‘Health & Wellbeing — An important piece of the jigsaw’.
23.08.19: This week I had the pleasure of spending some time with the Centrepoint’s Health Team (North) in order to understand more about this vital resource within the organisation, as well as how their work will fit within the planned Psychologically Informed Environment (PIE). The issue of young people’s mental health and wellbeing is now rightly getting more attention in wider society and the media (c.f. https://www.theguardian.com/society/series/mental-health-2019), including the recognition that in order for young people to reach their full potential in the future, they need to be physically and mentally healthy. One of Centrepoint’s key aims beyond the provision of housing, is that young people leaving our services are engaged in meaningful activities such as education, training or employment, and sometimes this requires additional intervention(s) to ensure that they are ‘ready’ and ‘able’ to access these. This is when our Health Team can step in, when the barriers relate to mental and physical wellbeing, to provide that important bridge from NEET (‘Not in Education, Employment and Training’) to EET (in ‘Education, Employment and Training’).
Research has shown that young people that access Centrepoint services have high levels of health and wellbeing needs (c.f. www.centrepoint.org.uk/media/1717/toxic-mix-exec-sum.pdf). Specifically, 25% of young people arrive at Centrepoint with a formally diagnosed mental health problem, with Depression the most common issue (50%), followed by Anxiety (20%) and Attention Deficit Hyperactivity Disorder: ADHD (20%). Although these diagnosed rates of mental health issues are significantly higher than young people in the general population, a likely result of the past traumatic early experiences, attachment issues and the consequences of homelessness itself, it is also concerning that there are even more young people in Centrepoint services without a formal diagnosis (or contact with statutory mental health services) that report symptoms or problems with their mental health. For example, Centrepoint statistics indicate that this can be a further one in six young people presenting to our services (16%) although the exact rates are unknown as often young people may not admit to their difficulties for fear of being further stigmatised. Moreover, mental and physical health issues can be compounded by the high rates of substance use and poor diet amongst this population.
Consequently, the Centrepoint Health Team, in line with the PIE model of providing psychological and emotional support, provides specialist help for young people on psychological issues through the provision of psychotherapy, as well as support to address substance use, mental health crises, relationship issues and nutrition. Therefore during my discussions with the Health Team I have met a wide range of professionals from psychotherapists to dietitians, as well as mental health, substance use and healthy relationship workers, all utilising their specific skills and knowledge to ensure that young people receive a holistic package of ‘in house’ support in all areas of their lives to improve their chance of engaging in education, employment and training and living independently in the future.
Whilst Centrepoint works closely with our statutory (and other voluntary sector partners) in supporting the health and wellbeing of young people accessing our services, such as local Children and Adolescent Mental Health Services (CAMHS) or Community Mental Health Teams (CHMTs), we recognise that high thresholds for access, waiting lists and travel costs can mean many homeless young people face barriers to receiving statutory mental health services or have past negative experiences that lead to an unwillingness to engage in the future. This is an issue highlighted by both Centrepoint (c.f. www.independent.co.uk/news/homelesshelpline/homeless-helpline-centrepoint-mental-health-young-and-homeles-austerity-cuts-nhs-local-councils-a7456806.html) and a report by the UK National Mental Health Development Unit (2010), which showed that homeless people with complex trauma histories often experience systemic neglect from traditional mental health services. Other homeless young people may not even understand their own complicated health needs and struggle to meaningful engage in externally offered services.
Therefore, by providing an in-house health service, as an adjunct to what may be available through local statutory services, Centrepoint can give young people access to tailored support when and where it suits them. Such an approach can also be less stigmatising for young people and provide early intervention to address issues before they reach a significant crises point, sometimes even preventing the need to access statutory services formally. This flexibility in access is a critical part of the original PIE approaches as developed in the USA first (e.g. Levy, 2013), and then the UK more recently (e.g. Johnson, 2013; Keats et al, 2012). PIE grew from the need to engage the often stigmatised and marginalised homeless population in a more meaningful way, by ‘going out to them’ rather than expecting ‘them to come to us’. This approach fits with more community psychology approaches, wherein flexibility is key, and services are co-designed to meet the actual needs of the users rather than offering what is perceived by professionals or commissioners to be needed; thus “beginning where the person is at, not where I wanted him to be” (c.f. Levy, 2017).
Although Centrepoint is beginning its formal PIE journey, my discussions with the Health Team this week have highlighted that we are already thinking ‘PIE’ in our approach to the health and wellbeing of the young people that access our services. By working directly with young people in housing services to address mental health, substance use, relationship or physical health needs, we can overcome common barriers to engagement in statutory services and ensure that the young people receive the help they need at the time and in the place that they need it. And by addressing the mental and physical health needs of homeless young people, we can reduce an additional but often significant barrier they may have in accessing education, training and employment in the future. Moving forward therefore, our Health Team is a valuable and critical part of the Centrepoint PIE, and a key part of the ‘jigsaw’ to #changethestory around youth homelessness…
