July 14, 2024 • 27 mins
In this episode of the Rural Homelessness Podcast, Matt McChlery discusses the topic of mental health and its impact on people who have experienced rural homelessness. He interviews Marianne Watson, the Integrated Neighbourhood Program Manager for the Fenland Locality for the NHS, and Coryn Price, an NHS Community Psychiatric Nurse. They discuss the high prevalence of mental health conditions among homeless individuals, the challenges of accessing mental health services in rural areas, and the need for innovative solutions such as mobile outreach services.
Links
Takeaways
- People who have experienced homelessness are likely to have poor mental health as a result of their experiences.
- Accessing mental health services in rural areas can be challenging due to limited transportation and digital connectivity.
- Mobile outreach services that provide a one-stop-shop for support, including mental health care, could be an effective solution for reaching homeless individuals in rural areas.
- Building trust and engagement with homeless individuals is crucial for providing effective support.
- There is a need for more funding and resources to sustain and expand programs that support homeless individuals with mental health issues.
Chapters
00:00 Introduction
00:28 Guest Introductions
01:27 The Impact of Mental Health on Rural Homelessness
08:42 Hidden Nature of Rural Homelessness
13:26 Building Trust and Engagement with Homeless Individuals
23:22 Innovative Solutions: Mobile Outreach Services
26:04 Conclusion
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:06):
This is the Rural Homelessness Podcast,where we discuss the important issues
around rural homelessness, hear from thoseaffected by it, and offer some solutions.
Brought to you by the award -winninghomelessness charity, The Ferry Project.
Welcome to the Rural Homelessness Podcast.
(00:28):
Hello and welcome to this episode of theRural Homelessness Podcast.
I'm your host, Matt McChlery Thank you somuch for joining me for this episode of
the show.
Now today I'm going to be chatting withMarianne Watson, who is the Integrated
Neighborhood Program Manager for theFenland Locality for the NHS.
(00:49):
And I'm also going to be having a chatwith Coryn Price, who is an NHS Community
Psychiatric Nurse.
And today we are going to be discussingthe topic of mental health, the mental
health services in rural areas.
And of course, why mental health is soimportant for people who have experienced
(01:10):
rural homelessness.
So let's welcome Maryanne Watson and CorynPrice to the podcast.
Hello, Maryanne.
Hello.
Hi, how are you?
I'm well, thank you.
And hello, Coryn.
Thanks for joining us.
Hello Matt.
Thank you very much.
Nice to speak to you.
So welcome to the Rural Homelessnesspodcast.
(01:31):
The first thing I would like to ask bothof you is looking at the topic of mental
health from the perspective ofhomelessness.
Did that someone who has experiencedhomelessness will have poor mental health
as a result of their experiences?
So, yes, unfortunately, it is very likelyin a recent audit that we that was
(01:54):
undertaken across Cambridge andPeterborough.
69 % or 150 people who responded to thatidentified themselves being diagnosed with
at least one listed mental healthcondition.
More often than not, you'll find thatpeople who experience poor health will
experience poor health as a consequence ofhomelessness, which can lead to worsening
(02:19):
mental health, also increased risk of self-medicating.
Hmm.
Karen, what's your experience?
I suppose I'm in a position where I workwith a homeless organization where they
support people who have come directly fromthe streets.
So my experience may be different in thesense that we're seeing people actually in
(02:43):
their situation at that time.
My experience from mental health point ofview would be that a lot of people have
hit an all time low really.
And like as Mary Ann just said,
of self -medicated with either drugs oralcohol to kind of numb the existence of
where they are at that point in time.
And also probably not put it's pretty alittle bit under reported as well because
(03:04):
a vast majority of people with mentalhealth problems who have hit the streets
or in old street homeless will not accessthe same services and potentially somebody
who lives in a property might do becauseat that point in time the main focus for
them is getting through the day andmanaging their kind of activities daily of
living such as getting them to eat,keeping warm.
If they are, if they are an addiction,it's about managing their addiction at
(03:26):
that point in time as well.
So mental health is always there, but canquite often be the undercurrent.
And so mental health has an impact becauseit's not just the mental health issue, I
suppose it kind of has a domino effect andthen might spiral into other things.
As you were mentioning, I'm about selfmedication, may indicated with like drugs
(03:50):
or alcohol or that kind of thing.
So what are the common...
mental health problems that you comeacross with those that have been homeless?
Is it anything and everything or do youtend to find a few that are fairly common?
(04:12):
From my point of view, I think the mainsort of would be low mood.
But I have seen throughout working atwhere I am at the moment at the Ferry,
it's people who've had long term
chronic mental health problems and havekind of slipped off the radar due to being
in crisis, stopping taking medication,getting into addiction, ended up as
(04:33):
homeless.
And then they have the relapse signaturescome back in again, which could be long
-term schizophrenia, psychosis, which isthen made worse by the fact that
potentially they're homeless.
And they may not have access to themedication they would have had before.
So again, it's that kind of domino effect.
And I think for me, the...
(04:53):
vast majority of people I work with wouldbe low mood, but I would say about 20 %
has been long -term chronic mental health,which has been made worse by their
homeless period predicament.
And Marianne, would you say that, in yourexperience, because we're focusing on
rural homelessness more specifically,would you say that homeless people in
(05:19):
rural areas present with
more mental health problems than those inurban or what's that what does that look
like when you compare one with the other?
