1. David - Homelessness By John Palmer, Rachel Clark, Luke Fuller, Heidi Beattie, Michelle Grant, Lynnette Bush, Lucy Webber

2.  Psychological  Reduced motivation  Mental Health Problems e.g. perhaps Schizophrenia  Depression  Loss of roles and habits  Trauma  Amnesia  Decreased self-esteem and confidence  Alcohol and Drug abuse  Physical and verbal abuse  Physical and Social  Malnutrition  Depleted water, if at all  Living on the streets  Poor self care  Diabetes  Cold/Hypothermia  Finances  Lack of sleep  Poor feet care  Lack of access to Health Care  Skin Problems  Toxic confusionals state  Low social role  Discrimination  Withdrawal symptoms  Dental problems  Stereotyping

3.  Communication and Rapport  Empathise  Build of rapport in order to have trust  Comfortable environment with no distractions  Reflective listening  Observation of body language  Holding and disarming communication  Problem free talk  Look for transference  Appointments attended on time by MDT  Leaving information for him to take away  Gain Medical history from socials services etc asking David’s permission  Self Reporting  First hand information  Gain insight into emotions and feelings of David  David may lie  Has deluded ideas and beliefs affecting what he might say  Unaware or lack of insight to his condition  Amnesia  Psychotic symptoms, telling him not to talk to people  Perhaps write a personal log, due to feeling uncomfortable talking

4.  Goals  Short term – Immediate health requirements; treatment of any immediate pathology/injury. A change of clothes and personal hygiene issues. Nutritional evaluation and address deficit. Immediate shelter for safety and welfare.  Medium term – 6-12 weeks detoxification. Access to group therapy and general counselling and support.  Long term – Sheltered housing scheme. Re integration of David into society, raising self esteem and confidence to establish himself as a member of society.  MDT/Services  OT  CPN/Mental Health Nurses  Dietician  Social Services  Podiatrists  Advocate  Care coordinator  Dentist  Social Security  Homeless Charities i.e. Big Issue  Rehabilitation Day Services  Non- Statutory and Statutory Drug and alcohol Services  Client centred care and overlapping of roles  All working to meet the same goals

5. Future Challenges  Isolation  Stigmatisation  Hospitalisation  Discrimination  Reduce socialisation  Further homelessness  Compliance with medication and services  Adjusting to societal norms  Violence  Poor physical health  Contact with old associates  Try and keep contact with the services and reassess at different times  Encourage David to occupy his time to provide alternatives to drugs  CBT  Demonstrate mastery to increase confidence and sense of purpose  Anxiety management