Tag Archives: health

Health, Mental health, Uncategorized, Wellbeing, Young people

Self-harm: the power of talking face to face

Self-harm has always been a taboo subject and in my many years of mental health nursing probably provided more challenges than anything else for me.

It touches at the very core of who we are and how we deal with stress. Our mental strength, or resilience to cope when under pressure, will prevail in many cases but not all.

Recently, new research by the charity YoungMinds suggested that many doctors do not know how to support young people who self-harm. And today comes the news that mental health patients are to be given the right to chose their consultant. As reported today, this will help end what can be a “like it or lump it” service – unlike patients with physical health issues, mental health patients can’t currently chose which psychiatrist they see.

Back to primary care; self-harm is still very much misunderstood by many, and the wider general public. As a mental health nurse, I confess at times to having felt at a loss myself as to how to respond to repeated self harm behaviours. You question your own approach if the problem remains despite intense nursing intervention.

But given that 10 per cent of 15 to 16 year olds are thought to have self-harmed, usually by cutting themselves, if GPs are offering a lacklustre response to the issue (not referring for counselling or for more specific mental health support), this is woefully inadequate.

The mental health charity Mind, suggests that if your GP doesn’t help, you contact the Patient Advice and Liaison Services – and you have a right to change your GP. Mind has some useful practical information on where to get help.

I have worked with some excellent professionals. However, I have also seen others who are in a privileged position to help but who try to look the other way. Or dismiss this as attention seeking behaviour.

In a profession known for its primary focus on the treatment of physical diseases, being presented with a self-harming patient provides an emotional litmus test for many GPs. Why do they get this so wrong sometimes?

Although I don’t want to generalize, I believe that some view this behaviour with frustration and a sense of hopelessness. By this I mean some medical professionals might not feel confident of their own training or understanding to be in a position to deal with things effectively.

Some GPs are too dismissive or refer to mental health services in the knowledge that more specialised knowledge will be available to plan appropriate treatment. Or they automatically reach for the prescription pad to prescribe medication without really asking themselves if a psychological approach would be the more helpful first option.

And yet all too often, just a listening ear will help, to allow the person to “offload” within the surgery. This is where the therapeutic relationship between the GP and patient is pivotal to treatment and recovery.

The power of talking openly about concerns face to face cannot be underestimated. A prescription for anti-depressants may be helpful in the long term but we should not rule out even a basic “talking and listening” opportunity as a first option (given GP’s have to stick to set consultation slots, I can see why this might seem an impossible idea – but an approach that encourages people to talk is the right one).

If a person with low self esteem tells the GP they are a “bad person” or “unloved”, the GP can use a simple cognitive behavioural approach of questioning the evidence to support this there and then, of which there is usually very little. And stress to the person that a thought is just a thought, not a fact. Simple but effective initial intervention to encourage someone to question their own negative thought processes.

So what to do?

Going back to my opening thoughts, while professionally I’ve found self-harming behavior extremely challenging, one thing I’ve never doubted is my empathy to try to look beyond the physical act of self harm to try to identify its underlining cause.

A behaviour as challenging as self-harm can distract you from seeing the person behind the behavior; what is the emotional conflict driving this kind of behaviour. People can change self-harming behaviours. Being positive and maintaining hope is the starting point of any intervention – and that goes for the professional as well as the individual.

Disabiloty, Health, Housing, Learning disability, Social exclusion, Third sector, Uncategorized

Bricks and mobility: buildings and disability history

Carved stone hands reading braille, on the exterior of the former Royal School for the Indigent Blind, Hardman Street, Liverpool. The Grade II listed school was built in 1850 (pic: English Heritage)
A gap in a church wall speaks volumes about the history of disability in England; lepers’ squints allowed people with leprosy to see the pulpit and hear the service through a small chink in the stonework, without coming into contact with the congregation.

Images of churches with lepers’ squints are among hundreds included in a web-based project launched today by English Heritage. The Disability in Time and Place resource encourages the public to understand changing social attitudes to disability via England’s architecture and shows the influence of disability on the built environment.

Eleanor House, Buckinghamshire, the Epilepsy Society, opening ceremony 1896 (pic: Epilepsy Society)

As Rosie Sherrington, policy adviser at English Heritage says of Disability in Time and Place: “In essence we can track disabled in and out of the community and back in again by looking at the range of buildings they inhabited.”

