So here it is, my first blog from #COT2017 and what a start it has been – frenetic, energetic and inspiring. And the latter can certainly be applied to this session, which concentrated on the work of three OTs in non-traditional roles within a traditional setting.
Sophie Koehne, Dan Lescure and John Sapani all work for KHP Pathway Homeless Team in London. Sophie and Dan are based at South London and Maudsley NHS Foundation Trust (SLaM for short) – in an inpatient mental health setting – while John is based in an MDT at Guys and St Thomas’ Hospital.
Having worked in a local authority homelessness team in a previous life, I was aware of some of the issues, and was intrigued by the opportunities for occupational therapy.
The trio began by setting the context of homelessness, which covers more than rough sleeping. It can take the form of temporary accommodation, squatting, ‘sofa surfing’, among other scenarios, and can be caused by many factors. The presenters referenced the recent tragedy at Grenfell Tower, which has left many people in a vulnerable situation with housing.
Homelessness is more than not having a stable roof over your head: there are legal and social implications; it can be isolating and destructive. Not only that, but in the past 5-10 years, homelessness has become seen as a health issue. The presenters outlined some eye-opening statistics: the average life expectancy of a homeless man is 47, while for women it is 43, compared with 77 and 82 respectively for the general population.
Mental health problems are prevalent in this population, although undiagnosed in many. In fact, delayed treatment and diagnosis of many health issues is common within those who are homeless. This is not helped by a lack of access to services, such as registration with a GP. Homeless people are more likely to access healthcare via A&E and be admitted to hospital. And, without proper planning and coordination for discharge, health issues may not be recognised or tackled. Health issues common in homeless people include early ageing and trimorbidity (mental health, physical health and substance misuse).
So, the aim of the team from their respective bases is to improve health outcomes and safe discharge by targeting frequent attendees to hospital. This is achieved through advice, recognising health needs, advocacy, and encouraging reintegration into society. Of course, challenges were identified with working with such a transient population: a lack of identity documents, financial insecurity, a lack of recourse to public funds, and discharge (frequently self-discharge) before housing support can be investigated.
But why OT? The practitioners explained that their dual training was a clear benefit when working with homeless people, because of the potential impact of their living situation on both their physical and mental health. Occupational therapy skills came into play, particularly in the ability to see the impact of a change in environment. While the medical team were looking at straightforward discharge planning, the team were thinking more widely about how the person may have to cope on the street, or in alternative accommodation. They were also experienced in working in a multiagency and multidisciplinary environment.
The presenters talked about their transitional work, supporting people before and after discharge, with the aim of reducing readmission.
A recent service evaluation by a health economist has shown value in their work: reducing length of stay by 24%, reducing readmission (although not across all sites – the presenters noted that in some places they had been so helpful, people had returned for more support!). Two case studies illustrated how the service had supported people through holistic assessments, setting goals and support through discharge.
If there was one take away for me, it was learning on the value of therapeutic use of self. The key with this client group is to establish rapport. People are being given opportunities to engage in occupations that they haven’t been able to without stable accommodation: cooking a meal, watching TV, getting a good night’s sleep.
But their work doesn’t stop there. Future plans include in-reach to hostels and working with OTs there, exploring experts by experience – homeless people who have turned their lives around – and expanding a network of OTs working in similar settings. If you’re interested – I am sure they would be keen for you to get in touch.
1st year pre–reg MSc student at the University of Essex
Department of Health (2010) Healthcare for Single Homeless People. Online at https://www.housinglin.org.uk/_assets/Resources/Housing/Support_materials/Other_reports_and_guidance/Healthcare_for_single_homeless_people.pdf [Accessed 19 Jun 17]
Crisis (2014) Turned Away: The treatment of single homeless people by local authority homelessness services in England. Online at: https://crisis.org.uk/media/20496/turned_away2014.pdf [Accessed 19 Jun 17]