Greater Manchester Mental Health NHS Foundation Trust (GMMH)’s Homeless Services are one of the first in the country to offer dedicated support for service users who have neurological conditions.
GMMH’s Homeless Services provide a range of support, care and treatment for people in Greater Manchester who are homeless, or are at risk of homelessness, and who are also suffering with mental health or addiction problems.
The service supports people on their mental health and/or substance misuse recovery journeys, and ultimately aims to work alongside health, social care and third sector partners to support them out of homelessness.
In March 2023, the service launched two specialist support offers for service users who have specific neurological needs.
The first offer is led by a specialist Neuropsychologist, and provides assessment and support to service users with a range of neurological conditions, including those who have acquired them through events such as a traumatic brain injury, stroke, encephalitis (swelling of the brain) or complications of substance use.
The second is led by a specialist Speech and Language Therapist, and focuses on specific speech, language and swallowing difficulty support for these groups, alongside those who experience complex mental health difficulties, are care leavers, or have been in prison.
The development of the speech and language offer has been supported by Change Communication, a charity working to address communication barriers in homelessness services in London.
The aim of the specialist support is to improve outcomes for homeless service users who have neurological conditions through increasing awareness across the health and social system of the barriers they face, improving understanding of how support and treatment can be adapted to better suit their needs, and increase access to and engagement with the right health and social support.
The service will test and implement new innovative ways for this to be done, and review how it could be rolled out in future.
Dr Viki Teggart, Consultant Clinical Neuropsychologist at GMMH’s Homeless Services said:
“Research in Leeds found that 48% of homeless people may have a history of brain injury, with 60% sustaining more than one injury. And the rate of moderate or severe traumatic brain injuries (from a blow or impact to the head) among homeless groups is nearly 10 times higher than the general population.
“People who are homeless are also at risk of other causes of brain injury and other neurological complications, including reduced oxygen to the brain, from events such as stroke or use of alcohol and drugs. In fact, 50-80% of individuals with a substance-use disorder experience at least mild cognitive impairment; and 35-40% of dependent drinkers have brain damage related to the effects of alcohol.
“Neurological conditions can seriously affect the way a person thinks, feels, functions, communicates, or behaves. This can cause breakdowns in care, for example if someone doesn’t attend an appointment due to memory or planning difficulties, or finds it difficult to regulate their behaviour effectively struggles to communicate in certain ways. Ultimately, it means that the care and treatment provided by health and social services can be less effective.”
Laura Cole, Speech and Language Therapist at GMMH’s Homeless Services added:
“The NICE guidelines on integrated health & social care for people experiencing homelessness are clear – communication needs should be taken into account, with extra support provided for people with speech, language and communication needs.
“Having a brain injury can have a huge impact on communication. And people experiencing homelessness are almost twice as likely to have a communication need compared to the general adult population.
“Research shows that adults who are homeless experience communication problems which prevent them from accessing healthcare. The shift to virtual healthcare during the pandemic further excluded this group, with anecdotal feedback showing that virtual appointments are much less likely to be attended by people who are homeless even with support from keyworkers.
“This healthcare is so important to help people manage their conditions and so without it, the issues can just get worse, and can act as a real barrier to recovery in a number of areas of their lives.”
The specialist neuropsychology and speech & language therapy support, led by GMMH’s homeless services, focuses on ‘assertive outreach’, meaning the specialists from within the service work with staff across the health and social care system to provide training, support, resources and advice to help them understand the challenges people with neurological and/or communication problems face, and how they can be best supported to overcome them.
Specialists from the service also work directly with service users to assess their needs, adapt their care and treatment plans, and link in any wider health or social services which they may benefit from.
Dr Viki Teggart continued:
“So far, we have provided direct support to service users in a number of different settings, including at their personal addresses, hostels and shelters, local clinic spaces, and town halls, as well as during local hospital admissions and substance detox admissions. We’ve provided neuropsychological and speech/language assessments, and have offered advice and guidance in areas such as memory retrieval strategies, controlled breathing and relaxation, sleep hygiene, and other adaptations people can make to improve their daily functioning. We’ve also developed a number of resources varying from weekly planners to memory aids and communication cards.
“In the future, we plan to work with lots of different health and social system partners, including housing providers, GPs, adult social care, probation, safeguarding, NHS mental health services and charities. We have been attending multi partner meetings to advocate for those who need extra support and help ensure this is consistent across different services. We are also developing a training and awareness raising offer for these professionals in areas like: understanding brain injuries, understanding communication and swallowing disorders, how to deliver capacity assessments, how to support people when they can’t regulate their behaviour, and how physical environments and care plans can be adapted to support recovery.”
So far, a total of 31 people across Greater Manchester have been directly referred for neuropsychology and / or speech & language support; and the service has attended partner meetings to support and advise on the care and treatment for many more. Initial anecdotal feedback already indicates a positive impact.
Ellie Atkins, Manager & Safeguarding Lead at the Entrenched Rough Sleeper Social Work Team, Adult Social Care Complex Needs Services, Manchester City Council, said:
“I have been working with a person who has an acquired brain injury and limited comprehension and communication.
“The Speech and Language assessment and support has made a significant and impactful contribution to this misunderstood person with very complex needs. This has been a landscape changer to the trajectory of care and support for them.
“I am thrilled that we have this dedicated support in GMMH’s homelessness services, given that almost 50% of people sleeping rough are likely to have a brain injury and executive dysfunction. This is such a welcomed, much needed and long-awaited progressive role.”
