/ PROTOCOL for redaction of PROFILES of study case's
for D-&-WB workshops inter-vision & evaluation
about : background - health - intervention - network - proposals
When the solution of complex situations seems impossible: how to listen for a deepest understanding ?
When the body speaks through his silence and his wounds: who will listen and hear before intervening
N.B. The PROFILE more than a PHOTO is a RADIOGRAPHY which will facilitate the comprehension of the inter - action
and the causes. NOT MORE than 2 pages. Attention please PROTECT PRIVACY OF EACH ONE
  1. BACKGROUND and environment / contextof profile of the person in relation to: the condition of ‘dignity’ and 'health' in which these people live. What kind of interrelation between these dimensions:
C aged 54 grew up in the midlands with his mother, father and siblings. C had 3 children who had very little contact with.From the travelling community, and due to C’s family history, C faced a lot of disadvantages and stigma growing up. After the death of his son due to addiction, C got involved in crime to feed his heroin addiction, resulting in him being in and out of prison over a 20-year period. On release from prison, C would return to his family home. But after the death of his parents, the family home was sold. Cwas left sleeping rough on benches and abandoned houses on release from prison. Due to the stigma attached to his family’s name it proved extremely difficult to get a landlord to accept C into private rented housing and for C to receive adequate supports. C entered emergency accommodation in MSC where he stayed for 15months. Recommendations for emergency accommodation is maximum 6months, but this was extended due to the complexities involved. C thrived in this environment where there was 24/7 support. He moved into long-term supported housing from here, where he stayed for 4 months. This broke down due to anti-social behavior and C’s difficulty to say no to visitors that were causing serious risk to himself and others. C withdrew from mental health services and stopped taking his medication as his addiction worsened. C shortly after returned to prison, he has since been released and again is sleeping rough.
  1. HEALTH: physical and psychic conditions.

C was diagnosed with paranoid schizophrenia when in prison. This was as a result of C experiencing some of the common side effects such as delusions, hallucinations, self-harm behaviour and after numerous suicide attempts. During his sentence in prison C would take medication daily and engage with psychiatrists. On release, C was referred to a local mental health service which he attended monthly for a depot injection and met a psychiatrist approximately every 3 months. When C’s addiction would worsen, attending these appointments proved very difficult and would lead to C disengaging with supports. This was seen upon moving to supported accommodation where C had to travel 30mins to engage with mental health supports.
C was also linked into Community Alcohol and Drugs Service (CADs) when in the emergency accommodation where he was on a methadone programme. The emergency accommodation had to advocated for a local pharmacy to dispense this daily to C as due to C’s previous convictions, the closest pharmacy that would accept him was located 30minutes away where C would have to travel to daily. There was very little communication between the mental health and drug services, only updateskey worker in thehomeless service would provide to each. Both services felt that his addiction was hindering his mental health and vice versa, requesting C work on the other before effective treatment could be done to help him.
  1. INTERVENTIONS description :
With the support of C’s probation officer and MSC completing the assessment in the prison, C successfully entered emergency accommodation directly on release from prison. Whilst this presented challenges in the community of the emergency accommodation due to stigma, this was managed through monthly community meetings were any issues were managed i.e. community feeling there was an increase in crime since C’s arrival, without any evidence for this. C had a successful placement and was linked into mental health and addiction services showing a vast improvement in his addiction and management of mental health diagnosis. It proved extremely difficult to secure private rented accommodation but by working with homeless service, C moved onto supported housing. Due to lack of easily accessible support services, C disengaged. Due to his personality and vulnerability, he also found it extremely difficult to control visitors, which lead to unauthorized visits out of hours causing risk to himself and others.
Case conferences were initiated by the homeless service where the majority of C’s support services did come together to support C to get the best possible outcomes. And whilst this was successful and a positive, this was not ongoing and was mainly to address C’s accommodation needs at the time. Support services did not engage in this long-term and not all support services were involved including the mental health service.
  1. WORKERS & NETWORK:

There was multidisciplinary work between the homeless service, probation officer, regional resettlement service, mental health service and addiction service which did result in some positive outcomes for C. What we feel was lacking, was direct communication between mental health services and addiction services. C’s dual diagnosis proved so complex that when one aspect deteriorated, it would affect the other. Without the collaboration of both services and local support, this had significant effects on C’s outcome.Whilst there were various individuals supporting C, there was no multidisciplinary team where all support services worked together on the same care plan.
  1. PROPOSALS:

  • Mental health services and addiction services to work closely together in supporting people with a dual diagnosis. A multidisciplinary team to be established where all services work together and meet weekly/monthly.
  • Mental health services to be more flexible in supporting service users locally i.e. if finding it difficult to attend appointments, to meet in the community or home (community support).
  • Accommodation to be provided by the local authorities to people who are experiencing difficulty renting from landlords due to their history or ‘name’.
  • Long-term secure housing facilities staffed 24/7 for people who need extra support to live independently.

  1. Personal factors influencing the launching and continuation of assistance process:

  1. C’s family history and social network made it very difficult for C to disengage in anti-social behavior and change his lifestyle. This was seen when C’s progress would deteriorate when socializing with old acquaintances, leading C into a cycle of addiction and crime and ultimately into a homeless ‘cycle’.
  2. Agencies such as the Local Authorities working with C who were not from a social care background did not show the same level of understanding re. C’s situation as C’s support workers in homeless service. This caused many barriers when advocating to get C the supports and outcomes that he deserved. This caused stress for workers who had seen the significant progress C was making with the right level of supports.

  1. Overall assessment of the case: strengths and weaknesses of the support net and/or interventions provided;

When the appropriate supports were in place, C made significant and very positive progress. The lack of multidisciplinary work and community supportwhen C’s mental health and/or addiction would deteriorate resulted in C relapsing to his old lifestyle of crime and addiction. This has resulted in him sleeping rough on the streets once again. C is currently trying to source accommodation, but is facing the same challenges as he did in the past.

OPTIONAL: Complementary elementson the situation of gradual degradation in terms of both physical and mental health
DIVERS: ....

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/ RESUMING the PROTOCOL of STUDY’s CASES
background - health - intervention - network - proposals
When the solution of complex situations seems impossible, how to intervene?
Fictitious name / Colin (C) / Codex D&W:
Gender / M X / F
Age / known: 54 / hypothetic:
Permanence time on the streets (in months) / known: / hypothetic: 96 months
Permanence time on the shelters (in months) / known: 15 months
hypothetic:
Hygienic conditions / Acceptable / bad X / very bad
Health conditions / acceptable X / bad / very bad
diagnosis declared: -
diagnosis hypothesized: -
Mental Health Conditions / diagnosis declared: Paranoid Schizophrenia
diagnosis hypothesized: -
Causes / factors of loss / housing: Death of parents (no family home) & imprisonment
health: Heroin addiction
In charge of / social services: Probation Officer, Regional Settlement Service (RSS)
health services:CADS (addiction)
mental health services: Community Mental Health Team
Collaboration of people / with a request: X
collaborative
indifferent:
oppositional:
Interventions / net-working:
individualists: X
complementary:
occasional:
sustainable:
Pathways / alternative: Long-term 24/7 supported housing
possible:

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