'The window of chance and change is a rarity, but with Tara, we made it'

Continuing her blog series about her work as a Peer Mentor, Colette Carter talks about her experience of supporting her client Tara…

Tara* did not belong to any associated city centre gangs, and was never co-dependant. She was totally self-reliant, and a self-isolated soul during her estimated seven years of rough sleeping in shop doorways, rat-riddled alleyways, public subways and the streets of the city centre in Birmingham.

Sadly, it’s unusual for a female to survive alone in such perilous conditions.

Tara had a larger than life character and amused many. Added to the multiple layers of clothing she wore to keep warm, she loved scarves and ostentatiously wore as many as she could at any one time, even wrapping them around her forehead, Rambo style, as well as her waist and wrists. She loved to dance and was good at it.

You would find her close to the town centre buskers, entertaining the crowds with her dance moves then cheekily holding out her own cap for small change. ‘God bless ya’ she would say. She could be familiar on a surface level with people she didn’t know by acting as a social butterfly, speaking in whispers, none of it making any sense. Some called her the ‘mad’ woman, others referred to her by name, but she knew very few.

Meeting Tara

Tara looked older than her 34 years when she first came to the attention of Shelter’s Lead Worker/Peer Mentor (LW/PM) service in early 2015. Street life had not been kind to a face that once highlighted her beauty, with exceptionally high cheekbones and piercing blue eyes. Vanity had deserted her, but she was aware of her decaying, blackened and broken teeth, and spoke mostly with her hand covering her mouth. Alcohol and drug use had taken its toll on her body, and her small frame drew attention to how underweight she was.

Was she constantly under the influence of substances, or was she suffering from an underlying mental health problem? Drawing a parallel between many of us, who have a few drinks and turn either into comedians or devils, Tara was no different. Her good, funny or bad behaviours were always credited to alcohol consumption.

She was a notorious nuisance to shop staff, security and the local authority. She was excluded from all homeless services – giving her no other option than to sleep rough – as well as the only drug service available in Birmingham. This meant she had no access to a consultation with the only doctor that could treat her addiction issues.

She could be hostile, aggressive and reckless, cause damage to property and hurt people. When Tara first accepted help from the LW/PM service in March 2016, she was practically unapproachable. She kept everyone at bay by deliberately using bad behaviour as a tool, which was well-rehearsed and calculated.

The saying, ‘hurt people, hurt people’ is a profound example in Tara’s case.

Our first interaction

One very cold morning in March 2016, Tara unexpectedly presented at the office. Barefoot. It had taken 12 months, and been a slow and precarious process trying to engage her. Due to her unpredictability, her risk assessment read as ‘only to be worked as a two-to-one’ (that’s two staff present at all times). As the team became familiar to the rough sleeping community in the city centre and news had spread about the service employing people that were once like them, we were welcomed to stop and chat with most. Tara used to turn her back and walk away from us in the beginning, so if ever we made eye contact, we would just nod. Slowly, the distance between us shrunk. Tara started to respond to a ‘hello’, and became inquisitive enough to ask us what we were doing.

Why was she barefoot? Tara said that someone had stolen her old boots as she slept, and she needed a replacement pair. As the service held an emergency cash fund, my Lead Worker and I took her to buy a new pair of winter boots and some other essential items. This was the first experience we had of being able to offer Tara support and assistance, and that’s all we did that day. We didn’t ask her to sign any paperwork, or try to make a future appointment. Off she danced in her new boots.

Years later, Tara apologised to me for that day. She admitted that she had taken off her old boots and hidden them safely before coming to the office. It wasn’t that she deliberately defrauded us – it was about more than a pair of boots. She said it had been her way of reaching out to us at that time without directly asking for help.

She had a mistrust of people and services, but she was inquisitive and wanted to get to know us in her own way – and in her own time. And that’s what the LW/PM service had the privilege of offering. No time restraints, clients led their own support to achieve their goals, not ours. They could dip in and out of support, and we had a no exclusion policy.

Tara and I just seemed to connect on that first shopping trip, and as time went on, I did not find her difficult or intimidating to work with. There were moments when she would gesticulate wildly (she didn’t at all mind a public audience), but I understood her behaviour as a way of dealing with emotional pain, and the inability to articulate herself correctly. I always knew when to withdraw from a support session.

