Tag: MCN

An Invitation to Empathy: Reflections on Delivering a Workshop with the Jobcentre

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In September of this year, Fulfilling Lives South East ran a series of workshops with frontline staff from the Brighton and Hove Job Centres. The overarching goal was to help improve the service to better support people with multiple complex needs. By our definition, we mean those experiencing co-occurring mental ill-health, substance misuse, homelessness or threat of becoming homeless, domestic abuse, and those with history of repeat contact with the criminal justice system.

Challenging perceptions

At the beginning of the workshop, as an icebreaker, we asked the attendees what they would like to get out of the session.  If I was asked that question as a facilitator, and someone with lived experience, the answer I would like to have given would be something like:

“To try and get people to really understand how someone else’s human experience can be so utterly incomparable and even incomprehensible to their own.  That just because we may, for example, be sitting across from each other in the same physical space, we are not experiencing the same reality.  Objectively, the physical space, the words spoken, tone of voice, facial expressions and body language, are all expressed in just one way, yet they are interpreted and processed differently by the recipients or observers, sometimes wildly so.  Our eyes and ears, depending on where our attention is focused, collect some of this information, and translate it into thoughts, feelings, sensations and emotions, not necessarily in that order, and to different degrees. 

An innocuous glance could trigger a flood of neurochemicals in the recipient that signals danger.  Unexpectedly bumping into an acquaintance in the street could trigger the same sensation as narrowly avoiding being hit by a bus.  Getting a ‘D’ in an exam might induce the same feeling as losing a loved one.  The difficulty is conveying how extreme and unpredictable these variations can be as we all only have our own experience as a reference.  Anyone can score their emotional intensity on a scale of 1 – 10 but comparing this experience to somebody else’s doesn’t truly mean anything as it is so subjective.   One person’s ‘6’ could be the next person’s ‘60’.  Some people are experts at hiding their internal state from the world, until they are not.  Don’t assume that because someone appears calm on the outside, they are calm on the inside”.

Empathy and reserving judgement

I imagine it is difficult to empathise with people who experience the world in this way due to the vast gulf in experience. It can seem so improbable that relatively minor events, or even what can be considered non-events, can cause such intense, unpredictable reactions. If, understandably, someone can’t empathise, perhaps the next best thing is to reserve judgement of others and approach complexity with compassion and curiosity. It was apparent from the workshops that the JCP staff already embodied and practiced this. That’s not to say the lived experience perspective wasn’t impactful. One attendee was moved to tears, another reflected that these workshops should be delivered to all new work coaches, and others acknowledged that we shouldn’t make assumptions as we don’t know what could be going on beneath the surface. I do feel that we left an impression on most attendees, in one way or another. The depth of that impression will vary from person to person. I think we succeeded in illustrating some of the difficulties that people with multiple complex needs can face, and how these challenges came to be.

Hearing something once often doesn’t result in permanent change.  Ingrained beliefs and habits change through repeated exposure to new behaviours and ideas.  The Brighton Job Centre team seem committed to an organisational culture of compassion and understanding, which is a great environment for the Fulfilling Lives ethos to flourish.

Written by a Fulfilling Lives South East Project Consultant

For more information on what we do, download our reports and resources please visit https://www.bht.org.uk/fulfilling-lives/

Why Women with Multiple Complex Needs deserve our attention during the passage of the Domestic Abuse Bill 2020

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The Domestic Abuse bill of 2020 will massively impact people with multiple complex needs, the below includes our response and thoughts on the subject.

Response to the third reading of the Domestic Abuse Bill

In June 2020, the South East Fulfilling Lives team responded to the call for evidence by the government on the draft Domestic Abuse Bill 2020[1]. In response to the third reading of the Bill that was passed in the House of Commons on 6 July 2020, we are disappointed that there is little in the Bill that directly references women with multiple complex needs.

Why do women with multiple complex needs deserve focus and legal protections?

