Rough Sleepers Initiative Team

We work with anyone accessing the Rough Sleeping Team who is experiencing drug and/or alcohol issues alongside a number of co-occurring needs such as:

• Anxiety, depression, mood swings, anger.
• Hearing voices or having unusual/distressing thoughts.
• Self-harm behaviours or suicidal feelings.
• Issues relating to past trauma, abuse, loss or victimisation.
• Alcohol.
• Street drugs.
• Prescription drugs.

Please note: For mild/minor mental health and substance use problems, we advise that efforts are made to encourage and support people to access their GP and local substance use services if this is feasible.

Our approach is to help people to access, transition into and make use of local available services, including seeking to remove any barriers to their inclusion. Our approach is not to replace existing services. Key aspects of our work are:

Pre-engagement and outreach

• We recognise that many people who are rough sleeping have had traumatic histories, and that this can make it hard for them to trust others and in turn may prevent them accessing mental health services. Alongside the Rough Sleeping Team, we can work slowly with people so that over time they may learn to trust us and may engage in further assessment.
• We adopt an ‘assertive outreach’ approach, recognising that people who sleep rough are unlikely to attend appointments in a clinic setting. We accompany Rough Sleeping Team workers on outreach and attend homeless support services, hostels and emergency accommodation for ‘drop-in’ clinics.

Engagement and assessment

• We conduct assessments to understand the person’s current mental health and substance misuse difficulties and their personal history, and how these impact on their life.
• We may conduct additional psychological assessment and psychological formulation where there are queries about additional factors impacting the person’s wellbeing and functioning.
• We may deliver brief interventions to individuals, focused on increasing mental health awareness, self-management, harm-reduction, and motivation.
• We refer people to appropriate local services for ongoing support or specialist assessment, for example to community mental health teams, early intervention in psychosis teams, primary care talking therapies or adult social care.

Consultation and staff support

• For people who are already under mental health/substance use services, ongoing support should be provided by their current teams. However, we can liaise with these teams, offer a limited period of joint-working and provide consultation/ advice in order to help people stay engaged with services.
• We provide regular staff group reflective practice and individual staff support/supervision sessions.
• We deliver a programme of staff training on topics pertinent to homelessness, mental health and substance use.
• We participate in key homelessness multi-agency meetings in the borough, contributing expertise from a health/mental health perspective.

As a small team there are some things we cannot do, including:

Crisis/emergency response: In the event of a crisis or emergency, please contact urgent care services.

Diagnosis/prescribed treatment: This normally requires assessment by a medical practitioner; we can help someone to access this.

Counselling/talking therapy: If someone is ready, willing and able to engage in counselling/therapy, then we can help them to access this.

Care co-ordination including safeguarding management: This would be provided by a statutory service and we would not replace the need for this. If this is needed, we will refer into services to help a person to access this.

Open ended work: We will try repeatedly to engage the person in direct work, but if this is not successful, we will have to close the referral. We can continue to work indirectly to support the person by providing advice to involved staff. The person can be re-referred to the team at any time.

The person should consent to meeting us for a comprehensive assessment of presenting needs which will include consideration of their mental health and substance use. Rough Sleeping Team workers in the borough can refer anyone they are working with by completing the Referral Form, and emailing: RSITeam@gmmh.nhs.uk

If the referral is appropriate, we expect to make contact with the person within five working days to arrange an assessment