Watch this Video of Beth Wilson, Director presenting on BRR’s Complex Needs Casework Model from our Intersectional Service Design event
We have developed a stronger approach to working with people who have a mix of complex problems like mental health and trauma, disability, homelessness or debt, in addition to their immigration problems. By building partnerships with specialist local providers and bringing dedicated expertise into the support team, we are reducing the barriers to accessing and engaging with support, and moving people away from crisis towards sustainable solutions.
Over the last four or five years we have seen an increase in the number of people presenting to us with multiple complex needs, needs that are difficult to support through a drop-in service. Often their situations weren’t getting any better over months or even years.
For example, we found people presented as disengaged from or not able to access mental health services. They were unable to engage with their asylum claims, often being either absconders or refused asylum seekers, and therefore unable to access housing and financial support.
We identified a number of things going on: homelessness and mental health problems, and sometimes also disability or debt. These are issues that lots of people who are not asylum seekers also experience, but for these people we saw them presenting in different ways or the solution is different because of their immigration status.
Almost by default, people were prevented from accessing mainstream services that help with mental health, homelessness, disability or care needs or debt problems.
As an organisation, we were very stretched. Our operational model means we are delivering services in a way that requires people to come to us and ask for help, provided in the high pressure drop-in environment.
So we weren’t equipped to support people with all the complexity of needs that go on outside the drop in. We would refer people to mainstream services, but they would just send them back to us. They didn’t know what to do with them and didn’t know how to navigate the fact that they also had an immigration problem.
What they really needed was a range of experts working together.
The partnership with Golden Key, which is a Bristol based network that supports individuals experiencing a complex mix of problems, has enabled us to really support people who were previously falling between the gaps of a number of different organisations due to the intersection of their needs with immigration status.
Together, we are now able to support people in the immigration system, who might also present with a wide range of other issues - from homelessness, to mental health issues and debt. They were previously ‘stuck’ in situations without access to appropriate support or the stability to follow a route out of crisis.
JS regularly came to drop in, always with a carrier bag full of letters and medication, without really understanding what any of it was for. He couldn’t tell us much about his time in the UK, he said he had been here for about three years, with his wife and children back in his home country, and so was alone.
We could tell from his letters that his asylum claim had been refused, so he had become homeless & had his financial support terminated. He also suffered from PTSD.
He struggled to remember appointments, was sofa surfing, and was struggling with anxiety and finding it hard to sleep, suffering nightmares.
We tried to help him re-engage with the asylum process, and to support him to access help through social care. But they wouldn’t accept that he had care and support needs and argued that really the problems he was experiencing were due to his immigration status.
So we introduced him to Golden Key at our drop in, where he was already comfortable. Their case worker could immediately see he needed stabilizing and support with his mental health as a priority. They helped him to re-engage and attend appointments with primary and secondary mental health; manage his medication and monitor it’s effectiveness; gave him a personal budget for winter clothes, and just taking the heightened nature of what he was suffering away.
He was then in a much better position for us to support him with re-engaging with the asylum process. We helped him to access legal advice and think about the evidence he might be able to gather, Golden Key were able to attend solicitor appointments and submit his fresh claim with him. He is waiting for his claim to be decided, but is now living in stable accommodation, his mental health is stable, and he is socialising and eating better.
We have changed how we build relationships and trust
The traditional drop-in model means you have to come and ask for the help you want. We now recognise that we can’t wait for people to come to us. A better way to build trust is to work with people to understand both their presenting problems, and what is lying behind them.
We understand that we are not experts in everything, but we are most effective when we work with others.
This has really been brought home in the partnership with Golden Key, as well as other connections we’ve established. Greater cross-sector understanding, partnerships where we each work to our strengths and establishing a shared responsibility to support those most vulnerable, means that we are able to work on a deeper level to address complex problems for a wide range of individuals.
Strengthened our ability to reduce crisis for people in the asylum process
Developing relationships with mental health teams, Adult and Social Care and a charity WECIL who work with Disabled People has increased knowledge and understanding within the team, led to mutual training programmes and more confidence in signposting people with specific needs to appropriate local services. We also worked with a Disability Rights volunteer who delivered training to staff and volunteers and supported us to develop signposting and services for disabled members.
We knew about Golden Key, but to be eligible for their intensive support, they required people to meet at least three criteria of homelessness/mental health/substance misuse/offending. Our clients usually only exhibited one or two, and so were even excluded from this otherwise perfect support structure.
So we worked with one of the Golden Key support workers, who has a refugee background, to encourage them to reconsider their criteria for helping those most in need, so that it included ‘insecure immigration status’ as another criteria.
So we were able to work together - BRR and Golden Key - using strength-based principles, to find a way of working with clients to help them work out their plans.
As part of our early action work, we took a step back to look at the needs of our members, and analysed the cases where things didn’t go so well, as well as the ones where we know we did a good job. This process highlighted where we needed to focus our energy.
Negotiating the logistics and resources needed to do this joint work during lockdown has been challenging. Golden Key often relies on our volunteer interpreters to communicate with our members. In lockdown that has meant us having to be directly involved in their client meetings in order to facilitate getting a telephone interpreter on the line. There are also limits to the number of people they can support, so when they have reached their caseload capacity, people we want to refer might have to wait before receiving support - which maintains the pressure on our service.
The support model we’ve established with Golden Key has strengthened our ability to reduce crisis for our members with complex needs. We want to embed this learning into our own practice and are now piloting a new, dedicated support worker role within our casework team to make this work more sustainable, in addition to continuing the partnership.
We will continue to advocate for organisations to understand the importance of immigrations status, and not to see it as a barrier to providing a service. We hope to extend our training offer on this following successful sessions with adult social care.
Work with people with lived experience, your staff and volunteers to look at how you provide support and whether there are people who find it difficult to access or engage with your services. Identify the limitations and think of ways you could bridge these gaps.
We are stronger when we work together. You can really strengthen the support you’re able to provide clients by developing partnerships with organisations with specialisms around a particular area of disadvantage, or like Golden Key who focus on supporting people with multiple complex needs.