St Barnabas Hospice wanted to help tackle bereavement as a cause for homelessness, by building a support network for homeless people in Lincolnshire and providing counselling services.
The project began in 2019. It aimed to:
help homeless individuals come to terms with grief and build healthy coping mechanisms
teach professionals working with vulnerable individuals to identify complex grief and signpost to relevant services
support individuals who have addictive behaviours due to bereavement.
The hospice set up a specialist one-to-one bereavement counselling service with an experienced psychotherapist, who spent ten hours a week at a local homeless shelter. The psychotherapist provided one-to-one therapy and signposted people to appropriate hospice services. Service users were heavily involved in deciding on the content and structure of each therapy session.
Outcomes
The psychotherapist supported 33 homeless clients during the project and continues to support clients on an ongoing basis.
Mental health assessments were carried out before and after therapy. Following the one-to-one counselling, the team found that several clients stopped engaging in unhealthy coping mechanisms such as using drugs and self-harming. Several were able to volunteer, find paid jobs, reconnect with family members, and gain independent housing.
The hospice carrier out a survey of support workers in the partner organisations. This showed overwhelming improvements in clients’ self-esteem and a reduction in addiction behaviours and mental health crises.
Facilitators, challenges and advice
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Key facilitators
St Barnabas Hospice has a close partnership with Lincolnshire YMCA, which was a key factor in the success of the project.
The hospice meets regularly with partner organisations to help monitor clients.
The wide reach of the project would not have been possible without the support of community workers in Lincoln who signposted clients to the service. This includes GPs, community mental health nursing teams, housing officers and local mental health trusts.
The Masonic Charitable Foundation funded the project via Hospice UK, which allowed St Barnabas to develop and implement this project.
Challenges
Some clients do not attend their initial sessions, or only stay for short appointments. Non-attendance can be a way for clients to test the commitment of a new service or therapist. Most people with low attendance went on to fully engage with the therapy in time.
The mental health support needs of homeless people can differ widely, and there is no single approach that is effective for every individual’s needs. Sessions should be led by a highly skilled therapist with experience of allowing clients to drive the therapeutic process. This is time-consuming and limits the ability of the therapist to see a high number of patients.
COVID-19 forced the service to move to online delivery. It significantly increased the anxiety of the community and had an impact on their wellbeing.
Tips and advice
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Ensure services are available in the spaces where communities feel safe, rather than relying on individuals to come to hospices. Engaging with clients from vulnerable populations requires immense trust.
Operate a flexible attendance policy to allow clients to test out services. Give them time to understand that therapeutic support is a resource they can choose to access rather than something being imposed on them. Do not revoke access to services for individuals who miss sessions.
Be receptive to the different needs of individuals and ensure therapists have a wide base of knowledge that is suitable for a range of approaches.
Future development
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The project has demonstrated that homeless individuals need bereavement support. St Barnabas has shared learning from the project with other hospices and homeless shelters in the Midlands, so that other organisations can establish similar therapeutic support.
The evidence gathered in this project encouraged the local NHS Holistic Health for the Homeless team to include a psychotherapist as part of its support.
