missing link - Bristol - Healthwatch Bristol

MISSING LINK 21 JUNE 2016 Healthwatch Bristol facilitated an informal focus group with women who are currently using or have used Missing Link Services. The focus group participants discussed a range of topics including GP services, mental health services, Missing Link Services and experiences of being homeless. The workshop was also attended by Bristol City Council and Missing Link staff. \\tcffileserver\sharedfolders\PROJECTS\HEALTHWATCH\Healthwatch Bristol\Engagement\engagement reports Bristol\Individual pieces of engagement reports\2016\Missing Link and Healthwatch Bristol 21 6 16.docx

MISSING LINK 21 JUNE 2016

“Missing Link has helped me grow,

Contents Section 1: Introduction

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Section 2: You Said

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(the services covered are: primary care; secondary care; mental health services; Missing Link and Next Link services; and experiences of homelessness and homeless services)

- Themes in feedback (p3) - Comments in full (p5) Section 3: Next Steps -

stand on my feet, get counselling, do art

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Healthwatch will… (p11) Looking forward (p12) Well Aware and Advocacy (p12) Tell Us Your Story (p13)

groups, have contact with my kids.”

Feedback from a Missing Link service user.

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Section 1: Introduction About the focus group: Missing Link invited Healthwatch Bristol (HwB) to facilitate an informal focus group with Missing Link service users.  Missing Link were keen to hear from service users about what they thought of Missing Link services and were aware that service users may feel more comfortable feeding back to someone who is not a member of Missing Link staff.  HwB were also keen to hear from the group participants about their experiences of health and social care services in general; share information about volunteering with HwB; and provide information about Well Aware, NHS Complaints Advocacy and Complaints Procedure Advocacy and AVoice advocacy services.  Bristol City Council joined the focus group to hear from the participants about their experiences of being homeless.  Six Missing Link services users, all female, took part in the focus group. Three Missing Link staff members, one Bristol City Council staff member and one HwB staff member took part in the focus group. The Missing Link staff members offered to leave the room so that Missing Link service users could speak openly, but the Missing Link service users decided they were happy for the staff to remain and that they could speak honestly with them in the room. About Missing Link: Missing Link is a mental health and housing service for women in Bristol. Missing Link was established in 1982 to provide a range of housing and support to women who either have acute or long term mental health needs. Missing Link support women who are homeless, or have a history of sleeping rough or whose housing is at risk because of their mental health issues. W: http://missinglinkhousing.co.uk/ Some of the focus group participants had also used Next Link services. Next Link is part of Missing Link Mental Health Services and provides domestic abuse support services. W: http://nextlinkhousing.co.uk/

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Section 2: You Said… Themes in feedback Primary care – specifically GP practices and pharmacies 12 comments received 7 Negative

2 Mixed

3 Positive

 Commentators felt judged by primary care staff because of their history of drug and/or alcohol addiction and/or mental health issues. They felt that this judgement impacted upon the treatment they received.  Due to homelessness and being a resident in several different support houses, the commentators had experience of having to regularly change GP Practice. They reported a lack of consistency in their care and frustration at the changes each new Practice made to their medication.  The group suggested that primary care staff (including front line staff such as receptionists) receive training on addiction, controlled drugs and mental illness to challenge their preconceptions and reduce judgmental behaviour.  The group said that it was difficult to make a complaint about care received because the complaints process was unclear and telephoning the Practice to speak to someone about your complaint was complicated by a lack of credit on their mobile phones.  The group valued GPs who took the time to listen to them.

Secondary care 1 comments received 1 Negative

0 Mixed

0 Positive

 The commentator praised staff on the respiratory ward of the Bristol Royal Infirmary and the Bristol Drugs Project worker who visits the ward for being helpful and non-judgmental and for ensuring she received her controlled drug medication.

Mental health services

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6 comments received 3 Negative

1 Mixed

2 Positive

*Due to time constraints, it was not possible to discuss mental health services in depth. Six comments were, however, made whilst discussing other services. The participants expressed interest in coming to a second focus group to solely discuss their experiences of mental health services as they said they had a lot of feedback to share.  The group felt that mental health services need to work around the person rather than trying to place them in a condition specific service. They reflected on how it has been difficult for them and people they know to access support for mental health illness, addiction and homelessness at the same time.