Our conversations touched on the trials and tribulations of family life, parents and siblings, school days – happy and sad – our children, we even talked about some of the trauma we had experienced. We had a mutual understanding of shared experiences, and it was common to see us sitting on a town centre bench chatting. As meaningless as that may have looked, I was breaking down barriers and building trust with someone who had not experienced the warmth of positive human contact in many years.

Informing our work with PIE

A portion of the Lead Worker/Peer Mentor’s National Lottery Community Fund finances were used to educate us about Psychologically Informed Environments (PIE). PIE is a new tool being used by staff supporting homeless clients who have experienced complex trauma. PIE considers the psychological make-up of those being supported – their thinking, emotions, personalities and past experiences. PIE also considers the needs of staff, developing skills and knowledge, increasing motivation and resilience.

Having had PIE training, I was aware that supporting Tara in her own environment – outside and sitting on a public bench was where she felt most comfortable – led to the foundation of our professional relationship. This led to self-disclosure from both of us, mixed in with everyday news, gossip, laughter and tears. For the first time in years. Tara felt a part of ‘something’. I listened, remembered and valued her opinions. Once we had developed the acquaintance and built trust, the road to real change started for Tara.

The road to change

This is where the uniqueness of the project proved its worth, not just in cost savings to the public purse, but to the priceless investment in broken people, who had assigned their lives to the predicament they lived in – and expected to die in. No one had ever told them that there was another side of life they had every right to, and could access with the right support, a little self-belief and inspiration from a Peer Mentor (PM). Peer Mentors could engage the most entrenched, hard to reach, broken human beings because they too had once believed there was no way out of the lives they had led.

PMs had been able to address and repair their inner damage and traumas, because each and every one of us was inspired to change by someone who believed in us, and told us there was a new way of life just waiting if we had a little self-belief, trusted in someone else were prepared for a lot of emotionally hard work. Fear of change was prominent, causing feelings of panic and suffocation, but we were supported by our peers through the hardest of times. Therefore, this is what the Peer Mentors passionately delivered to every client that was assigned to the LW/PM service. The same amount of care and support that had once been offered to us.

A multi-agency approach

The Lead Worker (LW) and I identified Tara’s needs, and the LW arranged many multi-agency meetings. These were with homeless hostels to find a safe place for Tara to sleep, the drug and alcohol service to discuss overcoming the exclusion, the probation service because she had not been attending appointments, Social Services, as her LW had submitted a safeguarding report due to her vulnerability, and the Mental Health Service to discuss dual-diagnosis and a mental health assessment.

It was always assumed that Tara was under the influence of substances, but her LW and I had discussed our doubts about this assumption, and considered a mental health issue to be more prevalent and obvious to us. All parties often sat around the table together, agreed to actions and held each person or service accountable. Tara was always invited to the meetings as we were a client-led support service, and attended as and when she wanted to.

Transparency is key

I believe in complete transparency, no matter how difficult or upsetting it may be. Due to our established relationship built on the basis of trust, difficult information was easier to deliver, as it was always followed with a solution. I never believed in hiding anything from any of my clients. As long as they had capacity, they had a right to know. Hiding discussions and decisions allows for doubts and paranoia to creep in, and interferes with the relationship you have developed. The client could also feel as though they were no longer in charge of their own support. I came to this conclusion by the way I was treated. Professionals were discussing me but ignoring me until they explained their decision on what was best for me. Having capacity, surely I should have been involved in any decisions relating to me?

The fact that Tara’s reputation preceded her was probably her biggest downfall. There were a lot of closed-minded service staff that were politely challenged by the LW and me. Challenging others on behalf of all our clients was an everyday occurrence for Lead Workers and Peer Mentors. We were able to spot cracks in systems that clients with multiple and complex needs were falling through.

Our expectations of other services were as high as our own. We expected services to conform and perform in accordance with their mission statements and what they promised to deliver. We found that sometimes it boiled down to a minority of staff that made decisions in accordance with their personal views, and not those of the services they were representing. Educating staff about the four complex needs and leading by example was the platform the LW/PM service gave us.

Assessing Tara’s needs

We used two types of paper assessments. The first one was the New Directions Team (NDT) assessment that gave an instant score. The higher the score the more need for support. Tara scored high, and as she became more trusting and engaged, we used the Outcome Star (OS). The lower the score, the higher the need for support with an agreed support plan. Tara fitted both.

