18 December 2023
In March 2021 the Health Foundation granted Brighton and Hove Common Ambition project (BHCA) three years worth of funding. BHCA is part of the health foundation’s common ambition programme. The Health Foundation is an independent charity committed to bringing about better health and healthcare for people in the UK.
The BHCA project aim is to look at the current health and homeless system in place for
Brighton and Hove and to investigate how one can improve the health care system and approach within a co- production setting. Co- production is using the voice of individuals with lived experience. To see from their view point of having been through the system.
The project is run by a project manager employed by Arch healthcare and with a participation lead from Justlife. A team from Brighton University made up of a principal investigator and social policy expert, a community psychologist, a sociologist and a historian of housing. Plus the individuals with lived experience of homelessness.
The BHCA steering group firstly needed to see what services are already available currently in Brighton and Hove and to understand how the service works and how the services work together as a whole. From this point we can focus in on what can be improved and where the challenges for a homeless person would be.
Firstly BHCA co-produced a group agreement to create a safe space. The group agreement is a good representation of how one should relate and acknowledge each other as part of the basic everyday life of interactions between human beings. The agreement empowers people to feel able to open up into a discussion where all voices are heard and met with dignity. The agreement creates respect and patience to ensure no power play is involved and you can agree to dis-agree within a productive participation. Everyone can bring something of value to the table.
The focus of the group is to create understanding from different viewpoints and from this point collaborate to make real change within the health and homeless structure to benefit each individual and the population of Brighton as a whole.
Change that is not about profit or selfish gain. Change that has no other aim than to facilitate goodness, understanding and happiness for the individual person.
A system that is tailored for the well-being of society.
Brighton and Hove Common Ambition (BHCA) created a map with all the services available currently in the local area. This in itself was a minefield, let alone for the person who needs to navigate themselves through it at ground level 🤔😬😳
We needed to pin down where exactly the challenges and barriers were in accessing help with health care and housing issues.
After mapping out the services and categorising them into different areas as in substance mis-use, mental health, community groups, housing and accommodation, sexual health and employment/benefits, BHCA mapped out the housing pathway where the challenges and barriers were identified.
My intention for this article is to highlight more of what I have learned and identified through being part of the project since Nov 2021.
I feel the health and homelessness system could learn a great deal from just the ways of working that the group developed, which grew through the ongoing conversations and reflections within the meetings. Creating a space that is relaxed and safe where we all serve a common goal is so important for communication and to explore and create ideas. With the creation of the group agreement, working in a trauma informed way and introducing a check in and a check out at the start and finish of each meeting.
Communication is key for any system to work efficiently, in a way that achieves maximum productivity in a well organised, non discriminatory competent way.
What if all employers introduced these working protocols within the working environment?.
This would enable individuals to communicate with each other and feel valued as a person. A platform to have a voice within your sector. This could open up a huge array of opinions and ideas to produce better working relationships and produce better working practices and systems within.
Once BHCA mapped out the housing pathway the group identified that the actual housing system itself needs to be addressed as a whole to improve health. Some of the key challenges that were identified and the ones where I feel I would like to highlight here are:
😖 A lack of trust in the health care services, this can manifest in different ways, for example: misdiagnosis and a lack of joined up services.
🥱 Long waiting list for treatments
🤒 Not enough mental health support, including: outreach, crisis support, services and staff available to meet need.
😬 A lot of judgement and stigma within the system and services. People do not feel listened to, there is not enough respect built into communications and interactions.
🤔 Tick box mentality to accessing services that leads to people not being able to access the services they need as the person does not fit all the cry- teria! 😪
🤯 Mental distress, neurodiversity, language and terminology barriers can stop people from communicating, accessing and engaging with services which leads to not receiving the support they may need.
😐 No continuity of care along the pathway particularly after being housed, finishing rehab and leaving prison.
🗣 Communication and care between services can be disjoined, databases do not join up and this often results in people having to repeat their story.
So, how would you like to be treated when asking for help?
Human beings are complex creatures and we all come from different backgrounds and relate in different ways. Each person sees and reacts in their own manner and experiences life from their view point. So how can we then build a system that can benefit and relate to each and every person without discrimination, where a person can be helped regardless of whether they tick all the right boxes.
Good relationships are needed within every facet of society. Humans form parts of their identity through the accumulation of their experiences and interactions with other people, how one is treated and how one reacts and relates to that influence impacts who that person becomes.
Fresh born babies do not have a self concept. They do not have an idea of who they are. Once they start to interact with other people they begin to create an image of themselves, a feeling and thoughts of who they are. That is partly picked up from the views and opinions of other people.
I feel it is not just about health care. Are you able to separate health with social interactions, value of identity and purpose of being. Personally in my opinion they all go hand in hand for health and mental well-being.
A solution to these challenges identified by BHCA is to create a safe space, (that is led by people who have had experience in being homeless), where you can access help, advice and information that is open to the public. The basic needs of a human being has to be addressed as a priority before anything else. Basic needs such as food, water, shelter, to shower and wash clothes and social interaction. Importantly it’s a safe space where you can come and just relax without having to engage but the option is available if chosen.
In the front would be a cafe offering food and drinks and a safe space to chill and have conversations with each other. Within the whole area of the building would be different areas of interest. An information, I.T. and communications hub, a services hub, and a learning hub. Having peer lead spaces where appropriate and the capacity for volunteer and staff training.
The idea is to have different individuals from different service areas working under one roof where they can communicate and engage with each other. This would join up the services and improve communication and the system as a whole because your able to see how each other is working and how then you could improve the system currently in place. You’re unable to do this when no one knows each other or how the other service operates.
If you were to have regular held spaces possibly with lived experienced individuals and with the focus of improvement and implication, I feel this would benefit everyone!
The building needs to be accessible and the opening times I feel would be quite important as a lot of community centres and safe spaces do not open at weekends or evenings and feel this needs to be considered.
A person who needs help could be given one worker who would stay with them throughout and form a good relationship while addressing that person’s needs. This would help build trust and be less traumatic for each individual because it’s all done under one roof instead of being sent here and there and around the block and back! 😆 The individual would only need to tell their story once and hopefully feel valued as a person. You can help a person once you see who that person is, how they operate and what would make them happy. It takes time for that relationship and information to form, a 20 minute conversion once in a lifetime does not cut it! The person needs to trust you firstly and feel comfortable in the environment. This would in turn help with mental health and loneliness and have a place to be while waiting for your help to evolve. The interactions and training within the space would help with stigma and understanding of different types of people.
So, what next?
Unfortunately the BHCA project is coming to an end in March 2024 as no more funding is currently available to continue…We are still looking!!
BHCA have done other pieces of work to contribute towards helping improve the Brighton and Hove health system like co-designed a training module for medical students and the Maps themselves have been very helpful. And more!
Feel free to have a look at our resources page, all our work is there.
Are you able to help or know anyone who could help towards keeping this amazing project going? Do you have any ideas on the subject?
Hope you enjoyed the article and feel free to contact us at any time.