D-&-WB_profiles-2016

 
H O M E

PROFILES   Dignity  & Well-being
EXCHANGE & INTER-VISION PROGRAM
concerning interventions & pathways for Homeless
with mental health problems

 COPENHAGEN 3rd WS   27 - 28 - 29  October 2016

 

1.   THREE  NL  WOMENS -      by   Mieke Portegies   -   Recovery Group Holland   -   Amsterdam

 

1.       BACKGROUND and environment / context 

I’ll write about these 3 women, because my experience is that some women search for another route than homeless men. It is a kind of dialogue, do you start homelessness and find a solution or do you stay in your situation. Homelessness seems for some women a luxury which they could not choose. And their psychosocial problems, their depressions and anxieties, makes that they lose their home and find a solution without wellbeing and dignity. I am curious if there is knowledge about the route of homeless women and if not, maybe we can develop that. So I write about this 3 different women, searching for a patron.


This is about women in Amsterdam

1   Young woman, 23 years old

2   Woman, 28 years, 1 child of 4 and pregnant      

3   Woman, 40 years, child of 15 years

2.       HEALTH:  physical  and  psychic conditions  : 

1.   She had a depression for a long time. Than her mother become ill and she take care of her mother for 2 years. Her mother died in December 2015. Because of her depression and taking care of her mother and her isolation because of her depression, she did not think about what happens after her mother died. In Amsterdam, children could not stay in the house of the parents, when they die. If you take care of your parent, and you can prove that, than you are permitted to stay in this house. So in march 2016 she had to leave the house. She becomes homeless and had a big depression. She had no income and decided to ask staying with a former boyfriend. She tries to work, but because of her depression, she could not manage this. She stays with him, without income and because he has one, she did not get welfare money. He has a small studio, one bed, no sleeping room. So she pays with sex and a little physical violence. The young man has also become in a difficult situation, a woman guest with a psychological problem and no place to go. He has to take a responsibility witch is not his, but of the city of Amsterdam. Amsterdam act not knowing that it is responsible. No entrance.

2.   The woman had a child of 4 year and become homeless.. She  had a agoraphobia and a depression. Her daughter has to go to school. She decided to rent a expensive house and ask another woman to live with her, share the rent. This woman become jealous and told the corporation that the forms are false. The woman with the child has lo leave the house. She decided to live with her friend, a small house with 2 woman and 3 children and a fourth is coming. The depression increase. The homelessness organization told her she has to come to them, but she refuses. I do not really understand why. She would not bring her little daughter in another new situation, she said.  She does not want to give her friend problems with her depts. and that’s why she would not ask for extra welfare income.  The children have psycho social support and she also. Stuck and 8 months pregnant.

3.  This woman had an own little business. Than her husband left her and she becomes a depression. She could not work anymore and her income stops. She get welfare money. The rent of her house was more than her welfare money, so she has to leave. She and her daughter start living with a friend. She could only stay there for a few months and then they had to leave. With a child you can go get a place for homelessness. The day she had to do that, she decided to go to her parents.  If she had no daughter she would prefer to go to a house for homeless woman. I do not really understand what is happening.

3.       INTERVENTIONS  description : 

1.      She had to problems with the law about welfare. She share a house without a separate room. With that maybe she could prove she was a temporarily guest. And the other problem if they accept her for welfare money, than she has to wait one month for finding a study or a job. She was ill, so this was a problem.

2.  Because of her agoraphobia and her pregnancy and her little daughter, solving her problem was complicate. She and her child got psychotherapy, but I think that was only thinking they are doing something, but it did not solve the situation. What she want was a house for her own and that is what thousands of people ask the city of Amsterdam. She was not be able to explain (even nonverbal) her situation and was doing nothing, hoping for a solution. We start to ask  another kind of benefit, now for young people. But this takes months and it is not sure that she will succeeded in this.

3.     This woman was active in trying solve her problem. She was dealing with her debts and was phoning everyone, searching for solutions. She worried about the health of her daughter. The most work for her was to get access to be named official as urgent. And then, when she start living with her parents outside the city, as a temporary solution, she could not say that. The welfare benefit would stop then and also the support for help to solve the debts problems.

4.      WORKERS & NETWORK:

1.  I have written to the problem solver of the welfare institution and explain the situation and ask for using the new interpretation of the law. He said yes and told the welfare organization to support her.

2.  She did not want actors, they told her to use homeless support and she refused. The welfare institution explained me she has no right for benefit because of the law about household. Finally I told her (she was 8 months pregnant than) she has two opportunities.
A) I explained about money issues and if they solve this, their money is more, even if the bailiffs do come.
B) She has to go to the house for homeless people and explain her agoraphobia and what it meant for her and her daughter if she goes to such a house.

3.   We decided that she goes to an organization for debt solving which work the fastest. That has influenced on starting to become official urgent for searching houses. Living outside the city become a new problem, but we keep that secret

5.       PROPOSALS:

Amsterdam has decided to offer homeless people within 3 months a solution from 2020. At this moment all kind of steps will be taken. I feel proud that they do the research from homeless perspective with peer workers.  I like to support Amsterdam by this. We have done a research in 2010 about “guests, a new target group in preventing homelessness”

And now I wonder if it is important to define homeless women as a new target group.

6.       PERSONAL Factors influencing the launching and continuation of assistance process:

possible stigmatization of person taking charge or applying for assistance;

-  sources of stress and burn-out for assistance workers;

-  changes in staff during assistance process; clashing cultural aspects.

It is about homeless perspective and client perspective. In the Netherlands there will come a new law about supporting client perspective. For myself, as a social worker supporting client perspective, it is not easy to work in my health organization and in the city of Amsterdam.

7.      Overall assessment of the case

If these cases will be published, I would like to change ages and situations of the 3 women. They can recognize themselves, even now I do not use their names. For now I like to be as specific as possible.

 

Mieke Portegies

Recovery Group Holland

Amsterdam

14-10-2016

 

2.   Il Signor P  -   by Giuseppe Bernetti  -  SOS  Comune  di Roma  

 

1.       BACKGROUND and environment / context 

He has been staying in Italy since 1998, leading street life since 2003

The reason why he came in Italy is not clear. - His chronic condition has continued for over 13 years

His breakdown familiar relationships dates back to 1998. P. does not relate to anyone.

He spoke about himself only once, thanks to the cultural mediators, even if he didn’t report why he slipped into a
social distress. The social emergency service of Rome has Known him since 2005

He has been monitored for 10 years during which refuses any contact with the street workers.

He has welcomed in one of the shelters in December 2015, following discharge from hospital for acute health event.

He is no longer able to provide for himself and take medication.

He suffers from many organic and neurological diseases.

2.       HEALTH:  physical  and  psychic conditions  : 

His long stay in the street has definitely exacerbated the psychological conditions that we believe date back many years ago. 

He suffers from visual and auditory hallucinations – he talk to inanimate objects – but not to people. He has behaviors and stereotyped movements.

3.       INTERVENTIONS  description : 

The head of the consulate who visited P. in June told that the man is married and has got sons in Sweden. P. signed the authorization for the tracing of relatives, we are still waiting for news from the Embassy.

For a long time he has always shown indifference to any form of help and has always refused hospitalization. He was hospitalized following a serious illness, to discharge from the hospital was placed in a shelter. He has been refusing wash and sleep in the bed for years. .

The contacts with the Swedish Consulate and psychiatric visits has been possible only after the reception at the shelter

In Italy, particularly in Rome, although there are reference standards, the social-health integration is very tiring. There are no psychiatric outreach services. Recently the Department of Social Affairs signed a protocol with the NIHMP (National Institute for the Promotion of Health, Migration and contrast of poverty diseases). Thanks to this protocol, P entered into a care pathway.

The agreement with the INPS makes possible health interventions in the street and in the shelters.

4.       WORKERS & NETWORK:

Emergency Social Services of the City of Rome Shelter INMP - National Institute for the Promotion of Health, Migration and the contrast of the poverty diseases Swedish consulate coordinated actions between SOS - shelter - Inmp – Consulate 

The non-application of the relevant legislation. integrated interventions are put in place often only to specific categories of discomfort. Immigrants, children and so on.

