As with the homeless population in general, a high proportion of HOP clients suffer from some form of mental illness, but often find it difficult to access mainstream psychiatric services. HOP’s Mental Health team aims to help and support clients in addressing their mental health problems, by providing alternatives to the usual emergency routes.

Building trust

Mental health workers undertake regular streetwork and duty shifts, engaging proactively with clients in a planned, focused but flexible manner to develop relationships and arrive at appropriate decisions regarding psychiatric intervention. Much of this work, which can take up to several months, is carried out in conjunction with the weekly psychiatric clinic jointly run by HOP and Edinburgh Homeless Practice.

Fast and flexible

For homeless clients, a key priority is circumventing the usual delays involved in accessing psychiatric services, and so reducing the need for emergency admissions. The clinic’s flexible appointments system enables clients to be seen where and when they choose, with most initial assessments taking place within three days. On-street assessments by the clinic’s psychiatric registrar can be arranged for those unwilling to attend appointments, and emergency telephone advice is also available. Following referral by mental health workers, priority cases can usually be seen at the clinic within two weeks.

Complex needs

As well as mental health difficulties, many of HOP’s clients also have problems with drug and/or alcohol dependency. Mental health staff therefore work closely with HOP’s specialist addictions workers as well as the streetwork team, both through joint streetwork shifts and ongoing consultation regarding individual clients’ needs. In addition to joint working within the project, we also provide advice, support and training to external agencies involved in the homelessness and mental health sector.

Mr P For Persistence

Thursday, March 06, 2008

Mr "P", 43, slept rough in Edinburgh for many years. He was usually to be found staying in the same doorway, enabling HOP staff to engage with him over a period of time.

While living on the streets, Mr P made use of very few homeless services other than food handouts, and had even stopped attending the winter night shelters, following a dispute with another of their clients.

Initial contact with outreach workers soon prompted concerns over Mr P’s mental health. He was often witnessed responding to non-existent stimuli, as well as exhibiting other bizarre behaviour. Although he denied experiencing any positive symptoms of psychosis, he agreed to an on-street psychiatric assessment, arranged through the clinic jointly run by HOP and Edinburgh Homeless Practice. This determined that while he was suffering from a mental illness, he did not require emergency detention at this time.

Instead, it was decided that mental health workers would continue to ...