More than half of every one in 20 women who experienced extensive physical and sexual violence and abuse across their life course have a common mental health condition, one in five have experienced homelessness, and one in three have an alcohol problem[2]. In December 2018, 93% of the women on South East Fulfilling Lives’ own caseload had experienced domestic abuse. Of these women, 76% were homeless (rough sleeping/in temporary accommodation/sofa surfing/in hostels), 96% had both substance misuse and mental health needs when we began working with them, 88% had histories of offending, and 72% had disabilities.[3]

Why should the complex needs of domestic abuse victims be named and defined?

Domestic abuse takes place in a wider context and not all women experience similar levels of domestic abuse nor possess similar privileges or resources to get the right support at the right time. Women facing multiple disadvantage are some of the most marginalised victims of domestic abuse and an unequal society, and are often ostracized from society and support services. They are more likely to present with a history of extensive violence and abuse, have complex and overlapping needs such as high rates of mental health problems, substance misuse, contact with the criminal justice system and homelessness. They are also more prone to victim-blaming by professionals in statutory services or being labelled non-engaging or non-compliant by essential services[4].

Having a one-size-fits-all response to domestic abuse that fails to acknowledge different levels of vulnerability creates a culture around “worthy” and “unworthy” victims of domestic abuse. Therefore, we believe that the complexities of some of the most vulnerable victims’ lives should be named and adequately defined in order to provide more targeted support as well as legal protections. Whilst we welcome the widening of the statutory definition of domestic abuse to include emotional, coercive or controlling, and economic abuse, we also reiterate our call for the Bill to include a clear definition of ‘Multiple Complex Needs’.

Reconsidering New Clause 23: Commissioning specialist domestic abuse services

We are disappointed that a majority of MPs voted against the new Clause 23 which seeks to establish a statutory duty on relevant public authorities to commission specialist support and services to all persons affected by domestic abuse[5]. Women with multiple complex needs, who use the independent and women-led specialist domestic abuse services seldom respond well to traditional forms of service delivery models and access routes to support.

Our own project learning revealed that women with multiple complex needs are harder to reach, less visible to services and under-represented in statistics[6]. Research carried out by AVA and Agenda found that out of 173 local areas in England and Wales, only 19 had access to support for women facing multiple disadvantage that could address all of the following issues: substance use, criminal justice contact, mental-ill health and homelessness.[7] Survivors with complex needs and their children often require additional services and higher levels of support and outreach by trusted professionals who have the social skills and gendered understanding of how perpetrators operate and who can empathetically support them on their path to freedom and recovery.

In our experience, the response to domestic abuse continues to be siloed, with little joint work between the police, probation services, substance misuse services, children’s services and health practitioners and the specialist charities working supporting women. Victims of domestic abuse with complex needs require a holistic, comprehensive and whole-systems approach to tackling domestic abuse which includes partners in housing, health, relevant public authorities and statutory services in addition to the Bill’s sole focus on criminal justice and crisis response. This means an integrated cross-government response, rather than individual departments publishing separate guidance and being provided with separate funding arrangements.

Furthermore, those experiencing domestic abuse and complex needs may access a range of public services, such as their GPs, who are often the first point of contact.These non-specialist services play a crucial role in early intervention by identifying complex needs and recognising signs of abuse. Yet, women frequently do not receive a service which reflects an understanding of the complexities, dynamics and risk issues of domestic abuse or receive a trauma informed response, due to a lack of understanding. Thus, we urge for specific training duties for non-specialist domestic abuse services to be established in the Bill and embedded within the implementation plans. This echoes Agenda’s #AskAndTakeAction campaign, which places a duty on public authorities to ensure all frontline staff make trained enquiries into domestic abuse, which is crucial to ensuring victims get the support they need at the earliest possible opportunity [8]. 