Missing Link and Next Link services 17 comments received 1 Negative

6 Mixed

10 Positive

*The negative comment refers more directly to Spring House Care Home than to Missing Link services. *The six mixed comments are suggestions for additional things Missing Link could do and not criticisms of existing services.  The feedback about Missing Link and Next Link was overwhelmingly positive. Commentators valued being given a safe space in which to develop their confidence and health.  The group were open to the idea of forming a regular service user involvement group so they could continue to input into how Missing Link services are delivered.

Experiences of homelessness and homelessness services 9 comments received 9 Negative

0 Mixed

0 Positive

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 The group reflected on how it is difficult to feel safe, make progress or develop the ability to look after your own wellbeing, when you are constantly moved from one homeless service to another.  The group members unanimously agreed that, for them, women only accommodation is essential in enabling them to feel safe and make progress.  Group members shared negative feedback about Jamaica Street Project House which they referred to as the worst homeless shelter in Bristol. They said that people with mental illnesses were often taken advantage of by other residents (for example via having money or prescriptions stolen from them).

Comments in full Primary care – specifically GP practices and pharmacies Negative feedback: 

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The commentator has been a patient at both Bedminster Family Practice and Montpellier Health Centre. The commentator, who is a Missing Link service user, has had to change Practice because she has been moved to different accommodation. At both Bedminster Family Practice and Montpellier Health Centre, the commentator has been asked to explain to the receptionist why she requires a doctor’s appointment. The commentator does not feel she should have to share personal information with the receptionist. The commentator is prescribed controlled drugs, due to a history of drug addiction, and does not wish to share this information with the receptionist, especially as she has experience of being judged by health care staff. The commentator states that she has been judged by staff at Bedminster Family Practice and Montpellier Health Centre and their adjoining pharmacies when trying to order and collect controlled drugs (prescribed to support with drug addiction). The commentator feels like she is left until last because of what is on her prescription. The commentator recently missed two days of her prescription, because of poor communication from Montpellier Health Centre. The GP Practice told her that the medication was not ready, but it had in fact been waiting for her in the pharmacy. The commentator said that missing two days of her medication puts her at risk of relapsing into addiction. A second commentator said that she had heard other people say that their controlled drug prescription had been “lost” at Montpellier Health Centre. A third commentator said that they had been given their prescription script by Montpellier Health Centre GP Practice three minutes before the pharmacy closed and as such had not been able to collect their prescription.

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The focus group participants (six women who use Missing Link services) agreed that not having a named GP who they can always see for support makes it difficult to build a trusting relationship with a GP. They also commentated that, due to changes in abode, they often have to change GP Practice and this breaks up the continuity of their care, especially when the new GP says they cannot see notes from the previous GP. Several group members had built a good relationship with a GP, but then had to move Practice and this good relationship was lost. The group felt that it would be helpful for the GP at the Practice you had been a patient at to speak to the GP at the person’s new Practice. Two focus group participants (Missing Link service users) said that when they have moved to a new GP Practice, due to a change in abode, the doctor at the new GP Practice has reduced the amount of the controlled drug they are prescribed (to support with drug addiction) or decreased the amount they can pick up at one time – for example, one commentator picked up her controlled drug prescription weekly at Bedminster Family Practice, but now has to pick up her prescription twice weekly at Montpellier Health Centre. Getting to the pharmacy at Montpellier Health Centre twice weekly is difficult for the commentator as she has emphysema and struggles to walk. The commentator is a patient at Whiteladies Health Centre and reports that whilst she was suffering from depression she felt judged by receptionists at the Health Centre. The commentator said that due to her depression, she was probably not “coming across as friendly”, but that she felt penalised by the receptionist for being mentally ill. The commentator said that the staff spoke rudely to her and lost her prescription. The commentator said that she wanted to complain, but in the end did not. The commentator felt that receptionists should have more training on mental illness. The commentator said that their GP at Horfield Health Centre did not listen to her – the commentator has mental health and addiction issues and experience of homelessness. The group, Missing Link service users, said that “99% of doctors are judgmental and don’t listen”. They said that, however, it was difficult to make complaints about care received in primary care settings because it was not clear how to make a complaint. They said that telephoning the GP Practice is not always possible due to limited credit on their mobile phones.

