‘Time to let LEWS’: Introducing the new PIE informed Lambeth Emotional Wellbeing Service in National Mental Health Awareness Week’…
19.05.2022: As I write this week’s PIE blog, the first for a while due to leave and other commitments, I have been reflecting back over a very busy period as the lead for Psychologically Informed Environments (PIE), at the national youth homeless charity — Centrepoint. A significant part of this time as been getting things in place for a new contract that the PIE team has won in conjunction with our wonderful Centrepoint Psychotherapy team in Lambeth, South London. This is a very exciting and innovative opportunity for service delivery, including the first time our Centrepoint PIE offer has been directly commissioned, rather than being included as part of our ‘standard offer’. This highlights that local commissioners are recognising the specific value of both a PIE approach and the access to individual psychotherapy for homeless young people, who can often be excluded from traditional statutory care pathways. I hope to highlight further the bespoke homeless psychotherapy offer in Centrepoint, and in particular in Lambeth, in a future PIE blog.
For this week however, it feels like a good moment to raise awareness of what is planned in the new Lambeth Health & Well-being Service (LEWS) as this offer is due to launch across the borough of Lambeth on the 1st June. Moreover, this is timely because it is also National Mental Health Awareness Week this week (c.f. https://www.mentalhealth.org.uk/our-work/public-engagement/mental-health-awareness-week). Previous PIE blogs (c.f. https://medium.com/@drhelenmiles/reflecting-back-the-social-determinants-of-mental-health-and-the-importance-in-a-psychologically-c12009ce7d72) have highlighted Mental Health Week in the past, although this year’s theme is ‘Anxiety’. Of course, anxiety is a normal emotion in all of us, although sometimes events or circumstances can mean it can get ‘out of control’ and therefore start to become a mental health issue. For the young people we support in Centrepoint, there are many things that might trigger their anxiety, including the fact that they are currently ‘homeless’ and maybe separated from just those relationships with family and friends that support most of us to cope when we are stressed or anxious. Consequently, rates of anxiety amongst homeless young people are generally higher than their ‘housed peers’ (c.f. Centrepoint, 2021: https://centrepoint.org.uk/media/4650/prevalence-of-mental-health-need-report.pdf).
Moreover, homeless young people can often face other challenges such as exams, starting work, managing their money and accessing the food and other thing that they need. Sometimes this anxiety can trigger other ‘challenging’ behaviours that can be difficult to manage in supported accommodation services (e.g. substance use, self-harm, social avoidance, aggression etc.). Therefore, it is important that we think about ways we can support homeless young people with their anxiety. A good link with some strategies to support those with anxiety can be found here: https://www.mentalhealth.org.uk/our-work/public-engagement/mental-health-awareness-week/what-can-we-do-cope-feelings-anxiety. However, the most important things we can do to support homeless young people is recognise this anxiety in them, even if they may struggle to name it as such and then offer them a safe ‘listening’ space to express these emotions. Being present and available for the young person is critical, and listening with empathy and without judgement is vital. Only then, can we start to work collaboratively with them to consider how they can manage their anxiety and access further support if needed, in order to fulfil their potential in the future.
Which brings me back to our new LEWS service at Centrepoint in Lambeth. I am delighted to welcome Dr Caroline Bradley (PIE Principal Clinical Psychologist) back to the PIE team after her sabbatical in Zimbabwe to lead this project on the ground. She brings with her a wealth of experience, both within Centrepoint as well as her previous roles, in order to develop this service in conjunction with the wider PIE team and the Centrepoint Psychotherapy team. This is also a really exciting opportunity to align both these teams further, working together to ensure the best outcomes for homeless young people in south London as well as for the staff that support them. I am therefore going to hand over the rest of this week’s PIE blog to Caroline, to outline further the service we are planning to offer. Moreover, if there are any budding psychologists or newly qualified clinical psychologists reading this blog, who are interested in joining the LEWS PIE Team, then please do get in touch via hmiles@centrepoint.org to discuss further some of the new roles available. For now though, over to Caroline…
‘Exciting times in Lambeth: Launch of the new emotional wellbeing team! Centrepoint holds the emotional wellbeing of the young people in our services as central to our work. Over the past 4 years, we have developed our innovative and flexible psychologically informed environments service and offered over 1000 reflective practice sessions to staff across the country! We have worked jointly with staff and young people to develop hostels or supported accommodation services, which do not just provide housing, but provide a home. This is therefore a very exciting opportunity to develop our mental health, psychotherapy and PIE support to homeless young people in the Lambeth Housing Pathway in the form of the Lambeth Emotional Wellbeing Service (LEWS). This is an pioneering and unique project which offers the first opportunity for Centrepoint to support young people experiencing homelessness and housing instability to access a joint psychologically informed housing service and direct mental health services.