We also hoped to see the Bill pave the way for new forms of accommodation that can provide emergency rapid-access accommodation that is self-contained and dispersed within communities, where wrap-around support is provided, and to include Specialist Multiple Complex Needs Refuge Accommodation as an option as often additional complex needs, such as substance misuse, excludes women from accessing the current refuge models, meaning many are being forced to return to their partner and abuser or being placed in non-specialist accommodation settings.

For the Domestic Abuse Bill to be truly transformational in its intent and also its outcomes, it is vital that no victim is left behind, and all victims feel heard, safe, and valued. Although many improvements have been made to the Bill, there are still holes in the protection the law provides to some of the most marginalised victims of domestic abuse. As the Bill is in the process of being scrutinised by the House of Lords[9], we hope further amendments will be tabled to ensure the scope of its protection is extended to all victims, especially those who have complex needs, and face multiple disadvantages and vulnerabilities simultaneously.

This post has been authored by Aditi Bhonagiri, with valuable contributions from Emily Page, Sandra Sylvester and Rebecca Riley.

If you have any questions after reading this piece, please feel free to get in touch with the author at aditi.bhonagiri@sefulfillinglives.org.uk

For more information on what we do, download our reports and resources please visit https://www.bht.org.uk/fulfilling-lives/

1 https://publications.parliament.uk/pa/cm5801/cmpublic/DomesticAbuse/memo/DAB86.pdf

2 http://weareagenda.org/wp-content/uploads/2015/11/Hidden-Hurt-full-report1.pdf

3 https://www.bht.org.uk/wp-content/uploads/2019/11/Fulfilling-Lives-Manifesto-for-Change.pdf

4 https://www.changing-lives.org.uk/wp-content/uploads/2019/03/Too-Complex-Evaluation-Final-Nov-2018.pdf

5 https://www.theyworkforyou.com/debates/?id=2020-07-06e.780.0#g781

6 Sarah Robinson, Oct 2016, Where are the Women?: Supporting Women with Multiple Needs. Cached at: https://wy-fi.org.uk/?mdocs-file=2277

7 https://avaproject.org.uk/resources/mapping-maze-full-report/

8 https://weareagenda.org/askandtakeaction/

9 https://services.parliament.uk/bills/2019-21/domesticabuse.html

Behind Closed Doors

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Kate is a Playwright,  and Project Consultant Assistant with Fulfilling Lives. In this piece she writes about her experience of domestic abuse and what services have been being doing to combat it during the current pandemic

No one knows what goes on in people’s lives behind closed doors, but what is known is that there has been a sharp increase of domestic violence during the Coronavirus outbreak, with us all having to live our lives in lock-down. For some, trying to live in an abusive relationship can be traumatising, fearful and shameful. What I mean by shameful is that it can be something that people do not want to talk about in case they are not believed, or they are frowned upon. They might have been made to believe it is their fault, and even be frightened to think that what they might share could get back to the person who is abusing them.

I say this as someone who has lived most of my life in violent, controlling, coercive relationships and it’s not just as easy as getting up and leaving or talking to someone about it. The amount of times I wanted to talk to someone, especially after I had taken a beating. That hand around my throat, strangling me. That knife held to my throat, in front of my children. That trainer that is just about to stamp on my head. Oh and how can I forget the line “I didn’t mean it, it won’t happen again, I promise, I love you”. Unfortunately, time and time again, I believed that line and believed it was love. What I should have believed in more is the saying, that actions speak louder than words. This is exactly what has been happening in many communities during Covid-19.