Mixed feedback/ suggestions: 

The group, Missing Link service users, suggested that primary care staff (including front line staff such as receptionists) receive training on addiction, controlled drugs and mental illness to challenge their preconceptions and reduce judgmental behaviour.

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In response to being asked about attendance at cervical and breast cancer screening appointments, the commentators said that they do receive their letters about screening but do not always attend. One commentator said that it would help her if she was supported to get to the screening appointment as her breathing difficulties make it hard from her to walk to the Practice.

Positive feedback: 

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Before she had to move GP Practice, due to a change in abode, the commentator was a patient at Eastville Medical Practice. The commentator praised the Medical Practice staff and said: “they treated me like a human being” and showed her respect. The commentator said that staff at Broadmead Medical Centre and the pharmacy (located in Boots) are brilliant as they have a very good understanding of addiction and are not judgmental. The commentator said that her GP at Monks Park Surgery is brilliant because he listens to her. She said that a GP who listens is a “rare find” and she does not want to have to move to a different GP.

Secondary care 

The commentator has been an inpatient on the Respiratory Ward of the Bristol Royal Infirmary on several occasions due to her emphysema. The commentator also has a history of drug addiction and receives a regular prescription for controlled drugs. The commentator said that the staff on the respiratory ward are “excellent, very helpful and nice”. She said that she does not feel judged by the staff and that they always ensure she receives her controlled medication. The commentator praised the Bristol Drugs Project (BDP) worker who visits the ward and said that the BDP worker on the ward helped her to see her regular BDP worker during her most recent admission.

Mental Health Services Negative:  

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The commentator said that mental health services in Bristol will “only support you if you actually harm yourself”. The commentator said that people with severe mental health issues are often using homelessness services, including Jamaica Street Project House, but not being “picked up” by mental health services. They said that these people get taken advantage of in homelessness services by other service users (including having money and prescriptions stolen from them). The six group members said that if you have a mental health illness and are homeless then you just get moved from mental health services to homelessness services because the service providers “don’t know where to put you”. They said this means

you end up not getting support for your mental health. The group said that people need to be given a say in their treatment rather than “just being shunted from place to place”. Mixed: 

The commentator is currently having her third mental health assessment in Bristol. The outcomes of the previous two assessments she has had have been that she does not reach the threshold for support. The commentator states that her most recent and current assessment process has been slightly better than the two previous assessments.

Positive:  

The commentator is currently using Kinergy Counselling. She has received one-to-one and group counselling and says that Kinergy staff have been fantastic. The commentator said she had heard good things about Golden Key and liked that they supported people with a range of diagnoses/ complex needs including homelessness, addiction and mental illness. The commentator said that often people with complex needs/ multiple diagnoses get passed from one service to another so it was good that Golden Key was supporting the person with all their issues.

Missing Link and Next Link services Positive feedback: 

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The commentator said of Missing Link services: “Missing Link are great. I don’t know what I would have done without them.” The commentator added that they were suffering from depression and had been abused and that they could not speak to their family, but Missing Link gave them someone to speak to. The commentator said that the fact Missing Link is a women’s only service makes it easier for her as she has suffered abuse. The commentator said that Next Link “allowed me to grow and develop” and that it was a “safe haven” in which she could find out who she was. The commentator expressed her gratitude to Missing Link and Next Link for the support they had given her. The commentator said that whilst a service user of Next Link she had disclosed historical abuse and that now she has “opened the box” she needs support and is being given counselling and support via Missing Link. The commentator said that she was anxious about moving from Next Link, where she felt safe, to Missing Link. The commentator said that the support she has received from other Missing Link service users has helped her with the move. She said that her support worker from Next Link telephoned her when she moved to Missing Link and is