Yeah I suppose when you think of largecities and towns compared to a rural
environment you've got quite differentsort of layout of services and so on so
(05:42):
services and often you know centeredaround large cities towns and
that does create barriers for people whoare living off the streets.
So for example, public transport is abarrier at times and things like digital
connectivity as well.
So it really does make things much morecompounded really for those living rurally
(06:09):
and also obviously with those people whoare living off the streets.
And also just to say, I suppose that thosepeople probably feel socially isolated
too.
So that's something that the differencebetween that sort of rurality versus large
cities and towns.
And would you say that the provision ofmental health services in rural areas, do
(06:36):
they tend to have to be more flexible orinnovative than those say in a city
because they're having to deal with allsorts of different things but
it's only the one place that people canaccess them rather than a variety of
places.
yes definitely so really you'd be lookingto try and provide outreach services and
(07:02):
you know it would be really trying toreach those people so I think we know that
people are possibly living hidden and wedon't necessarily know about those people
in you know living in tents and variousplaces and so on.
So it's really, can we provide thoseservices on an outreach basis and take
really our services out to those people?
(07:24):
I totally agree with that.
I think the thing is, is like you say,within urban situations, it's very visible
or more visible.
And I think in a kind of rural locationsuch as where we are, it's more about
trying to find those people and locatethem in Woodland.
The old assertive outreach model has kindof diminished slightly within community
mental health trust.
(07:44):
And I think,
in terms of the work I do with the RoughSleepers Initiative, it's about going out
and finding these people.
And we do rely a lot on local dog walkersor farmers or people that live rurally to
actually report back to the districtcouncils.
And usually it's because it's kind of anot in my backyard scenario.
Because you do get, whilst there is inrural areas, there is quite a lot of
(08:09):
poverty.
There's also a lot of affluence as well.
So those affluent areas.
will not want to see the homeless peoplelittering the woodlands and the lovely dog
walks.
So we do rely on that a lot for people tofeed back.
And I think when we do the outreach work,a lot of people who are living in
woodlands want to be hidden because thatway they don't feel so vulnerable, they
(08:30):
don't feel so exposed.
So I think it's very different becauseit's not as in your face.
And I think that's where the problems canlie as well, trying to locate these people
who are very vulnerable.
Yes, that's a good point.
And we're talking about one of thedifferences with rural homelessness is
that it's a hidden thing quite often,whereas in cities it's more out in the
(08:55):
open, it's a bit more obvious.
Would you say that that kind of alsomirrors itself in how the mental health
problems present themselves with peoplewho've been homeless in the rural area or
compared to the city?
Are their problems more hidden?
Are they more difficult to get to orexpress themselves or deal with?
(09:19):
From my point of view, because we live ina rural, because of this rural area, we do
get a lot of land workers and people whocome here to do the seasonal land work.
So quite a few of the people that I workwith have not got recourse to public
funds.
So therefore they will make their own wayin life and therefore become a small
subculture within that kind of rural ruralarea.
So, yeah, I think there is definitely thathidden aspect.
(09:42):
So from the situations that you've comeacross, Coryn, with the work that you've
been doing with people in this situation,can you give some insight into some of the
situations that you've come across?
I suppose this week it's been somebodywho's got long -term schizophrenia and has
(10:03):
been sleeping in a tent in a dog walkingarea.
The person is out of area as well, sothey've come from the West Midlands down
to the locality to...
try and reconnect with their family.
When they've reconnected with theirfamily, they're in addiction.
Family dynamic has changed somewhat sincethey lived in the area.
So therefore the family don't want themaround their children because they present
(10:24):
as quite unusual and quite, well, quitescary, I suppose, to their family.
So that reconnection has gone wrong.
And whilst they're here, getting back tothe area they're from has been quite
difficult.
So that when they present to the public,they're generally in crisis.
this person had a diagnosis ofschizophrenia had been detained under the
Mental Health Act in the past.
So a lot of it is about digging back intotheir mental health history to find out a
(10:48):
kind of chronology of what's happened,what's gone on.
And it turns out this person was quitehigh risk, had been under probation in the
past as well.
So there's a whole kind of, a whole, likeyou said, the domino effect of all the
agencies that have been involved in thepast, we need to kind of plug them all
back in again.
And because that person hasn't got anaddress,
their GP is no longer in the area.
(11:09):
There's a lot of background work that goeson to make sure that person is supported
by all the agencies that need to be whilstalso thinking about the protection of the
general public as well, because thatperson may have sort of quite a historical
forensic history.
So that's been a big deal this week,trying to manage that person and also get
them into some sort of accommodation withthe risk being so high.
(11:32):
Because the first thing people will see interms of temporary accommodation is,
they are a risk to others as well asthemselves.
And so that's been quite a complex one.
And I do think when people hit the streetsand they come from another area, it is
trying to kind of piece together thejigsaw where they're from, what their
history was, medication, and then givingthem the care package that the parity
(11:54):
would have if they were living in a house.
So yes, a lot of different strands to tryand pull together there.
Obviously from you telling us that story,it's obviously important to provide
support with mental health problems forpeople who have experienced homelessness.
(12:20):
Marianne, have you got any more statisticsor anything like that to do with mental
health and homelessness and the impact andeffect it has or even that the service is
available to homeless people?
