A multi-sector partnership has created a centre to support the needs of homeless people.
Across the city, medical professionals, charity workers, policymakers, academics, students and those with personal experience of living on the streets are coming together for discussions driven by a united belief. A belief that what the world needs now is compassion for the wellbeing of homeless people.
By Edd McCracken
If you are homeless in Scotland today, according to the charity Streetwork, the average life expectancy is 47 for men and 43 for women. That is around 30 years worse than the general population. Those are the homeless who flit between friends’ sofas, prison, hostels, bed and breakfasts, and, only occasionally, the streets. For those who call the country’s pavements their permanent home, it is much worse. Their life expectancy plummets to 39-years-old, according to the charity Streetwork. That is a lifespan of a Briton born in the 1500s.
Sadly, after years of decline, homelessness is on the rise again. Last year, Shelter announced an increase in the number of people in Scotland registering as homeless. In 2017/18, nearly 35,000 people declared themselves to be without a home. Edinburgh’s night shelter, which is run by Bethany Christian Trust through the city’s winter months, recorded more than 700 individuals using it this year, a grim uptick on previous years.
It all asks a very urgent question about what the world needs now to tackle the problem. It’s a need that has sparked animated, passionate conversations among a group of key multisector partners across Edinburgh. They have now come together to offer one answer: the Centre for Homeless and Inclusion Health.
Opening the door to collaboration
Formed in 2017, the Centre is a collaboration between the University of Edinburgh and the NHS, the third sector, the council, local government, academia and – crucially – people who have been homeless. It brings together individuals and agencies that come into regular contact with the issue of homelessness, but might not habitually work together in tackling it. It has a simple ambition within a complex, multilayered field: to improve the health and wellbeing of people who experience homelessness.
More than 700 individuals used Edinburgh’s night shelter this winter.
“For me the Centre acts as an open door between the University and the partners,” says Dr Fiona Cuthill, Lecturer in Nursing Studies at the University, who is the Centre’s Academic Director. “Our partners said they’d like education courses and to be at the very beginning of research projects. They said, we want staff and students to come out and work in our organisations. They also felt that there’s loads of things the University can do, in terms of evaluation and data collection.” And shot through everything that the Centre does is making sure that those with experience of homelessness are heard.
Dr Steph Grahmann is a Research Fellow, tasked with devising new strands of enquiry for the Centre. Working with people who have lived life on the street is key to everything she does.
“The intention is not to treat people who are homeless as objects of research and talk about them in the third person,” she says. “Rather, we want to bring them to the table as the actual experts on their situation. I could do research on homelessness for the next 20 years and I wouldn’t have the same insight that someone like Josh has through his experience.”
Sharing lived experiences
Josh Dumbrell became homeless when he was 19. His mum kicked him out for the last time after several years of substance abuse. Within months he had exhausted the goodwill of friends and family and found himself in night shelters around his native Hampshire and Surrey.
“It started with the first time I was drunk. I look back on it and realise how ill equipped I was to deal with life, until I could change the way I felt,” he says. “I only felt safe and secure if I was heavily under the influence. So that’s what I did.”
Stints in rehab and prison marked the following years, taking him eventually to Edinburgh. A cycle of recovery and relapse continued for 14 years. He slept rough around 100 times. Finally, seven years ago, he tamed his addiction through Alcoholics Anonymous.
If you are homeless in Scotland today, the average life expectancy is 47 for men and 43 for women.
“I was a long time clean and sober before I realised that this could be for the long term and that recovery was possible,” he says. “I had a genuine sense that these people cared about me, even though I knew they wouldn’t if they really knew me, which is a common feeling for people in early recovery.”
Josh’s experience, and many like his, is contributing to the Centre. He is working with researchers and speaking to students, sharing his testimony on how homelessness and its attendant issues affects health.
I could do research on homelessness for the next 20 years and I wouldn’t have the same insight that someone like Josh has through his experience.
“I suffered from psychosis several times in withdrawal,” he says. “I had seizures. I woke up in hospital, stitched up, with no recollection of how I got there, around 30 times. I was brought back from overdoses 20 times. I just demonstrated a suicidal, total lack of self-care.”
He now works for the Salvation Army in Edinburgh’s Cowgate, delivering an intervention to reduce harm among the homeless through peer support. Having once lived on the front line, he now works it. His caseload includes people in their early 30s and 40s with the lung capacity of 100-year-olds and people carrying blood-borne viruses. They trust him, he says, because of his history.
Learning new ways to build trust
“The NHS and the care it provides implicitly requires a trust on behalf of the recipient that most of the population take for granted, but that many on the streets find difficult to develop,” says Dr Adam Burley. He is a Consultant Clinical Psychologist in NHS Lothian’s Psychotherapy Department and criss-crosses Edinburgh on his bike, servicing the city’s homeless services.
