Dedicated support now on offer for homeless people in Wigan with neurological conditions

Greater Manchester Mental Health NHS Foundation Trust (GMMH)’s homeless services provide a range of support, care and treatment for people who are homeless, or are at risk of homelessness, and who are suffering with mental health or addiction problems.

It can now offer support to these people with specific neurological needs.

A specialist neuropsychologist provides assessments and support to people with neurological conditions, including those acquired through events such as a traumatic brain injury, stroke, encephalitis (swelling of the brain) and complications of substance use.

A specialist speech and language therapist 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 support 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 people 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 increasing access to and engagement with the right health and social support.

Consultant clinical neuropsychologist Dr Viki Teggart said: “Research in Leeds found that 48 per cent of homeless people may have a history of brain injury, with 60 per cent 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 to 80 per cent of individuals with a substance-use disorder experience at least mild cognitive impairment and 35 to 40 per cent 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.”

Speech and language therapist Laura Cole added: “The NICE guidelines on integrated health and 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 support focuses on “assertive outreach”, meaning the specialists 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.

They also work directly with people 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 Teggart said: “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, 31 people across Greater Manchester have been directly referred for neuropsychology and/or speech and language support. Staff from the service have attended meetings to support and advise on the care and treatment for many more.