I haven't necessarily got statistics offwith me currently, but I suppose it's just
(12:41):
to say that it's so important really tosupport those people who are homeless and
are struggling with their mental health aswell to ensure that really they don't end
up in a mental health crisis and thenrequire...
emergency services, whether that's anambulance or you know they end up being
(13:03):
admitted to hospital.
So really it's key that we try and supportthese people as much as we possibly can so
they don't end up in that kind of crisismode really.
And how important is it for somebody inneed of support for them to want the help?
(13:24):
Can you effectively help someone if
they just want to be left alone in theirtent in the woods?
Or does there need to be some level ofengagement from the person who you're
reaching out to?
From my perspective, yes, I think, youknow, at times it probably is hard to
engage with people.
(13:46):
But, you know, we've just got to keeptrying and trying as much as we possibly
can, because everybody, you know, has, youknow, that sort of been...
human and having that humanity about aperson.
You know, we don't, it's that sort ofdomino effect that Coryn talked about
really.
(14:08):
There can be a multitude of things goingon for that person.
It's really trying to unpick that.
I think there's also a massive mistrustfrom people who are in that position as
well, because ultimately if you've hit thestreets and you've got mental health
issues and physical health issues,
Nine times out of ten, the people I'veworked with feel they've been very much
(14:28):
let down by services whilst they probablyhaven't and potentially they might have
disengaged.
I think there's still an element of a kindof duty of care from the agencies to have
kept that person engaged.
I think for me, it's just about constantlyrevisiting someone and always letting not
letting people down.
So when you say you're going to dosomething, do it.
And that way you're building up thatengagement and making sure that person
(14:51):
feels more confident in what you sayyou're going to do.
You're actually going to.
you're going to deliver.
And I think that that is in a rurallocation, especially I found that that
message starts to spread.
So one person gets a nice hotel room, it'severy accommodation.
The next person who's in need will go,absolutely.
Do you know what?
Such and such got something.
So maybe I might get that as well.
(15:12):
So the word spreads to which is quiteimportant when it comes to engagement.
It's about constantly going out andspeaking to them, giving them something
back so that you've got a bit of a tokeneconomy almost.
to kind of draw them in and make sure thatyou are there to help and not just to be
an interfering person in their lives.
That's really good.
What would you say from your perspectives,what are some of the toughest challenges
(15:37):
that you are currently facing in yoursetting?
I think just to, I would probablyreiterate what Coryn's just said around,
you know, engagement at times.
and building that trust with individualscan be such a challenge.
But also just really one of the toughestchallenge quite often within our services,
(16:02):
the NHS is around funding and having theresources required to continue with these
programmes.
So, as Coryn said, working on this roughsleeper,
Project if you like and being able tocontinue that really good work that's
taken place and actually really kind ofadd to that as well and what more can we
(16:29):
offer these people in order that they'reyou know filling filling you know having a
really happy healthy life.
My challenge is the age -old institutionalmemory I'll call it because that's
something my manager likes to use is thatword.
It's about, I mean, I've worked in thisfield for a quarter of a century, which
(16:51):
makes me sound ancient.
But I think the thing is, is that there'salways been that kind of ingrained theory
that if somebody is an addiction andsomebody has mental health, you can't join
them together and work together with thosetwo different episodes.
In my opinion, it's chicken and egg.
You can't depict what came first.
And I think it's really important to...
(17:13):
not focus on what's going on for thatperson with the addiction and with the
mental health, but work with it combined.
And I really like that way of workingbecause I think it's more meaningful, it's
more client centered.
And just because somebody is using alcoholto manage their mental health doesn't mean
their mental health is any less important.
Because if you strip away, everybody's gota backstory in my opinion.
(17:36):
And if you strip away the reasons whysomebody uses alcohol or somebody uses
drugs,
It's never because they woke up thatmorning and think, right, my life's great.
I'm just going to get drunk today or takedrugs.
There's usually a reason and a lot of thereasons is nine times out of 10 of the
clients I work with, it's a traumahistory.
It's adverse childhood events that havehappened that had a really massive impact.
(18:00):
It's breaking down the family dynamic ofwhat's happened because to make them
homeless, stripping away all the stuff,you end up with somebody just like me and
you.
who could it could be anybody, any one ofus.
So my daily struggle is not so muchconvincing, but being very kind of
(18:21):
diplomatic with the truth about how muchpeople are using drugs or alcohol and
trying to make agencies focus on the factthat these are actually people that are in
need because their mental health.
And I do come across that the barriers forme would be.
especially from a professional perspectivewould be people saying, well, they're
making those unwise decisions or theircapacity or the usual buzzwords that
(18:47):
whilst they are meaningful words at thatpoint in time, irrespective of whether
somebody's got capacity or is making anunwise decision, they're still in that
situation.
You can't take that away.
They've not made that decision to lie in atent or sleep under a bush drenched in
their own urine because that's theirchoice.
(19:08):
life suddenly becomes very difficult.
It's like for instance if you have ahoarder, the hoarding becomes bigger and
bigger and bigger and at the end of it youcan't see a way out of it.
So the only small tunnel is potentiallysomebody reaching in and pulling them out
and I think that's how I work.
Just try and see beyond the chaos and pullthe person out the middle of it really.
(19:31):
It's a really good picture, thank you.
So those are some of the challenges youface.
