Salford Homeless Dual Diagnosis Team

We work with rough sleepers, or those high risk of rough sleeping in the city of Salford. We recognise that many entrenched rough sleepers may suffer with co-occurring conditions such as:

Mental health or wellbeing:

• Anxiety, depression, mood swings, anger
• Hearing voices or having unusual/distressing thoughts
• Self-harm behaviours or suicidal feelings
• Issues relating to past trauma, abuse, loss or victimisation

Use of substances:

• Alcohol
• Street drugs
• Prescription drugs

Poor physical health:

• COPD
• Untreated infections
• Abscess/wounds
• Brain injury
• Blood-borne viruses (BBV)
• Poor dental care

Physical health is addressed using the Salford Inclusion, GP service, who are part of our wider MDT. The option is available for our clients to register with this specialist primary care service.

Our approach is to help people to access, transition into, and make use of local available services, including seeking to remove any barriers to inclusion.

Our main aim is to support people into housing, and for people to be linked into services to support them in retaining accommodation and meeting their health and social care needs. Our approach is not to replace existing services. Key aspects of our work are:

Pre-engagement and outreach

• We recognise that many people who are rough sleeping have had traumatic histories, and that this can make it hard for them to trust others and in turn may prevent them accessing mental health services. As part of a multi-agency housing team, we can work slowly with people with the aim that over time they may find that they feel able to trust us and may engage in further assessment around any unmet needs.
• We adopt an ‘assertive outreach’ approach, recognising that people who sleep rough may be unlikely to attend pre-arranged appointments in a clinical setting. We see people on their own terms and in a location that suits their needs i.e. at their sleeping site and we work with community teams to support successful engagement.

Engagement and assessment

• We conduct assessments to understand the person’s current mental health and substance use needs and their personal history, and how these may impact on their life and current circumstances. • We may conduct additional psychological and/or psychiatric assessments/ formulations where there are queries about additional factors impacting the person’s wellbeing and functioning.
• We may deliver brief interventions to individuals, focused on increasing mental health awareness, self-management, harm-reduction, and motivation.
• We refer people to appropriate local services for ongoing support or specialist assessment, for example to community mental health teams, early intervention in psychosis teams, primary care talking therapies, substance use service, or adult social care.

Consultation and staff support

• For people who are already under mental health/substance use services, ongoing support should be provided by their current teams. However, we can liaise with these teams, offer a limited period of joint-working and provide consultation/advice in order to help people stay engaged with services.
• We aim for the team psychologist to provide regular staff group reflective practice and individual staff support/supervision sessions.
• We are part of a wider GMMH program of staff training on topics pertinent to homelessness, mental health and substance use.
• We participate in key homelessness multi-agency meetings in the borough, contributing expertise from a health/mental health perspective.

As a small team there are some things we cannot do, including:

Crisis/emergency response: In the event of a crisis or emergency, please contact urgent care services.

Counselling/talking therapy: If someone is ready, willing and able to engage in counselling/ therapy, then we can help them to access this via external services.

Care co-ordination including safeguarding management: This would be provided by a statutory service and we would not replace the need for this.

For those identified under the Rough Sleeper Initiative Team as rough sleepers, or at risk of rough sleeping in Salford.