

    Services can view women with complex needs as ‘out of control’ which may lead to a tendency for them to try and control women. This is unhelpful because these women have been so controlled throughout their life and relationships – it is useful to understand this as workers so we can provide a sense of safety in order that we may develop a working relationship through contained boundaries not by control.

    I can remember some years ago in substance use services there were particular sessions for women and an acknowledgement of their specific needs. It does seem there is less of this across all support sectors because of funding cuts. The past focus on equality of access including for women and BME groups seems to have diminished. There are particular issues for BME or refugee women trying to access mental health or substance use support.

    I think one gap in MH provision for women is probably psycho-educational support. Some women can think that because they have depression or anxiety or other mental health issues that there is something inherently wrong with them. Through psych-educational work they have the opportunity to learn the impact trauma can have on people and why they might behave in certain ways.

  10. Faye Mooney

    Summary of findings from ‘Making the link between mental health and youth homelessness: A pan-London study’, Mental Health Foundation & Centrepoint, 2006

    This study examines the increased risk factors for homelessness among 16-25 year olds. Key findings from service sector data included:
    • a lack of integration between services attending to housing and mental health needs simultaneously
    • a lack of mental health awareness, including low confidence across service sector staff to provide basic emotional support for young people within the generic housing and homelessness sector.
    Mental health problems commonly precipitated and were exacerbated by homelessness and were typically present within socially disadvantaged groups. However, promising practice examples were identified, reflecting innovative approaches delivering more comprehensive care.

    Mental health problems in young people: In recent years there has been an upsurge of scientific and media interest in the mental health of young people. However, our understanding of the long-term consequences of child and adolescent mental health problems is at a relatively early stage. Nevertheless, there is an emerging body of evidence that points to the long-term costs of child and adolescent mental ill-health for individuals, their families and communities.

    Associations between mental health and homelessness: It seems reasonable that in most cases the loss of one’s home will bring about stressors that can deplete an individual’s mental health. Thus, it is estimated that between 30% and 50% of single people experiencing homelessness have mental health problems compared with between 10% and 25% of the general population (Warnes et al 2003). More specifically in a London based study of young people experiencing homelessness in which psychiatric diagnostic criteria were used, two thirds met the threshold for a mental disorder (Craig et al 1996). In the same study 70% of those with a diagnosable mental illness had experienced their first symptoms before their first episode of homelessness.
    It seems likely that as well as creating or exacerbating mental health problems, homelessness might itself be precipitated by a mental illness. There is also the possibility that other factors may put individuals at risk of both homelessness and mental health problems. Against this backdrop Centrepoint (2005) has reported a lack of adequate provision to manage the increase in mental health problems amongst young people, which if untreated can lead to far greater long-term problems.

  11. Pippa Hockton

    Street Talk provides mental health care to women who are trapped in street based sex work and women who have been the victims of trafficking. The services provided include counselling, clinical psychology, group therapy, mediation, advocacy and representation before the courts.

    When a person experiences repeated abuse, their confidence and self-belief are destroyed and eventually they might even believe that they deserve to be hurt. The first step in helping someone who has been repeatedly abused, is to enable them to believe that they deserve better. This is an essential first step, without which other forms of help are likely to fail. Our aim is to reach some of the most vulnerable and marginalised women on our streets to enable them to feel entitled to live safely and with dignity.

    For more information see: http://streettalkuk.org

  12. Joanna Kowalski

    At Richmond Fellowship we’re well aware of the link between homelessness and mental health, which cuts both ways. We run a number of services that are providing increasingly more specialist mental wellbeing support to deal with the issues that are related to homelessness.

    An example is our complex needs homeless service which forms part of our Durham and Darlington floating support service. Around 60% of the people we work with through this service have diagnosed mental health issues. If we took into account undiagnosed mental health issues then this figure would be much higher.

    We pick up referrals from people with multiple issues and chaotic lifestyles as well as homelessness or the risk of homelessness. Some of the people we help are street homeless but a lot are ‘sofa surfing’ or in temporary accommodation.
    Women are rarely street homeless but often have greater and certainly different needs and the impact of the current welfare reforms is starting to affect our client group. Women we’ve worked with or currently work with have a range of presenting issues such as domestic violence, substance misuse, children at risk, offending behaviour and alcohol issues.

    To illustrate the complexity of the cases we manage, here is Sally’s story [not her real name]:

    “Sally is 25 and originally from Dorset. She moved to Darlington after being abused by her ex-partner. She was suffering from depression and had previously taken an overdose which resulted in hospitalisation.

    She arrived in Darlington with no social networks, no family and only a bond agreed by the council. She had no income, had used up any savings and was unable to pay the rent. She was facing eviction and had no alternative accommodation.

    She came to Richmond Fellowship’s homelessness service after visiting her GP. We established and provided support, daily initially and for as long as required, using the specialist skills held within the team. We contacted the Darlington Domestic Violence Unit after the potential arose that her ex-partner was aware of where she was now living. We created a link with the local police and they assisted with security devices for her windows and doors. We supported her to change to another bank account to make her financial footprint less traceable and signposted her to Victim Support who helped her make a criminal injuries compensation claim regarding her trauma at the hands of her ex-partner.

    We helped Sally access counselling and sign up to the Freedom Programme for victims of domestic abuse. We also supported her with sorting out her finances and with finding a job.