In your opinion, what do you think some ofthe big challenges are that a homeless
person might face, especially when itcomes to accessing mental health services
in rural areas?
I think in a rural area specifically, asMary Ann touched on, it's transport,
(19:54):
digital exclusion.
Nowadays, people always expect to haveaccess to a phone that's going to have all
the information on it.
I mean, I know for a fact, I'm sat herenow with two phones.
I can access anything on my phone.
I can book a doctor's appointment.
I can book a flight.
I can do anything.
For somebody who's experiencing homeless,especially in a rural location, most of
(20:15):
the time they're hidden away in a kind ofwoodland under a bush.
It's accessing a library where they canplug a phone in, accessing somewhere where
they look really dishevelled and are quiteembarrassed.
And I think that's the biggest challengefor me for that homeless person.
They can't access the services availablebecause they haven't got
the local public toilet, they can go inand have a quick wash or the swimming pool
(20:38):
where they can go and have a shower.
Those amenities aren't as available inrural areas as they would be in urban
areas.
And plugging your phone in and havingaccess to stuff, sorting your benefits
out.
I mean, as a somebody who's reasonablytechnically advanced, even I struggle with
it.
So how would I expect somebody who's gotno mobile phone and no understanding of
(21:00):
how to access things to be able to dothat?
if you're living in a tent and the lastthing you're thinking about is, I better
log on today to make sure my universalcredit is up to date.
I think digital exclusion is huge,especially really.
Marianne.
Yeah, and I suppose to add to that is, youknow, if you think that people may that
(21:22):
person may not have any money and theycan't so they can't access the transport,
the transport, the transport might noteven be where they are.
So actually being able to get to theseplaces, you know, they're probably going
to have to walk to, you know, a clinicsomewhere or what have you to the library,
(21:44):
et cetera.
So, you know, there's all those sorts ofthings to take into account for somebody
who's living off the streets or, you know,in a woodland somewhere.
And when you say walk, I...
Some people might not understand that thatdistances in rural areas are pretty vast.
So, so walking, we're not just talking,you know, five minutes down the road or
(22:08):
whatever it is.
It's, it's a proper long trek that mighttake you all day or half a day or
whatever, just, just to get to the publictoilet or, or whatever it is.
Yeah.
So then after highlighting lots ofproblems and difficulties and things,
what are some of the solutions we might beable to offer?
(22:30):
Or if we had a magic wand and we're ableto wave it, what are some of the things we
would like to see happening, whether it bein the NHS or local government or
whatever, in order to help homeless peoplein rural areas access the mental health
services they need?
(22:51):
I would love...
This is my utopia vision.
If I ever win the lottery, this would bewhat I do.
Cambridge have a really good, a reallykind of a good base where they have the
van go out once a week.
I think for rural areas to have a vehiclethat could have everything on board to
deal with people's, to do a kind of onestop shop where you can access, get a
(23:14):
toothbrush, get a little cheap mobilephone, plug your phone in.
And that, that method of transport goesaround all the rural areas the way you
know they're going to be.
people can have a wash on board.
It does happen because it's happened inother areas.
They can access the little things theymight need, just a packet of, I don't
know, a packet of wet wipes or somethinglike that.
(23:35):
See a mental health nurse, see a physicalhealth nurse who's on board that vehicle.
And the person who's really homeless knowswhat time that's gonna come, when it's
gonna be there and can access thatsupport.
And if there's anything that needs doingthat could be followed up by the person on
that transport.
So it's almost like a community communitysupport truck, whatever.
(23:57):
Maybe a nice landry of defender if thegovernment wants something that would
work.
And I think it really would, because Iknow from working in Cambridge, they've
got the van that goes around once a weekand that van.
is people's lifeline.
People will go there, they will getsupport, they'll get food, they'll get
(24:19):
clothes, they'll get something that'sgoing to give them a little bit of a boost
or something to look forward to, to behonest with you.
And if there's anything that needs doing,the people on the van can start to get
things moving for them, get them pluggedinto services, make other agencies aware
they are there.
If they've got drug and alcohol issues,get them back onto scripts, get their
medication sorted.
(24:40):
I mean, I'm a non -medical prescriber andit's not beyond the realms of possibility
to do this.
And I think that would be where, if I hadthat funding and commissioning Magic Wand,
that would be to me pretty simple.
Excellent.
Thanks, Coryn.
How about you, Mary Ann?
Yeah, that would be fantastic to have thatsort of service available really.
(25:05):
I think, you know, what Coryn and the teamat Ferry have
provided for those people who are sleepingand providing some of those outreach
services, it would be really great to havethat continue and make that sustainable
really going forward.
So, I'm very much a supporter of what theFerry Project have done.
(25:29):
They've really worked with so many clientslocally and have got people back into
accommodation.
So very much a supporter of them.
people like the Ferry Project, thecharitable organizations who are doing
some fantastic work.
But yeah, we just need to keep pluggingaway to see whether we can get the funding
to make some of these things sustainable.
(25:51):
And also as Coryn said, would be getting avan, you know, van going out to provide
those outreach service would be fantastic,would be brilliant.
Mm, really good.
So, well, thank you.
Thank you for giving us your insights andyour thoughts all around the topic of
(26:11):
mental health and of course those peoplewho are experiencing rural homelessness.