Resort to informal collaborations to reach institutional arrangements, Demonstrating the usefulness of networking the resources and skills

5.       PROPOSALS:

The lack of cooperation of healt services is the biggest obstacle. Also with social services, and sometimes with the consulates who fear to deal with cases of people suffering from psychiatric disorders

The operational proposal is to continue with drug therapy prescribed by INMP and to solicit the cooperation of the Swedish Consulate .

6.       PERSONAL Factors influencing:

Mr P.’s acute psychiatric aspects determining the lack of cooperation prevent the dialogue and to recover its history. The slowness of interventions by the Embassy risks causing further adaptation of P. to where it is now – shelter

 

7.      Overall assessment of the casE

The Network's strengths are determined by the constant work of the staff of the center there was a marked improvement of the human condition.

The ability to use a medical staff who travel (INMP) and reach directly the patient.

 

3.  Mister J.  Portuguese  -  by  Celeste Brissos  - Diretora Unidade de Emergência SCML

 

1.   BACKGROUND and environment / context 

“J” is Portuguese. He lived in a foster care institution since he was 7 years old. He never had contact with his father. His mother, having 3 more sons and not available to raise all children, sent him to the institution. After reaching adulthood J tries to live independently, however always maintaining contact with his mother and sometimes going to live in her house but only briefly. He goes out of Portugal, moves to Spain, trying to live from his performance as a street artist and occasional jobs, he starts consuming illegal drugs and committing small crimes, that lead him to being arrested for one year in this country. Returning to Portugal he goes to live in a squat house in Lisbon, together with other youngsters. He doesn’t look for any help from formal institutions and tries to manage his life on his own and with his street friends, however always maintaining contact with his mother.

He starts a relationship with a girlfriend, also living in the streets and they both start to consume harder drugs, he creates a heroin dependency and commits small crimes that lead him to a 1 year prison sentence on parole. He gets a dog on the street that becomes his best friend and lives with him.

Suspicious about any formal institutions he doesn’t look for any help and does not see his homeless situation as a problem, however since he’s on parole, he’s followed by the Portuguese Social Rehabilitation Institute.

Eventually a outreach team contacts him and follows his path on the streets for one year where he lives performing as a street artist, switching between living in squat houses and roughly on the streets, always refusing any formal help from the institutions. Eventually this present year at the age of 29, after breaking up with his girlfriend, he recognizes is heroin dependency as a problem and seeks help on the Lisbon Support Center for Homeless Persons, looking for drug dependency treatment. He refuses any placement in homeless shelters, refusing to separate from his dog’

2.       HEALTH:  physical  and  psychic conditions  : 

J is a person who does not goes regularly to any health institution and for several years his health is not checked, neither physical nor mental. He has no complains. Still relatively young, he does not have any known chronic health condition except for his drug dependency.

After his request for help he is offered medical consultations and exams on Santa Casa da Misericórdia de Lisboa health services. The doctor that sees him says that in general his health condition is mostly ok, however warns that his life style will lead to future deterioration and is concerned about his heart condition, requiring that he’s seen by a heart specialist. He has also been proposed to go into a methadone treatment, however he refuses saying he does not want to replace his heroin dependency with other dependency.

3.       INTERVENTIONS  description : 

During one year the outreach team seems him and engages with him on the street. J refuses any kind of formal support, however the team manages to create a relationship with J and goes on telling him that when he wants help will be available. After going to the Lisbon Support Center for Homeless Persons seeking for help and after having a Case Manager assigned, “J” is referred to the National Drug Institute for dependency treatment.

The outreach team helps him to get new ID documents and to go to consultations. He’s also referred for the Santa Casa da Misericórdia de Lisboa health services. “J” starts to go to consultations at the General Directorate for Intervention on Addictive Behaviours and Dependencies (Lisbon center: Taipas) where a plan is made between him, his case manager and Drug Institute social technician, so that he goes into drug detox treatment.

The first step will be a 1 week detoxification followed by a 1 year treatment in a therapeutic community. On every step “J” knows what plans are being made, and he’s invited to express his own opinion, availability and doubts so that he feels he has also an active role in the creation of his life project.

4.       WORKERS & NETWORK:

The homeless situation is primarily leaded by his case manager and most responsibility lies in him, however several actors have been invited to participate, namely:
- Health services (public)
- Drug dependency Services (both public and private)
- Outreach teams (both public and private) The health services do not always accept the role of the social services and poor communication is very frequent, on this specific case however that was mitigated by the fact that both social and health services mostly belong to the same institution: Santa Casa da Misericórdia de Lisboa and communication has been mediated by his case manager, that usually accompanies him to consultations.

Barriers: The addiction treatment on a rehab center follows standard procedures that take some time between first consultation and the referral to a detox treatment (need for several consultations, medical exams that have to be done outside of the public services with need for further scheduling and finally waiting list for treatment).

In between the first request for help and entering into the detox program, at least 3 months pass, on wish motivation for treatment can fluctuate.

The role of the case manager as mediator between the several services and the person can be seen as a advantage in this situation. The fact that the person does not want to separate from his companion animal, the dog, creates some barriers: Shelters and rehab centers usually do not allow dogs. Addiction is also a barrier as most homeless shelters do not allow persons with active drug dependencies .

5.       PROPOSALS:

The intervention, even when in a street context, always implies the definition of an intervention plan, negotiated with the active participation from the person. The technician has to be able to establish an empathic and facilitating relation for the achievement of the social reintegration project. The admission into a therapeutic community, within the jurisdiction of the Health Ministry, should be a less bureaucratic process and more agile, since the recovery process can be compromised by the process sluggishness. .

6.       PERSONAL Factors influencing

“J” personality is marked by anti-social characteristics that make him very suspicious of any institution and any formal help.

Heroin addiction treatments have very low success rates and very high relapse rates.

That can cause exhaustion and burn-out into the assistance workers that may look with disbelief to a person seeking help.

7.      Overall assessment of the case

A plan has been established for the recovery. “J” knows that plan, he accepts it and participates in it. “J” is still relatively young and has shown potential and willingness.

As with any drug addiction situation, caution must be present and we have to be ready for potential relapses. However we can say in this situation, there’s hope for “J”.


 

4.  Miss C.  Portuguese  -  by  Celeste Brissos  - Diretora Unidade de Emergência SCML

 

Miss C. is an elderly woman, 88 years old, chronic homeless for about 10 years at the Lisbon airport. She was accompanied by an outreach Team – “Associação Novo Rostos Novos Desafios” to the Emergency Unit for a first attendance in February 2016. She was very resistant to any attempt to accommodate her and returned on her own to her sleeping site overnight. Two weeks later, and in conjunction with an air hostess that daily spoke and supported her, a new attendance was possible. She agreed to leave the streets and was conducted initially to Integrative Unit from “Associação de Assistência de São Paulo”, an option that she refused, and later to a guesthouse that has a protocol with our services, where she remains to this day. Note that the daily routine of the elderly was to spend the day in the central downtown area of Lisbon and return in the last subway to the airport. The air hostess friend, a reference figure in this process, would bring her some food and some aircraft magazines and there, in a protected place from the airport she would sleep sitting. When she was lodged in this guesthouse, she complained of back pains, because she was not used for a long time to sleep in a bed.

 

1.   BACKGROUND and environment / context 

Miss C. was born in Oporto city, in a family context with 9 brothers. She speaks of her close relationship with his father, a schoolteacher in the town where they lived, and the family socioeconomic status above average for the time. As an adult she worked in a social institution named Bissaya Barreto, in Coimbra town, where she took care of children. Later she came to Lisbon to work as a nanny at "wealthy" families’ houses, having also traveled a lot over the years.

Even after she was 65 years she worked as domestic but caring for an elderly woman. When that elderly woman died, she became houseless and “took refuge” at the airport. She never married or had any children, but kept some relationships. This is a woman who prefers to step away from close relationships, whether with colleagues or with family.