We supported Tara for 15 months with an acute rise in engagement, but not behaviours. In June 2017, she went to prison for assault and theft. While in prison she did not use substances and was a model prisoner, but her mental health became a worrying factor to staff. Close links with the prison through telephone calls, emails and visits kept us well informed. The prison doctor prescribed her medication, but it had been a difficult assessment as Tara was experiencing paranoia, and was unable to answer questions relevant to the assessment.

We had found it hard to get Tara a mental health assessment in Birmingham, as we were informed that they couldn’t be completed if the person is under the influence. But was she always under the influence? It was difficult for us to tell sometimes. Was it learned behaviours and acting skills that separated Tara from receiving the attention she needed, or did she have an underlying mental health condition that required treatment? It was the biggest and most difficult barrier we faced at that time. Tara was released from prison in October 2017, after four months, and re-engaged with LW/PM service when we arrived to collect her upon release.

While Tara was in prison, I had applied for a Lead Worker post and had been successful, so I continued to support Tara, but as a Lead Worker with a new Peer Mentor. I was keener than ever, as I had spotted the potential to further Tara’s recovery. Tara had told us during a prison visit that she was ready to make changes to her life, and was going to abstain from drugs and alcohol. It was evident to me that her mental health had taken precedence over all else in her support plan. The abstinence from alcohol and substances – mainly Mamba, a psychoactive substance that is smoked – was secondary, but just as important. In order to support both these needs, suitable accommodation was imperative.

Barrier after barrier

I encountered barrier after barrier. Accessing accommodation proved to be incredibly difficult, even before she was released. I tried many accommodation providers – some said that they were not equipped to deal with Tara’s mental health issues, and some recoiled at the very thought of accommodating her due to her previous behaviour and reputation.

Tara was a high-profile client, meaning there was several main agencies involved, who almost seemed to care for her welfare until I asked them for help. By rite of passage, Tara should have been able to access the rehabilitation centre here in her home town. She had made every effort whilst in prison, and was now four months clean of alcohol, illegal substances and prescription medication. So why were my referrals being ignored?

I took my concerns to my team leader and service manager. They had always supported my support plan with Tara and the decisions I made. My Service Manager was invited to a MAM (Multi-Agency Meeting) with other service managers relevant to Tara’s future. I was unable to attend, as it was scheduled for the same morning Tara was being released from prison. I had already made plans with Tara promising I would be there when she was released. I wrote a list for my Service Manager, with reasons I would have lobbied in that meeting, and we all thought we had a strong case.

For reasons that were never fully explained, their one and only offer for Tara was accommodation at a high needs unit in the city for six weeks. At six weeks, they would regroup and discuss her future further. I had knowledge of the facility, and although they provided very good support for their residents, most of the residents were not abstinent from alcohol or drugs.

A chance for change

The window of chance and change is a rarity. The best chance is at the very moment you experience a physiological change to your thinking. Many people battling addictions experience it. A moment in time comes when you have earnestly had enough of taking substances, and the fear of change is challenged by bravery.

But the offer of a place at a facility right at that very moment is rare. You may be asked, like Tara was, to come back in six weeks – but all too often, by then you have lost the determination you were experiencing, and psychologically you have ‘given up’. The substances have yet again taken you hostage. I was very concerned about the accommodation decision and, felt as though we may be setting her up to fail.

We arrived at the property and the residents were happy to see Tara, but for all the wrong reasons. Tara was filled with fear and in trepidation; she did not want to talk to any of them and scuttled to her room quietly. To try to describe her mood, it was almost like she was shell-shocked, numb. I followed her to her ground floor room. Clean, tidy and warm. I looked out of the window. Two residents were standing not six feet away from her window. One had a can of alcohol, and both were in the process of handing money over to a drug dealer. She assured me she would be ok, but as I drove away, I was adamant I was going to do something about it.

My determination paid off when I received a reply email from one of the many private rehabs I had contacted, asking me to give them a call. As I have never won the lottery, I don’t know what it feels like, but I likened the feelings I was experiencing to those of winning. Tara had an initial offer of eight weeks, which was extended to 12 absolutely free. WOW, what an opportunity. The man who owned the facility was taken by my passionate appeal, Tara’s resistance to get involved with her housemates, and the fact that she was still clean and sober. He was an ex-addict, and believed, as I did, that everyone should be given a chance no matter who they are.

We arrived at a luxurious establishment in Derby, one week after she became a resident in the high need’s unit in Birmingham. What a roller coaster of emotions for her to deal with. She was still in a shell-shocked state. But the planets had aligned, and Tara was getting her chance.