Why was the LEWS service commissioned? Lambeth Local Authority (LA) identified that the young people in their housing pathway had significant unmet mental health needs and that gaps in mental health provision were contributing to worse outcomes for this group of already marginalised young people. A needs assessment undertaken in the borough in September 2020 identified that 19% of young people in supported housing and 25% of young people in semi-independent living services had support needs around mental health. Substance use was also a significant unmet need with 19% of young people in supported housing and 13% of young people in semi-independent living services reporting substance misuse. Young people in focus groups run by Lambeth LA fed back that they used substances to cope with trauma and mental ill health, suggesting that the levels of substance misuse were related to unmet mental health need.
However, despite these figures, engagement with mental health and substance misuse support was low with only 10% of young people in semi-independent living services and 18% of young people in supported accommodation services engaging with a mental health service. The number of young people accessing substance misuse services was even lower with only 7% of young people in supported accommodation and 2% of young people in semi-independent living services accessing support for their substance misuse. The needs analysis also highlighted high numbers of young people with suspected undiagnosed neurodiversity issues (e.g. Autism Spectrum Disorder, Attention Deficit & Hyperactivity Disorder) and additional needs.
Many young people struggle when the support offered by statutory Child and Adolescent Mental Health Services (CAMHS) comes to an abrupt end when they turn 18. Negotiating the world of hard to access adult services is often overwhelming and discouraging for young people. They often face long waiting lists or may be told that their presenting concerns are not severe enough to meet the threshold for statutory service support. Bridging the gap between child and adult services is even harder for young people who have recently moved to a a new area, do not speak English as a first language or who are in mental health crises.
Moreover, adolescence and young adulthood is a challenging and tumultuous time for many young people. However, at Centrepoint we know from working with young people therapeutically for over 18 years that those challenges are multiplied for young people also facing housing instability and homelessness. They are more likely have experienced loss, neglect and traumatic experiences prior to accessing housing support, as well as facing the difficulties and stigma of living in supported accommodation. In addition, in Lambeth specifically, many of the young people in need of housing support have experience of the care system, have arrived in the UK seeking asylum following a traumatic migration journey, or have experienced criminal exploitation and serious youth violence. Some are raising their own young families and are attempting to access education. As a result, many of the young people in this housing pathway require a thoughtful, compassionate and tailored support for their emotional and mental wellbeing which is designed to be easy to access and to work with them holistically.
What is Centrepoint’s vision for homeless young people in Lambeth? Consequently, at Centrepoint, we have designed a holistic wellbeing and PIE offer for the borough. We are aiming to offer a joined up, thoughtful and trauma informed service to the homeless young people in Lambeth, available to be accessed at any point in their housing ‘journey’. Importantly, we hope to work jointly with young people to co-produce services, as per a PIE, so that they feel useful, accessible and supportive.
The emotional wellbeing team will comprise of myself, as well as other psychologists, psychotherapists and a pathway social worker. We will offer young people and housing services in the borough a tiered approach which aims to systematically address the emotional wellbeing needs of young people. This ranges from low intensity support for young people with less severe difficulties to individualised support for those who need more intensive support. Therefore, the plan is for the team to offer the following to homeless young people in Lambeth as appropriate:
- Psychological / Psychotherapy Assessment(s).
- Brief psychological interventions in conjunction with keyworkers such as crisis management and safety planning.
- Group ‘workshops’ for young people to support their psychosocial functioning.
- Individual psychotherapy for young people who need more intensive, individualised support
- Neuropsychological Assessments to assess undiagnosed neurodevelopmental, learning or cognitive needs.
In addition to this, Lambeth teams will have access to our Psychologically Informed Environments (PIE) approach in the form of:
- Monthly Team Reflective Practice (RP).
- 1:1 Case Consultation to staff re: Challenges with the Young People they support.
- Support to create psychologically informed physical environments.
- PIE informed Staff Training.