According to a niece, with whom we contacted, there was talk in the family that her aunt, Miss C. might have some psychiatric disorder but the subject was considered "taboo". Currently she maintains the same record, with an affable though suspicious behavior.

2.       HEALTH:  physical  and  psychic conditions  : 

The elderly has an extrovert attitude, with careful hygiene and appearance. She’s oriented in time, reasoning is maintained, sometimes it seems she doesn’t want to give any specific details of her life, but apparently because she does not want to expose herself to strangers and not because of any lack of memory. She has some normal physical problems of her age, particularly in terms of mobility and vision.

She was hospitalized in August with diagnosis of erysipelas (bacterial skin infection, lower limbs) with further integration in a Convalescence Unit (for skin treatment skin and marching training). At the time she was in the Convalescence Unit, she has created relationship with the technicians, played activities that gratified her (particularly small sewing arrangements), wanting to postpone the date of discharge. These facts lead us to consider that although she is resistant to the relationship when she keeps relations for a considerable period she binds in a very strong way and even excessive, having trouble after in dealing with the frustration.

According to her family, there were some rumors that Miss C. might have some psychiatric illness. In regard of medical tracking she accepts only to be seen by her family doctor (she’s registered and monitored in the Health Center of Alvalade - Dr. Calado).

3.       INTERVENTIONS  description : 

Relevant data:

• Successive approaches by the Outreach Team to the user until she accepts to visit the services.

• The importance of the relationship with the technicians, with the help also of the friendly air hostess, at her entrance into accommodation.

• Consultation of possible responses, like the Integrative Unit from the “Associação de Assistência de São Paulo”, initially and later response in a guesthouse (temporary response), where she’s up till today.

• Initially, the user complained of the Guesthouse room putting defects at everything (for example - the bed sheets were not well-stretched)

• Intervention project focused on finding accommodation (room), with Home Support responses for supporting the activities of daily living.

• The elderly was accompanied to two bedrooms having always rejected the existing alternatives. She complained for several reasons, including the location not being in the Lisbon downtown central area, not having a place to wash clothes, too many stairs to climb, among other factors.

• After these visits she insisted she wanted to stay at the guesthouse, having already established a good relationship with the staff.

4.       WORKERS & NETWORK:

Involved in the process: - Outreach Team “Novos Rostos Novos Desafios” - Integrative Unit from “Associação de Assistência de São Paulo” - Technical case manager - Air Hostess / friend (central element in the trust establishment with the case manager) - Emergency Unit - Santa Casa da Misericórdia de Lisboa - Health Services (Health Centre, Hospital and Convalescent Unit).

5.       PROPOSALS:

The services for elderly persons seem short in flexibility and not tailored to the specific needs of each person. That restricts the integration on that kind of support structures that over time have become unadjusted to the real needs.

6.       PERSONAL Factors influencing

The personality characteristics of this particular user, especially distrust and difficulty in accepting changes have hampered the intervention. However, she has accepted well the case manager changes.

7.      Overall assessment of the case

AThe main goal of the intervention has been reached: This older woman left the streets after 10 years that she stayed overnight at the airport. It becomes evident the need to create more innovative responses to the elderly .

 

5.   Daniel   -  by   Victor   Soto   -   St Joan de Dios – Barcelona

 

1.       BACKGROUND and environment / context 

32y old Spanish black male, parents from Equatorial Guinea. Occasional telephonic communication with mother that lives in the States, parents divorced when he was 18, and he stayed with father in Spain. Father’s abuse probably made him leave home.

Mother sends him money (frequency not known). Sister also lives in USA, little contact. Had a relationship with a woman (2010)with whom he went briefly lo live with, and says he has a child with her??

1) Referred in March 2010, arrived from Madrid 2009, probably not more than 1 year in the streets previously.

2) In the streets due to abusive relationship in fathers home in Madrid, In Barcelona probably no relationships, except
    occasional people he might meet in specific settings such as basketball fields.

3) Used to refuse any offer of services till 2013, when accepted a hostel. ’

2.       HEALTH:  physical  and  psychic conditions  : 

Diagnosed with Paranoid Schizophrenia, no other illness detected

1) Keeps a Rappers look , saying he writes and sings rap, according to his beliefs, liked to be near basketball courts, as
    if belonging to some sort of gang, but no interaction. Wouldn`t enter certain places because thought they were
    racist against him

2) Initially referred in March 2010, discharged in Oct 2011 (lost contact) Regained contact in Feb 2013.

3) No difference of opinions between professionals

4) Not the case .  .

3.       INTERVENTIONS  description : 

Initially referred due to display of psychotic symptomatology whilst in a hostel, with behavioral repercussion, soliloquy in front of tv, unmotivated laughter, and personal neglect.

1) Mental Health interventions: Involuntary admissions in 2 occasions, due to unstable mental state and behavioral repercussion, on the second occasion becoming a potential risk to others. With good results, stabilizing mental state. On 2 occasions referred to a case manager, to provide a more individual approach, with a good response, since it improved his engagement with us. Social Interventions, was appointed a SW so he could benefit from free lunches, laundry etc., and a free hostel was appointed and benefit allowances were applied for. All of these interventions were of great help for him since it increased his quality of life.

2) After second compulsory admission into hospital, very stable, and accepts interventions. He was offered a hostel by social services, and still keeping the room, and well adapted. Currently on the process of obtaining a pension, due to his psych. Illness.

3) The figure of a case manager is extremely important. It proved very important as a engagement instrument, and also during the compulsory admission, escorting him to hospital in the ambulance, and staying with him during the admission process in the hospital. .

4.       WORKERS & NETWORK:

1) There were many actors involved, and networking and cooperation were present and crucial.

2) In this case the professionals were from the public sector, (social services and mental health) and some resources
    were from the private, like the hostels. The collaboration was in a economic basis.
    The public sector , in this case the SS were buying services ( paying for the room in the hostel)

3) Performing synergies between social services and mental health services occurred in the way of formal meetings
    every 1-2 months were cases were discussed, and action plans shared. Other contacts were in the way of informal
    telephone contacts, and joint visits with mental health professional and social worker.

4) The care was divided between the service providers, each institution which is private, acts as a service provider for
    the administration, and therefore one institution contracted by social affairs, acts as a service provider for social
    affairs and is responsible of all the social action plans, pensions, housing, hostels, food… And a other institution
    contracted by health department of the admin, was responsible of the mental health team, prescribing medication,
    and the admissions into hospital.

5) An important barrier was that initially he had lost all his documentation, and these were necessary to request a
    pension, (income).

6) Due to the lack of income, the pensions had to be paid with a budget that the social provider has for these cases.
 

5.       PROPOSALS:

1)The figure of the case manager is important in the way that it can help with all the coordination difficulties, increase the engagement of the person, and act as a referent for the person. This figure has to be empowered by all the network, and work closely with the person, and that is way , the case manager should only take max 15 cases..

6.       PERSONAL Factors influencing

1) In this case not relevant.

2) A big source of burn out for professionals, was the lack of collaboration of Daniel with the services, he would not oppose them directly , but would basically not engage In the plans and not carry them out.
 

7.      Overall assessment of the case

The persons condition has improved, he continues with a case manager that can individualize the interventions and is a source of detecting the needs that Daniel expresses!! Still without any pension but the petition has been made.

Living in a hostel.


 

 

6.  SALVATORE D.   -  by  Giuseppe Riefolo, Silvia Raimondi ASL RM1 - IT

 

1.       BACKGROUND and environment / context 

Salvatore D. was born in Palermo 55 years ago. He was reported to the S.O.S., social operating room of the municipality of Rome, 4 years ago, placed at the intersection of three busy roads in the northern area of Rome. It is possible that in a previous period he was accompanied by a woman in a different area of the town. People living nearby his couch never complained about his presence and even provided food and clothes, when allowed by him.

In March 2016, a special team of our municipality, whose target was to supervise the historical area of Rome, decided to “remove” Salvatore from his corner without advising any of the institutions involved in his care: the S.O.S. services, the policemen in charge for that area, the volunteers’ organizations, our mental health department. The most surprising matter on this action was the complaint of an inhabitant of the area, who missed Salvatore and was very much upset for the rude way the intervention was set up.

