Jill* has been engaging with Opportunity Nottingham since 2014. Whilst this engagement has been important in developing trust with a service, and also developing a meaningful relationship with her Personal Development Coordinator, she has not progressed in relation to the issues stemming from her multiple needs. Her NDT scores have remained in the high 30’s and her Homelessness Outcomes Star scores have remained low.
However, since being referred to the Primary Care Mental Health Service (PCMHS), important changes have occurred that illustrate the vital role the service can play – and hopefully chart a way forward for Jill. In addition to multiple needs, Jill has for a long time been subject to a violent relationship. Past efforts to refer Jill to mental health services in relation to these issues have been limited due to her chronic alcohol consumption. Through referral to the PCMHS however, she has over a number of sessions and through the input of her PCMHS Worker, been able to develop “distress tolerance” techniques. These are psychologically based coping methods to help her deal with the difficulties she faces, which she would otherwise cope with through excessive alcohol consumption. Her PCMHS Worker has shown persistence and flexibility in enabling this to happen – for instance, seeing Jill whilst she was not entirely sober and also not giving up on her despite some “no shows”. These are both issues that could lead to patient discharge in some mental health services.
As a result of this support from her PCMHS Worker, input from Jill’s alcohol worker is becoming more effective. Her alcohol consumption has reduced to the point, where her PCMHS Worker is hopeful that a successful referral can be made to a service which will help Jill address specific issues . Additionally, her PCMHS Worker has been able to attend case conference meetings connected to the domestic violence Jill has experienced – and provide vital psychological input into these; specifically communicating that Jill’s tolerance of the violence stems from “maladapted attachment” and “abandonment fears.” Two key outcomes stemming from this have been firstly; a more informed understanding from the police regarding Jill’s situation, and secondly; a review of approach by Jill’s accommodation provider with the acknowledgement that eviction may not be the best option, and other strategies can be pursued, particularly if supported by a psychological approach.