The image-led project features institutions and landmarks, among them the Le Court Leonard Cheshire Home, often taken as the first meeting place of the disability rights movement where Paul Hunt began campaigning with other residents in care. The pictures are from English Heritage’s archive and also draw on historical images lent by the charity’s partner organisations.

Disability in Time and Place is being launched at the Graeae Theatre, Hackney (among the country’s leading fully accessible theatres) this afternoon with speakers including Tara Flood, ex-paralympian and director of ALLFIE (the Alliance for Inclusive Education), and architect and access expert Dr David Bonnett, whose pioneering work includes the refurbishment of the Royal Festival Hall.

Guild of the Poor Brave Things, Braggs Lane, Bristol (pic: Brave and Poor Ltd)

Among the places featured is the Guild of Brave Poor Things in Bristol (above), the first meeting places for disabled self-help groups. The visual history also includes the Liverpool School for Indigent Blind, opened in 1791 by Edward Rushton, who was blind. Rushton’s school was the first in Britain that aimed to give people the skills to be more independent.

Other sites featured are churches designed for deaf congregations such as St Bede’s Church in Clapham and St Saviour’s in Acton, both in London (the latter is still used as a deaf church). They have dual pulpits, one for the chaplain and one for the interpreter, as well as bright lighting and raked seating to boost visibility.

English Heritage’s web resource is divided into six sections, each taking a specific historical period – the Tudors or the early 20th century, for example – and looks at the building types associated with it.

Sherrington adds: “In the medieval period we have the idea that disability was a direct consequence of mankind’s sin, and therefore a religious matter. However disability as a result of disease such as leprosy was widespread, and an ordinary part of everyday life. It was not understood in the same way as we see it today.”

Moving onto Tudor times, she says, much of the care provided by monasteries and the church was destroyed during the dissolution, having disastrous consequences on the lives of disabled people. Paradoxically, Henry VIIIs “fools” were people with learning disabilities paid to entertain the court. It was a privileged role and they were thought to have divine wisdom.

“The 18th century saw the idea of disability being a matter of physicality rather than morality,” according to Sherrington, “and providing for the disabled became a matter of civic pride. As such many private asylums and enormous hospitals for the war disabled (like the Chelsea Pensioners) were built.”

With the rise of asylums and workhouses, disabled people were hidden away (although Sherrington adds “ this was though of as a positive move enabling disabled people to receive the ‘treatment’ they needed”). With the 20th century came the attitude that many people had incurable conditions (Sherrington draws our attention to the rise of eugenics “and the perceived need to separate those who were ‘healthy’ from those believed to be ‘inferior’”). But then two World Wars resulted in the notion of “heroic disabled” and the emergence of memorial villages and specialist rehabilitation hospitals.

According to Baroness Andrews, who chairs English Heritage, the project “is a history of the nation’s buildings and of a significant proportion of our population which, until now, has gone unexamined and untold. It is the part of the history of every town and city, with the schools, chapels and hospitals which surround us all each day but it has remained invisible and silent.”

English Heritage worked with a disability history steering group which included disabled employees, disability history academics including Jan Walmsley from the Open University’s Social History of Learning Disability Group and Dr Julie Anderson from the University of Kent who specialises in war disability. Partners included ALLFIE (the Alliance for Inclusive Education). Other sources of advice, information and images include the Greater Manchester Coalition of Disabled People, Disability History Month, the Centre for Disability Studies in Leeds, Leonard Cheshire, the Epilepsy Society, New College Worcester. All the content has been translated into British sign language videos by deaf interpreters.

* English Heritage has also updated its, Easy Access to Historic Buildings, available to download.

Health, Local government

Prevention, partnership, proofing against the future

With less than six months to go before councils adopt responsibility for public health from the NHS in April 2013, much depends on successful collaboration between cross-sector agencies.

As the date approaches, the latest Guardian public health seminar gathered together an expert panel and audience of 50 stakeholders to discuss the changeover. The debate focused on partnership between the public and private sectors and barriers to integration. Read the rest of my piece on the Guardian website.

Mental health, Older people, Social care, Uncategorized, Wellbeing

Why I always had time for George: older people and mental health

I’m walking across the grounds of the psychiatric hospital on a very wet winter evening and a patient, let’s call him George, steps out from behind a bush to talk to me. He needs to tell me something that he feels is important and can’t wait.

We both stand for quite a while talking (he’s a staunch socialist and wants to talk politics) and both get soaked to the skin. I think to myself that it’s more respectful to hear what he wants to say then hurry on and seek shelter. As we eventually walk back to the ward together, he is calmer, seemingly content to have got his feelings off his chest.

