Supporting the most vulnerable in society – two Specialist OTs tell their story as part of OT Week
05 November 2020

Supporting the most vulnerable in society - two Specialist Occupational Therapists tell their story as part of OT Week

As part of our celebrations to mark Occupational Therapy Week, two of SCFT’s Specialist Occupational Therapists have spoken about the life-changing work they do to support some of the most vulnerable members of society.

Gemma Buckley and Susie George work within the Homeless Service in Brighton and Hove. The team was initially set up in 2013 and is now led by Caterina Speight, Specialist Nurse, and is based in Morley Street in Brighton.

The team support the homeless population living in hostels with long term physical health needs, to promote re-engagement with health services, reduce hospital admissions and to help clients manage their conditions more easily.

This is their story:

“We predominantly see homeless people in hostels across the city, and those in temporary/emergency accommodation. The nurses in the team also carry out rough sleepers’ clinics – these are held at day centres and people drop in for breakfast or are coming for another service and can access nursing and physio. The service is open to those that that are potentially vulnerably housed or at risk of homelessness, including ‘sofa surfers’.

“Referrals are via charity outreach workers; GPs; self-referral; and via the drug and alcohol service; and community nursing teams.  As the team has become more well-known the more referrals come in. We generally see clients who are at one of the hostels, in the community, or at day centres. In terms of client groups there is a real mix, you have the elderly frail and the young, very mobile people with incredibly, complex and chaotic lifestyles.

“As occupational therapists we work in a person-centred way, looking at short and long term goals. Our days are very changeable. What you plan to go and do might often not be what you end up doing! For example it could be one off visit for equipment provision, or working with a client around social reintegration. A lot of intervention would be around mental health needs, around people with depression and anxiety – looking at anxiety management; behavioural activation, to help people set and achieve their goals.

“People might have a goal to do voluntary work; or they might want to go outside of the hostel; or want to go to the Recovery College. We work with clients around substance use; understanding their mental health, they may have just been diagnosed e.g. one client had just been diagnosed with a mental health condition, he didn’t understand it and had lost his confidence. We look at educating people about their condition and working with people to understand their situation, and reintegrate them back. People are often occupationally deprived because of the situation they are in and a great deal of our work is trying to re-engage them.

“In addition to 1 to 1 work we also run groups, for example self-care skills, or socialisation skills groups. Across the city we run a number of groups each week: cooking group; self-care group; and a fishing group (off the groin next to the pier). Although we have eight men who would be really keen to do mackerel fishing!

“Engagement really depends on how clients are doing in their recovery and if they want to come back. We also run a gardening group in New Stein Mews which culminates in a big barbecue every year. All the staff get really into it and really involved and we have banners and everyone comes to it, but we end up cooking!”

“The challenges of the role are people not understanding what OTs do! Sometimes the challenges can be complex cases, clients with severe and enduring substance use and mental health issues. The role has more of a mental health bias than a physical one, a great deal around substance use. I think resources also impact, such as lack of appropriate accommodation; staffing, and of course the motivation of clients.  The challenge of navigating the whole system, there are so many different splinters which is noticeable when you have someone new coming into the team. When you have been there a while you know which charity does what etc. We have now decided to do a community folder, so we can highlight what is available – there is so much available. That can be problematic, not knowing where, what route to go to for specific help, which charity does what

“Seeing people moving on to less supported living is a huge reward of the job that we do. Also seeing a change, seeing people enjoying life more, feeling more confident, being able to cope with life better, having more resilience, just engaging with other people, socialising when they have been so isolated; getting out and about, seeing people smiling and participating in activities, that is really rewarding. Success can be considered to be a reduction in substance misuse, clients having a structure in their day, getting onto voluntary work, or even just attending a group can be considered an achievement, e.g. recovery college groups, or even doing something independently can be considered a huge success for people that have been isolated for such a long time. Or for some of those people just staying in their accommodation rather than sleeping out, which is part of the Rough Sleeper Strategy.

“In our team we all have a really good sense of humour. You do have to rely on your colleagues for support. We do like to walk a lot, we are lucky that some of the hostels are near Morley Street, so having that walk in between clients is quite nice. I think it is having time away and time to unwind, having that balance between work and home is really important. It is really important to have regular breaks, otherwise you do get burnt out. You notice it with the team, you need to be taking time away. I think it is about supporting each other – if there is a crisis we can always have a debrief, a chat.”