Voices from the frontline – survivors of complex services

You think you’ve heard it all, and then you hear this: “I was homeless when I went into hospital. They discharged me onto the streets one winter evening in my wheelchair. I was readmitted three days later with hypothermia.” This was just one of the powerful voices of people labelled as having multiple or complex needs at the launch of Voices from the Frontline by the Making Every Adult Matter (MEAM) coalition (Clinks, DrugScope, Homeless Link and Mind, with support from Gulbenkian and Lankelly Chase).

It’s a strong report based around quotes from people who use services and frontline workers. Having ‘multiple needs’ means that people may for instance have mental health problems, misuse substances and are homeless. We all know that these challenges go so often together, but the people in the report talk consistently of ‘single issue’ services from which they are excluded for not fitting a single box. In some cases, statutory agencies almost compete with each other to apply their different sanctions, but were equally competitive when it came to avoiding assuming responsibility for the whole person.

Conversely, people talked about workers determined to see the whole person. One attendee at the launch said his psychiatrist simply referring to him by name was enough to make him re-evaluate his self-image. The gentlemen nearly sent to his death by his local hospital, had found a route back into life through his key worker helping him, amongst many other things, to participate in sailing and volunteering. Another panel member was now drawing on his own experiences to work in a guidance and mentoring role.

The report is strong in its own right, but also for me, tantalisingly suggested a message that isn’t yet quite developed. Services were single-issue, short-termist and in some cases, more effective at sanctions than support, partly because they couldn’t see the whole picture of a person’s multiple needs. But equally because, I thought, they couldn’t see that the whole person was more than just a basket of needs. It took someone working in a counter-cultural way (the MEAM approach) or against the grain of their own employer, to help the person find their way to contribute. A worker said ‘we need to help the public see the person”. ‘We’ can’t do that unless at least some of us are employees and leaders with lived experience to draw on, like the man who talked about sharing with others the ‘survival skills’ he learned in his own years trying to find the right support, and a way back into his community.

Until people with lived experience are a core part of every team at every level, services will retain their topsy-turvy view of the world, in which it’s the humans who are complex, not the dysfunctional gatekeeping and risk-management systems. This report is subtitled ‘Listening to people with multiple needs’. It could equally have been subtitled ‘Listening to survivors of multiple services’.

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