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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 net".

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 actually works.

Keith Talbut is a psychiatric nurse for a homeless organisation.