So thank you, Marianne and Coryn forjoining us on the Rural Homelessness
Podcast today.
Thank you.
Thank you very much.
Thank you.
It was a pleasure.
And thank you as well for listening tothis.
(26:31):
episode and don't forget that the ruralhomelessness podcast comes out twice a
month on the 1st and the 15th so I lookforward to having the pleasure of your
company again really soon on anotherepisode of the rural homelessness podcast
where we'll be talking with some morepeople about some of the issues around
rural homelessness.
(26:53):
I look forward to the pleasure of yourcompany really soon.
Thank you.
Thank you for listening to the RuralHomelessness Podcast brought to you by The
Ferry Project.
Visit our website on www .ferryproject.org .uk.
This is the Rural Homelessness Podcast,where we discuss the important issues
around rural homelessness, hear from thoseaffected by it, and offer some solutions.
Brought to you by the award -winninghomelessness charity, The Ferry Project.
Welcome to the Rural Homelessness Podcast.
(00:28):
Hello and welcome to this episode of theRural Homelessness Podcast.
I'm your host, Matt McChlery Thank you somuch for joining me for this episode of
the show.
Now today I'm going to be chatting withMarianne Watson, who is the Integrated
Neighborhood Program Manager for theFenland Locality for the NHS.
(00:49):
And I'm also going to be having a chatwith Coryn Price, who is an NHS Community
Psychiatric Nurse.
And today we are going to be discussingthe topic of mental health, the mental
health services in rural areas.
And of course, why mental health is soimportant for people who have experienced
(01:10):
rural homelessness.
So let's welcome Maryanne Watson and CorynPrice to the podcast.
Hello, Maryanne.
Hello.
Hi, how are you?
I'm well, thank you.
And hello, Coryn.
Thanks for joining us.
Hello Matt.
Thank you very much.
Nice to speak to you.
So welcome to the Rural Homelessnesspodcast.
(01:31):
The first thing I would like to ask bothof you is looking at the topic of mental
health from the perspective ofhomelessness.
Did that someone who has experiencedhomelessness will have poor mental health
as a result of their experiences?
So, yes, unfortunately, it is very likelyin a recent audit that we that was
(01:54):
undertaken across Cambridge andPeterborough.
69 % or 150 people who responded to thatidentified themselves being diagnosed with
at least one listed mental healthcondition.
More often than not, you'll find thatpeople who experience poor health will
experience poor health as a consequence ofhomelessness, which can lead to worsening
(02:19):
mental health, also increased risk of self-medicating.
Hmm.
Karen, what's your experience?
I suppose I'm in a position where I workwith a homeless organization where they
support people who have come directly fromthe streets.
So my experience may be different in thesense that we're seeing people actually in
(02:43):
their situation at that time.
My experience from mental health point ofview would be that a lot of people have
hit an all time low really.
And like as Mary Ann just said,
of self -medicated with either drugs oralcohol to kind of numb the existence of
where they are at that point in time.
And also probably not put it's pretty alittle bit under reported as well because
(03:04):
a vast majority of people with mentalhealth problems who have hit the streets
or in old street homeless will not accessthe same services and potentially somebody
who lives in a property might do becauseat that point in time the main focus for
them is getting through the day andmanaging their kind of activities daily of
living such as getting them to eat,keeping warm.
If they are, if they are an addiction,it's about managing their addiction at
(03:26):
that point in time as well.
So mental health is always there, but canquite often be the undercurrent.
And so mental health has an impact becauseit's not just the mental health issue, I
suppose it kind of has a domino effect andthen might spiral into other things.
As you were mentioning, I'm about selfmedication, may indicated with like drugs
(03:50):
or alcohol or that kind of thing.
So what are the common...
mental health problems that you comeacross with those that have been homeless?
Is it anything and everything or do youtend to find a few that are fairly common?
(04:12):
From my point of view, I think the mainsort of would be low mood.
But I have seen throughout working atwhere I am at the moment at the Ferry,
it's people who've had long term
chronic mental health problems and havekind of slipped off the radar due to being
in crisis, stopping taking medication,getting into addiction, ended up as
(04:33):
homeless.
And then they have the relapse signaturescome back in again, which could be long
-term schizophrenia, psychosis, which isthen made worse by the fact that
potentially they're homeless.
And they may not have access to themedication they would have had before.
So again, it's that kind of domino effect.
And I think for me, the...
(04:53):
vast majority of people I work with wouldbe low mood, but I would say about 20 %
has been long -term chronic mental health,which has been made worse by their
homeless period predicament.
And Marianne, would you say that, in yourexperience, because we're focusing on
rural homelessness more specifically,would you say that homeless people in
(05:19):
rural areas present with
more mental health problems than those inurban or what's that what does that look
like when you compare one with the other?
Yeah I suppose when you think of largecities and towns compared to a rural
environment you've got quite differentsort of layout of services and so on so
(05:42):
services and often you know centeredaround large cities towns and
that does create barriers for people whoare living off the streets.
So for example, public transport is abarrier at times and things like digital
connectivity as well.
So it really does make things much morecompounded really for those living rurally
(06:09):
and also obviously with those people whoare living off the streets.
And also just to say, I suppose that thosepeople probably feel socially isolated
too.
So that's something that the differencebetween that sort of rurality versus large
cities and towns.