She graduated 12 weeks later.

A few steps back

Unfortunately, bad news caught up with Tara. On the morning she graduated from the rehab in Derby, she made a phone call to her family, bursting with pride at her achievements. She had plans to visit them, until she was told that her grandmother had died while she had been in rehab. Her family had no knowledge of how to find her, or who to contact. Her Nan was dead and buried. Tara fell to pieces.

Without telling anyone of the tragedy, she left to catch her train and bought a can of Special K cider on the way. She arrived in Birmingham and went missing for three days. Full of sorrow and shame when she reappeared, she feared she had let us down. We were relieved she was alive. She had not used any substances but had continued to drink. I noted she was back to her whispering behaviours, and I was uneasy.

I had arranged a place for Tara at a ‘dry house’ upon her return to Birmingham, but because she was drinking alcohol, she could not access the accommodation. Abstinence was the rule. I approached a manager of a nationally known hostel in Birmingham, and we agreed she would give Tara a bed if I was still available to fully support her – which I was, with the help of my PM, who had formed a good professional relationship with Tara by this time.

Mental Health issues started to take a grip on Tara while at the hostel, despite her abstinence from alcohol. I informed her doctor, who visited her and arranged a home visit from the Birmingham Mental Health outreach team. My PM and I visited every day. Some days her paranoia was too much to bear, and she would not let us in. The hostel staff were fantastic, and between us all, we did everything we could until she was eventually admitted to a mental health unit on a section.

It was harrowing to see her being taken away that morning. Once we were allowed to visit, we did so every day, and the staff at the unit updated us on her progress. We attended the psychiatrist’s meeting weekly, as Tara had given her consent to share. We watched her improve with a different combination of medication. The doctor said she’d had a Psychotic Episode.

‘I felt that everything would be alright’

As before, I was in contact with the dry house, and the manager attended the mental health unit to do a face-to-face assessment with Tara and approved her for a place upon discharge. Tara’s face lit up. I could see the spark in her eyes return from the vacant darkness of old, and was bursting with pride at her strength and determination. This was a blip in the road to recovery, and Tara was back. I felt everything would be alright.

Tara had become extremely shy without her bravado blanket of substances, so when she moved into her room at the dry house, she found it difficult to mix. She was prescribed a cocktail of medication, which they took care of and administered to her every day, and slowly she started to come out of her shell.

After everything she had been through, Tara now had to look internally, with the help of mutual aid, and find out who she really was. Frightening, but she wasn’t about to give up. She had been through so much, and always with the LW/PM service beside her.

An occasion to be remembered

Blooming was a word I used a lot to describe her appearance as the months passed by. Slowly we relinquished intense support, allowing her to grow with the support she was receiving from the accommodation staff, and the camaraderie of her housemates. She was accessing mutual aid groups and mostly enjoyed the social benefits.

‘It’s my birthday’, she said when I answered her telephone call. ‘I’m one year clean and want you to come to my birthday meal’. When I think of all the barriers that were put in her way, it was amazing that she was here celebrating one whole year clean and sober. Sitting next to Tara in the restaurant enjoying a meal with a dozen or more new friends, eating birthday cake for dessert and singing ‘Happy Birthday’ as loud as we did was a very special night to be remembered.

In the end

RIP Tara. She was coming up to her second year of being clean and sober. We’d been on a shopping trip only five days before she died of natural causes. At her funeral, the not-so-tiny church was packed. She arrived like a princess in a horse-drawn carriage. And everybody cried.

What a testimony to the LW/PM service. Tara would not have died in a clean bed, in clean pyjamas, clean of drink and drugs with a peaceful mind and lots of true friends. Instead, she would have died in a doorway, dirty and neglected. The only company, the voices in her head. A product of today’s society. A number on the government homeless list. A misunderstood, wonderful human being ravaged by multiple and complex needs due to ignorance and a severe lack of funding.

The LW/PM service gave Tara time, love and understanding. Supported her through dark days, over hurdles as big as mountains, and believed in her. I’d like to think she died comforted by her Nan, with a smile on her face. At peace with her achievements, knowing she was loved by all who had the pleasure of meeting her, and the huge capacity she had to love others back. She lived a rich and meaningful life, in the end.

Tara Collins 1981 – 2019.

* The name of our case study has been changed.

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