Homeless and inclusion health
Homeless and inclusion health
Report
M any homeless health , care and voluntary sector services are recognising the role that occupational therapists can play in supporting people experiencing homelessness in their journey . However , occupational therapists are often in isolated roles and with relatively limited evidence for best practice in homeless and inclusion health services , there is a need to share our learning together .
I helped establish a small network of occupational therapists working in homeless services within London almost nine years ago , aiming to establish peer support and share best practice . This has now grown to a national network of 60 occupational therapists , students , occupational therapy assistants and apprentices .
The network is hosted by the Faculty of Homeless and Inclusion Health and the charity Pathway . The group meets online to discuss practice issues and share innovative ways of working . The first study day for this growing network of occupational therapists working in homeless and inclusion health services was a success .
Homelessness goes beyond those sleeping rough and includes people who are sofa surfing , in temporary accommodation or hostels , and people in insecure housing or squats .
The number of people experiencing homelessness has risen over the last few years , with government statistics showing that almost 300,000 people were owed a homelessness duty as they were either at risk of homelessness or already homeless in 2022-23 – up 7 % on the previous year .
NHS England ( 2023 ) describes inclusion health groups as ‘ people who experience homelessness , drug and alcohol dependence , vulnerable migrants , Gypsy , Roma and Traveller communities , sex workers , people in contact with the justice system and victims of modern slavery ’.
People in these groups often experience exclusion from healthcare and wider society for varied and complex reasons .
People experiencing homelessness are likely to have : experienced complex trauma in their early years , compounded by the trauma of homelessness ; a higher risk of acquired brain injury ; experience trimorbidity ( experiencing physical ill health , mental ill health and substance misuse ); and have limited social networks for support .
The impact of homelessness on people ’ s health is increasingly recognised and for people in these groups , health outcomes are extremely poor .
On 9 November 2023 , during OT Week , 20 people from across the UK and Ireland met in London for our first ( and hopefully annual ) study day . The themes included the legal frameworks of our work , our unique understanding of executive functioning and neurodiversity and homelessness .
The day opened with introductions and an opportunity to talk about our ‘ superpowers ’. These included kindness , working with complexity , hearing people ’ s stories , advocacy , passion and tenacity . I felt honoured to share a room with so many occupational therapy ‘ superheroes ’.
The first session was presented by Hilary Neal , Operational Lead , East London Foundation Trust , and Rosemary Amran , Senior Practitioner , East London Foundation Trust Rough Sleepers Adult Mental Health Project ( RAMHP ), on the legal frameworks used in homelessness and why we need an occupational therapy perspective .
Hilary outlined the need for legal literacy within our roles , with a particular focus on selfneglect . We explored a complex case study in small groups . It was interesting to hear from occupational therapists working in different settings and how we adapt as OTs .
The conclusion was that each group wanted to know more about the client and spend more time getting to know them and their situation , which demonstrates our passion for patient-centred care .
Hilary then presented the key legal frameworks we work within on a regular basis .
My take-away message from this session was the importance of using our occupational therapy perspective to inform wider decision-making within these legal frameworks , so that people experiencing homelessness can receive the best care in a person-centred way .
Rosemary gave some background to the current safeguarding environment within homelessness , its focus on self-neglect and increased focus on executive function .
Safeguarding is predominantly social work led ; however occupational therapists are very familiar with assessing many of the issues around selfcare , self-confidence , self-identity , relationships , isolation and the reasons behind the ‘ choices ’ people are making .
She took us through the history of executive function from an occupational therapy perspective , considering how executive function sits in the center of safeguarding , mental capacity , the Mental Health Act and best interest meetings . We had discussions about how involved occupational therapists are in executive function assessments and how we contribute to legal assessments .
April 2024 OTnews 39