    Unfortunately, Sally was injured in a serious car accident which also wrote off her car. As she had no other support networks, family or friends, she contacted the Richmond Fellowship team from her hospital bed. We liaised with the police, insurance companies and rescue services, reclaimed belongings from the car and supported her through her physical recovery. Without access to our service, Sally would have had no other means of resolving these problems.

    Because she could not work while she was injured we helped her claim SSP and housing and council tax benefit. She had to access food from food banks and struggled to meet her rent and utility bills. She was then unable to continue to work at this point as she had no means of transport to carry out her role.

    However, thanks to the support she had received from Richmond Fellowship she felt more confident and safe to relocate back to Dorset where she could be supported by her family and where other job opportunities opened up. We supported her with her move back and ensured she was in touch with the local domestic abuse service and Freedom Programme so she could get ongoing support if she needed it.

    We will contact Sally again in six months to see how she is getting on.”

    For more information visit our website at: http://www.richmondfellowship.org.uk

  13. Amy Dymyd

    NIWE Eating Distress Service

    NIWE Eating Distress Service was established in 1988 to support people experiencing a difficult relationship with food and their eating. People contact NIWE in order to obtain support and information for eating distress / disorder. This includes women, men, young people and carers or those supporting someone who has difficulties around food.

    NIWE provides :

    · email/telephone/postal support and information

    · initial meeting for support and information

    · possibility of joining a support group (women aged 18 and over only – no upper age limit)

    · awareness raising sessions on eating distress/disorder for groups and projects

    · training for agencies and individuals

    · survivors’ group for those in recovery to help raise awareness

  14. Sara

    Understanding Self HarmFor some years, SANE has drawn attention to the need for people who self-harm to be given understanding and help.

    In 2004, the National Institute for Health and Clinical Excellence published the first treatment guideline on self-harm, revealing 170,000 people a year attended A&E departments with many being sent away with no proper help.

    SANE responded to the report, initially drawing on the growing numbers of calls to the helpline reporting self-harm in increasingly violent ways. Our concerns were broadcast locally and nationally and our statement carried by The Independent.

    In 2009, SANE undertook a major qualitative research study collecting data via an online survey from 946 anonymous people aged 12 to 59. The data we collected charts self-harm behaviour from first episodes through to full recovery.

    Please read more here.

  15. Gail Gray

    Rise refuge has had a dedicated mental health refuge worker since 2005. This role supports all other professionals who support refuge residents to access the local professional partnership systems and structures around mental health and substance misuse. Women who have needs around mental health and substance misuse are assessed during the referral procedure and a support plan is put in place to follow them through Rise services. We work closely with local substance misuse organisations and community mental health teams that support women throughout their stay at refuge and once they are resettled in the community. As part of the induction process for this role the refuge mental health worker will complete visits with specialist mental health and substance misuse services in the statutory and voluntary sector. She is supported through regular individual and group supervision. Her practice is enhanced by attending training and conferences that are relevant to the specialist aspects of her role and incorporates this learning into her daily practice.
    She attends local forums such as Drugs and Alcohol Working Group (DAWG) and the Community and Voluntary Sector Mental Health forum to share tools and raise awareness.

    For more information on Rise see: http://www.riseuk.org.uk

  16. Manchester Womens Aid

    Manchester Women’s Aid (MWA) identified the need to develop specialist support for women with mental health issues and recruited a mental health support worker. MWA challenges the belief that women fleeing abuse with mental health/substance use issues are ‘too risky’ or ‘too chaotic’ for refuges. The aim of the post is to work directly with women using our services, train staff to be able to respond to service users with mental health needs and promote good practice and referral pathways with external agencies to improve the response to victims of abuse with mental health needs.

    The worker aims to:

    • Ensure all women identified as having a mental health need receive an initial mental health assessment.

    • Ensures all frontline staff can identify the signs & symptoms of mental ill health & how to make a referral to appropriate services.

    • Assess all clients using the PHQ9 scale for depression & the GAD 7 (General Anxiety Disorder Scale), clients are screened and their needs addressed via one to one support, referral to external agency or via group work.

    An evaluation of the Mental Health Support Worker post is attached.

    For more information on Manchester Women’s Aid see: http://www.manchesterwomensaid.org

  17. OIWG

    Comments on Mental and Physical Health from St Mungo’s Women’s Peer Research 2013:

    ‘On the ball with that here definitely, if they notice someone’s not feeling very well or they’ve not seen them for a few days they check if you’re OK, if they know you’re not feeling well they get you to call the doctor.’

    ‘Support is variable in different homelessness projects especially on mental health. If you don’t possess a diagnosis and aren’t on meds some staff don’t recognise a problem and can be very unsympathetic’

    ‘Some support services have a lack of knowledge of eating disorders.’

    ‘Can refer me (mental health) to someone. As to physical health, they come with you if you need to go to the hospital or dentist which is good, other places don’t do that.’

    ‘you can always talk to someone if you feel down’.

  18. Joy Doal

    Anawim’s mission statement is to support women and their children, especially women vulnerable to exploitation including prostitution. It seeks to provide wider positive choices to help them achieve their goals and reach their full potential as part of the wider community. To this end Anawim treats everyone with dignity and respect, recognising that every woman and child matters as an individual. Anawim seeks to work with partners and other agencies to challenge that which degrades and diminishes.

    In April 2012, Anawim started a pilot project in partnership with the Department of Health by creating a Mental Health Alternatives to Custody Project.

    The Preliminary Evaluation Report on the Anawim Mental Health Alternatives to Custody Pilot Project is attached.

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