1. Policies must target the homeless in particular. This requires the recognition of the homeless as a specific group within the socially excluded that need solutions that are specific to their situation.
   
   
2. Solutions must address the multidimensional nature of homelessness, considering housing, employment and welfare alongside mental and physical health.
   
   
3. Policies must be based on the presumption that homelessness is a stage of life that people enter into, but from which they can also escape. Therefore, treatment must comprise of prevention, reception and reintegration, and support must be offered on a long-term basis.
   
   
4. Close partnerships should be fostered between private and public associations, such as local authorities, NGOs, health organisations etc. Each has expertise in particular areas and can make a contribution to addressing the challenges faced by the homeless. These partnerships should be backed by policy and legislative requirements if they are to have maximum benefit.

Below are the key findings in existing good practices for working with the homeless experiencing mental health problems:

1. Users should be approached to help overcome a common lack of trust in public services. Traditional services must be customised to meet the needs of the homeless.
   
2. Labour insertion should take place alongside treatment, as employment is the key to building self-confidence and empowering the individual.
   
3. Lasting interventions are crucial, so that the trust of the user is maintained. The support process must be continued for as long as it is required.
   
4. Civil society organisations must have the capability to provide input to local policy makers.

An illustrative example where the above policy recommendations are pertinent is in the case of dual diagnosis. In such cases, clients may require dual treatment for drug abuse and mental health problems, where integrated treatment is given simultaneously and patients receive combined, modified care, which is customised for them as individuals. In the first instance, policy makers need to be aware of these situations, and thus the specific resources that are required for treatment. Efforts must be made to co-ordinate the various organisations that will be supporting them.

Below are some specific recommendations in the provision of integrated treatment:

1. There must be active outreach for clients in places where homeless people are found.
   
   
2. A holistic view must be used, taking into account the importance of work, living and social relationships.
   
   
3. Decisions should be shared between the client, relatives and other significant people.
   
   
4. Medical treatment, where appropriate, should be given for psychiatric and drug abuse problems.
   
   
5. A long-term perspective should be adopted towards treatment and care.
   
   
6. The spiritual welfare of the client is also important. Daily cultural and leisure activities should be made available and efforts should be made to integrate clients into the labour market.
   
   
7. Staff from different professional backgrounds should be employed with significant experience in psychiatric care, drug abuse, and social work. Special care should be made to ensure that staff are wholly committed and are prepared to work enduringly to build security and confidence with the client.
   

Good practices chosen from the thematic area homelessness and mental illness, Bologna conference 21st – 22nd October 2004

The Job Agency, Bologna, Italy
The Job Agency is a service provided by the Mental Health Department of the Local Health Authority in Bologna.

Aims & objectives:

• To therapeutically rehabilitate psychiatric patients through employment. Work plans are to be designed to restore a sense of dignity to the patient by giving the patient autonomy, but also behavioural and social guidance.
  
• To develop an innovative operating model that enhances the opportunities for psychiatric patients in the labour market, through pre-employment and on-the-job training. Although the department is seeking to expand the project significantly, it is crucial that the employment offered is of high quality.

Programmes of activity:

• The mental health department establishes and carries out rehabilitation programmes, and also seeks out programmes that can be adapted to the needs of psychiatric patients. Training is given in accordance with the various types of opportunities and resources that are available.
  
• Programmes are customised for the individual patient and special care is taken to match clients with suitable work places. Particular consideration is given to the route the work placement will take from beginning to end, the structure of the company/organisation, the duties to be carried out and support and assessment.

Best practice:

• The job agency is an excellent example of integrated treatment at work. A holistic approach is taken, where work is the key to the spiritual welfare of the individual. Daily activities and good habits are formed, helping to rebuild broken lives and restore dignity and confidence. The opportunities provided allow for a sense of personhood to be restored, as reconstituting the life around the patient is interconnected with biomedical treatment.
  
• Close co-operation between various public agencies ensures the smooth operation of the programme (e.g. employment centres, universities, local health authorities, and also private bodies that are keen to work with the socially disadvantaged).
  

Single Point of Access, Bologna, Italy
The Single Point of Access (SPA) project is run by the Social Services Coordination Department of the Comune di Bologna. The project was initially designed for drug addicts, but has since expanded its remit to include all homeless people. The service is, however, still largely used by drug addicts and those with ‘dual diagnosis’.

Aims & objectives:
To reinstate the homeless on a path towards integration by providing the essential first step in social services, covering primary needs.

Programmes of activity:

• SPA provides advice and information about the range of social services available to homeless people from its unit, which is open six days a week.
  
• Clients visit the centre for an initial appointment where his/her needs are established. During the second visit, the client is given an in-depth plan that outlines which services should be used.
  
• Clients are given support in accessing services for drug addiction and/or mental health problems.

Best practice:

• The project provides a tailored therapeutic path to its clients based on individual needs and on a working partnership between staff members and clients, ensuring that decisions are agreed upon on ‘both sides’.
  
• The range of advice offered at the unit allows for a comprehensive overview of the needs of the client to be assessed and matched with the appropriate services on offer.
  

Stödhuset (Support House), Malmö, Sweden
Stödhuset was set up in December 2003, when it began to provide supported housing and associated social services for homeless clients. In August 2004, a psychiatric reception was added to diversify and further integrate service provision. The support house is run by the City of Malmö, the City District of Kirseberg and the Malmö psychiatric clinic.

Aims & objectives:

The support house aims to provide an integrated service for homeless men and women who suffer the dual diagnosis of drug abuse/addiction and psychiatric illness, particularly schizophrenia, whilst providing them with stable housing in the same building in which treatment is given.

Programmes of activity:

• A multidisciplinary service is provided. This includes psychiatric treatment and rehabilitation. Counselling is also provided on site.
  
• Housing conditions are very good and there is a high tolerance of drug abuse. There are ten rooms and each client has their own tenancy agreement.
  
• Clients who are long-term patients are encouraged to reintegrate and are given their own flat to increase their independence.

Best practice:

• The project is a clear illustration of integrated services at work, involving close cooperation between social and psychiatric services.
  
• Support is provided on an individual basis and is tailored to the individual.
  
• The provision of psychiatric treatment within the same building as supported accommodation removes, as much as possible, the barriers to seeking help for homeless people.