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Opinion: mentally speaking

May 04 2015
Many homeless people report mental health problems, but are they getting the help they need?

The figures tell a sobering story. In the last five years, homelessness has increased by 40 per cent in the UK. What’s more, a staggering 80 per cent of the UK’s homeless population report mental health problems. But will they get the help they need?

My experiences as a community psychiatric nurse suggest not all will.

After all, how could they? Funding for mental health has been cut for three consecutive years now.

Since last year, there’s been an eight per cent fall in mental health budgets and a rise in referrals of 20 per cent to Community Mental Health Teams (CMHTs). No wonder so many healthcare professionals are feeling the pressure of having to do a lot more with less.

Across the board, cuts are being made to the number of mental health professionals based within homeless organisations. Previously, a hostel might have had a mental health professional on site, or specialist groups to advise. Now there are now just the basics: a bed and a roof over your head.

In my job, I rely on homeless voluntary organisations that run throughout winter to meet some of the shortfall. But now, as summer approaches, they are not there.

The result is many people suffering an episode of full mental health – whether they are experiencing a psychotic episode or feeling suicidal – are presenting to A&E and often end up being discharged back to the streets.

Some 35 per cent of homeless people were admitted to A&E complaining of a mental health problem over the past six months.

The current psychiatric hospital bed crisis makes accessing hospital care difficult. So what are you to do?

There is hope. The homeless Hospital Discharge Network helps homeless people in London who require ongoing nursing support following discharge from hospital and offers ‘step up, step down’ care. This is the equivalent to what the non-homeless get after a hospital visit, for example a nurse to visit them in their home.

The different they make is immeasurable, and we need more money invested in these services if we are to meet the demands and to prevent worsening of mental health rates in the homeless population. The problem of cuts in other essential areas has an impact too.

As a psychiatric nurse, I should spend my time supporting, educating and treating mental health and general wellbeing. Instead, I spend my days filling out applications for welfare support or contacting the local council to help find emergency accommodation for our service users. Who else, my patients ask, is there to ask for help?

According to the Mental Health Policy Group, by 2030 we will be witnessing two million more people in the country with mental health needs. It is essential that proportions of the budget are specifically set aside for homeless people.

This is not just about being humane. To put it bluntly, the research shows time and time again, that it’s cheaper to address someone’s mental health issues when they first show up in a hostel than to wait until their situation becomes ever more complex. More collaborative working between services needs to be supported and emphasised, and a broader understanding of the cycle of factors contributing to poor mental health, including environment, substance misuse, physical health and social needs, is urgently needed.

We need to pull together as a nation to treat our most vulnerable as a matter of priority.

What do you think? Have you struggled to access mental health services? Tell us what you think: karin@thepavement.org.uk

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