Homeless - good practice examples

We are highlighting examples of good practice. Some of these are described in (sometimes hard to find) documents. Others have been provided by nurses working with excluded groups.

You might also like to refer to the guidance, policy and voices sections for further information on the homeless.

If you would like to send us an example of good practice please use the online form.

These are the good practice examples described below.

Re-establishing links between homeless people and mental health services

I have worked part-time for the Scrine Foundation as a mental health nurse for about three years. Homeless people are socially excluded and may have had little or no contact with trained mental health workers. Moreover, it is acknowledged that there are a disproportionate number of people with mental health problems who are homeless, compared with the general population. Individuals may lose their home because they are mentally ill and vice versa.

In this area it is very difficult for homeless people to register with a GP. This closes off one of the key access routes to specialist services, including mental health and the people most likely to experience ill-health are often the least likely to have easy access to care.

They can also present to specialist services as very challenging, which along with their unsettled lifestyle can add to their experience of exclusion. People with dual diagnosis/complex needs, can become part of a "patient tennis" situation, with the patient as the ball being bounced between different services but never finding the appropriate one, and eventually losing confidence in the whole system.

The existing referral process insisted on written referrals, offered little or no chance for discussion with fellow professionals, and an appointment system that meant that at least some clients would never get past first base before they moved on.

I wanted to design a system that treated everybody fairly and with dignity, whilst at the same time using the window of opportunity I had with these socially excluded people to screen them for mental health problems and seek help for them.

I decided to offer every service user a mental health screening and designed a screening tool which could be used with any client and which, we hoped, would identify a range of mental health problems if they were present. As a result of these meetings, we now attend the local intake team meeting, where there is mutual exchange of information about clients, better planning and a smoother referral pathway.

I use a data collection tool that allows us to demonstrate month on month, and year on year, the degree and nature of mental health problems encountered, broken down by a variety of significant factors, including age, gender, ethnicity, background. This is obviously useful in demonstrating where the needs lie and what input is given, as well as supporting funding bids.

I have also created a presentation on 'Homelessness and Mental Health' which I have shown to church groups, students and homelessness workers, amongst others.

Over a three year period we have raised the profile of homeless mentally ill people. We have forged better working relationships with our colleagues in the Health Service. We have done this by careful screening, data collection, and by persisting in drawing them to the attention of a variety of other agencies. On the client side, I worked with people who had either opted out of statutory mental health provision or never engaged with it in the first place.

I try to counteract negative attitudes and expectations in clients by treating them respectfully and professionally, despite their frequently challenging behaviours. I strive to get them to acknowledge the problems that have contributed to their homelessness and seek appropriate help to change things.

Example kindly submitted in February 2009 by Neil Goddard, mental health specialist nurse, Scrine Foundation, Canterbury.

The Scrine Foundation is now known as Catching Lives. It is an independent local charity dedicated to supporting the homeless, vulnerably housed and destitute in and around Canterbury. For further information go to the Catching Lives website.

For further details you can download the full report of Re-establishing links between homeless people and mental health services (Word 175KB).

Queen's Nursing Institute: Opening Doors project

Opening Doors is a two year project run by the Queen’s Nursing Institute,  that aims to improve the health of homeless people and families, with particular reference to substance misuse and using the QNI national network of over 600 nurses and other health professionals who work with homeless people. This page introduces some of the projects that are part of the Opening Doors network - see Opening Doors: Focus on...

There is also, as part of the project, a case study describing the experiences of a 39 year old man who has needed long term support from a homeless health service – see a service user case study. 

Prior to Opening Doors the Queen’s Nursing Institute led a Homeless Health Initiative in 2010. Learning resources from this initiative are made available. Section B Module 4 on quality improvement provides a number of case studies. See Improving healthcare for homeless people.

DH Care Networks Housing Learning and Improvement Network (LIN): Homelessness prevention and hospital discharge

This section of the Housing LIN presents a set of case studies which explore ways in which housing authorities and hospital trusts are addressing the issue of discharge of homeless people. These case studies demonstrate how the protocol guidelines developed by the Homeless Link and the London Network for Nurses and Midwives, and published by the Department for Communities and Local Government, have been used. See Homelessness prevention and hospital discharge: three case studies.

North Ayrshire Council: Homeless Prevention Service

North Ayrshire Council won a Gold Award in the 2012 COSLA Excellence Awards (the Convention of Scottish Local Authorities) for its work in refocusing its service on the prevention of homelessness rather than just responding to people already in crisis.

In their submission the Council state that they have successfully transformed both the culture of the organisation and the relationship with their customers. As a result of the changes made to the service structure “shifting resources from crisis response to early intervention”, the service has reduced the levels of homeless presentations by 49 per cent over a four year period. The completed award application form is included in this page on the COSLA website and gives details of the services and its impact - see Achieving better outcomes - North Ayrshire Council: Homeless Prevention Service. 

The Scottish Government in a news report of January 2013 describes how the Council has used specialist teams to enable individuals “to make informed housing decisions based on their own needs and aspirations ... through talking through all possible options with an individual they have a much better opportunity to secure a planned rather than crisis move". The service has “also taken the innovative step of actively offering mediation and negotiation services for those individuals who could safely return home rather than become homeless”  - see Homelessness prevention reaps real benefits.

The North Ayrshire homeless service page is at Homelessness Advice and Support.