What will LEWS look in practice? All our team members will be co-located in each of the pathway services to increase our visibility for staff and the homeless young people they support. We want to let staff and young people know we are available and easy to access for support. When young people enter the housing pathway, they can request an introductory meeting and initial consultation with our Practitioners so they understand the resources and support available to them. Staff can access monthly team reflective practice as well as psychologically informed training in areas such as substance use, mental health, professional boundaries, working with risk, dealing with challenging behaviours, trauma-informed approaches, managing complex emotions and thoughts as well as locally relevant training such as working with criminally exploited young people or supporting unaccompanied asylum seeking minors.
We will also develop a young person’s steering group and they will lead on the co-production of our wellbeing services as well as developing psychologically informed environments through changes to the physical environments of the supported accommodation services. We will operate a simple and quick referral system for young people who wish to access psychotherapy and neuropsychological assessment but other interventions such as our group workshops will have a flexible open-door policy so young people have ‘choice’ and ‘control’ about attending. Initial assessments or requests will be undertaken by Keyworkers and then, with the consent on a young person, transferred to our Clinical Team to case formulate and ascertain the most appropriate offer. All keyworkers will be supported via our PIE training to learn, practice and understand how the assessment process works so we maximise appropriate referrals into the service.
So, what support can young people access?
Group Workshops: Often, when we are facing challenges in our life we can be left feeling alone. We can feel unable to speak to friends or family members about our difficulties, which can both compound our feelings of isolation as well as stopping those around us from sharing their own experiences and ways of coping. As part of LEWS, we hope to co-produce group-based workshops based in the supported accommodation services or other appropriate locations, to support young people to discuss and manage their emotional wellbeing. These may include topics young people wish to discuss such as dealing with anger, how to regulate emotions, building resilience, social anxiety, self-care, managing low mood, and moving on from homelessness. However, we aim to co-produce these sessions with young people so that they are accessible and rooted in their local needs and they can take the lead on the topics. By working jointly with our PIE psychologists, these group workshops will be relaxed and youth-led spaces to think about mental health, which are supported by psychological evidence-based approaches to managing mental health and transition.
Short-term Crisis Support and Advocacy: Unfortunately, we know that young people can face crises in their mental health, safeguarding or following an unexpected event such as a loss or bereavement. We aim to offer timely and easy to access crisis and advocacy support for young people. The PIE psychologists will work in conjunction with the homeless young person’s keyworker to support them through a crisis and scaffold into longer term support if needed. In practice, this could mean developing collaborative and accurate safety and risk management plan(s) in conjunction with the young person as well as other professionals involved in their care. It may also mean offering advice and consultation to staff around a specific issue, or providing advocacy support and signposting for keyworkers to ensure that young people access the appropriate statutory services that can meet their needs in a timely manner.
Individual Psychotherapy Offer: Centrepoint has a long tradition of offering high quality, confidential and individualised psychotherapy to homeless young people. We are delighted to be able to continue and develop this offer in the LEWS team. Highly skilled psychotherapists will offer young people individual clinical sessions to improve their mental health, overcome social or emotional challenges and reach their full potential. Therapists will provide a safe, welcoming, space so young people can express and process their feelings, gain deeper insight into their issues, find better ways to cope with fears, heal from trauma, and improve relationships.
Neuropsychological Assessments: Many homeless young people have had intermittent access to educational settings, and as such have often had their underlying cognitive needs overlooked. In the new LEWS offer, young people will be able to access neuropsychological assessments if there concerns are identified with regard to intellectual disabilities or difficulties, learning difficulties (e.g. Dyslexia), Attention Deficit & Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD). Following assessments, young people will be further supported to access relevant statutory services where available, and recommendations will be provide to keyworkers regarding any appropriate adaptations required in their support of a young person both within the supported accommodation services and/or enabling them to access further Education, Employment and Training opportunities.
So when does this start? As noted above the start date is the 1st June, and we are currently completing a local scoping exercise and recruitment to the team. We look forward to beginning to work with staff and young people in the homeless pathway in Lambeth to create the well-being a PIE informed support services that they deserve. So watch this space! We will be reporting back in due course on the outcomes of this innovative and exciting service, and in the meantime if any readers would like any further information on the LEWS offer, then please do get in touch with Dr Helen Miles (PIE Lead) or myself on cbradley@centrepoint.org…’