At the police station where Salvatore was taken, he has been informed that his mother was looking for him and that he was declared “missing”. A few weeks later, Salvatore found a new place in which he rebuilt his couch, a little bit more hidden and not far away from the previous, but once again it has been destroyed by the police intervention. Nowadays, he’s living just a few metres far away from the last bed. Salvatore is loquacious and quite often talks about his family, large and very poor and describes a period in which he lived and worked in Turin.

Despite the pleasure Salvatore shows in being in touch with our group, it is very hard to get him into a helping relationship: Salvatore refuses any kind of concrete support, such as food, clothes or any form of guidance. We may say that he evokes the image of a foreign body inside an organism that tries to extrude it and it is possible that he detects all the attempts to protect him as ways to get rid of him If you go for a visit, it seems like he really wants to talk to you, but he builds a wall of words, which is impenetrable and he doesn’t activate any kind of listening: apparently there is no way to establish a dialogue with him. It is remarkable that even if Salvatore rejects any proposal to be housed in a shelter, yet he arranges his cabin, with a special care for the roof and that he is proud to declare that he owns the fidelity card of the supermarket nearby his couch! ’

2.       HEALTH:  physical  and  psychic conditions  : 

Salvatore suffers from chronic paranoid schizophrenia. We may suppose that this disease arose during his adulthood, getting more and more organized and closed off to any kind of help.

It is also highly predictable that Salvatore has never been treated in a specific way, due to the slow and progressive development of this pathology, that may arise without acute phenomena.

Salvatore’s psychopathological organization is well described and isomorphic to its relationship with the social context, whereas his presence is so visible and at the same time totally inaccessible. .  .

3.       INTERVENTIONS  description and network : 

Our team’s intervention has been set up two months ago, activated by the local police, that in this case was asking for our help. In this team collaborate some volunteers’ associations (S. Egidio, CARITAS, Don Di Liegro, local parishes); the Social Operating Room – S.O.S. – of the municipality of Rome, the Traffic Police, the San Filippo Neri Hospital, the Policlinico Gemelli Hospital, the Villa Maria Pia Clinic, the two shelters handled by the Sisters of Madre Teresa di Calcutta, a team of anthropologists of the University of Rome La Sapienza (prof. ssa Laura Faranda), the Public Mental Health of the ASL RM/1, whose duty is also to coordinate the operations.

We have three main goals:

1) to establish a confidence relationship;

2) to accompany the person from the road towards safer facilities;

3) to acquire information to re-establish the relationship network that in most of the cases has been sharply suspended. We are therefore trying to get in touch with Salvatore’s relatives and to direct him toward a cure .

4.       WORKERS & NETWORK:

 

5.       PROPOSALS:

According to our experience, it is evident that to take care of people living in the streets, with serious disorders of social behaviour means to co-operate, basing integrated intervention between all the organizations involved. This not only means significant cost reductions, but also avoids the waste of energy and the risk of failures and discharge of responsibility. In our opinion, such a vision should be a matter more relevant to health policies rather than economic ones: in a vacuum of regulations, our group tries to compensate in a naive way, sometimes at the limits of legality.

Proposals:

1) It is necessary to structure, maybe at the city level, a group of integrated intervention that acts with coordinated procedures.

2) We need appropriate medical structures to host homeless supposed to be affected with serious sanitary disease: a normal emergency room is not prepared to receive contagious and infective patients (scabies, TBC, HIV, etc.)

3) Our current legislation does not provide funds for diagnostic and pharmacological costs if the person is not Italian and does not own STP or ENI social cards. According to our rules, any health or rehabilitation project should be financially supported by the Sanitary Department of territorial jurisdiction to which is addressed the patient. This obviously discourages taking charge of these clinical cases, due to the economic burden and the increased commitment required.
 

6.       PERSONAL Factors influencing

 

7.      Overall assessment of the case

 

 

7.   MISTER B     -     by    Catherine Glew  - Senior Policy & Pub. Aff. Off.       St Mungo’s    London  UK

 

1.       BACKGROUND and environment / context 

I interviewed B at St Mungo’s supported accommodation in North London in August 2016, one week before he was due to move into his new flat. Two years previously, he was sleeping rough in London for 6-8 months.

“I came back in the country after going on a long-term holiday around 2013.  I came back, I stayed with a friend but the friend who I was staying with could no accommodate me anymore…When I left, I didn’t have anywhere to go.”

B had lost contact with his friends after being abroad for a few years: “the only friend I had asked me to leave.”

He was told: “because of my age group I could not get on housing, I could not go to private renting because of my age group.  So, that affected me, even though I was entitled to benefits, I wasn’t entitled to full benefits that the private sector was asking for. Yes, so there was nowhere for me to get any help.”

2.       HEALTH:  physical  and  psychic conditions  : 

B described his lifelong experience of hearing voices, which began in childhood. Before he slept rough, B had only spoken to his family about hearing voices.

I always used to hear voices before but I did not realise it was an illness.  I thought it was just a normal thing…Some people that told me in the past it was a spiritual thing travelling through you… my elder people who did not have as much information about medical issues.”

His mental health deteriorated while he was sleeping rough: “whilst out on the street my mental health illness increased highly.  I started doing things I shouldn’t have been doing and from there started consuming alcohol quite heavily in the street just to get rid of the pain that I was going through.” 

“I could hear all kinds of thoughts being put into my head that were not mine.  I was paranoid all the time…Anger, a, sort of, angriness and getting upset and angry all the time…I was not in control of myself.”

He began to act violently and to harm himself: “I used to just punch anything…Just to get rid of the anger that was driving me, so when you feel the physical pain you feel better.”

B was eventually detained under the Mental Health Act for two months and received a diagnosis of paranoid schizophrenia: “It was very scary, very frightening but at least the positive outcome of it was I got access to medication…It has worked, it has stabilised me.”

3.       INTERVENTIONS  description : 

Before he was sectioned, B did approach services for help during the time he was sleeping rough.

He stayed close to the police station in order to feel safe. He spoke with outreach workers. He approached the accident and emergency department in a local hospital.

I thought, ‘What am I suffering from?  Have I got things like HIV or AIDS?  Is there something wrong with me?’  You know, all those.  I started going to A&E, asked them that I needed to get a check-up…they were asking me why I think I’ve got AIDS or HIV.  I was like, ‘I don’t know.’  I just told them there’s something wrong with me.  I don’t feel well.  That’s the only illness I could think that could affect me.  I wasn’t aware of any mental illness that I had.”

B believes that his lack of awareness about his own mental illness delayed him receiving treatment and care: “The doctors took a while to discover what was wrong with me because maybe I wasn’t giving them the right information.  Mentally I was not even capable of giving the doctor the right information.”

He spent time in inpatient psychiatric care and in prison, where he received medication. Despite this, he slept rough again for 2-3 weeks after leaving prison: “I would just carry my medication around on the street and taking it whilst out on the street after I came out of prison.” He spoke about the difficulties of complying with medication programmes while sleeping rough, either because medication was liable to be stolen or because side-effects made people additionally vulnerable.

B was housed with St Mungo’s and received support from community mental health services including a care coordinator. He found that being supported and prompted to take his medication, as well as engaging in counselling, was helpful for his recovery.

4.       WORKERS & NETWORK:

B has appreciated consistent and coordinated support from his mental health team and care coordinator, an example of joint work between the public and the voluntary sector

“They’ve been here 24 hours, 7 days a week where I can contact them…They’ve worked through thick and thin on my behalf. They connected with my key workers, connected with my substance abuse worker.”

5.       PROPOSALS:

B reflected on his time sleeping rough: “From my experience when I was out on the street, I did not have access to the help that I needed.”

He highlighted several important features of effective services:

  • Being assertive: getting people to approach them.  To approach people who are homeless and trying to at least show them, ‘Look, you know, the services are there which you can get access to that can help you with your mental well-being.”

  • Being consistent: “Here we have 24 hour support.  We always have somebody to go and talk to if we have any problems.”

