NHS ‘dual diagnosis’ support helps homeless GM residents with most complex needs find homes
The Dual Diagnosis service, provided by Greater Manchester Mental Health NHS Foundation Trust (GMMH), as part of the Greater Manchester Housing First (GMHF) homelessness pilot led by Great Places Housing, is successfully helping homeless people with some of the most complex health needs to find and stay in safe housing.
GMHF is a partnership, launched in April 2019, and commissioned by the Greater Manchester Combined Authority (GMCA) with funding from the Department of Levelling Up Homes and Communities (DLUHC). Its aim is to rehouse people who are homeless or at the risk of being homeless across all 10 Greater Manchester Boroughs. Following the success of the initial three-year programme, it was recently extended for a further two years and has now helped more than 350 people into a safe and secure home of their own.
Dual Diagnosis refers to the experience of multiple, complex health challenges, such as mental health and/or substance misuse problems, alongside homelessness. It is very common for those experiencing enduring homelessness to have a dual diagnosis need, and providing specialist dual diagnosis support has been a vital part of the GMHF programme - with 94% of people supported in the first three years of GMHF reporting substance misuse issues, 88% reporting mental health issues, and 85% reporting both.
Since the launch of GMHF programme, the GMMH Dual Diagnosis arm of the programme has been providing specialist support to those with dual diagnoses. The team is comprised of four Dual Diagnosis Practitioners who work closely with service users and staff to empower them to better understand, manage and overcome the complex challenges that people with dual diagnoses face, to support them out of homelessness permanently.
This is done through a package of training for frontline workers (in areas such as Trauma-Informed Care and Harm Reduction); engagement and assessment of service users; encouragement of multi-agency working to address individuals’ needs in a more holistic, joined-up way; and encouragement of service flexibility, and where necessary, system change.
GMMH has delivered 20 training sessions to date, and continues to deliver training regularly to all new GMHF starters, and ongoing refresher training to GMHF staff. This sits alongside GMMH Recovery Academy resources and courses, which are available to all homeless sector partners.
In addition, 412 service users have been supported directly through the Dual Diagnosis service.
Pictured: The GMHF/Dual Diagnosis team with Mayor Andy Burnham
Adam Clayton, Interim Service Manager for Homeless Services at GMMH said:
“Working as a partner on the Greater Manchester Housing First programme has been an amazing opportunity to offer a whole system approach, collaboratively, to best meet the needs of people experiencing homelessness.
“People who experience homelessness are often marginalised from society and face barriers to access services most of us take for granted. People generally require support in multiple areas of their lives and cooccurring conditions such as substance use and mental health needs (often referred to as dual diagnosis) create additional barriers to accessing support for both housing and health needs.
“Through delivery of a trauma-informed, dual diagnosis model, we are able to work with everyone, regardless of their needs. This is done in partnership with the other Housing First partners to ensure these needs are considered on an individual and comprehensive basis. Our practitioners then work with people accessing Housing First and the wider staff team, to identify unmet needs and support them into mainstream services where appropriate.
“Throughout the time that Housing First has been delivered within Greater Manchester, we are delighted to have provided support and interventions to hundreds of people with a dual diagnosis.”
Emily Cole, Programme Lead at GMHF said:
““The Greater Manchester Housing First Partnership is helping to write the blueprint for scaling up the Housing First intervention, striving to bring about systemic change and prove the case beyond all doubt that it should be rolled out across the country.
“Housing First is a model of housing and support, with a plethora of research demonstrating its effectiveness at ending homelessness for those whom other services have been ineffective. It differs from the traditional Supported Housing model where people need to meet certain conditions to prove themselves ready for their own housing, and instead provides no conditions apart from a willingness to give managing a tenancy a go. Based on the ethos that housing is a human right, housing is provided first as a stable base from which other issues can be addressed, with long term intensive support provided.
“Our partnership is made up of 12 cross sectoral organisations from housing, health, the Community and Voluntary Sector (CVS), and people with lived experience; all working together to deliver the service across the region. Our partnership was the first in Greater Manchester to integrate health working, in partnership with GMMH, to provide specialist NHS Dual Diagnosis Practitioners, Psychiatry and Psychology as an integral part of the delivery model, working alongside frontline staff to provide the necessary support to people with co-occurring conditions. The Integration of health is now seen as an essential element for any homelessness intervention targeted at people with the most complex needs. Our work with GMMH has not only been transformational for the individuals supported but for the system itself; and it has been a pleasure to be on this journey with all practitioners involved.”
Michelle's story
Pictured: Michelle outside Parliament
“Growing up, I experienced abuse at home, and have struggled with physical health problems as a result, which are still ongoing. Over the years, this has made me vulnerable, and I have experienced a number of abusive relationships where my finances and freedom have been restricted.
“For years, I struggled to get the help I needed – my physical health got worse, and out of desperation I turned to illegal substances to self-medicate. I was forced into homelessness and was sleeping rough or in temporary hostels, where I experienced further assaults.
“I really needed help, but I was labelled as ‘intentionally homeless’, meaning I didn’t qualify for permanent housing. But this wasn’t right at all – I would be no safer at home. My physical health problems also weren’t taken seriously by my GP - they just saw me as a ‘junkie’.
“Just as I was ready to give up, I was referred to Housing First by Manchester Action on Street Health (MASH), and this is where my story really started to change. My Housing First Support Worker, Natalie, was amazing. She really took the time to get to know me, to understand what I have been through, and help me access the support I need – including finally finding a place of my own to live.
“I also received support from GMMH Housing First Dual Diagnosis Practitioner, Jade. She spoke to me about my physical and mental health needs, and then made sure the proper support was put in place. She liaised with my GP on my behalf, and made sure that they were doing the right tests, treatments and referring me on to the right specialists.
“She also provided a range of support and resources for my mental health – I’ve learned about Post-Traumatic Stress Disorder (PTSD), grounded and mindful breathing, managing flashbacks and managing pain and fatigue – which has been so useful.
“Without Housing First, I would be in a doorway or dead. But life now is so good now! I now have the proper medication I need and no longer use illegal substances. I have my own home – my own private space – where I can do the things I love to do. I grow plants, learn Korean, do yoga, play the piano, read, and watch films. I pay my bills, and do my weekly shop. I don’t have to worry about how I am going to be able to access things like clean water, toilets and washing facilities like I did when I was homeless. This I will never take for granted.
“My daughter lives with me which is amazing. She has passed her A-levels with flying colours, and will be off to university soon. I’m so proud of her, and so happy to be her mum. I am in the process of fighting for access rights to have contact with my younger son. My Dual Diagnosis Practitioner, Jade, is supporting me throughout this process, and is by my side at every Family Court session. My Housing First Worker Natalie has also been instrumental in this process - she’s been there every step of the way from completing the court application to supervising contact.
“Natalie still visits me regularly, and she’s only ever a phone call or text message away. She helps with anything from little admin tasks like reading over emails and letters, to advocating for my rights as a tenant, and providing moral support when I’m sad or frustrated or when I have exciting news to celebrate. Everyone should have a Natalie.
“I now volunteer at MASH and a local foodbank, and recently I visited the Houses of Parliament, to share my story and talk about how Housing First helped me. This felt like a real full circle moment.
“I am passionate about advocating for the rights of people experiencing homelessness – there are still so many who are struggling. The people I have seen and spent time with on the streets are resilient, brave and tenacious – they have had to be. They just need a chance for someone to believe in them, give them a helping hand, and provide that foundation of stability, and there is so much value they could contribute. This is what Housing First gave to me.”
