A psychological approach to homelesses: Brighton’s Single Homeless and Rough Sleepers Team

Generally, the public sees only the most visible end of the homelessness spectrum – the person sleeping in a doorway or begging for loose change. But the root of the problem runs deep. Areas such as Brighton and Hove still have high numbers of rough sleepers and single homeless people, despite official counts suggesting they have declined over the years.

Brighton and Hove is increasingly looking at preventive measures. After all, it is not enough just to provide accommodation. New tenants need the skills and confidence to maintain a whole lifestyle if they are to be kept from falling back into homelessness.

A client’s emotional and psychological needs are an essential part of the equation, and this is where Brighton and Hove’s innovative Single Homeless and Rough Sleepers Psychology Team steps in. The team of four psychologists work within the housing strategy division of Brighton and Hove Council and are employed by Sussex Partnership NHS Trust. They are now gearing up to take on their first clients.

But that’s easier said than done. How do you involve people who often have difficulties integrating into society?

Clinical psychologist Vicky House, who heads the team, says: “We know that many homeless people have been through ­experiences that lead them to feel wary or uncomfortable about accepting help. Some people may be reluctant to trust public sector services.

“We are planning to offer flexibility. For some, the formality of an outpatient office may help them feel safe. For others, having meetings at their accommodation may feel more comfortable, and there may be others who find it easier to think things through in a café or on the beach.”

House has found herself at the forefront of a movement to apply psychological techniques to homelessness that were first developed to combat alcohol and drug addiction. An example of this is the use of “motivational interviewing” alongside more established techniques such as cognitive behavioural therapy.

“Homeless people are a group who have historically had poor access to psychological interventions,” House explains. “Motivational interviewing helps people explore their ambivalence about change – particularly changing behaviours that are causing problems in a person’s life.”

Trying to change someone’s behaviour, even if it is for their own benefit, could be seen as coercive. However, House emphasises that the approach encourages clients to make their own choices. “When I think of what I have seen of Derren Brown and Paul McKenna on TV, I think of techniques that seem to an observer to be a bit mysterious and difficult to understand – something that is ‘done to’ someone else. One ethos I have in my clinical work is transparency and ­collaboration. The approaches we will use are about offering opportunities for people to learn skills to empower themselves to make changes.”

It’s not just homeless people who will benefit from the psychologist’s skill. Supported housing workers are being trained to recognise where a focused ­intervention for clients is needed. “The feedback we have received from front-line workers is that opportunities for training in how to help clients cope with the issues that cause them distress are limited,” says House. “Yet these are the issues that front-line workers are expected to deal with on some level from day to day and may contribute to evictions and the cycle of repeat homelessness.”

Just as important is the opportunity for workers to talk about what is often a high-pressure job. After a session with the team, one worker said: “I felt that it helped with my stress levels today.”

As the spearhead of a new movement, the eyes of the government are now on the ­service and Hilary Armstrong visited the team earlier this year when she was social exclusion minister. With lasting success the technique could be a model for other local authorities.

“Across the homeless sector, there seems now to be an acceptance that people need ‘more than a roof’ to escape homelessness,” says House. “Although there are few psychologists funded to work specifically with homeless people, where this is happening there are examples of really good work.”

Therapeutic value

The team will carry a maximum caseload of 21 clients at any one time and will also facilitate fortnightly training and supervision groups for 23 practitioners from different supported housing projects in the city. They will use:

● Cognitive behavioural therapy (CBT), which can help people make sense of overwhelming problems by breaking them down into smaller chunks. Unlike therapies that look into someone’s past, CBT tends to focus on the here and now.

● Solution-focused brief therapy, which is based on the notion that focusing on the solution is more beneficial than investigating the problem.

● Motivational interviewing, an evidence-based approach to overcoming the ambivalence that prevents people making desired changes in their lives.

● Attachment theory, which explores the effect of early attachments to a care-giver and how this influences subsequent relationships.

See what The Inspector has to say about Adult service issues

This article appeared in the 19 July issue under the headline “A good place to think”