This scene took place more than 20 years ago (I mention it in my book, Sticks and Stones) but I believe now what I thought then, that my exchange with George is what real empathy is all about. It’s what being non-judgmental is about, what being human is about, what being a nurse is about.

I have nursed enough people during my time as a mental health nurse to understand that life is a bit of a lottery. I have seen the elderly lose their dignity in nursing homes and in hospitals. This is not always through dementia. This could be depression or psychosis, or other debilitating illnesses depriving them of their confidence, self worth, and esteem.

But as the recent figures about suicide rates rising among the elderly show, mental health issues may be overlooked in older people as society mistakenly presumes dementia is the only condition older people experience. Another assumption is that depression is a normal part of ageing, because the elderly have more of a sense of their own mortality.

I hope that whatever befalls me in my old age I am shown the same respect and compassion as I believe I have shown others. There’s often a failure of respect not just because of deliberate neglect or a lack of compassion, but through ignorance – through not treating people as individuals or not meeting their emotional needs.

So how do we prevent this? Essentially it is around searching for the person behind the illness and stepping back for a second and thinking “how would I like to be treated if this was me?” or “would I like to be looked after in this environment?”

Of course I’m not arguing against the completion of care plans, but I do worry that the increasing onus on form-filling and box-ticking can deny care staff more time to spend with those they support. A care professional might be spending hours on admin, or typing up a care plan – but how does the person in their care know this is part of them being cared for? They’d rather have our face-to-face time I’m sure.

Person-centred care, as the name suggests, is meant to put the client at the heart of the care planning process. This care is collaborative and negotiated with the client (theoretically). However, often when someone is acutely psychotic and lacks all insight, nurses then become the advocate and the care must be planned depending on what is required to get the person well again. As for personalisation and personal budgets, the take up is sadly not as high as it should be; people worry about risk management and general funding pressures that can put people off.

Compared to when I was in a clinical setting, today’s care world involves a far more litigation and risk-averse culture which takes staff away from the client. At the time I knew George, I could spend longer in one to one sessions with clients, so could my colleagues, but more often than not, today’s staff are only allocated a set amount of time each shift to spend in one to one, face to face therapeutic sessions on the wards.

Staff cutbacks on the wards and in the community will also reduce the time staff can spend with clients in face to face interventions. However staff should still show empathy and be non judgmental in all approaches, because this is the essence of their roles.

Clearly, organisations promoting older people’s issues have a role to play in raising awareness and educating. We stigmatise the elderly as much as we stigmatise the young people, so we need more positive promotion of what the elderly can offer society. Countries like China and Japan, for example, revere the elderly and yet in this country I think some people view them as an afterthought, a burden.

The hospital where I met George has long since been converted into a block of expensive flats while the man himself, already in his 80s when we had that long rainy chat, will have passed away many years ago. But the memory of that evening stays with me as a reminder of the underlying principle of care as I see it; listening to, respecting and having the individual – not “the system” – as your main focus.

Education, Employment, Health, Uncategorized, Young people

The next generation of social entrepreneurs?

Amid the talk of troubled families and approaching the anniversary of the 2011 summer riots, it’s tempting for many to pigeonhole young people as feckless and hopeless. A Europe-wide project, however, aims to encourage a new generation of social entrepreneurs into the movement for social change.

There are an estimated 11m EU citizens involved in the social businesses and Brussels-based JA-YE (Junior Achievement Young Enterprise) Europe Social Enterprise Programme aims to motivate young people to find solutions to socio-economic problems, boost their employability and give them practical skills in enterprise and ICT skills.

Teams of young entrepreneurs aged 15-18 from 10 European countries have just competed in JA-YE’s (which is funded by businesses, institutions, foundations and individuals) first competition to create social businesses. with the entries judged different countries.

The winning enterprise Nomeno (“No means no”), from Norway, developed Safe and Sound, a bracelet with a warning whistle that helps summon help in an emergency. The team is donating profits to the to the Norwegian National Association for Victims of Violence. Second place went to Russian young people, for the social enterprise TrustCane to create advanced walking aid canes.

Think Fit, a team from Tre-Gib School, Carmarthenshire, representing the UK, came third. The project, aimed at boosting healthy living, created activity cards in different languages to encourage children to exercise. The social business also produces branded water bottles, T-Shirts, high-visibility tabards and bags. The young people have also created Welsh, French and Spanish versions of the pack.