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continuing to keep in touch to ensure that the progress she made at Next Link continues in Missing Link. The commentator said that this continued support and continuity has been very helpful. The commentator said that Missing Link helps you to find groups you can participate in and has motivated her to take part in new activities. For example, she was reluctant to take part in gardening, but was motivated to do so by Missing Link staff and ended up really enjoying it. The commentator said she really likes New Ways House (a Missing Link high support house) and that the level of support given is very good. The group, all Missing Link service users, said that they liked the accommodation provided by Missing Link because it feels safe, is secure, is clean and because there are staff there who take time out to listen to you and help you. The commentator said: “Missing Link has helped me grow, stand on my feet, get counselling, do art groups, have contact with my kids.” The commentator said that her Missing Link support worker helped her to access an art group run by Second Step. The commentator enjoys the art group and described using colours to understand feelings which, she said, helps with metal health. She added that group members can take home art they have made in the group to “enjoy”. The commentator also said that Second Step staff were able to offer one-toone advice and help with emotions and benefits and that talking to the other group members was helpful as they had similar experiences to her. All six group members, service users of Missing Link, agreed that it is “100% important that it’s women’s only accommodation”. They said that the women’s only accommodation allowed them to feel safe and that they could relate to the other women and offer each other support. Several commentators, Missing Link service users, said that they value that the Missing Link and Next Link Key Workers always ask what the person thinks or wants from their treatment. They said that being asked for their input into decisions about their lives is very different to previous experiences they have had where no-one has asked them what they thought or wanted. The commentator said she appreciates staff at Missing Link taking her to the doctors as, due to breathing difficulties, she struggles to climb the hill to the GP Practice.

Mixed feedback/ suggestions:  

The commentator said that it would be good if the waiting lists for support from Missing Link and Next Link were shorter. One commentator suggested that Missing Link could develop a peer support service or befriending service through which people could use their own experiences to support each other.

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It was suggested by the Missing Link focus group participants that they would enjoy trips or days out, for example to the seaside. The HwB and Missing Link staff suggested the idea of forming a regular Missing Link service user involvement group and asked for the participants’ feedback on this idea. The group were positive about developing such a group. They suggested that the group could discuss social opportunities and activities that they could support each other to do and ways of sharing information about opportunities. The group acknowledged that there are lots of groups and activities run by organisations other than Missing Link which they could attend, but that it can be difficult to find out about these groups and that attending on your own for the first time can be intimidating. They welcomed the suggestion from Missing Link staff that they could select different groups to visit and try out with Missing Link staff. One group member asked for the notice board in her Missing Link house to be moved to a place where more people would walk past it. The Missing Link support worker said she would action this request.

Negative feedback: 

The commentator was told by staff at Spring House Care Home that her grandchildren would be allowed to visit her in the Missing Link accommodation. When the commentator became a Missing Link service user, she discovered that her grandchildren were not allowed to visit. She wishes that children were allowed in the Missing Link accommodation and that she had been told the truth before moving to the Missing Link accommodation.

Experiences of homelessness and homelessness services Negative feedback: 

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The commentator, who has personal experience of being homeless, said that you have to be living on the streets to get support and will not be helped if you are temporarily staying with friends/ sofa surfing. The commentator added that if you move out of Bristol because you do not have somewhere to live in Bristol, it is then very difficult to get support back in Bristol. Several commentators, with personal experience of homelessness, said that there is a lack of communication from Bristol City Council homelessness services. The commentators had been told by staff that “we can’t help you”, but given no signposting to other services. The commentator said that when they were homeless they had gone to the police station for help. They said the police had tried to help, but when they could not find anywhere for her to stay, had just left her.

