Results from the conference in Bologna, October 2004.

The second Catch conference Homelessness and Mental Disturbance, October 2004 was organised by the Municipality of Bologna. The goals of the conference were:

• identify best practices in the Homelessness and mental health domain;
• identify different approaches to similar problems with a particular attention to the different national legislative frameworks.

The conference included: field visit to homeless shelters in Bologna; field visit to the USL (Local Health Authority) Bologna Mental Health Dept; a plenary session aimed at highlighting local activities and peculiarities in the management of homeless persons in Bologna, Italy. Four specific workshops were organised to carry out an in-depth investigation on: The dual diagnosis; Structures for the Homeless; Picturing the hardship and The representation of an integrated social service.

Workshop 1: The dual diagnosis
Based on a pilot experience carried out in Malmo, it targets people characterised by drug abuse and mental disorders. The service is managed through a strong coordination and co-operation between psychiatric care and drug abuse units and has deployed the customised approach to users. They approaching users in their natural environment and involve users and relatives in the decisional process.

Workshop 2: Structures for homeless persons
The workshop dealt on the impact the different national legislative frameworks have on the organisational aspects. In Italy, following the Basaglia law, lunatic asylums are no longer allowed while in the other CATCH partners’ countries these still exist it was highlighted where such asylums exist even people with slight behavioural problems are in a condition of social exclusion or at risk of exclusion. A peculiarity of Bologna is the city has no special shelters for homeless people with mental disorders. The difference of approaches identified during the workshop has suggested to in-depth analyse intervention methodologies which will be further developed by Bologna.

Workshop 3: Picturing the hardship
The aim of this workshop was to focus on the self-representation of the hardship bound to social exclusion through the use of painting. The art-therapy methodology allow the participants to paint a picture of the hardship bound to social exclusion on their own or to create a common picture that might show a common representation of the homelessness complexity The final comparison between the participants put in evidence the following points: the theme of the road appear both as a negative meaning (strive for survival) and in a positive meaning (as a personal life-journey that will lead homeless people to be happy again). The theme of exclusion the feeling/being different from the “normal social body”, in terms of possibility and needs more than in terms of desires. The final comparison between the participants put in evidence the following points:

• the theme of the community, referring to both the original community and the street one
• the theme of the contrast between desperation and hope
• the theme of the friendly support in contrast with the strictly professional one

Workshop 4: The representation of an integrated social service
The workshop was based on 2 role-play, in which every one were asked to play a specific role. Some played an institution (such as mental health Dept, social services, labour reinsertion office, mensa, etc), some acted as the users, while two participants were asked to be the observers.

The first role-play showed the dispersion of social services, which were represented by the institution-players in a positive level for its autonomy, speed of intervention and low-stress-level, while at a negative level it was seen for an almost absent control on the users’ program and for the high level difficulty of exchanging information. The second role-play showed how the concentration / connection of social services: was perceived by the institution-players as a major strength and control on users and was perceived by the users-players as invasive (privacy violation) and forced approach (their programs forced according to the institutional needs instead of their own).

Good practices
Here follows three good practices from the Bologna conference with their innovative features.

TELECEM
Promoted by: Manchester - Toucan-Europe
Innovative features:

• Multidisciplinary approach
• Strong co-operation between the mental health dept. And social co-operatives
• Specific support to facilitate labour reinsertion for users with mental disorders also through the creation of individual enterprises
  The methodology for intervention was counselling and psychiatric support. The funding of the project was a co-operation between public and private funding. Financial resources and training activities managed directly by Toucan Europe. The results were higher chances of social reinsertion for homeless persons with mental disorders and that training has had a therapeutic effect on mental conditions.

AGENZIA LAVORO (LABOUR AGENCY)
Promoted by: City of Bologna and USL Bologna
Innovative features:

• Strong co-operation between the USL mental health Dept and the city social services
• Specific support to facilitate labour reinsertion for users with mental disorders also through the creation of individual enterprises
  
  The methodology of intervention was that the psychiatric the Agenzia Lavoro appointed a tutor who followed the user along a personalised / customised reinsertion / therapeutic process. Financial resources and training activities are provided directly by the USL Bologna.
  The results were higher chances of social reinsertion for homeless with mental disorders and
  avoidance of redundancy for the services provided by the two institutional bodies involved in the process.

ARBORETO PROJECT
Promoted by: City of Bologna
Innovative features:

• Strong co-operation between the City Social Dept and Third sector (social co-operatives)
• City funding the operation; management provided by social co-operative
  
  The methodology of intervention was to focus on the labour reinsertion of homeless with mental disorders. They were trained in gardening by the co-operative and deployed in the maintenance of a city park. Financial resources are provided by the city of Bologna (labour fellowships); once the training is over the social co-operative hires the workers. The results were a high percentage of reinserted workers and a balanced financial burden between public and private actors.

Key findings
The chosen good practices showed the following common features which CATCH evaluated as key in the care of homeless persons with mental disorders:

• need to encourage long lasting and integrated reinsertion process rather than spot interventions
• need of strong co-operation between institutional bodies to maximise impact and avoid redundancy
• need to involve the private sectors (both social co-operatives but also profit enterprises)
• need of individual support (i.e. tutoring and counselling)

Due to various phenomenon (e.g. immigration, family structure, labour market, etc) the homelessness is rapidly changing. To a higher demand of diversified services does not correspond a proportional increase of financial resources to fund additional or extended services. A possible back up to this challenging situation may go through the re-organisation of existing services and in particular through:

• a stronger co-operation among involved organisation to increase efficiency and avoid waste of resources
• an higher involvement of the private sector in the homeless reinsertion programmes
• a complete “re-thinking” of delivered services to meet the constantly changing demand.

Download paper {pdf}

Mensa Bus - Bologna {pdf}

Salztorzentrum - Vienna {pdf}

Social Sanitary Ambulatory - Torino {pdf}

Support House - Malmö {pdf}

Telecem - Manchester {pdf}

The Access Point - Edinburgh {pdf}