“Once I started working with the homeless it became obvious that I was working with a population that doesn’t fit in well with mainstream healthcare structures,” he says. “By virtue of their earliest experiences of care having been massively problematic – riven with pain, anxiety, trauma and abuse – a lot of people we work with often have real difficulty trusting care. That’s the ailment really. We’ve been fighting an ongoing battle to shape the NHS and local authorities to be more understanding. That’s no criticism of the NHS – big organisations find it hard to set up niche services.”
A lot of the time the treatment isn’t a specific intervention. It’s more about being around someone, building up trust, developing a relationship – sometimes over years.
Which is where something like the Centre comes in. Dr Burley is part of the Centre’s founding steering group, which sees the partners meeting up for monthly discussions. From providing support to more than 25 staff groups across the public and third sectors over the last 12 years, he sees how someone from an NHS background can learn.
“A lot of the time the treatment isn’t a specific intervention. It’s more about being around someone, building up trust, developing a relationship – sometimes over years. And that’s the treatment,” he says. “In the health service, we don’t have that. But it turns out there’s been third-sector services that have been doing this for years. And doing it very well. They just don’t call it health. But it is, and some of the most fundamental health work you can do. Because they are not recognised as health workers, they don’t get recognised as being able to tell us what works, what is useful, or help develop services that are outwith traditional models.”
And that is his hope for the Centre, that it will be a place to “house, amplify and clarify” the experiences of the partners, and “push ideas forward using the power of research.”
Doing things better
Ewan Aitken is Chief Executive Officer of Cyrenians, a charity that has been supporting the homeless and the vulnerable for 50 years, and a founding member of the Centre’s steering committee. Cyrenians has had a ringside view of some of the less successful endeavours to tackle homelessness over the decades. “It is the social challenge,” says Ewan, that “most confounds the logic model.”
“If the Centre does anything, we need to get away from the idea that if we get lots of A, problem B will be sorted,” he says. “Homelessness is simply not like that.” What the Centre can do, he believes, with the University using its “size and gravitas to be facilitator and the catalyst”, is to create a space for third-sector organisations to step back and do some thinking.
In 2017/18, nearly 35,000 people in Scotland declared themselves to be without a home.
“We’ll do things together and be brave enough to do so because it is under the banner of the Centre. We’ll reflect on it and then ask, what can we do better? This back and forth will bring the lived experience to the heart of the conversation. That will be powerful,” Ewan explains.
In the summer of 2019, groups of students – overseen by members of University staff – are working with Cyrenians. It is just one of the ways the Centre is already living up to its ambition. Elsewhere, students from Edinburgh College of Art will be holding workshops with people experiencing homelessness, working on a mural for the new Inclusive Edinburgh building at Panmure St Anne’s in the Cowgate. The former school house is being converted into the new home of the Edinburgh Access Practice and Access Point, and will be a one-stop-shop for homeless needs in the city centre.
Without compassion, you can't do this job.
Working across boundaries
Inclusive Edinburgh’s Homelessness Manager is Isobel Nisbet. She too is excited by the Centre’s possibilities. “I’ve been a manager for 20 years and this is the first time it feels like there is a lot of joining up,” she says.
By hosting the University within the Inclusive Edinburgh building and being part of the Centre’s steering group, Isobel hopes to harness academia’s power to make a difference on the streets.
“We’re always looking for ways to build evidence into our practice,” she says. “If I’m looking to measure how effective intervention is, I can now work across boundaries and talk to an expert about that. We can really use the knowledge within the University to inform and develop our services.”
Speak to anyone involved in the Centre and they will say that underlying all these processes, information sharing and transactional relationships, is something even more fundamental.
Isobel sums up what the world needs now. “Compassion is crucial,” she says. “We are working with a number of challenging people who, because of trauma and mental health, can sabotage things for themselves. Compassion has to be a part of that. They have to feel it. It has to be part of you. It’s obvious if it is not. Without compassion, you can’t do this job.”
You can do all the research about homelessness, but without compassion it’s a bit empty.
Taking a compassionate approach
To see how the Centre is infusing compassion into everything it does, meet Emma-Jane Robertson. This fourth-year nursing studies student is part of the first intake onto one of the Centre’s two 10-week courses, run at undergraduate and masters level.
“You can do all the research about homelessness, but without compassion it’s a bit empty,” says Emma-Jane. “In terms of being a nurse – which I love doing – this course has changed my perspective on how I treat patients that come in.
“Hospital staff – and it’s not their fault – can become frustrated by what they call ‘frequent flyers’, or repeat visitors, who are mainly homeless,” she continues. “My course is filled with people from clinical development, government and the NHS who have been working for 20 or 30 years. The perspectives and real-life application they bring someone who is young and naive is really amazing. It makes it easier to step back and realise everything else that is going on. It has helped me care better.”
About the writer: Edd McCracken is joint Head of News at the University. He is a former arts correspondent for the Sunday Herald and his freelance work has appeared in the Guardian, Holyrood Magazine, the Scotsman, Time Out Dubai and www.bookriot.com.
Find out more