Government and Services Response to DV

The government and services have been acting. There have been some fantastic campaigns raising awareness of domestic abuse, here are some examples:

  • Numerous organisations have created information posters and leaflets with key guidance for ‘non-specialist services”.
  • Pharmacy schemes with the launch of the “safe space” initiative where Boots, Superdrug, and Morrisons have allowed their consulting rooms to be a safe space for women experiencing domestic abuse. Go to the healthcare counter and ask to use their consultancy room. The pharmacist will you show you to the safe space and once inside you will have access to all specialist domestic abuse information and be able to make the call safely. https://uksaysnomore.org/safespaces/.
  • There is printed information of the national domestic abuse line on pharmacy bags and at the bottom of Tesco’s shopping receipts.
  • UK says no more has the #listeningFromHome campaign. Encouraging members, friends, colleagues, and neighbours to be aware of and to report signs of domestic abuse whilst in lockdown. If you are concerned you can help by following these guidelines:Check in with victim but be mindful communication channels maybe monitored or call the police.
  • If you are feeling unsafe the best thing to do might be to call 999 and get support from the police. You can do this silently if you are worried about your partner knowing. When dialling 999 from a mobile listen to the prompts from the operator, then cough or tap. The operator will then prompt you to press 55 this will transfer your call to the police, pressing this only works from a mobile and does not allow police to track your location.  
  • “At home shouldn’t mean at risk” logo has been added on the specialist domestic abuse services and if you are experiencing domestic abuse you don’t need to stay at home. Police response and support services remain open for help and support visit https://www.gov.uk/guidance/domestic-abuse-how-to-get-help  #YouAreNotAlone campaign.
  • The sanctuary scheme provides an alternative to relocation away from family and friends with vital support networks and key services through installation of enhanced security measures in your home. It’s voluntary, free and available to both homeowners and tenants who meet certain requirements. The scheme is funded by members of the Hastings and Rother Domestic Violence forum which has reps from CGL, Sussex Police, HomeWorks, and Optivo. If you would like to request sanctuary in your home call the CGL Domestic Abuse Portal service on 01424 716629 or housing options team on 01424 451100.  
  • East Sussex refuges are still accepting referrals. You can self-refer or enter through Hastings, Eastbourne, Lewes and Wealden and Rother councils or alternatively through East Sussex Police or the Portal. Also, through health services and social care website http://www.refuge.org.uk
  • Fulfilling Lives also played an essential role in trying to influence the content in the Domestic Abuse Bill for women with Multiple and Complex needs.


I really hope that this great work and national/local campaigns that has taken place during the coronavirus pandemic, has encouraged women experiencing domestic abuse to open their doors and walk free from the abuse that can happen behind closed doors. I know if these nation-wide campaigns were taking place when I was living this traumatic life then I would have felt safer to step forward, speak up and flee the violence, a lot sooner than I did.  So, let’s try to keep these conversations going within our communities not only to encourage, support and make people feel safe, but to also reduce the stigma that can occur around domestic abuse. Long may these campaigns against domestic violence continue after the coronavirus pandemic eventually ends.


Useful Contact Numbers

  • Emergency accommodation outside of Hastings Borough Councils working hours 01424 451999
  • Portal’s helpline 0300 323 9985 or 01323 417598 for Eastbourne, Lewes and Wealden or 01424 716629 for Hastings, Rother and Rye or alternatively online at https://theportal.org.uk
  • Women’s aid email info@womensaid.org.uk or helpline@womensaid.org.uk
  • Rise helpline 01273 622822 or general enquires 0300 323 9985 or https://www.riseuk.org.uk
  • National Domestic Abuse helpline 0808 2000 247 or https://www.nationaldahelpline.org.uk
  • Penny appeal Domestic Abuse support helpline 0808 802 3333 or http://www.pennyapp eal.org/
  • Rights of women.org.uk offer free advice in family, immigration, and criminal law 020 7251 6577
  • Men’s advice line 0808 801 0327
  • National LGBT+ 0800 999 5428
  • Karma Nirvana 0800 5999 247 Honour based abuse and forced marriage
  • Shelter give advice if your homeless and fleeing Domestic Abuse

https://england.shelter.org.uk

  • Hastings and Rother Samaritans 0330 094 5717 or call 116 123 free from any phone


Fulfilling Lives – Good practice for DA clients

We would like to share with you this Fulfilling Lives South East Partnership Good Practice document on the subject of supporting women with complex needs who are experiencing, or at risk of, domestic abuse during Covid-19 restrictions.

