St Mungo’s LifeWorks psychotherapy scheme

The LifeWorks project is enabling homeless people to use therapy services even when they are still using drugs and alcohol

Long waiting lists coupled with an expectation of abstinence from drugs and alcohol make psychotherapy services unobtainable for most rough sleepers but a project run by homeless charity St Mungo’s has changed this situation in four London boroughs.

The three-year LifeWorks project offers homeless people rare access to psychotherapists regardless of whether they are misusing substances and without any formal diagnosis of a mental health problem. The project, which runs in Lambeth, Kensington and Chelsea, Camden and Islington, involves one-on-one weekly sessions with a psychotherapist over a six-month period and is one of 12 national pilots funded by the Cabinet Office’s adults facing chronic exclusion (Ace) programme. It was also shortlisted in the Andy Ludlow Awards for innovative ways in tackling homelessness.

Alongside homeless people the service, which received £500,000 from Ace, is also available to people living in psychiatric wards and forensic units and others who are at risk of becoming socially excluded.

Since it began in January 2008 the project has worked with about 166 clients. An assessment found that 75% of these were achieving positive outcomes. Lee Murphy, the project’s manager, says the findings show it is possible for psychotherapy to work even if clients continue to use drugs or alcohol. He says that although many homeless people don’t have mental health conditions as severe as schizophrenia or bipolar disorder the service is responding to a need for medium-term solutions.

“We have tried to set a path to say you don’t need to be abstinent. This path is between longer term psychiatric provision and cognitive behavioural therapy type provision which is geared towards low level anxiety,” he says.

“We have found that even when clients are continuing to take substances there is still some work that can be done – maybe around a specific issue – that can be very beneficial.”

Gabrielle Brown, one of the psychotherapists on the project argues that psychotherapy should be on offer to everyone.

She says that while it can be technically difficult working with people if they are under the influence she has seen benefits for such clients. She says some people have also accessed the service as a part of giving up using substances and will abstain from using before they see the therapist. Other positive effects have included people entering training and employment and simply taking better care of themselves.

Brown says that for one set of clients the effect can be particularly beneficial.

“One group of clients we work with have been separated from their children. A part of what they want to do is sort themselves out so they can re-establish contact and that most usefully happens when they are in therapy and that’s quite exciting,” she says.

Psychotherapy gives people a place to talk and tends to focus more on people’s emotions and histories rather than needs-led issues such as substance misuse.

The project uses psychodynamic psychotherapy. This branch of the discipline works on the idea that early life has an impact on learned behaviour and that we all become caught in patterns that we are not consciously aware of.

Brown explains how the therapy also helps people to form an overview of their lives and this can be especially useful for those who were in care or prison: “There’s a strand that comes in from narrative therapy. For people who have experienced adverse early events it can be very helpful to gain a coherent narrative and a sense of where they have been.”

Clients can either self-refer to the project or be referred by their key worker. Mark, 38, is a British citizen but he was born in Gibraltar and grew up in the US. He came to England after serving a prison sentence in America and was put in touch with St Mungo’s by the charity Prisoners Abroad as part of a resettlement programme.

Mark, who now lives in a council flat in Morden, south London, received weekly psychotherapy as a part of the programme for six months with Jo Williams, a psychotherapist on the project who works with people referred through St Mungo’s employment team. He says the creation of a routine was helpful in itself.

“It became a really important, stable part of my life when each week I had this appointment no matter what else happened and I would move heaven and hell to go there,” he says.

Mark says that six months of psychotherapy was not enough but it has helped him to gain a new perspective and he is set to begin a training course shortly.

“When you look at your life and you have somebody else look at it you are able to analyse things from a fresh perspective. Things that you thought were one way might not always be what they seem. They have a tendency not so much to have hidden meanings but you discover things you think are unrelated are patterns and from those patterns you are able to make better decisions,” he says.

St Mungo’s publications

This article is published in the 27 August 2009 edition of Community Care magazine under the headline Abstinence not necessary