I suppose the niggling concern I have is how easy it is for kids to access the kind of scheme run by JA-YE- not being an education specialist, I’m not certain how schools would have things like this on their radars. That said, with much focus on the lost generation of n’er do wells, it’s worth nodding anything that aims not only to raise aspirations, but teach practical skills to make young people more employable.

Cuts, Disability, Health, Housing, Learning disability, Local government, Older people, Social care, Uncategorized

Sticking plasters, surgery and spending reviews

A damp squib of a sticking plaster, or what health secretary Andrew Lansley has said is the “most comprehensive overhaul [of social care] since 1948” and an end to the care lottery?

Most early reaction to today’s long awaited care and support white paper and its associated draft bill is firmly on the side of the former view.

I’ve yet to read all the detail, but while there’s a much-needed focus on elderly care, there’s not enough of a recognition for other sections of society needing care and support, and nothing to plug the funding gap.

As Merrick Cockell, chairman of the Local Government Association, told Radio 4’s Today programme this morning: “We haven’t got time to tinker around…We’ve got to look at radical change.” The LGA has said there is a £1.4bn gap this year between the money available and the cost of maintaining social care services. There’s a good run down of the council perspective on the LGC website and while this post from Ermintrude2 was written before the publication of the white paper, it’s a really good explanation of the issues.

While today’s announcement picks up some from the Dilnot report (Dilnot suggested a system for the elderly where the total cost of care would be capped to £35,000 and support to old people should be extended to those with assets of £100,000), any “victory” for common sense and civil society is bittersweet because it fails to lacks the cash to make real far-sighted change a reality. The proposals might well show good will, but there’s no financial way (this communitycare.co.uk piece relates to the vision for social work, which could be undermined by the lack of cash).

It is, as shadow health secretary is quoted in the Guardian’s politics live blog as saying, “a pick and mix approach to the Dilnot package”. So the government hasn’t taken up the “once in a lifetime opportunity” that Dilnot mentioned when he launched his vision of how to fix the social care system.

Among today’s main points are plans for an optional social insurance scheme under which people pay the government premiums to ensure that their costs for care and accommodation are capped, and a “universal deferred payments” system where councils lend money to those needing care, then recover the cash when the house is sold after death. Sound sensible – perhaps even familiar? That’s because it’s already in use – around 9,000 people already used deferred payments.

Today’s government press statement suggests we watch this space: “The government will continue to work with stakeholders to consider in more detail variants under the principles of the Dilnot commission’s model, before coming to a final view in the next spending review.”

Having already waited with bated breath for today’s long overdue white paper and draft bill, it’s unlikely that many will hold it much longer.

Here’s a flavour (by no means a comprehensive round up) of reaction on Twitter and the web to today’s social care white paper:

Richard Humphries, senior fellow at the King’s Fund: “There is a financial vacuum at the heart of these proposals which undermines the bold and ambitious vision for a reformed system set out in the White Paper.”

Julia Unwin, chief executive of the Joseph Rowntree Foundation: “Successive governments have failed to act. Without a sense of urgency more of us face insecurity and uncertainty as we age. The failure to address social care properly will only mean more pressure on the NHS thereby destroying all hopes of a sustainable and functioning health system in the future.”

Clare Pelham, chief executive of disability charity Leonard Cheshire Disability: “It is a question of fundamental decency that disabled and older people should be able to live their lives with dignity in Britain in the 21st century. We hear a great deal about the need to support older people through dignified social care, but it is important that the needs of younger disabled people are not overlooked.”

Mark Goldring, chief executive of Mencap:”The social care system is in crisis. Years of underinvestment and cuts to services have left one in four adults with a learning disability literally stuck in the home, isolated and at risk, with family carers at breaking point and scared about the future…We are reassured to see that the Government has committed to fund immediate reforms, but this promising blue print will never get off the ground if it fails to address the chronic underfunding in social care. The Government cannot delay any longer, and must now outline an urgent plan of how it intends to fund social care reform in the long term.”

Carers UK chief executive Heléna Herklots: “The measures set out in the draft Care and Support Bill would move from piecemeal carers’ rights legislation to the establishment of carers’ rights in government legislation and, for the first time, equalise carers’ rights with disabled people rights…But to make these rights a reality, what carers also need is a social care system with the resources to overcome years of chronic underfunding and rapidly growing demand. Those who face soaring care bills, service cuts and a daily struggle to access even basic support from the social care system, may see new rights in legislation as empty promises without the funding to back them up.”