During May and June 2020, people with lived experience of multiple and complex needs interviewed local client-facing staff and researched organisations’ responses to Covid-19 before bringing together the information presented in this document.

We hope you and your colleagues find this a useful tool in your work and if you have any feedback or suggestions about the document please do contact us.

Good Practice Document: https://www.bht.org.uk/wp-content/uploads/2020/11/Best-Practice-T2-COVID-Document-V12.pdf

If you have lived experience of multiple and complex needs and are interested in working or volunteering with us, please contact Nelida at nelida.senoran-martin@sefulfillinglives.org.uk. 

Volunteering with Care and Gratitude through Lockdown

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In this post one of our volunteers describes the highs and lows of volunteering and returning to the world of work under lock-down. Exploring mental health, recovery, immigration, self-care and gratitude.

“Well, here we go again!”

I was quite excited about working with the Fulfilling Lives project – it was a space where I felt I could find a support group with a broader purpose along with working on myself and feeling like a contributing member of society again. I began volunteering with the project in Brighton in early March 2020, a few days before the COVID-19 crisis escalated, resulting in a full-blown pandemic and worldwide enforced lockdowns of varying degrees.

My first thought on hearing this news was …“well here we go again!” My last job, which was nothing short of a dream, came to an end as a result of the UK’s withdrawal from the European Union on 31 January. I quit my studies in psychology for it. The job lasted three months and was the first job I had had after three difficult years of recovery from mental illness, constant financial precarity, immigration issues, a string of job rejections and feeling like a loser for still having my parents support me in my late twenties/early thirties, since I had no recourse to public funds.

Artwork by Rosi Tooth / @rosi.illustration

“Move on and move up”

I desperately wanted to move on and move up in life. I wanted to rebuild my life again and grow some solid roots in a place that has been home for the last six years. I finally had the energy and the motivation, but my confidence felt akin to a flimsy fabric in tatters and my mental health a thin sheet of ice ready to crack open under undue stress and pressure.


Back in March, as the prospects of an indefinite lockdown became all too real, I was pleasantly surprised to hear that our weekly Action Group meetings for the Fulfilling Lives volunteers were to continue despite the restrictions. Our meetings were to be held online on Microsoft Teams. From past experience, it’s quite challenging to have productive online meetings or sustain these interactions because face-to-face interactions are indeed difficult to replace. So, I didn’t have high hopes, I trusted my typical self to lose interest if this carried on.


Amazingly, it has been more than three months now and I have only missed one meeting so far. The support and engagement opportunities from the staff at Fulfilling Lives has been absolutely phenomenal. It has been refreshing to have Teams as an online communication platform because you know that you can write a quick note or have a phone call straight away. It reduced the time that it takes to formulate a well-worded email and get a response. It has also increased the fluidity of these interactions, which helps you feel like you’re working and being productive; having those channels of instant feedback can help you feel validated.


But what really made it work? In my opinion, the focus on the structure of the meetings and good timekeeping was noteworthy. The project consultants facilitating these weekly meetings for volunteers would religiously send out an agenda before the meeting, stick to it and send us the minutes of the meeting after it ended, even if all of that effort was just for one person in attendance. If everything else in your life feels like it’s in disarray the last thing you would expect is a weekly meeting to join the party.

Artwork by Rosi Tooth / @rosi.illustration

Building Confidence

I was relieved that life had slowed down for everyone. I was tired of constantly playing catch-up and feeling like I’m falling behind. I’ve always grossly underestimated how long it takes me to get from point A to point B – this has probably been one of my biggest downfalls. I think the fact that the only travel I made to participate in the weekly meetings was from my bedroom to my living room played a huge role in helping me build my confidence again. The option to partake in meetings yet not be seen can be comforting for someone having a bad day for whatever reason. Now that this area of work has caught my interest and solidified my confidence, maybe as next steps, I can work on addressing my travel anxiety now that the lockdown has been finally lifted.