  • Fulfilling basic needs: “when I got accommodation, there are also things that fall into place.  I could take my medication, I could refresh myself or clean myself.  Be able to eat well and feeling that you belong somewhere, that really did help my mental illness”

6.       PERSONAL Factors influencing

For B, his personal experience of hearing voices in childhood and the explanation he received from his family affected his own perception of his mental health.

7.      Overall assessment of the case

B received well-organised care and treatment and has made progress with his recovery. However, it is unacceptable that he had to sleep rough for months, with his mental health deteriorating, in order for care to become available.


 

 

8.   Blanche :  Chantal Magdeleinat  - SMES  Centre Hospitalier Sainte Anne 

 

1.       BACKGROUND and environment / context 

Blanche is a French woman, tall and thin. She is about 60 and has been living on the street, in Paris, for many years. Different mobile units have tried to communicate with her : social teams, medical teams, volunteers…She is always very polite but she never gives her name or answers a personal question. She never accepts shelter, even in winter and sleeps every night outside. She is filthy and carries a lot of newspapers tied with strings. She has no shoes and her feet are in rags. She moves from place to place in a small area. She is calm and stays in the streets for hours doing nothing. She never asks for money.

2.        HEALTH:  physical  and  psychic conditions  : 

She doesn’t complain about anything. She doesn’t seem to have any physical problem. But when she speaks, it’s obvious for everyone that she has a psychiatric illness. A former nurse of our team knows who she is. She has schizophrenia and was hospitalized many times in the past, more then ten years ago. We got her medical file from the previous hospital.

3.       INTERVENTIONS  description : 

We talked a lot about that woman. What should we do? Leave her on the street or bring her to the hospital against her wishes. It was very difficult to decide: it was not an acute problem but something very chronic and there was clearly no physical problem that required immediate attention. Finally, I went to meet her on the street. She had schizophasia, it means she looked like a woman with a normal verbal exchange but actually all her sentences were non-sense. She did not pay attention to her life condition and it appeared to me that her capacity for judgment was very bad. She did not care about her situation because of her mental illness. When we studied the previous file, it appeared she was much better when she had medication. That’s why we decided to bring her to the hospital and so we did. She was hospitalized against her will.

4.       WORKERS & NETWORK:

A large association which included social workers was also involved with Blanche. At the beginning they pointed out the situation on us because they were worried. After Blanche was hospitalized, they came to visit her very regularly and she showed she was very happy to see them.

5.       PROPOSALS:

In some occasions, hospitalization can be a benefit for that kind of people but they need to stay a long time to improve. -the intervention by the social workers is very important because they can really build a relationship with the person. Beyond the medical treatment, this permanent link is a key point in Blanche’s improvement.

6.       PERSONAL Factors influencing

EVOLUTION : During the first three months, there was no improvement with treatment at the hospital. She said she was really unhappy to be there and she did not understand why she was there. She did not talk to other patients. She just said she was never hospitalized before. She had no perception disorders. On the physical level, there was no problem. She really was in good health. After 3 months, things changed slowly after a change in medication. She felt better and better, asked to contact her family (children and father), asked for help to get a new ID (she lost her ID years ago), and started to get dressed normally, to take showers, to put shoes on…and she began to say she did not want to return on the streets. She is still at the hospital, 6 months later .

7.       Overall assessment of the case

From this case, the general question is: how to decide what’s better for homeless people with chronic mentally illness without any acute medical problem? Is it possible to find some guidelines in order to make a decision in these situations? Hospitalization has to be long and it’s not common nowadays to stay in a hospital for a long time. Even less for homeless people.

 

9.    Mr. Pedro, Portuguese, male, 59 years old (2016)  by  Antonio Bento

 

1.       BACKGROUND and environment / context 

Born in the North of the country, he has been lived there for many years, before he leaved the country and went to many others countries. He has never been married and he don’t have children or profession, but he likes to help in the church. From many years until now he has been an alcoholic dependent. 

2.        HEALTH:  physical  and  psychic conditions  : 

He has been healthy until last year, when he had a cerebral vascular stroke. So, he have stopped drinking for some time and received treatment. He returned to drink and went to Lisbon, where he has been living in the streets. After sometime he enter in church based therapeutic community for alcohol and drugs dependents, but after a short period of time he refused to stay and returned to live in the streets.

At the beginning of the year he was admitted in an acute psychiatric unit, after the entrance in an emergence room of a general hospital, aggressive and in a very bad condition. Discharged he have appeared in the psychiatric consultation one or two times and disappear.

After some months he has been readmitted and this time it was possible to do a better work with him and established a more solid relationship. Now he was prepared to enter again in the same therapeutic community .

3.       INTERVENTIONS  description : 

The first intervention was medical, in the general hospital, after the cerebral vascular accident.

The second has the therapeutic community.

The third the psychiatric hospital and the medication and psychotherapy.

The fourth was again the multidisciplinary mental health team, during the second psychiatric admission.

The fifth was the second intervention of the therapeutic community.

Both organizations (mental health team of the psychiatric hospital) and the social team of the therapeutic community never give up of Peter.

4.       WORKERS & NETWORK:

It was vital the cooperation with different workers, in health and social fields, public and private, and the networking of many people, working together for helping, caring and treatment of Peter.

5.       PROPOSALS:

 Public mental health team and private therapeutic community will continue to work together, never give up of the person and giving his resources to him.

Whenever it would be necessary both teams are prepared to different kind of interventions ad problems (including the non success).

And, who knows, perhaps one day Peter will be in his own home!

6.       PERSONAL Factors influencing

The staff of both institutions is all prepared to manage with this kind of cases and situations.  .

7.       Overall assessment of the case

The final result is not yet achieved, but there are strong evidence that we are in a good way.

 

10.   Richard  -  by Elias Barreto  (PT) 

 

1.       BACKGROUND and environment / context 

Richard is a 40 year old man, rough sleeping nearby a hotel in a central area of Lisbon. The hotel was putting a lot of pressure on the municipality outreach team to do something about him, since several hotel customers complained that he displayed unappropiate behaviour, like masturbating openly in front of the hotel. The municipality outreach team talked about this situation at the regular supervision meetings with the psychiatric hospital team (CHPL), and asked this team to go out and make an evaluation of the situation. .

2.        HEALTH:  

By the end of November 2015, the CHPL psychologist together with the municipality outreach team approached Richard on the street. At distance we saw him restlessly walking around, making gestures and whispering to himself. He accepted talking to us, displaying an adequate conversation on a superficial level, although he would whisper and show grimaces while talking, suggesting he was having other thoughts or internal dialogues that he was not sharing. He acknowledged that he had in the past several psychiatric hospitalizations - “i am emotional unstable… the doctors talk about bipolarity...”. He also refers having an hystory of drug abuse, since he was 21 years old: cannabinoides, cocaine, LSD, etc. He had interrupted medication and the psychiatric consultations at the hospital. He rejected our offer to help him resuming those. At the moment he was only preoccupied with his feet, which he thought were too yellow. He was invited to visit us at CHPL (psychiatric hospital) and we also suggested to look for “Medicins du Monde” that would be in that place soon, and maybe could help him with his feet .

3.       INTERVENTIONS  description : 

Richard never showed up. As his behaviour was growing increasingly disturbing (agressive behaviours, daylight masturbation, soliloquy, intense restlessness) eventually, the psychiatrist of the CHPL team wrote a report to the health authorities suggesting that he was sent for a psychiatric evaluation. This led to his admission in a psychiatric unit for one month, during which it was possible to establish that he had had 5 previous hospitalizations. The first was in 2011, with the diagnosis of acute manic psychotic episode induced by substances. The others had similar diagnoses and his present doctor believed it was a toxic psychosis.

4.       WORKERS & NETWORK:

After hospital discharge, Richard was supported by the social services with a room. He even payed a visit to his mother living in a different city of the country. During this year he has been going to the hospital for psychiatric consultations and medication prescriptions. He looks clean and his behavior is more adequate. Recently he was seen at the same place where he was roughsleeping before, casting doubt if he is back on the streets or if he goes there to earn some money by helping park the cars (a common way to earn informally some money).