And would you say that the provision ofmental health services in rural areas, do
(06:36):
they tend to have to be more flexible orinnovative than those say in a city
because they're having to deal with allsorts of different things but
it's only the one place that people canaccess them rather than a variety of
places.
yes definitely so really you'd be lookingto try and provide outreach services and
(07:02):
you know it would be really trying toreach those people so I think we know that
people are possibly living hidden and wedon't necessarily know about those people
in you know living in tents and variousplaces and so on.
So it's really, can we provide thoseservices on an outreach basis and take
really our services out to those people?
(07:24):
I totally agree with that.
I think the thing is, is like you say,within urban situations, it's very visible
or more visible.
And I think in a kind of rural locationsuch as where we are, it's more about
trying to find those people and locatethem in Woodland.
The old assertive outreach model has kindof diminished slightly within community
mental health trust.
(07:44):
And I think,
in terms of the work I do with the RoughSleepers Initiative, it's about going out
and finding these people.
And we do rely a lot on local dog walkersor farmers or people that live rurally to
actually report back to the districtcouncils.
And usually it's because it's kind of anot in my backyard scenario.
Because you do get, whilst there is inrural areas, there is quite a lot of
(08:09):
poverty.
There's also a lot of affluence as well.
So those affluent areas.
will not want to see the homeless peoplelittering the woodlands and the lovely dog
walks.
So we do rely on that a lot for people tofeed back.
And I think when we do the outreach work,a lot of people who are living in
woodlands want to be hidden because thatway they don't feel so vulnerable, they
(08:30):
don't feel so exposed.
So I think it's very different becauseit's not as in your face.
And I think that's where the problems canlie as well, trying to locate these people
who are very vulnerable.
Yes, that's a good point.
And we're talking about one of thedifferences with rural homelessness is
that it's a hidden thing quite often,whereas in cities it's more out in the
(08:55):
open, it's a bit more obvious.
Would you say that that kind of alsomirrors itself in how the mental health
problems present themselves with peoplewho've been homeless in the rural area or
compared to the city?
Are their problems more hidden?
Are they more difficult to get to orexpress themselves or deal with?
(09:19):
From my point of view, because we live ina rural, because of this rural area, we do
get a lot of land workers and people whocome here to do the seasonal land work.
So quite a few of the people that I workwith have not got recourse to public
funds.
So therefore they will make their own wayin life and therefore become a small
subculture within that kind of rural ruralarea.
So, yeah, I think there is definitely thathidden aspect.
(09:42):
So from the situations that you've comeacross, Coryn, with the work that you've
been doing with people in this situation,can you give some insight into some of the
situations that you've come across?
I suppose this week it's been somebodywho's got long -term schizophrenia and has
(10:03):
been sleeping in a tent in a dog walkingarea.
The person is out of area as well, sothey've come from the West Midlands down
to the locality to...
try and reconnect with their family.
When they've reconnected with theirfamily, they're in addiction.
Family dynamic has changed somewhat sincethey lived in the area.
So therefore the family don't want themaround their children because they present
(10:24):
as quite unusual and quite, well, quitescary, I suppose, to their family.
So that reconnection has gone wrong.
And whilst they're here, getting back tothe area they're from has been quite
difficult.
So that when they present to the public,they're generally in crisis.
this person had a diagnosis ofschizophrenia had been detained under the
Mental Health Act in the past.
So a lot of it is about digging back intotheir mental health history to find out a
(10:48):
kind of chronology of what's happened,what's gone on.
And it turns out this person was quitehigh risk, had been under probation in the
past as well.
So there's a whole kind of, a whole, likeyou said, the domino effect of all the
agencies that have been involved in thepast, we need to kind of plug them all
back in again.
And because that person hasn't got anaddress,
their GP is no longer in the area.
(11:09):
There's a lot of background work that goeson to make sure that person is supported
by all the agencies that need to be whilstalso thinking about the protection of the
general public as well, because thatperson may have sort of quite a historical
forensic history.
So that's been a big deal this week,trying to manage that person and also get
them into some sort of accommodation withthe risk being so high.
(11:32):
Because the first thing people will see interms of temporary accommodation is,
they are a risk to others as well asthemselves.
And so that's been quite a complex one.
And I do think when people hit the streetsand they come from another area, it is
trying to kind of piece together thejigsaw where they're from, what their
history was, medication, and then givingthem the care package that the parity
(11:54):
would have if they were living in a house.
So yes, a lot of different strands to tryand pull together there.
Obviously from you telling us that story,it's obviously important to provide
support with mental health problems forpeople who have experienced homelessness.
(12:20):
Marianne, have you got any more statisticsor anything like that to do with mental
health and homelessness and the impact andeffect it has or even that the service is
available to homeless people?
I haven't necessarily got statistics offwith me currently, but I suppose it's just
(12:41):
to say that it's so important really tosupport those people who are homeless and
are struggling with their mental health aswell to ensure that really they don't end
up in a mental health crisis and thenrequire...
emergency services, whether that's anambulance or you know they end up being
(13:03):
admitted to hospital.
So really it's key that we try and supportthese people as much as we possibly can so
they don't end up in that kind of crisismode really.
And how important is it for somebody inneed of support for them to want the help?
(13:24):
Can you effectively help someone if
they just want to be left alone in theirtent in the woods?
Or does there need to be some level ofengagement from the person who you're
reaching out to?