Similarly, I have also been able to participate in other staff-level Theme meetings, which are open to volunteers and brought together frontline workers, team leads and project consultants in one room around a specific topic like ‘Domestic Abuse’ or ‘Health Inequalities’ or ‘Treatment Pathways’ and more. This deepened my interest in the project but in normal circumstances, these spaces would’ve felt out of bounds or too much of an effort, given that participating in these meetings required travelling between the offices based in Brighton, Eastbourne, and Hastings. I’m not implying that face-to-face meetings should be replaced but not having to travel has made a world of a difference to this process of building confidence and finding value in volunteering. So perhaps, this could’ve been one big experiment to explore more hybrid ways of working or maybe it’s a testament to living beings’ innate ability to survive and adapt in any given situation.

Artwork by Rosi Tooth / @rosi.illustration

Self Care

Outside of my life as a volunteer, I’ve been doing several things to keep well, since I couldn’t afford ongoing psychological support. I read the books on recovery-focused self-help books for mind and body that I had collected over the years – brilliant authors like Gabor Maté, Johann Hari, Carl Rogers, Carl Jung, Peter Levine among others. I’m also eternally grateful for how many professionals and organisations have generously offered their time and knowledge at no cost or by donation/self-selective fee. As a result, I attended several conferences, events, workshops and festivals online. I took a Level 2 certification course on supporting people with mental health needs at the Greater Brighton MET College and self-improvement courses on Personal Boundaries and Self Expression. I meditated for an hour every day with a lovely online support group called Stay Aligned that was led by two local mindfulness meditation teachers. I played music online every week with a recovery orchestra, the New Note Orchestra. I took clowning and theatre lessons and free dancing lessons that were sponsored by the Brighton & Hove City Council among many other activities.

I intentionally kept myself busier in confinement than I am otherwise. The fear of relapse in such a situation is what drove me to fill my time and clear my inner space. While I might come across as someone who is on the high-functioning end of the spectrum, I’m hyper-aware that it may take very little to throw me off track. Also, repeated setbacks in life have really tested my resilience to cope. But since the lockdown, I figured that if I don’t stare down at the abyss that forever awaits me, then one day I will, almost magically, find a fully-grown pair of wings that will help me fly again.

Artwork by Rosi Tooth / @rosi.illustration

Living With Gratitude

I began writing in my journal every time I felt overwhelmed – these were my own thoughts and some letters I will never send, but also poems, literary excerpts or quotes that I had come across, which felt like unlikely guides or signs from above and beyond. And, there is one simple ritual I follow every night – I ask myself what I have learnt and what am I grateful for today, which I would really recommend as a daily practice to anyone. Finally, I will leave you with a thought-provoking question that my mindfulness meditation teacher often pulls out during our sessions: When times are grim, are happy people more grateful or are grateful people happier?

Thank you for reading.

Artwork by Rosi Tooth, please check her amazing work out over at https://www.rosi-illustration.com/shop

If you have lived experience of multiple and complex needs and are interested in working or volunteering with us, please contact Nelida at nelida.senoran-martin@sefulfillinglives.org.uk. 

Pilot evaluation helps share learning and shape future design of local MARAC system

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Fulfilling Lives South East has collaborated with East Sussex County Council and Brighton & Hove City Council to evaluate the impact of a pilot trailing a new approach to the local MARAC systems.

The Multi-Agency Risk Assessment Conference (‘MARAC’) is a regular weekly local meeting to discuss how to help victims of domestic abuse at high risk of murder or serious harm. It brings together Representatives from a number of agencies in the local area to discuss the safety, health and wellbeing of people experiencing domestic abuse (and their children) and to agree actions and safety plans in order to reduce risk and keep individuals safe.

