• Dialogue with the mental health service manager to re-engage their support for Hugh, and for hostel staff
As I leave, Nicola is thankful for my support and action.
13TH April 2006
Securing Mental Health Support....
Having intensely renegotiated and referred Hugh back into mental health services I have subsequently secured a CPN (Linda), in homelessness for one half day per month.121 I am delighted – a small, significant mental health thread in the net which I hope will grow and which strategically enables me to develop the HNA report.122
Linda and I collaborate in our 'battle-plan' to engage Hugh. The basement meeting is filled with young residents. Hugh, at 54 years, is instantly identifiable. Perhaps because they are summoned to attend, none of the residents make room for us to sit - so, like humpty on the wall we perch on a coffee-table. I negotiate the resistance, seeking views on health service access. In my information letter (Appendix 4) I have told residents about our respective roles.
Hugh fires an opening shot directly at Linda.
“You should be ashamed of yourself, working in psychiatric services in the UK. How could you?” The moment is tense. Others look on. Linda apologises - I wish she hadn’t! Momentarily we are in retreat but Linda comes back stronger, more positive about her role and the way mental health is embracing the Recovery programme.123 Hugh continues his bitter attack on psychiatrists whom, he declares, should be imprisoned or shot for what they do. How, I wonder, can we draw him into a therapeutic space?
I am getting anxious about the young guys in the room who may not engage with mental health services because of what they hear. I invade the space, balancing the conversation by acknowledging his experience and views.
121
The CMHT manager accompanied me to my Bail Hostel clinic following crisis health incidents. Her comment was, “Why haven’t we been here before”. Resources were immediately released time for homeless development but only for one half day per month. I arrange an induction day for the CPN to shadow me in my clinical work. The CPN takes over my Bail Clinic.
122
Strategic role: Public Health, Health Needs Assessment on Health and Homelessness (Appendix 1) 123
134
“Hugh, other people are helped by mental health services. What you have experienced sounds horrendous and you need to do something with those feelings. Other people have felt like you too... I sense your injustice. Write about your experience …If you allow me to, I can use them in a study... to make a political and academic difference”
He likes this and instantly agrees. By validated his experience intellectually, he begins to engage. I tell him more about this research. I include others in dialogue. In this space, I draw them into a caring network about local progress in health and homelessness, shifting tension to create flow for dialogue. The group becomes vocal about health issues!
Hugh is calmer. He begins to talk about himself - like Pamela (Text:1) he is another health professional who has not practiced since his illness. His knowledge of health, like Pamela's, shines out. When the group session concludes, Hugh stays with us – it feels like an engagement success. But his illness is apparent,
“Influential people have caused my downfall….people in government offices… all over the world.”
The king’s men - plotting against him in his everyday world.
He is wrought with suffering, disclosing that he was brutally assaulted and raped. I challenge myself on dealing with post-rape experiences. Robinson (2003) points out how trauma plays a significant role in the loss of housing and perpetuation of homelessness; healing hurt is core in the therapeutic relationship. I want to ease his suffering but how? It is so deep and he is so angry. I surf his resistance and anger to find his wavelength. Johns (2009:111) illuminates,
When people experience crisis...their wave patterns are likely to become chaotic; descents to ever greater depths as suffering and despair take hold...understanding experience helps...(but) this can be difficult when the person is resistant, angry, uncooperative
Like a dance, Hugh takes a step or two with me, and then seems to remember that he can’t trust us because we are the king’s army of health workers who has been “abusive” to him. Progress is tentative. He walks with us as we are leaving. Linda suggests they have tea next week, and he agrees. I am hopeful that with her psychiatric experience, a healing space can develop. I leave Linda to contact me feeling relief that the homelessness burden is shared and I can progress with the homelessness HNA and strategy.
135
31st May 2006 Couldn’t put Tony together again… The fragile net tears.Linda phones. Hugh died over the week-end.
Suicide, I ask. The post-mortem is being performed as we speak. Her shock is evident. I feel shocked! My gut wrenches further,
“He refused to do chores. Staff and other residents were getting upset by him. I took the hard
line… I advised Nicola to evict him... I discussed it with my manager first.”
The hard line - eviction.
… Wrenched too, because … … I discussed it with my manager…
No return to me. Where am I positioned clinically?
Too busy in my Public Health strategic role to pick up the telephone and check progress, trusting that I would be contacted if problems arose. In reflective guidance I am challenged for blaming myself. This is vulnerable work where nothing is predictable. But I also recognise that a clinical team around me would make homelessness less disparate. The relationship between me and the CPN requires nourishment; she has her support in the mental health team but they are only tentatively linked into homelessness trajectories.
Wheatley (2006:145) in her seminal work on systems knowledge notes, "To make a system stronger we need to create stronger relationships...if a system is suffering it lacks sufficient access to itself....it might be ignoring those who have valuable insights." Amalgamating mainstream mental health services in homelessness is insufficient if services do not have time to develop a deeper understanding of homelessness and a whole-systems approach within it, where relationships are strengthened.
I confront Linda,