5.       PROPOSALS:

 It is hard to know what to do to break the recurrent cycle “street-acute psychotic episode- hospitalization- a period of overall improvement- drug abuse- street…” It seems that one factor has to do with the difficulty of Richard stabilize in an occupation or job. He has been in the recent past in a professional trainning course but he ended up excluded because of missing too many classes

6.       PERSONAL Factors influencing

Once he is hospitalized, there is a quick remission of the psychotic episode, and he can make some progress with his life. The fact that he has a long history of drug abuse, and hasn’t given up his habits of consumption make him vulnerable to loose what he has built and eventually go back to the street .

7.       Overall assessment of the case

At the present moment, Richard is attending his psychiatric consultations and adheres to medication. He might not be sleeping in the streets, since he presents himself clean and goodlooking. But during daytime he is doing the same activities e did before: parking cars for money.

 


11.

1.       HISTORIQUE :  états des lieux - profile de la personne ,  en relation aux conditions de «Dignité et Bien-être» :
 quelle partie attribuer à la dimension temps, rupture du lien social – abandon ; au manque de soins ?      

En 2013, nous sommes interpellés par madame Gertrude assise sur un banc à la gare du midi entourée d’un sacré nombre de sacs. Nous apprenons par la suite que madame est suivie au samu social mais qu’elle ne peut plus y aller pour cause de pediculose trop importante. Mme dit pourtant prendre soins d’elle dans un autre centre mais cela s’avère ne pas être vrai.

En 2015, nous retrouvons le réseau de madame lors d’une réunion-réseau. Cela nous permet de mettre les pièces du puzzle ensemble. Madame n’est pas en ordre sur le territoire belge. Elle est en demande d’un logement et d’avoir de l’argent. Elle serait arrivée en Belgique avec son mari. Semble avoir le syndrome de Diogènes.

Lors des rencontres suivantes, mme a un discours très décousu. Dit être médecin, architecte, etc.

En juin 2015, après le passage du juge de paix en rue, un administrateur de biens est désigné. Il nous aidera précieusement par la suite quant à sa situation sociale.

En 2016, le service social accepte d’octroyer une aide médicale urgente. Mme refuse toujours de se déplacer chez le médecin, car dit qu’elle est elle-même médecin. Un médecin viendra finalement la voir en rue à deux reprises.

 

2.       SANTE physique - psychique: information complémentaires sur l’état (diagnose déclarée soit hypothèse diagnostic)

Aurait eu un accident vasculaire cérébral en 2015

Psychose chronique

Entend des voix

Reste isolée tte la journée

Elle accumule les objets qu'elle déplace tjs avec elle

Elle soliloque en permanence.

Confusion psychotique

Ne s'oriente pas dans le temps

Est incapable de faire des démarches administratives

 

3.       INTERVENTIONS :   description -  quels en étaient les dispositif  -  quels en ont été les  résultats et  les difficultés

- 2015 : 6 réunions réseau

- 2016 : 2 réunions réseau

- Septembre 2016 : un médecin généraliste de la maison médicale où mme est inscrite vient la voir en rue

 

4.       INTERVENANTS & RESEAU :  description des intervenants et de leur rôle dans les intervention.     

Centre d’hygiène

SMES

Centre de nuit

Centre de jour

SAMU SOCIAL

Assistante sociale du service social

Administrateur de biens

IDR

Docteur

 

5.       PROPOSITIONS :  lesquelles pourraient être généralisées – adaptables – spécifiques  -  prioritaires      

à Via le médecin généraliste, organiser un passage aux urgences pour mise au point médicale (car MEO non justifiée selon le MG)

à  Accélérer les démarches sociales pour avoir un revenu – Européenne et donc ça bloque

 

SYNTHESE  des données de base et complémentaires 
pour mieux comprendre la personne, la complexité du problème, les demandes, le processus d’exclusion et inclusion
 

Nom fictif :               Gertrude

National : OUI       NON

Codex D&W:

Genre

M

F

 

Age

connue   : 1965

hypothétique

Contexte familial

connu   :

hypothétique   : Mme aurait beaucoup d’enfant – deux frères en Belgique

Temps de séjour à la rue  (en mois )

connu   : depuis 2005

hypothétique:

Temps de séjour dans des centres  (en mois) 

connu :

Hypothétique : 1 mois

Conditions d’hygiènes  

satisfaisantes 

médiocres

mauvaises 

nulles

Conditions santé  

satisfaisantes 

médiocres

mauvaises 

en danger

diagnostic déclaré : accident vasculaire cérébral

hypothèse de diagnostic :

Conditions santé mentale

diagnostic déclaré : Psychose chronique

hypothèse de diagnostic :

Causes /facteurs de la perte

maison : situation familiale compliquée – beaucoup de maladies des uns et des autres

santé :

Suivi  par 

services sociaux :

Centre d’hygiène

Centre de nuit

Centre de jour

SAMU SOCIAL

Assistante sociale du service social

Administrateur de biens

IDR

Docteur

centres de santé mentale : SMES

Collaboration ou non
de la personne 

elle pose une demande:

elle  est collaborative

elle est indifférente :

elle est oppositive :

Interventions   

en réseau avec … :

Centre d’hygiène

Centre de nuit

Centre de jour

SAMU SOCIAL :  Assistante sociale du service social  Administrateur de biens

IDR  Docteur

SMES

chacun pour soi :

collaboration occasionnelle avec : SAMU SOCIAL, AS du service social, docteur

collaboration régulière avec : SMES, centre d’hygiène Administrateur de biens

Parcours

alternatifs proposés : mise à l’abri des conditions hivernales, suivi médical et psychiatrique.

processus encore possibles : décision du service social pour octroyer un revenu

               

 


12.

1.       HISTORIQUE :  états des lieux - profile de la personne ,  en relation aux conditions de «Dignité et Bien-être» :
 quelle partie attribuer à la dimension temps, rupture du lien social – abandon ; au manque de soins ?      

En 2015, nous rencontrons M. à plusieurs reprises. Il est chaque fois au même endroit à la sortie d’une station métro.

Rapidement un service du réseau demande l’aide d’un service psychiatrique à domicile. Ils viendront rencontrer M. à plusieurs reprises en rue.

Nous n’avançons pas dans le suivi médical. M. refuse tout. Nous décidons de mettre en route une mise en observation non urgente.

La situation sociale est complexe car tout déplacement avec M. est difficile voir impossible. M. refuse tout déplacement. L’assistante sociale viendra en rue rencontrer M. Malgré cette rencontre, elle exige que M. vienne au service social. Un administrateur de biens est mis en place et sa situation sociale est rétablie. M. a des droits en Belgique mais vu qu’il est radié au service social il n’a pas de revenu et ne peut donc payer la mutuelle. Le service social refusera à plusieurs reprises d’octroyer une carte médicale vu que M. a des droits en Belgique.

Nous organisons une réunion réseau et développons en parallèle un réseau de vigilance (citoyens, commerçants, etc.)

 

2.       SANTE physique - psychique: information complémentaires sur l’état (diagnose déclarée soit hypothèse diagnostic)

Trouble du comportement

Vu par un service psychiatrique : pas de diagnostic décrit.

Auto-exclusion ++

Pas beaucoup d’information concernant sa situation médicale (pathologie chronique ?)

 

3.       INTERVENTIONS :   description -  quels en étaient les dispositif  -  quels en ont été les  résultats et  les difficultés

- Rencontres en rue en 2015

- Développement d’un réseau informel (formé de citoyens, commerçants, etc.)

- Service psychiatrique à domicile vient en rue rencontrer M.

- Juillet 2016 : réunion réseau

 

4.       INTERVENANTS & RESEAU :  description des intervenants et de leur rôle dans les intervention.     

Educateurs de rue

Assistante sociale du service social

IDR

Administrateur de biens

SAMU SOCIAL

Service psychiatrique à domicile

 

5.       PROPOSITIONS :  lesquelles pourraient être généralisées – adaptables – spécifiques  -  prioritaires      

à Mise à l’abri dans un hôpital pour mise au point médical et transfert vers un lieu de vie adapté à ses problèmes de santé mentale/logement.

