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This paper – the final paper of a series of three – aims to discuss the implications of the findings from a service user needs assessment of people experiencing homelessness in the Northwest of England. It will expand on the previous paper by offering a more detailed analysis and discussion of the identified key themes and issues. The service user needs assessment was completed as part of a review of local service provision in the Northwest of England against the backdrop of the COVID-19 pandemic.

Semi-structured questionnaires were administered and used by health-care professionals to collect data from individuals accessing the Homeless and Vulnerable Adults Service (HVAS) in Bolton. The questionnaires included a section exploring Adverse Childhood Experiences. Data from 100 completed questionnaires were analysed to better understand the needs of those accessing the HVAS.

Multiple deprivations including extensive health and social care needs were identified within the cohort. Meeting these complex needs was challenging for both service users and service providers. This paper will explore key themes identified by the needs assessment and draw upon further comments from those who participated in the data-gathering process. The paper discusses the practicalities of responding to the complex needs of those with lived experience of homelessness. It highlights how a coordinated partnership approach, using an integrated service delivery model can be both cost-effective and responsive to the needs of those often on the margins of our society.

Data collection during the COVID-19 pandemic presented a number of challenges. The collection period had to be extended whilst patient care was prioritised. Quantitative methods were used, however, this limited the opportunity for service user involvement and feedback. Future research could use qualitative methods to address this balance and use a more inclusive approach.

This study illustrates that the needs of the homeless population are broad and varied. Although the population themselves have developed different responses to their situations, their needs can only be fully met by a co-ordinated, multi-agency, partnership response. An integrated service model can help identify, understand, and meet the needs of the whole population and individuals within it to improve healthcare for a vulnerable population.

This study highlighted new and important findings around the resilience of the homeless population and the significance of building protective factors to help combat the multiplicity of social isolation with both physical and mental health problems.

The discussion provides an opportunity to reflect on established views in relation to the nature and scope of homelessness. The paper describes a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 pandemic. Recommendations for service improvements will include highlighting established good practices including embedding a more inclusive/participatory approach.

The purpose of this paper is to offer an opinion piece that documents the experience of losing an adult sibling to suicide and explores the experience of personal and family grief.

This narrative is written from an autoethnographic perspective and uses the current evidence base to support a personal reflection.

This paper identifies the complex nature of bereavement following death from suicide and considers those factors that support more positive outcomes for those grieving.

This piece focuses on autoethnographic data but is supported by findings from the wider evidence base.

The importance of seeking positives as part of the healing process when processing complex grief.

Disclosure has been identified as an important part of processing complex grief associated with suicide bereavement and yet suicide remains a taboo subject for many.

This autoethnographic piece details the experience of dealing with a sibling suicide and the importance of creating the opportunity for positive reflection to process complex grief.

The purpose of this paper – the second of three – is to report the findings from a service user needs assessment in those who have contact with a local homelessness service in the North-West of England.

Data were collected using a semi-structured questionnaire that included a section exploring Adverse Childhood Experiences. Aggregated data from a total of 100 completed questionnaires were analysed to understand the nature and scope of those accessing the Homelessness and Vulnerable Adults Service (HVAS).

Homeless people accessing HVAS face a number of challenges, which reflect their upbringing and chaotic and complex lifestyles. Reports of multiple disadvantage, social isolation, physical and mental health problems were common among the cohort.

This was a small cohort study, and the authors accept that this may potentially limit the scope of the findings. Themes identified are, however, reflected in wider research and official data collection sources. Future research may seek to widen the data collection methods to offer a more representative cohort.

The provision of co-ordinated multi-agency support is essential to tackle health inequalities experienced by those who are homeless.

The complex issues often experienced by those who are homeless can further compound the impact of social exclusion on health and well-being. The reduction of statutory support and increased emphasis on self-reliance can further impact those people on the margins of society.

This study identifies how multiple deprivations and social isolation impacts upon health and well-being, further compounding a person’s ability and willingness to engage with services. It raises the question of the systems failure to respond effectively.

This paper – the first of three – aims to explore some of the complex physical and mental health needs of those experiencing homelessness. It will act as a leader to the other articles by establishing the nature of the problem and offer a rationale for carrying out a service user needs assessment as part of a review of local service provision in the North West of England against the backdrop of the current COVID-19 epidemic.

There are a number of complex social and health inequalities often experienced by those who are homeless. Effectively tackling these requires a co-ordinated multi-agency response to both prevent and tackle the harms associated with being and becoming homeless.

Partnership working offers the best opportunity to meet the complex needs of those experiencing homelessness. The current delivery model being actioned in the North West of England highlights the importance of the links between statutory and non-statutory services. An ongoing service user needs assessment will further help to highlight contemporary issues faced by those experiencing homelessness and those providing services in the context of the COVID-19 epidemic.

Future papers as part of this series of three will consider the implications of social exclusion and barriers to accessing services faced on a day-to-day basis by those experiencing homelessness.

The opportunity to reflect on established views in relation to the nature and scope of homelessness. It will consider the implications exclusion from society and service provision that this group face on a day-to-day basis. The paper will describe a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 epidemic.

Over 100 years ago, Emil Kraepelin revolutionised the classification of psychosis by identifying what he argued were two natural disease entities: manic depressive psychosis (bipolar disorder) and dementia praecox (schizophrenia). Kraepelin's discoveries have since become the “twin pillars” of mainstream psychiatric thinking, practice, and research. Today, however, a growing number of researchers, clinicians, and mental health service users have rejected this model and call for a symptom‐led approach to prioritise subjective experience over diagnostic category. The purpose of this paper is to ask: how can the published first‐person accounts of experts by experience contribute to these debates?

This paper analyses the representation of psychiatric diagnosis in two prominent autobiographies: Kurt Snyder's Me, Myself, and Them: A Firsthand Account of One Young Person's Experience with Schizophrenia (2007) and Elyn Saks' The Center Cannot Hold: My Journey Through Madness (2007).

As well as providing a prognosis and a plan for treatment, the psychiatric diagnosis of schizophrenia gives shape and meaning to the illness experience and ultimately becomes the pivot or platform from which identity and memoir unfold.

The paper introduces two popular autobiographical accounts of schizophrenia which may be useful resources for mental health service users and clinicians.

The paper highlights the complex ways in which people interpret and make meaning from their psychiatric diagnosis.

The paper demonstrates that first‐person accounts make an important, if frequently overlooked, contribution to debates about psychiatric diagnosis.