The Mental Health Foundation’s report, The Mental Health Needs
of Homeless Young People, reinforces what I see daily as a
psychiatric nurse for a homeless organisation: the direct link
between homelessness and mental health problems.
Writing in the article “Home Truths” (Community Care, 22
August) a spokesperson for Crisis suggested one way to confront
this. He said agencies that co-operated created “a much stronger
chance of succeeding than working in isolation with a client”. But,
for this to happen they must admit that some clients may have
problems that supersede the ability of a single agency.
If the client is homeless, has mental health problems and possible
substance misuse issues, I fail to see how one agency can
adequately cover all these complexities. The fact that some still
do shows an arrogant disregard for the client. There appears to be
a distinct lack of professional “honesty” displayed by some
individuals, particularly within statutory service provision.
There can be no doubt that mental health service provision is under
strain at the moment with structural changes, poor staff morale and
a lack of managerial direction. This has led to a noticeable
increase in my caseload of clients who have “slipped through the
My second gripe is the lack of ownership of clients. A strange
dichotomy considering my earlier point, but social workers and
mental health nurse professionals seem to lack the ability to say
“this case is mine and I would like to solve it with help from all
those who can”. Instead all too often there is guarded secrecy
around sharing information, lest someone is critical.
Millennium Plus was initiated in 1999 as a three-year joint
initiative between Shelter and Crisis, with some financial support
from the government. It is intended as a multi-agency tool to
assist complex cases. There are some excellent examples of agencies
working together, but this can provide consistency.
It is centred on the client with their complete involvement. Each
panel can consist of agencies, such as social services, mental
health teams, substance misuse teams, police, probation and anyone
who can have an effect on the client’s care plan. All agencies come
to the meeting with a view to chipping in a small part of a care
plan, and the agency that called the Millennium Plus meeting ties
all of this together. All agencies being open and honest, it
Keith Talbut is a psychiatric nurse for a homeless