à Collaboration avec l’hôpital pour une prise en charge malgré le refus

 

SYNTHESE  des données de base et complémentaires 
pour mieux comprendre la personne, la complexité du problème, les demandes, le processus d’exclusion et inclusion
 

Nom fictif :               Léon

National :  OUI       NON

Codex D&W:

Genre

M

F

 

Age

connue   : 41 ans

hypothétique

Contexte familial

connu   :

- A un oncle qui vient parfois le voir en rue. Celui-ci voyage beaucoup et a des enfants. Il vit en Belgique. La maman de M. qui est au Congo lui a demandé de s'occuper de lui. Mais est tès 'culpabilisant' vis-à-vis de M.

- Soeur: plus jeune, à ses papiers d'identité. Habite en dehors de Bruxelles. Ne se voit pas "souvent".

-Toute la famille de M. est au Congo. Son père est décédé. Ce qui a fortement perturbé M.

hypothétique   : 

Temps de séjour à la rue  (en mois )

connu   : 5 ans

hypothétique:

Temps de séjour dans des centres  (en mois) 

connu : ?

hypothétique     : ?

Conditions d’hygiènes  

satisfaisantes 

médiocres

mauvaises 

nulles

Conditions santé 

satisfaisantes 

médiocres

mauvaises 

en danger

diagnostic déclarée  :

hypothèse de diagnostic : trouble du comportement

Conditions santé mentale

diagnostic déclarée 

hypothèse de diagnostic : trouble du comportement

Causes /facteurs de la perte

maison : décès de son père

santé :

Suivi  par 

services sociaux : Educateurs de rue, assistante sociale du service social, IDR, Administrateur de biens, SAMU SOCIAL

centres de santé mentale : service psychiatrique à domicile

Collaboration ou non
de la personne 

elle pose une demande:

elle  est collaborative

elle est indifférente :

elle est oppositive :

Interventions   

en réseau avec  …: Educateurs de rue, assistante sociale du service social, IDR, Administrateur de biens, SAMU SOCIAL

chacun pour soi :

collaboration occasionnelle avec :

collaboration régulière avec : Administrateur de biens, SAMU SOCIAL, assistante sociale du service social, Educateurs de rue

Parcours

alternatifs proposés  : mise à l’abri dans un hôpital pour mise au point médical et transfert vers un lieu de vie adapté à ses problèmes de santé mentale/logement.

processus encore possibles :  mise à l’abri dans un hôpital

               

 

Vaincre la pauvreté n'est pas un geste de charité; c'est un acte de justice, un acte de protection d'un droit humain fondamental, le droit à la dignité et à une vie décente. Tant que subsiste la pauvreté, il n'y a pas de vraie liberté   (Nelson Mandela)

Dans certains pays, il n'y a pas une famine de pain , les gens souffrent au lieu de terrible solitude, de désespoir affreux, de terrible haine, parce qu'il se sent indésirable, désespéré et désespérant... Il a besoin de quelqu'un qui le comprend et le respecte.     (MadreTeresadi Calcutta)

___________________________________________________________________________________________________________________________________

13.
 

1.       HISTORIQUE :  états des lieux - profile de la personne ,  en relation aux conditions de «Dignité et Bien-être» :
 quelle partie attribuer à la dimension temps, rupture du lien social – abandon ; au manque de soins ?      

En 2015, nous avons un premier contact avec M. en rue. Son comportement pose question. « …son corps est cassé… » dit-il.

Depuis lors il répètera à plusieurs reprises qu’il se débrouille bien seul, qu’il va bientôt rentrer dans son pays natal. M. a des liens téléphoniques avec sa maman qui ne vit pas en Belgique. Il a des projets concrets de remise en ordre de sa carte d’identité par exemple.

En avril 2016 M. entre dans notre suivi. Nous creusons alors sa situation médicale et sociale avec lui. M. est connu du SAMU social et d’un hôpital. Les hospitalisations de M. ne sont pas évidentes. M. se montre agressif et non collaborant, il ne respecte pas les consignes.

Il sera finalement mis en observation dans un hôpital de Bruxelles. Les contacts avec le service seront nombreux.

Actuellement, un projet de retour au pays est organisé par l’assistante sociale du service. Le contact avec l’ambassade n’étant pas aidant les démarches sont longues et délicates. En effet, est-ce que M. sera habilité à prendre l’avion seul ? Est-ce qu’une escorte est possible ? Est-ce qu’un suivi médical sera assuré dans son pays ? Cette situation remet réellement en question l’accès aux soins en Europe. 

 

 

2.       SANTE physique - psychique: information complémentaires sur l’état (diagnose déclarée soit hypothèse diagnostic)

- Maladie infectieuse

- Toxicomanie

- Consommation d’alcool

- M. dit se débrouiller – dans le déni ?

 

3.       INTERVENTIONS :   description -  quels en étaient les dispositif  -  quels en ont été les  résultats et  les difficultés

- Mai 2016 : aide médicale urgente en ordre

- Jusqu’en aout 2016 : en rue

- Aout  2016 : Mesure mis en observation

 

4.       INTERVENANTS & RESEAU :  description des intervenants et de leur rôle dans les intervention.     

- Infirmiers de rue : Coordination du suivi en rue/Réseau

- Centre d’accompagnement aux toxicomanes. M. y va chercher son traitement.

- Samu social : M. y est connu depuis 2015 – Comportements difficiles car M. souvent imbibé.

- Centre d’hygiène : M. y va prendre une douche de temps en temps

- Centre de jour : M. y va manger de temps en temps

 

5.       PROPOSITIONS : lesquelles pourraient être généralisées – adaptables – spécifiques  -  prioritaires      

Retour en Italie facilité

 

SYNTHESE  des données de base et complémentaires 
pour mieux comprendre la personne, la complexité du problème, les demandes, le processus d’exclusion et inclusion

Nom fictif :               Marcel

National :  OUI       NON

Codex D&W:

Genre

M

F

 

Age

connue   : 1971

hypothétique

Contexte familial

connu   : a une maman et un cousin qui vivent dans un autre pays de l’UE

hypothétique   : 

Temps de séjour à la rue  (en mois )

connu   : ?

hypothétique: a quitté son pays natal en 2012 – a vécu au Pays-Bas un moment (en rue ?)

Temps de séjour dans des centres  (en mois) 

connu : ?

hypothétique     : ?

Conditions d’hygiènes  

satisfaisantes 

médiocres

mauvaises 

nulles

Conditions santé 

satisfaisantes 

médiocres

mauvaises 

en danger

diagnostic déclarée  : maladie infectieuse grave

hypothèse de diagnostic :

Conditions santé mentale

diagnostic déclarée : ?

hypothèse de diagnostic : désorientation temporelle

Causes /facteurs de la perte

maison : ?

santé : ?

Suivi  par 

services sociaux : Infirmiers de rue, Samu, centre de jour pour toxicomanes, centre d’hygiène, centre de jour

centres de santé mentale : ?

Collaboration ou non
de la personne 

elle pose une demande : pour avoir son traitement (méthadone)

elle  est collaborative : NON – dit se débrouiller – va retourner dans son pays natal bientôt (va se débrouiller pour ça)

elle est indifférente :

elle est oppositive :

Interventions   

en réseau avec  …:  Samu social, centre de jour pour toxicomanes, les hôpitaux

chacun pour soi :

collaboration occasionnelle avec :

collaboration régulière avec : les hôpitaux et centre de jour pour toxicomanes

Parcours

alternatifs proposés : mise en observation

processus encore possibles : retour dans son pays natal (UE – droits)

               

 

Vaincre la pauvreté n'est pas un geste de charité; c'est un acte de justice, un acte de protection d'un droit humain fondamental, le droit à la dignité et à une vie décente. Tant que subsiste la pauvreté, il n'y a pas de vraie liberté   (Nelson Mandela)

Dans certains pays, il n'y a pas une famine de pain , les gens souffrent au lieu de terrible solitude, de désespoir affreux, de terrible haine, parce qu'il se sent indésirable, désespéré et désespérant... Il a besoin de quelqu'un qui le comprend et le respecte.     (MadreTeresadi Calcutta)

 


Danish cases SMES seminar 29.10


14) My Ravn; Gadens stemmer (Voices of the Street) Presentation of case: A job with meaning and purpose – I'll describe the process of becoming a guide at ‘Gadens Stemmer’ (The Voices of the Street) in relation to this main point of the seminar: HOW mental health services, emergency and assistance services, housing services, reintegration services can work together, contribute and facilitate the promotion of dignity and well-being of these suffering people without distinction of origin, sex and age.