From my perspective, yes, I think, youknow, at times it probably is hard to
engage with people.
(13:46):
But, you know, we've just got to keeptrying and trying as much as we possibly
can, because everybody, you know, has, youknow, that sort of been...
human and having that humanity about aperson.
You know, we don't, it's that sort ofdomino effect that Coryn talked about
really.
(14:08):
There can be a multitude of things goingon for that person.
It's really trying to unpick that.
I think there's also a massive mistrustfrom people who are in that position as
well, because ultimately if you've hit thestreets and you've got mental health
issues and physical health issues,
Nine times out of ten, the people I'veworked with feel they've been very much
(14:28):
let down by services whilst they probablyhaven't and potentially they might have
disengaged.
I think there's still an element of a kindof duty of care from the agencies to have
kept that person engaged.
I think for me, it's just about constantlyrevisiting someone and always letting not
letting people down.
So when you say you're going to dosomething, do it.
And that way you're building up thatengagement and making sure that person
(14:51):
feels more confident in what you sayyou're going to do.
You're actually going to.
you're going to deliver.
And I think that that is in a rurallocation, especially I found that that
message starts to spread.
So one person gets a nice hotel room, it'severy accommodation.
The next person who's in need will go,absolutely.
Do you know what?
Such and such got something.
So maybe I might get that as well.
(15:12):
So the word spreads to which is quiteimportant when it comes to engagement.
It's about constantly going out andspeaking to them, giving them something
back so that you've got a bit of a tokeneconomy almost.
to kind of draw them in and make sure thatyou are there to help and not just to be
an interfering person in their lives.
That's really good.
What would you say from your perspectives,what are some of the toughest challenges
(15:37):
that you are currently facing in yoursetting?
I think just to, I would probablyreiterate what Coryn's just said around,
you know, engagement at times.
and building that trust with individualscan be such a challenge.
But also just really one of the toughestchallenge quite often within our services,
(16:02):
the NHS is around funding and having theresources required to continue with these
programmes.
So, as Coryn said, working on this roughsleeper,
Project if you like and being able tocontinue that really good work that's
taken place and actually really kind ofadd to that as well and what more can we
(16:29):
offer these people in order that they'reyou know filling filling you know having a
really happy healthy life.
My challenge is the age -old institutionalmemory I'll call it because that's
something my manager likes to use is thatword.
It's about, I mean, I've worked in thisfield for a quarter of a century, which
(16:51):
makes me sound ancient.
But I think the thing is, is that there'salways been that kind of ingrained theory
that if somebody is an addiction andsomebody has mental health, you can't join
them together and work together with thosetwo different episodes.
In my opinion, it's chicken and egg.
You can't depict what came first.
And I think it's really important to...
(17:13):
not focus on what's going on for thatperson with the addiction and with the
mental health, but work with it combined.
And I really like that way of workingbecause I think it's more meaningful, it's
more client centered.
And just because somebody is using alcoholto manage their mental health doesn't mean
their mental health is any less important.
Because if you strip away, everybody's gota backstory in my opinion.
(17:36):
And if you strip away the reasons whysomebody uses alcohol or somebody uses
drugs,
It's never because they woke up thatmorning and think, right, my life's great.
I'm just going to get drunk today or takedrugs.
There's usually a reason and a lot of thereasons is nine times out of 10 of the
clients I work with, it's a traumahistory.
It's adverse childhood events that havehappened that had a really massive impact.
(18:00):
It's breaking down the family dynamic ofwhat's happened because to make them
homeless, stripping away all the stuff,you end up with somebody just like me and
you.
who could it could be anybody, any one ofus.
So my daily struggle is not so muchconvincing, but being very kind of
(18:21):
diplomatic with the truth about how muchpeople are using drugs or alcohol and
trying to make agencies focus on the factthat these are actually people that are in
need because their mental health.
And I do come across that the barriers forme would be.
especially from a professional perspectivewould be people saying, well, they're
making those unwise decisions or theircapacity or the usual buzzwords that
(18:47):
whilst they are meaningful words at thatpoint in time, irrespective of whether
somebody's got capacity or is making anunwise decision, they're still in that
situation.
You can't take that away.
They've not made that decision to lie in atent or sleep under a bush drenched in
their own urine because that's theirchoice.
(19:08):
life suddenly becomes very difficult.
It's like for instance if you have ahoarder, the hoarding becomes bigger and
bigger and bigger and at the end of it youcan't see a way out of it.
So the only small tunnel is potentiallysomebody reaching in and pulling them out
and I think that's how I work.
Just try and see beyond the chaos and pullthe person out the middle of it really.
(19:31):
It's a really good picture, thank you.
So those are some of the challenges youface.
In your opinion, what do you think some ofthe big challenges are that a homeless
person might face, especially when itcomes to accessing mental health services
in rural areas?
I think in a rural area specifically, asMary Ann touched on, it's transport,
(19:54):
digital exclusion.
Nowadays, people always expect to haveaccess to a phone that's going to have all
the information on it.
I mean, I know for a fact, I'm sat herenow with two phones.
I can access anything on my phone.
I can book a doctor's appointment.
I can book a flight.
I can do anything.
For somebody who's experiencing homeless,especially in a rural location, most of
(20:15):
the time they're hidden away in a kind ofwoodland under a bush.
