Job description: Complex Needs Manager at St Mungo's
Areas of interest: Housing and homelessness – services for women with complex needs, Domestic abuse, Families and children – including relationships, Substance use, Women involved in the criminal justice system, Mental health and wellbeing, Childhood trauma – including being in care or childhood abuse, Employment and skills, Improving support for women involved in prostitution
Eleanor Levy's Recent Activity
"Further to discussion on trauma and abuse in childhood I attach some data analysis regarding data collected in my previous role working in Probation"
Reply To: Childhood trauma and women’s homelessness
"Prior to working at St Mungo's I worked in probation. In 2004 in an effort to resolve a contentious issue about the focus of my work, My manager and I agreed that I conduct a study regarding the needs of our clients. The initial object of the study was to establish alcohol treatment needs in relation to needs regarding other drug treatment, the latter receiving the majority of resources. I collected data concerning age, gender, ethnicity against needs regarding offending behaviour, physical health, mental and emotional health, housing, alcohol need, other drug need, education and training need. Within mental and emotional health after a few samples, I soon identified trauma as a major issue and adjusted my study to provide data on this as well. The study demonstrated far beyond what I set out to achieve, regarding treatment needs related to alcohol use. The study showed a prevalence among our women clients of trauma that was at much higher proportions than would be expected in general. Even more striking was that with increasing OASys scores (whether for alcohol or other drugs) it became more and more likely that the client would have suffered earlier trauma, typically childhood sexual abuse. I could predict with over 90% certainty that a women in this client group had suffered trauma, given a certain level of alcohol or drug OAsys score, with at least two other needs.
My conclusions from the study were that if offending behaviour is serious enough to require probation order or prison, and there are other needs such as substance use, homelessness, educational problems, physical or mental health issues (typically anxiety or depression) these are strongly indicative that the client will need support to manage PTSD.
I printed out the entire study data sets which took up several A3 sheets pasted together, in which the data were stacked according to intensity of need and how this collated with incidence of trauma, and pinned up to a whole,wall of our group room to show my boss. I remember responding to my manager's increasing dismay as she absorbed the full impact of how many women clients suffered unrecognised and untreated trauma. It was the realisation of a vast tragedy that brought us both to tears, and an unforgettable demonstration of what complex needs means.
I developed a screening tool based on DSM IV to assess clients for PTSD, and found that therapeutic interventions supported by GP prescribing were effective in supporting women to develop an effective coping strategy. By providing Counselling, I was able to convert clients previously disengaged from other programmes and support their re-engagement. Broadly speaking clients either opted to draw a line and concentrate on here and now coping strategies which after some 1:1 support brought them back towards group treatment in DRR, OSAP and the like; or they decided to explore the subject of trauma in more detail, find a therapist (occasionally they elected to continue counselling with me).
It is tragic that after so many episodes with different agencies including substance use, criminal justice, social services, health services, DWP etc that so many clients, especially women, do not have this need accurately and competently identified or treated. With a bit of ingenuity and some multi-agency case coordination and advocacy the story could be so different."
Reply To: Childhood trauma and women’s homelessness
"The main challenges that women face in receiving the right support, at the right time include that there is too little integration of services that address mental health and wellbeing, alcohol with other drugs, housing and social needs, physical health and criminal justice and legal needs. For women in our client cohort, there is a high prevalence of a particular group of problems. However, mainstream services tend to address these needs individually rather than together (if at all) and a single approach is often being pursued, rather than multiple approaches which are harmonised by multi-agency coordination which is often lacking.
Women may find themselves in a service where they are in a minority and it is not unusual for women putting themselves forward for support in a particular niche to be advised that they may be the only woman in the service, though some good practice has emerged where services have set a policy to maintain an appropriate gender balance, which is often all that is needed for the issue to be addressed. There is a strategic need to recognise and support this sort of good practice but commissioning nationally, regionally and locally is rarely integrated to a level where services that introduce this policy are given the necessary strategic support.
For example, a residential treatment facility that would hold places open specifically for women so as to maintain a balance, and not fill them with men, will naturally have a slightly lower level of occupancy at some times, which has economic consequences. Overall, their results might be more effective in terms of completion of treatment and sustaining gains afterwards, yet usually commissioning criteria are not adjusted to recognise and reward this.
Some of the key themes in relation to women and substance use include that there is still an imbalance in sentencing for women who are seen as drug users, whereby harsher sentences than might be expected are still resulting in too many women going to prison rather than receiving interventions in the community that would support them better.
There is a high propensity towards cocaine dependence for women who have suffered trauma, such as childhood sexual abuse. This trauma tends also to pre-dispose them towards abusive relationships. There is recognised research to substantiate this, yet services such as residential rehab which integrate approaches for both drug dependence and trauma are extremely rare.
The elevated adrenalin levels produced by cocaine dependency mirror and entrench the effects of trauma, and the side effects are uncomfortable. It is therefore very common for women who have suffered trauma and become dependent on cocaine to mitigate the effects with alcohol, heroin or other central nervous system depressants. The combined use of alcohol and cocaine is particularly problematic, because when these are metabolised in the liver, cocaethylene is produced, which is itself more addictive than either taken separately. Use of one often produces strong cravings for the other, reinforcing the cycle of dependence, which is underpinned by trauma. The neuroscience of these mechanisms is now much better understood, but this improved scientific understanding is not yet reflected in treatment developments.
One should also mention “shame” as a component of drug and alcohol problems. For women, cultural factors make the experience of shame related to use and dependency different. While there are recognised treatment methods to address this for both men and women, they are rarely available to either in substance use treatment services."
Reply To: Substance use: helping women with drug and alcohol problems