 

15) Sally Timm & Lars Peter L Jensen; Psychiatric Hospital: Psychiatric street team Presentation of case: Skizophrenia and Homelessness: mad travellers Waiting text

 

16) Ayfer Baykal; Shelter for homeless: Mændenes Hjem (Mens House) / Cafe Klare Waiting text


17) Søren Hasselø; Fristedet (Housing unit) 1. BACKGROUND and environment / context §108 Municipal council shall provide accommodation in facilities that are suitable for long-term residence to persons who, due to significant and permanent physical, or mental impairment, need extensive help in ordinary, everyday functions or care. Sundholm Care has 52 residents with an average age of approximately 50. They have extensive drug and alcohol addictions in common.. Most of the residents have moved in after being homeless, imprisoned or hospitalized. You could say that we are often where you end up as a last resort and many of our residents never move away from here. Sundholm is a special place with a long history of being a place for societies “Persona non-Grata” and has over the time been, and is still a home for poor people, Jail for young people under the age of 18, a hospital and shelter. Even now it is secured behind walls (once there even was a moat) but fully accessible for everyone.

2. HEALTH: physical and psychical Most are further characterized by having comprehensive health challenges such as HIV, Hepatitis, KOL, and various injuries as a result of a long life with abuse such as dementia, liver damage, etc. Furthermore they often have psychiatric problems - only few are actually diagnosed and even fewer are treated for these because of their addictions.

3. INTERVENTIONS When you live in a §108 housing. Is it generally like having your own home. This means for example; we accept that the citizen has an active drug or alcohol addiction. We have no authority to impose sanctions against the citizens and it is also nearly impossible to evict a citizen. Therefore, the professional social aspects of our work is tied to relationship formation and long-term goals. We work with Harm Reduction and rehabilitation. But in a realistic matter and from a viewpoint that – “1 bottle of vodka a day, is better than 4”. Often simply getting a roof over their heads, food in their stomachs and treatment of illnesses is a huge boost, and has a great impact on their general problems.

4. Social- and health workers involved and network In addition to the daily care tasks, we’re often mediators / translators between citizens and the established system. We try to ensure attendance and treatment in hospitals and addiction centers, or support in contact with the public system or family. It is often experienced that citizens do not get the appropriate treatment due to their psychological challenges. this often leads to miscommunication with the public system, due to the fact that they are not sufficiently trained to deal with the challenges, that our citizens face. We are in many ways, our citizens advocate, and we try to help them, to the best of our abilities.

5. PROPOSALS for better services? • Social Education and specialization within the field. • More Staff • On a economical level, a system that sees establishments like Sundholm, as an long term investment

6. Case

60 year old John moved in 5 months ago. He has lived here before, but had difficulty settling in and therefore moved out after years of trying. However, it was not possible for John to live alone. His apartment was not kept safe. This was due to, amongst other things, John’s big drug and alcohol addiction. Because of this, he was unable to take care of himself, or his home. He was eventually evicted and lived a short while on the streets. It was therefore with Johns great benevolence, but the lack of other offers, that he moved in with us again. John has been abusing drugs and alcohol most of his life and because of this, has been placed in both judgement, and treatment regimes, countless times. He "Hates" social workers and the system in general and therefore is difficult to work with, but at the same time, he has a great need for us. It quickly became clear to the staff that John's health was very bad and after some admissions to the hospital, doctors found out that he had severe gangrene in one leg. In the hospital, after a visit by the doctor, John is very upset. The doctors said that they need to amputate his leg, which John opposes. They are trying in every way to persuade him, which only results in more anger. Doctors eventually calls for psychiatrists to determine whether John is psychotic, giving the doctors permission to amputate Johns leg off against his will. We are present and enter into dialogue with them about how we experience John's mental state. We contribute with knowledge about how he handles with authority, his habitual condition and whether we consider him psychotic or or not. This leads to John’s discharge, duly informed that his decision will most likely have dire consequences. Subsequently John changes his behavior towards the staff. He is appreciative and experienced as more calm than ever. The staff works with him in relation to his wishes regarding funeral and family. Staff supports him in making his new room feel like home. The staff initiates plans for treatment going forward, and helps John get official papers drawn, which guarantees him that he will not be revived from a possible cardiac arrest. During the whole process staff works to motivate John to change his mind and say yes to an amputation, but John is confident in his decision and repeatedly explains to us, that his time here is over, and all he wants is to die in peace. He dies a month later, after having felt probably the calmest and safest, that he had felt in a very long time despite his circumstances.

 

18) Justine Kilbey Mitchell; Daycenter: Den Sorte Gryde (The Black Pot) Waiting case


19) Louise Christensen; PhD, Aalborg University Maybe


20) Per Glad; projekt UDENFOR. Streetwork Waiting case


21) Henrik Kromann Hansen; member of user-organisation: SAND “Excluded from society by hasty, unconventional law Sentenced and convicted to psychiatric treatment and viewed as cantankerous Psychiatrist, finding reasonable doubts, turning the responsibility upside down, but only equipped with inappropriate tools and limited to using awkward solutions.”
 


 

 

PROFILE COLLECTING'S PROTOCOL

 

  1. What we have done

  1. In the beginning of the project: processing the structure of a protocol to collect the biographic profile divided in 5 sections: a) Background b) Health c) Interactions description d) Workers and networks e) Proposals

  2. May 2016 (in Florence): it was presented an integration of the protocol after a first analysis of the profiles collected. A restricted group of representing the organizations involved in the Dignity and Wellbeing Project have discussed about and shared the new focus points to be used like tools for the integration and clarification of the profiles already collected.

The principal points discussed were:

  • - Definitive clarification about the qualitative nature of the survey’s tool (the protocol) and rejection of different tools to collect informations (like quantitative tools or closed question’s questionnaires);

  • - Clarification about the most important aspects to point out in the collecting of new profiles;

  • - The addition of two new thematic sections to the protocol: a) representations and self-representations impacting on the taken in charge (eventual presence of stigma impacting on the taken in charge, orientation made by the social operators and the support team); b) overall evaluation of the cases collected
     

  1. At the end of the project we are going to have:

  1. ...XX profile/study cases;

  2. ...many informations about the different ways of interaction between services system and people in extreme discomfort condition in the different contexts;

  3. ...the opportunity to analyze and to articulate the informations collected in order to be able to have in the same time a general reasoning that, in one hand, underlines the common aspects of the profiles collected and in the other, points out the specifity singularities.
     

  1. What have we yet to do?

To the editing of the final report, we have to realize three different phases:

  1. The analysis of the informations collected. For each profile, we have to proceed at a deep reading and at a reprocessing of the informations collected: The informations will be encoded in order to create semantic units able to underline in the different scopes, common aspects, and specifities

  2. Reorganization of the informations collected: when the first phase will be ended, we will proceed to the drawing up of the index of the final report.
    The informations collected in the profiles will be reorganized in a logic way following the thematic sequence identified in the index. Nowadays the index can be considered equivalent to the thematic scopes of the protocol, however probably the qualitative analysis will determine a different articulation of the relevance’s order and the presentation of the thematic cores.

  3. Final report. The final report will follow the thematic order of the index. To respect the qualitative nature of the tool that we are using the descriptive and discursive section will be interpolated by citations extracted by the profiles collected.

 


 

 

 

 

 

 

 

 

SMES-Europa - Secretary Tel.  (+) 32.2.5385887 -  mob; +32.475634710  -   E-mail: smeseu@smes-europa.org