Christine Grover (LWPM Team Leader) talks about her experience of supporting her client Joe…
When I was challenged to think of a client case that summed up the Lead Worker/Peer Mentor (LWPM) service for me, there was one that sprung to mind immediately. Someone with all four multiple complex needs (homelessness, mental health problems, substance misuse, and offending), who was excluded from nearly every service in Birmingham. Someone who everyone considered to be a ‘lost cause’, but who proved everyone wrong and turned his life around.
Joe referred himself to the LWPM service four years ago, after his partner at the time was allocated a Lead Worker and a Peer Mentor. He had started rough sleeping aged 14 to escape an abusive home environment and had been on the streets until I started supporting him at the age of 36. He was heavily abusing solvents (up to 15 cans of butane lighter fluid a day), using crack cocaine and heroin.
Joe didn’t trust any services, and when support was offered, it was often met with an official complaint. He had gained the reputation of being aggressive, and the number one perpetrator of anti-social behaviour within Birmingham City Centre. He reported hearing voices, but this was written off as a consequence of his solvent abuse by multiple mental health professionals I referred him to over the years.
It took me nearly a year of trying to engage with Joe before he opened up. It was a year of complaints, being shouted at, or ignored. I would try and find him most days just to say hello and let him know that I was there.
A turning point
The turning point in our relationship came when Joe was arrested for assault against his partner. I visited him in prison every week for three months, and we would talk for as long as we could before I was told to leave. Joe told me about his background, his aspirations, and the barriers he thought prevented him from moving forward. He would also write to me every week about life in prison. Joe apologised to me for things he had said before, and for the first time, was willing to embrace support.
I had arranged for Joe to move into supported accommodation on his release, and all assessments were completed in prison to save him the worry of doing this on the day of release. Joe stayed in the accommodation for six weeks before returning to rough sleeping. But he was recalled to prison as he wouldn’t engage with probation.
Breaking the cycle
This started a pattern of behaviour every time Joe was released, which was used by services as evidence that he wasn’t ‘ready’ for support. It resulted in a Criminal Behaviour Order being issued. But it conflicted with my experiences of the Joe I had visited in prison, who was intelligent and determined to change his life – he just didn’t know how. He told me that his whole identity was ‘Joe from the streets who used gas’, and he didn’t know who else to be.
Joe spent two years in and out of prison, but each time he was inside, he made progress regarding his substance misuse. He started to have brief spells of abstinence from solvents when he was released, and I could see how important this seemingly small step was.
Towards the end of his prison sentences, Joe began to consider a detox. It was clear from talking to Joe that he couldn’t achieve this goal in Birmingham, so I made a case to the local substance misuse services to fund an out of area placement. This was declined. Funding was finally provided from Public Health England for him to access detox and rehab out of the area.
Joe was confident about completing this when I spoke to him in prison, but he was also anxious about what his life would look like afterwards. On the day of his release, his Peer Mentor met him and arranged train tickets to the detox facility just outside London, but Joe didn’t go. There were hours of different members of staff trying to encourage Joe to give it a try, a tortured look on his face. He had severely limited self-belief and was petrified of changing who he was.
During prison sentences when substance misuse was reduced, Joe presented with low mood, anxiety and paranoia. He was prescribed anti-depressants but was only concordant with this medication while he was in prison. There was also an increase in self-harm and suicidal ideation.
Even while he was in prison, with consistent support Joe’s confidence increased, and he began to engage with substance misuse services when he was released, making plans for how he could eventually be free from addiction. Following his last prison sentence, Joe was able to identify the link between his solvent abuse and his offending behaviour – and he was able to abstain from this. He hasn’t used solvents in over a year now.
I referred Joe to the Housing First programme as he had been excluded from all other accommodation in the area. I supported him to move into a property and he remained there for a year with intensive support. There were no further arrests in this time, and Joe has managed to complete his probation order.
Following the reduction in his substance misuse, Joe experienced a decline in his mental health, sobbing uncontrollably daily as he felt everyone was conspiring against him. I referred him to mental health Crisis Services, and finally, he was referred to the Community Mental Health Team.
Joe was finally listened to and diagnosed with having a psychotic episode. He has complied with his treatment, and although he still experiences ongoing paranoid ideation, he has learnt the skills to manage this.
The real Joe
Joe continues to engage well with support, and there hasn’t been an episode of aggressive or abusive behaviour towards staff or others in over two years. This is the real Joe, who was hidden for so long by substance abuse and a fear of trusting others. When people meet him now, they often show disbelief when I tell them his story. How could it be the same polite, kind and insightful person they see today?
Joe’s case taught me about the potential everyone has for change when they are given the chance to access the right support at the right time.
The last time I spoke to Joe, he told me that he had bumped into some police officers who knew the ‘old him’, and they praised him for the person he has become. Joe laughed telling me that he never thought he would see the day when he had a nice conversation with the police, but I could hear the pride he felt in achieving his goal of turning his life around.
*Names have been changed