David Orr, chief executive of the National Housing Federation: “We’re pleased the White Paper recognises that housing is crucial to the integration of health and social care, and welcome the investment to build more supported housing for older people and younger disabled adults…We need a health service that invests in services that keep people out of hospital, not one that simply treats them when they get there….the Department of Health needs to encourage local government and the NHS to pool budgets, focus on housing-based preventative services and set out its full proposals for the funding of social care – for today and for tomorrow.”

Nick Young, chief executive of the British Red Cross: “That the Government is accused of failing to address the social care crisis is no surprise. The scale of the funding problem is enormous and growing. It will take courage, creativity and tremendous degree of political will to solve. That isn’t going to happen overnight.”

Reaction on Twitter using hashtags #carewhitepaper, #ukcare and #carecantwait (also check out ‏@sim89 Storify‬ compilation of early responses):
‏

@ageuklondon Though it contains some good ideas, the #carewhitepaper doesn’t go far enough. The problem of care will not go away and is getting worse!
‏@Sensetweets Deafblind people continue to be abandoned, as funding fails to materialise – our response to the #carewhitepaper
‏@TonyButcher #carewhitepaper – like excitedly looking forward to your birthday but then only getting a cheap pair of Primark socks – disappointing
‏@gary_rae If this is a “watershed moment” for #ukcare then we’re clearly drowning. #carecantwait #dilnot
‏@Marc_Bush Care crisis demanded decisive action. Today we got a holding statement…’ @scope rspnd 2 @DHgovuk ‪#carewhitepaper‬ http://tiny.cc/scopetocare
‏@WoodClaudia focus on deferred payments in ‪#carewhitepaper‬ due to absence of other funding ideas. It is option for some, not THE solution being proposed
@Ermintrude2 Disappointed that headlines about #carewhitepaper all seem to concentrate on selling houses to pay for care. System about so much more.

Disability, Health, Local government, Social care, Third sector, Uncategorized

“People aren’t cases, they’re individuals”

Debbie Walker is “a guardian angel”, according to Julie Mason, whose 86-year-old mother, Elizabeth, has Alzheimer’s.

Two years ago, when Walker, a Sheffield Council care manager, met them, Elizabeth’s care involved daily agency staff plus Julie and her sister as unpaid carers. The family felt Elizabeth lacked choice and control, spent a lot of time with nothing to do and had little social interaction. Read the rest of my piece on how one council is letting external organisations lead on support planning on the Community Care website.

A support planning session at Sheffield city council (pic: Sheffield city council)
Health, media & communication, Music & arts, Uncategorized, Young people

The science of the sofa

Artist Michael Pinsky launches Fidget (pic: Geoff Caddick/PA)
Is there a science to sitting on the sofa? Any benefit to being on your backside? An art to sitting on your arse? An innovative new project by one of the country’s leading artists blends science and art in a bid to persuade the public that there is, sparking debate about obesity, activity, exercise and health along the way.

Comedienne Katy Brand helps launche Fidget (pic: Geoff Caddick/PA)

Launched in King’s Cross yesterday to capitalise on the Olympics (which many of us will sit around watching, doing very little exercise) the pop up Fidget campaign promises an “interactive canopy housing an arts experience”, created by renowned British artist Michael Pinsky.

Six “game zones” under the canopy encourage people to try simple activities for themselves and learn about the difference that moderate movement can make. On average, people spend about four hours a day watching television.

Dr Wilby Williamson, who has been involved in the development of Fidget (pic: Geoff Caddick/PA)

Run by London Arts in Health Forum and funded and supported by the Wellcome Trust, the project runs for a year, touring London before a nationwide tour of festivals, public spaces and other events this summer including Skegness, Edinburgh, Bradford, Bristol, Taunton, Gateshead and London Broadgate (see website for more details). There will also be interactive online communication tools developed by online charity YouthNet, which support young people online.

Disability, Health, Mental health, Music & arts, Olympics

Art fights social taboos

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Living with chronic health problems and facing social taboos are issues at the heart of an international artistic collaboration about HIV/AIDS as part of the Cultural Olympiad.

Portrait by Rachel Gadsen © Rachel Gadsden

© Rachel Gadsden

The powerful images here are part of the Unlimited Global Alchemy project
which launches today as part of the London 2012 Festival. After today’s launch at the Museum of Archaeology & Anthropology in Cambridge, the exhibition culminates at the Southbank Centre during the Paralympic Games.