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The commentator said that Bristol City Council homelessness staff had given her a list of mixed accommodation that she could try to find a bed in. The commentator said that she does not feel safe staying in the same place as men are staying. Several commentators said that Jamaica Street Project House is the “worst” in Bristol. One commentator said it might as well be called “Drug and Alcohol Street”. The commentators said that the house smells of urine and is disgusting. They also said that you are not allowed to leave your belongings there in the day/ you do not know if you will have a bed the next night and this is unsettling. The commentators did not feel safe at Jamaica Street Project House because it is mixed gender accommodation – many of the commentators have experience of domestic and/or sexual abuse. The commentators said that drug users, alcohol abusers and people with severe mental health issues are “all chucked in together” at Jamaica Street Project House and that people with severe mental health issues are taken advantage of by other residents – for example, they have their prescriptions stolen or money taken. The commentators said that people cannot report such instances either because they are too vulnerable to realise they could report it or because they are afraid of being judged by other service users or by staff. The commentator’s son was homeless, but did not have any issues with drug or alcohol and did not have a mental health illness. This meant that he could not get support. The group of six women said that it is hard to become settled and take control of your own wellbeing when you are constantly being moved from one homeless shelter/ service to another. One commentator said that being moved from place to place means that you never feel safe and never have the opportunity to grow and develop. She added that each time she is moved, she finds it difficult to take what she has learned about managing her wellbeing with her to the next place.

Section 3: Next steps Healthwatch will… All the feedback provided by the group has been inputted to Healthwatch Bristol’s database of issues and concerns. It will be included in the Healthwatch Bristol Feedback Feed Forward Quarterly Report. Healthwatch will be sharing this report with Healthwatch partners including Bristol Clinical Commissioning Group, Bristol City Council, the Care Quality Commission, NHS England and

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Healthwatch England. The report will also be presented to the Healthwatch Bristol Advisory Group to propose further uptake of the issues identified in this report. The report will be available on the Healthwatch Bristol website (www.healthwatchbristol.co.uk) and circulated to our mailing lists via the monthly e-bulletin.

Looking forward…. Plans for future work between Healthwatch Bristol and Missing Link Healthwatch welcomes and encourages Missing Link members to continue to contribute their feedback to us using the communication methods included at the end of this report. Healthwatch also supports members of community groups to become Volunteer Champions so that they can represent the experiences and needs of their community group. If you would like to find out more about volunteering with Healthwatch, please contact us using the details below.

Well Aware and Advocacy Well Aware can help you find out about activities, groups and services in Bristol and South Gloucestershire. Visit the website or use the freephone number to find out more. W: www.wellaware.org.uk T: 0800 808 5252 Advocacy is taking action to help people say what they want, secure their rights, represent their interests and obtain services they need. Advocates and advocacy schemes work in partnership with the people they support and take their side. Advocacy promotes social inclusion, equality and social justice. The Care Forum provides the following Advocacy projects which are all free to access and use: 

Complaints Procedure Advocacy – advocacy for people who wish to make a complaint to Social Services in Bristol, South Gloucestershire and BANES.

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Drugs and Alcohol Advocacy Services – for adults who use, or wish to use, Bristol’s drugs and alcohol services. Generic Advocacy – advocacy for adults in South Gloucestershire around social care issues. Eligible service users are from the following categories; older people, people with physical and sensory impairments, people with learning difficulty, people with mental health issues, and carers. Independent Mental Capacity Advocacy (IMCA) – for adults in South Gloucestershire who are facing a decision regarding accommodation, serious medical treatment, safeguarding or care review, who are assessed to lack capacity to this decision and who have no family or friends who are appropriate to consult. This project includes the South Gloucestershire IMCA DOLS service. Independent Mental Health Advocacy (IMHA) - to represent and support people who meet the eligibility criteria under the Mental Health Act 1983 in South Gloucestershire. Mental Health Advocacy – for adults who use mental health services in South Gloucestershire. NHS Complaints Advocacy – for people in Bristol and South Gloucestershire who wish to make a complaint about NHS services. Avoice Advocacy - AVoice - provides free, independent and confidential advocacy for vulnerable adults affected by crime and antisocial behaviour in the Avon and Somerset area.

To self-refer, contact Well Aware using the freephone number below: T: 0808 808 5252

Tell Us Your Story… Healthwatch Bristol wants to hear from you about your experiences so that we can tell services your needs to create the best local services. Text us - text bris followed by your message to 07860 021 603 Email us at [email protected] Call us: 0117 2690400

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Write to us at: Healthwatch Bristol, The Care Forum, The Vassall Centre,

Gill Ave, Fishponds, Bristol, BS16 2QQ Or visit our website to see more at: www.healthwatchbristol.co.uk

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