It's accessing a library where they canplug a phone in, accessing somewhere where
they look really dishevelled and are quiteembarrassed.
And I think that's the biggest challengefor me for that homeless person.
They can't access the services availablebecause they haven't got
the local public toilet, they can go inand have a quick wash or the swimming pool
(20:38):
where they can go and have a shower.
Those amenities aren't as available inrural areas as they would be in urban
areas.
And plugging your phone in and havingaccess to stuff, sorting your benefits
out.
I mean, as a somebody who's reasonablytechnically advanced, even I struggle with
it.
So how would I expect somebody who's gotno mobile phone and no understanding of
(21:00):
how to access things to be able to dothat?
if you're living in a tent and the lastthing you're thinking about is, I better
log on today to make sure my universalcredit is up to date.
I think digital exclusion is huge,especially really.
Marianne.
Yeah, and I suppose to add to that is, youknow, if you think that people may that
(21:22):
person may not have any money and theycan't so they can't access the transport,
the transport, the transport might noteven be where they are.
So actually being able to get to theseplaces, you know, they're probably going
to have to walk to, you know, a clinicsomewhere or what have you to the library,
(21:44):
et cetera.
So, you know, there's all those sorts ofthings to take into account for somebody
who's living off the streets or, you know,in a woodland somewhere.
And when you say walk, I...
Some people might not understand that thatdistances in rural areas are pretty vast.
So, so walking, we're not just talking,you know, five minutes down the road or
(22:08):
whatever it is.
It's, it's a proper long trek that mighttake you all day or half a day or
whatever, just, just to get to the publictoilet or, or whatever it is.
Yeah.
So then after highlighting lots ofproblems and difficulties and things,
what are some of the solutions we might beable to offer?
(22:30):
Or if we had a magic wand and we're ableto wave it, what are some of the things we
would like to see happening, whether it bein the NHS or local government or
whatever, in order to help homeless peoplein rural areas access the mental health
services they need?
(22:51):
I would love...
This is my utopia vision.
If I ever win the lottery, this would bewhat I do.
Cambridge have a really good, a reallykind of a good base where they have the
van go out once a week.
I think for rural areas to have a vehiclethat could have everything on board to
deal with people's, to do a kind of onestop shop where you can access, get a
(23:14):
toothbrush, get a little cheap mobilephone, plug your phone in.
And that, that method of transport goesaround all the rural areas the way you
know they're going to be.
people can have a wash on board.
It does happen because it's happened inother areas.
They can access the little things theymight need, just a packet of, I don't
know, a packet of wet wipes or somethinglike that.
(23:35):
See a mental health nurse, see a physicalhealth nurse who's on board that vehicle.
And the person who's really homeless knowswhat time that's gonna come, when it's
gonna be there and can access thatsupport.
And if there's anything that needs doingthat could be followed up by the person on
that transport.
So it's almost like a community communitysupport truck, whatever.
(23:57):
Maybe a nice landry of defender if thegovernment wants something that would
work.
And I think it really would, because Iknow from working in Cambridge, they've
got the van that goes around once a weekand that van.
is people's lifeline.
People will go there, they will getsupport, they'll get food, they'll get
(24:19):
clothes, they'll get something that'sgoing to give them a little bit of a boost
or something to look forward to, to behonest with you.
And if there's anything that needs doing,the people on the van can start to get
things moving for them, get them pluggedinto services, make other agencies aware
they are there.
If they've got drug and alcohol issues,get them back onto scripts, get their
medication sorted.
(24:40):
I mean, I'm a non -medical prescriber andit's not beyond the realms of possibility
to do this.
And I think that would be where, if I hadthat funding and commissioning Magic Wand,
that would be to me pretty simple.
Excellent.
Thanks, Coryn.
How about you, Mary Ann?
Yeah, that would be fantastic to have thatsort of service available really.
(25:05):
I think, you know, what Coryn and the teamat Ferry have
provided for those people who are sleepingand providing some of those outreach
services, it would be really great to havethat continue and make that sustainable
really going forward.
So, I'm very much a supporter of what theFerry Project have done.
(25:29):
They've really worked with so many clientslocally and have got people back into
accommodation.
So very much a supporter of them.
people like the Ferry Project, thecharitable organizations who are doing
some fantastic work.
But yeah, we just need to keep pluggingaway to see whether we can get the funding
to make some of these things sustainable.
(25:51):
And also as Coryn said, would be getting avan, you know, van going out to provide
those outreach service would be fantastic,would be brilliant.
Mm, really good.
So, well, thank you.
Thank you for giving us your insights andyour thoughts all around the topic of
(26:11):
mental health and of course those peoplewho are experiencing rural homelessness.
So thank you, Marianne and Coryn forjoining us on the Rural Homelessness
Podcast today.
Thank you.
Thank you very much.
Thank you.
It was a pleasure.
And thank you as well for listening tothis.
(26:31):
episode and don't forget that the ruralhomelessness podcast comes out twice a
month on the 1st and the 15th so I lookforward to having the pleasure of your
company again really soon on anotherepisode of the rural homelessness podcast
where we'll be talking with some morepeople about some of the issues around
rural homelessness.
(26:53):
I look forward to the pleasure of yourcompany really soon.
Thank you.
Thank you for listening to the RuralHomelessness Podcast brought to you by The
Ferry Project.
Visit our website on www .ferryproject.org .uk.
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