Health Promotion for People Experiencing Homelessness: What Workers Can Do
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Presentation given by Des Ryan, Edinburgh Cyrenians, UK at a FEANTSA conference on "The Right to Health is a Human Right: Ensuring Access to Health for People who are Homeless", 2006.
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Health Promotion for People Experiencing Homelessness: What Workers Can Do
- 1. Health Promotion for People Experiencing Homelessness Workshop 4 Des Ryan, Director Edinburgh Cyrenians What Workers Can Do
- 2. What is stopping us? ๏ข โHealthโ is for the experts ๏ข We are too busy ๏ข Health is not the priority ๏ข We are not funded to do this ๏ข Its against our beliefs
- 3. A Place of Opportunity? ๏ข Trusting, warm relationships ๏ข Seeing all sides of the person ๏ข A โcaptive audienceโ ๏ข Already helping
- 4. What Matters? ๏ข Immediate issues: e.g. sleep, food, worry, physical problems ๏ข โฆbut how are you feeling? ๏ข individual and group approaches
- 5. Good Food in Tackling Homelessness ๏ข 70% of street homeless suffering malnutrition ๏ข Food to 43 local charities ๏ข Cooking classes ๏ข Improving standards ๏ข User involvement ๏ข Promoted across Scotland
- 6. Developing Practice 1. Service policy โ commitment 2. Training โ developing an action plan 3. Bringing in support from health services 4. Review & evaluation 5. Training & support for staff in health promotion
- 7. We can make a difference
Editor's Notes
- My contribution is as a provider of services. 30 years in tackling homelessness, from volunteer on night time soup runs to Director of Edinburgh Cyrenians. Starting point: People need to be healthy and to feel well if they are to improve their lives. How do we help them to do that? Developing research and practice over the last 10 years Participants here who are running services will be dealing with a wide variety of client groups and circumstances and my comments will not apply to every situation, but I hope that there is something useful or thought provoking in what I have to offer
- Research โ Healthy Hostels and recent research with Health Scotland aimed at finding what else can be done by those working face to face with homeless people to promote health and well-being. What is stopping us? (examples) Health is for the experts โ specialist area; narrow vision of health; no confidence or training; mystique Too busy simply running the hostels or centres; no time or the right space to sit and talk Priority โ health may not be the presenting issue Funding : services increasingly tied down by funders to what they have to do (SP) โ workers are not given permission, training or encouragement by managers to touch this work. Hostels (etc) are often not seen as places of health promotion Beliefs โ e.g. religious organisations providing condoms
- Research finds that many โ not all - hostels and other such helping centres are in many ways the best place to start working with people on improving their health Relationships โ workers might lack skills and confidence but often have great working relationships Unlike a doctors surgery, people living & working together get an honest, rounded relationship Rightly or wrongly a hostel intervenes in lifestyle โ often rules on smoking, alcohol or drug use, sleep times, food (etc)โฆ If it has to do so, this is an opportunity to offer residents an alternative. E.g. how to turn a management problem into an opportunity โ example of stopping smoking and dealing with sleeplessness Both pieces of research suggest that health promotion can be integrated with other resettlement work
- Do health professionals have the same concerns and priorities regarding the health of homeless people as homeless people do about their own health? (The 2 bits of research suggest that there is a difference or a different way of describing it. Participants tended to view their health in terms of functional concepts such as taking regular exercise and getting a good nightโs sleep. In this respect health is seen as a tool for everyday living. Participants in the recent Scottish research expressed a greater concern for their physical health than their emotional or social health. Many participants did however recognise the importance of various dimensions of emotional health such as feeling in control of their lives and being generally happy) As peopleโs circumstances improve, their concerns become less short โterm: either different issues arise or the same issues are described differently e.g. new Cyrenians residents arrive, they report medical issues, if any. Over time, as they settle, the issue becomes โhow are you feeling?โ In Cyrenians case we provide 2 routes by which people might express the need and wish to do things that will help them to feel better: individual case support and group activities
- An example of health promotion in practice โ many others 70% of street homeless suffering malnutrition: organisations struggling to offer enough, quality or choice; food = depressing experience Year 2000: joined scheme to get surplus food Food to 43 local charities; Cooking classes; Improving standards User involvement Food experience of homeless people in Edinburgh has been transformed โ now to be promoted across Scotland
- The starting point is that management develops a statement of intent: We can do things in how we operate to help people to improve their health, to feel better and to change their lifestyle. Health promotion strategy in each place e.g. training workshops with staff and residents to look at what can be done e.g. Cyrenians: food, caffeine drinks, sport & exercise etc โ leading to an action plan. Making the hostel or centre into a place that promotes good health and well-being Having a determination to do something and a clear plan makes it easier to bring in and use health professionals to support this. Also many community resources available that the service may not be making use ofโฆ Review: it is exciting for those concerned to see the difference they can make in making their hostel or centre a place that is healthy and hat promotes better health & well-being. One of the by-products from work that has been done is the benefits for workers themselves: exercise, smoking cessation, better eating Workers themselves are often the champions of keeping the strategy going โ need for on-going training and support to ensure this work doesnโt fade into the background
- My proposition is thatโฆ improvements can be made in every service for homeless people. We can make hostels and other centres into healthier places. We can do things within them that help people to improve their health and to feel better. We can improve the ability of workers to help people to learn and to support them in a healthier lifestyle. The keys are: Owners and managers having an enlightened understanding of the part that health promotion has in tackling homelessness Training for workers to help them see what they can do The involvement of people using services Making demands and use of community health resources