Tower Hamlets: Outreach psychotherapy for rough sleepers

The council has taken on a psychotherapist to go out on to the streets and work alongside the borough’s outreach team, helping to turn around the lives of rough sleepers.


The challenge

Services for rough sleepers in the London borough of Tower Hamlets have been offering mental health support on the streets for the past seven years. This was done through a community mental health provider, which provided a mental health nurse to work with the council’s rough sleeping outreach team.

After two years that support started being covered by an advanced mental health practitioner who had the power to section people.

Those who sleep rough have been assessed, provided support and referred into mental health services where appropriate.

But Street Population Coordinator Kath Dane said the borough was still seeing problems. “We had clients who were really struggling with drug use, self-esteem and mental health problems.

“They were going from prison, to the streets, to hostels and back again. It was clear they had psychological problems that went much deeper and were often related to adverse experiences earlier in their lives.”

The solution

Tower Hamlets received funding from the Government’s Rough Sleeping Initiative to employ an outreach psychotherapist.

Day centre provider, Providence Row Charity, were tasked with recruiting a full-time practitioner, who specialised in trauma informed care.

Nora Gudev was recruited as the practitioner and started working with the service in September 2018. The main focus of her work is to go out with the outreach team and support clients on the street, and continue that support once they are in accommodation to prevent them from returning to rough sleeping.

The model is extremely flexible. Clients can be supported both in the short and long-term. Ms Gudev works with some clients for just a few weeks, whereas others have received support for months.

Ms Gudev said: “I explore the clients’ traumatic experiences in life with a receptive and flexible attitude, rather than with a dogmatic one. The aim is to help them understand their triggers, fears, addictions, anxieties, and difficulties with an open attitude.

“Rather than using specific interactions to ‘treat’ the clients, I am interested in exploring every individual’s experience. I introduce the concepts of ‘choice’ and ‘responsibilities’ and allow the clients to take the session where they need to go.

“In therapy, I often remind my clients that we are all in a constant process of becoming, and we have the opportunity to reinvent ourselves daily.”

The impact

On average, Ms Gudev works with just under 20 people each week. The service is still developing, but already she has had some really positive outcomes with the clients she has worked with.

For example, one client who had been homeless for 20 years has now moved into permanent accommodation and started volunteering to help people in similar situations.

Another client who had been battling drug addiction for many years has permanently stopped using drugs. Meanwhile, another client who had been living with serious PTSD has been able to participate in groups, classes, and even do some paid work.

Lessons learned

Ms Gudev said the nature of working with this client group means a lot of time is spent building relationships.

“It is very important to remain flexible with our clients. I often offer to see them more than once per week and for longer than the typical 50 minutes slots for psychotherapy.

“When I have established a trust and a relationship with the client, I begin to introduce boundaries and rules to which we abide together – such as pre-established time and place for the meetings, length of sessions and contact between sessions.

“But before this is possible we need to earn each other’s trust and I often have sessions sitting next to the client on the street, or taking an aimless walk together, or visiting them in their temporary accommodation.”

Tower Hamlets has also been quite strict in how referrals into the psychotherapist are made. Only the Tower Hamlets rough sleeping outreach team, run by St Mungo’s, is allowed to refer in.

“This has been done on purpose,” added Ms Kane. “We did not want the psychotherapist to be swamped with referrals as there is a specific client group we wanted her to work with. This group included those who have the least access to psychological support and for those whom traditional highly structured, building bases do not work for.”

How the approach is being sustained?

Tower Hamlets is hoping to receive funding from the Government so it can continue with the role until March 2020. Funding is due to run out soon.

Ms Dane said: “We’re pleased with how it has gone. The support is providing invaluable help to this client group. They have very complex issues, but we’re not always accessing or qualifying for mainstream mental health care.

“We also want to look at doing more in-reach work with hostels. We recognise there are similar problems being faced by their clients. If you want to make long-term progress you need the more intensive support like this.”


Contact details
Kath Dane
Street Population Coordinator
Tower Hamlets Council
kath.dane@towerhamlets.gov.uk