In 2019, the Joint Domestic, Sexual Violence & Abuse and VAWG Unit for Brighton & Hove and East Sussex reviewed the MARAC structures and referral pathways. The review highlighted the increasing numbers of referrals into the MARAC locally across Brighton & Hove and East Sussex, as well as highlighting the increasing challenges of safety planning for victims of complex and repeat cases. The MARAC Support Team worked with agencies to shape a new ‘Hub’ model in response to challenges identified in the review. A three-month pilot was launched in January 2020 to trial a new approach and was rolled out across Brighton & Hove and East Sussex.

This report shares the learning of the Brighton & Hove and East Sussex MARAC pilot with a view to informing the future design of the MARAC structures locally. We also hope that these findings and reflections can support other areas in the country who are interested in developing their own local MARAC structures and systems to improve outcomes for high risk victims of domestic abuse.

What the evaluation says

From this evaluation, the data supports that the MARAC meeting now feels safer and more effective than before. Meeting conversations have moved away from having an update-focus to allow for more discussion about safety and planning. The changes that have been made have created strong foundations to continue to develop this important space. The evaluation has shown that this is dependent on effective preparation, smaller number of meeting attendees, productive relationships between agencies, and effective chairing.

You can read the full evaluation report here: MARAC report to learn more about the evaluation findings and recommendations for the future.

IfFulfilling Lives South East has a particular interest in the experiences of people with Multiple and Complex Needs (‘MCN’). 93% of women who work with us have experienced domestic abuse and many are heard at MARAC. Our client-facing work has previously highlighted to us the challenges of discussing complex cases in detail within the previous MARAC structure and we are pleased to see that conversations appear to now be more focussed on risk planning, exploring agency involvement and ensuring accountability of actions. We are also very interested in how the evaluation highlights that complex cases require clearer definition and pathways within future MARAC systems in order to ensure safety planning is completed in the most effective way possible. This is an area that we hope will be included for further consideration and development in the future.

Fulfilling Lives is committed to continue working with partners across the public and voluntary sectors to support in finding new ways of working and testing new ideas to help improve the situation for women who have multiple complex needs and experience domestic abuse and violence. Should you wish to discuss the report further, please contact Rebecca Rieley, Systems Change Lead for FLSE:

rebecca.rieley@sefulfillinglives.org.uk

Author – Rebecca Rieley

Fleeing domestic abuse whilst having multiple disadvantages: How we can improve housing options

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Fulfilling Lives South East has collaborated with the University of Brighton to conduct research on what good housing could look like for women with multiple complex needs who are fleeing domestic abuse. The work draws together interviews with Fulfilling Lives’ workers and existing academic research to review the issue originally highlighted in Fulfilling Lives South East’s Manifesto for Change

The problem with domestic abuse and housing options

Domestic abuse does not occur in isolation from other issues. The research finds clear increases in likelihood of mental health issues, substance misuse and homelessness for people who experience domestic abuse. Despite this connection with multiple needs, services are not always able to provide suitable housing options for people in this group who are fleeing domestic abuse.

61% of local authorities do not have a homeless service specifically for women with multiple and complex needs (original source: ‘mapping the maze’ research report).

Managing complex risk, active addictions and trauma presentations often requires specialist knowledge and support. This is a challenge for services which may not be financed or equipt to provide the physical space or staffing required to support MCN women to stay safe. The result can be limited, inflexible offers of housing which can lead to rejection, eviction, or the choice to stay with an abusive partner to avoid having to engage with the system. Pair this with a limited housing stock offer in the South East, and the limitations of housing options are only exasperated for these women.

What can help women in this situation?