The project has been produced by Artsadmin and commissioned by the Unlimited programme launched to celebrate arts, culture and sport by deaf and disabled people.

© Rachel Gadsden

Artist Rachel Gadsden, who has lived with disability all her life and whose inspiring work I came across last year, began the project after seeing the work of South African artist Nondumiso Hlwele at the museum in Cambridge – Body Map, below, reflects Hlwele’s experience of living with HIV.

Body Map © Nondumiso Hlwele

Gadsen travelled to the Khayelitsha Township, Cape Town, pictured below, to collaborate with the artist-activist collective which Hlwele leads. The works in today’s exhibition were created over a six week residency in Cape Town in October last year.

Khayelitsha township where today's works were developed

Together, the striking pieces show what it’s like to live with disabling conditions and social prejudice. “At the heart of this life-affirming and timely collaboration is a celebration of survival against the odds,” say the artists. “It is also about access to art in a very broad sense, participation, and the potential for bridges to be built across cultural, educational and geographical divides.”

You can follow the project on Twitter with the hashtag 
#UGAlchemy and the exhibition is at the Museum of Archaeology & Anthropology in Cambridge until 18 August before it transfers to the Southbank Centre, London in September as part of the Unlimited Festival. There will also be a collaborative performance work once the project transfers to the Southbank.

Health, Housing, Third sector, Uncategorized, Women

I never imagined I’d be selling my body for drugs

Vulnerable women are the focus of charity St Mungo's new campaign

“I never imagined in a million years I’d be selling my body for drugs…I’m still doing it now… I’ve nearly been killed three times doing [prostitution]. I’ve been raped doing it.. as a result of that I got HIV doing it. But it’s easy money.”

These words belong to Angela (not her real name), 38, speaking to homelessness charity St Mungo’s (you can hear more from her on the St Mungo’s website here).

Her story highlights some of the particular issues homeless women are known to face more than their vulnerable male counterparts – prostitution and domestic violence, for example – which the charity is focusing on during its action week this week.

The week kick starts St Mungo’s new campaign, Rebuilding Shattered Lives, the aim of which is to give a platform to best practice and innovation relating to supporting homeless and vulnerable women.

Traditionally, homelessness services were designed with men in mind but in England over half of those living in temporary accommodation are women and a quarter of St Mungo’s 1,700 residents are women. Until just three years ago, women fleeing an abusive relationship were deemed intentionally homeless (and so didn’t have housing rights) and encouraged to return home.

Housing and homelessness campaigners have long argued for more attention to be paid to women and homelessness (a 2006 report from housing charity Crisis still makes for stark reading) given there can be additional factors in their lives which might push them into homelessness – domestic violence and abuse, for example. The true nature of women’s housing need can also be hidden as they opt to stay with friends or sofa surf between spells of rough sleeping. While they can access mixed housing, as opposed to female-only hostels, for example, there is an argument to say that that more widespread female-specifc, housing-related support would make recovery easier.

St Mungo’s 18 month-long campaign invites organisations, frontline staff and female service users themselves to contribute ideas on preventing women’s homelessness and supporting recovery. Campaign themes including childhood trauma and domestic violence, as well as educational and employment opportunities, and restoring links with families and children.

A recent survey of St Mungo’s female residents concluded that more than a third who slept rough say their experience of domestic violence directly led to their homelessness while almost half are mothers. More than one in 10 have a history of being in care.

It’s worth noting that, as well as the stories like Angela, there are other examples in the St Mungo’s campaign of how, with the right support, women have started to turn their lives around.

“Mel”, for example, was living and working on the streets for two and a half years before coming in. She told St Mungo’s staff: “I’ve never had any stability. I don’t get on with my family, I’ve always been around drugs and getting clean when you are around other users is difficult. But I’m getting there, slowly…When I moved in here a year and a half ago I was a mess and I just slept, catching up you know. Then I turned things around, turned daytime into time for ‘doing stuff’ and nighttimes for sleeping.”

She added: “To get your benefits and all that you need to get to appointments, you have to get out of bed and you need the right help. That’s what I got here, though it took me a while to adjust, to get my head stable. What you need is people taking you seriously, people listening to what you want. What people need to understand is that just because you don’t comply with their ‘rules’, don’t turn up or whatever doesn’t mean ‘give up on them’.”

As the campaign develops, it will be interesting to see what ideas and services for women like Angela and Mel are showcased and what changes, if any, the charity’s follow up surveys reveal about an issue that has only comparatively recently been given a specific focus.