1. Mind Your Head Out There
R. Khara, M. Firdosi, A. Mortlock, B. Kahai,
L. Collinson and J. Leveret*
In Partnership with SPEAR and Team Up 2016
Who are SPEAR?
SPEAR is a charity working with vulnerable homeless people in and around the London boroughs of Richmond.
SPEAR’s vison is: To enable homeless people in South and West London find secure accommodation and work towards a positive future.
Through their work SPEAR recognize that mental health problems are both a significant cause of and a significant perpetuator of homelessness.
In order to achieve their vison we need to help break the cycle of mental illness and homelessness.   
What is the Team Up Project? 
Elements of this Team Up project include:
Creation of a presentation on common mental health issues and their management that is accessible to non-healthcare professionals working with homeless people. 
Development of a screening tool to help SPEAR staff identify homeless people with mental health problems and allowing appropriate referral to mental health services. 
Delivery of information sessions to SPEAR project staff on the above; so that those working directly with vulnerable populations have the necessary tools to best support their clients.    
Creation of a legacy where these tools that can continue to be utilized for the support of homeless clients long after the Team Up project has ended. 
Background 1
Did you know……
80% of homeless people report some form of mental health issue? 
In line with SPEAR’s Homeless Health Link Service launched in Spring 2015, the screening tool will identify specific mental health needs including addictions and will facilitate an effective referral to primary health care and other mental health care providers.
Not only is it expected to contribute significantly to improving the mental health care of some of the most vulnerable in society, but also to have a wider impact in helping to reduce admissions to acute services such as A&E.
LEGACY 1: The workshop and template has been suggested for mandatory training for all staff at SPEAR and affiliated charities.
LEGACY 2: SPEAR staff have been equipped with the resources and knowledge to continue to teach others after the end of the project.
LEGACY 3: The average knowledge base of common psychiatric conditions has increased in our target population of SPEAR staff.
LEGACY 4: The average uptake of clients seeking help for mental health problems has doubled.
Legacy 5
Methods 2
An initial meeting was arranged with SPEAR to gauge staff expectations and what they would like to achieve by working with Team Up.
SPEAR’s current practices were discussed and their protocols for assessing and referring clients with probable mental health and drug and alcohol problems were reviewed.
It became clear that staff had no formal tools to identify mental health issues. Consequently there was a risk that clients with mental health issues were not being identified.
Staff acknowledged a need for training on common mental health issues and their management.
Together the teams decided to develop a concise questionnaire that can be used as part of client assessment to identify common mental disorders.
A literature review of mental health issues in the homeless population was completed.
With reference to current diagnostic tools, a concise two-page questionnaire was created.
An interactive lecture on common mental disorders affecting homeless clients was delivered to SPEAR staff.
Pre and post session assessment was carried out to identify any change in the knowledge base.
A plan to deliver more lectures and review the impact of the
questionnaire has been made.
This project had ambitious aims and great strides have been made in achieving these. Although it was often difficult to bring all relevant parties together to review progress face to face, the team were successful in using a combination of electronic communication and clearly delegating tasks to achieve the project aims.
The team found the guidance from SPEAR to be invaluable. The project was an excellent opportunity to bring together skills and knowledge from a large multidisciplinary team to create a feasible, successful project.
60% of SPEAR staff showed an increase in knowledge of common mental health conditions; with mean scores increasing form 43% to 73% following the interactive workshop. Furthermore 100% of SPEAR staff reported finding both the workshop and the screening tool useful.
The average recognition of mental health issues and subsequent referral to health care services rose from 17% prior to the project to 35% following the project.
The team plan to reassess referral to mental health services in in 6 months to determine further improvement. Feedback form SPEAR staff indicates the potential of a similar project focusing on physical health - a whole new project!
Discussion 4
Qualitative feedback on presentation:
‘Very informative and useful session’
‘Should be delivered to all staff, possibly earlier in the day to encourage uptake’
‘Absolutely an excellent session- the screening tool will make a real impact’
This project was aimed at supporting members of SPEAR staff with a client base of From the pilot workshop (n=5)
60% of participants showed an improvement in knowledge base of common mental health conditions, assessed by questionnaire.
Referral by SPEAR staff for mental health issues
Before Project: 17%
After project : 35%
Results 3
Did you know……
Every 15 minutes, a family is made homeless in the UK?
References
The unhealthy state of Homelessness. The Homeless Link
Sian Rees. Mental Ill Health in the Adult Single Homeless Population A review of the literature. Crisis, 2009
Mental Health and Homelessness. Guidance for Practitioners. The Queen’s Nursing Institute
* Names are in no specific order