The research indicated that the following approaches could be beneficial in addressing the issues:

INDIVIDUAL LEVELSERVICE LEVELNATIONAL LEVEL

Advocacy & trauma-informed support


Workers help individuals to get the best from the system, challenge stigma and support the emotional wellbeing
Flexible policies which acknowledge complexity


Identify MCN women through referrals and plan for specific needs. Provide as much flexibility as possible.
Funding for housing options


funding to provide staffing levels and spaces for women with complex needs to feel safe and maintain tenancies

Empower women with MCN

Use information and support for MCN women to make informed decisions about their support
Trauma Informed Workforces

Identify MCN women through referrals and plan for specific needs. Provide as much flexibility as possible.
Campaigning


Providing evidence of the need for specialist housing options and sharing best practice with national decision makers

The research also acknowledged that funding limitations into new housing approaches for women fleeing domestic abuse contributed to the restricted offer available and in the current context, the report encourages us to explore enhancing and improving existing services and systems to effect positive change.

What next?

Whilst academic research on the impact of domestic abuse was prevalent, finding research on domestic abuse and multiple needs was more challenging. This highlighted the need for further research in this area, both in terms of academic contributions and pilot projects which seek to improve outcomes in this area. Our student researcher concludes:

‘Working with Fulfilling Lives helped me understand the work that goes behind organisations that offer services for communities. The concepts of multiple complex needs and trauma informed responses really resonated with me, as I believe they can be applied to any services that provide help and support for communities.’ – Student Researcher

If you are interested in working with us in this area, please contact Rebecca at rebecca.rieley@sefulfillinglives.org.uk. The full report is out now and available to download here:

social-practice-report-fulfilling-livesDownload

Author – Kerry Dowding

How to create accessible primary healthcare for people with multiple and complex needs

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Fulfilling Lives South East has collaborated with the University of Brighton to explore how to maximise access to primary healthcare for people with multiple and complex needs. The research informed a report which highlights approaches to improving access which work, based on academic research and the experiences of local client-facing workers.

The problem with primary healthcare accessibility

People who have faced disadvantages such as mental health issues, homelessness, substance misuse issues and offending histories are much more likely than an average UK citizen to require primary healthcare for a range of long term conditions. However, evidence suggests they are much less likely than average to receive it – with indicators such as low life expectancies and disproportionately high access to A&E building a picture of the gap between need and adequate provision.

The solutions for people with Multiple Complex Needs

The research conducted by student research Inja Vetter indicated that the following approaches work well:

1. Intensive outreach programs carried out by multi-skilled teams to see people in the community

2. ‘One-stop-shops’ which consolidate social and health care services to provide holistic care in one place

3. Staff knowledge & awareness– informing workers about the challenges people with multiple and complex needs face, and skilling up the workforce in trauma-informed approaches 

4. Flexibility in services with making appointments, appointment times and locations. 

5. Continuity of care Striving for linked social care and health care networks which ensure close communication and collaboration 

6. Secure, long term funding to achieve meeting the health care needs of people with MCN in an appropriate way

Inja reflected on her reaction to the findings as they emerged:

‘Thematically, what surprised me most is how well health inequalities for people with MCN and many other groups are researched and documented. Seeing the so-called ‘science-practitioner gap’ reinforced my belief that it is really important to push for systematic changes around the provision of (primary) healthcare.’ – Inja Vetter

What next?

This research will now be used to identify the ‘bright spots’ within primary healthcare systems. Our systems change team will look to collaborate with local partners to celebrate these areas and explore how we can nurture and grow these further. The research author supported the continuation of building strong links with practice and academic research in the future:

‘Working with Fulfilling Lives was a wonderful partnership experience. It was a boost to my motivation to experience Fulfilling Lives as a place where scientific research and practical experiences really come together, inform each other and are applied in order to create change.’ – Inja Vetter

If you are interested in working with us in this area, please contact Rebecca at rebecca.rieley@sefulfillinglives.org.uk. The full report is out now and available to download here:

Social Research Report (Appendix)_Inja VetterDownload

Author – Kerry Dowding