"We need happy memories"

How people who have experienced homelessness are redesigning support

Professor Monique Lhussier & Dr Christina Cooper from Northumbria University, and an Experts by Experience panel

Fuse researchers at Northumbria University were recently awarded £1.4m for a project looking to understand connections between trauma, health and homelessness in the North East. Here the research leads share how they have previously worked to embed community voices to improve health and reduce disparities for people with experience of homelessness.

The link between trauma and homelessness has been well documented, with recent evidence showing that 94% of people experiencing homelessness have experienced trauma. In the majority of cases the trauma was complex and reoccurring, with 65% having experienced four or more traumatic experiences.



In 2023 we received funding from the Arts and Humanities Research Council to develop a network to better support people who had experienced homelessness. We were fortunate to work with eight Experts by Experience (EbEs), or Experts by ‘Disaster’ as Barnie (one of our EbEs) suggested; people who had experienced homelessness, and the complex multiple needs and exclusions that frequently co-occur. The nine months project aimed to develop integrated ways of working, embedding community voices into the system to improve health and reduce disparities for People with Experience of Homelessness (PEH).

Discussions, which were led by EbE throughout the project, reiterated that trauma was common and often started in childhood, and followed by further re-traumatising events. Karl commented that while he remembered in vivid detail what had happened to him as a child, he often could not recall what he had been doing last week, highlighting the lasting impacts of trauma. Further discussions highlighted negative impacts throughout life, from relationships, education, employment to mental illness, suicide and addiction.

We reflected as a group that PEH are often viewed through a lens that considers only their immediate needs; shelter, clothing, food, and healthcare. Drawing on Maslow’s hierarchy of needs we considered that only the bottom two tiers are the most consistently met, but belonging and esteem much less so. The Experts by Experience felt that people need to be given a chance to grow in more holistic ways across all tiers of the hierarchy in order to become healthier and happier.

Tonkin’s model of grief proposes a way to see a happy and meaningful future focusing on growth around the grief. From these discussions, we collaboratively designed the graph below, which superimposes Maslow’s hierarchy of needs with and adapted version of Tonkin’s, in a model to inform ongoing and future work.

We have begun to explore this model through three core project strands:

1. an innovation fund for which EbE were responsible;
2. participation in an accredited Northumbria University module, and
3. through understanding the impacts of involvement with the project.

The innovation fund pilot involved the development and implementation of five creative projects providing sustainable and varied opportunities for self-care, learning, and physical activity for People with Experience of Homelessness. One of those, the Hope Project, gave opportunities for 189 PEH to take part in new creative, social, or physical activities. Steven designed the Hope Project on the premise that ‘people need happy memories’, which those who have experienced trauma do not always have, to draw on when the going gets tough. Barnie explained that often people lose the motivation and ability to cook for themselves when they have lived on the streets. He designed cookery classes with a train the trainer model, meaning that many people have since benefitted from eating healthier food that they had cooked themselves. Lee set up a bike repair workshop so people can take part in physical activity and be more self-sufficient.

Being given the opportunity to manage a budget, help others and having the status of university student (“I have been called many things; it was nice being called a student!”), stood out as having had a positive impact for many of the Experts by Experience. Lee and Porl said that opportunities to shape the project and develop their skills as researchers led to them feeling trusted and valued as equal members of the project team. Further to this, involvement in the project gave a sense of purpose and belonging, and increased confidence for many EbE.

This supported the notion that it is possible to grow around trauma when we attend to people’s experiences, hopes, talents, potentials and ambitions, as well as their basic needs. It also challenged us, as researchers, to think of research not solely as a detached enterprise, but as an inherent part of a system that can support people to grow and have more positive and valuing experiences.

*This blog has been written in memory of Ben

References:

• Irving, A. & Harding, J. (2022) The prevalence of trauma in people who have experienced homelessness in England. Available at: https://www.oasiscommunityhousing.org/wp-content/uploads/2022/10/The-prevalence-of-trauma-among-people-who-have-experienced-homelessness.pdf
• Maslow, A. H. (1954). Motivation and Personality. New York, NY: Harper & Row Publishers.
• Tonkin, L. (1996). Growing around grief – another way of looking at grief and recovery. Bereavement Care, 15(1), 10-10.

Image:

1. Photo by Matt Collamer on Unsplash

Supporting people with Severe Mental Illness who face food insecurity to access a nourishing meal

Sally Smith, Peer Lead for Research, Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV)

I have met many wonderful and interesting people on the inside of a psychiatric ward. The immediacy and depth of connection between peers in there was an unexpected comfort in the most challenging of environments.

Illustration by Sally Smith

I remember lots of the stories shared in the smoking corners of gardens. We often reflected on how misunderstood we felt in the ward and in the world.

One young woman was desperate to stay on the ward as she knew that was the only way she was certain of ongoing access to food. Her cupboards empty, her benefits paused, she was terrified about discharge. I was unsure how much Dialectical Behavioural Therapy or anti-depressants would help: wouldn’t anyone feel miserable with no food or money?

I remember physical health checks on the ward being introduced. Being weighed and measured, compared to the graphs…. and yet being given medication that makes you want to eat sugar out of the bag, being locked on a ward with no way to exercise, offered beige food four times a day and feeling so damn lousy and desperate that motivation to even clean your teeth was a challenge.

It felt cruel and shaming. It certainly never helped me to change anything.

In my mind it is no surprise that the mortality gap for people with severe mental illness (SMI) continues to rise, the challenges and barriers around nutrition that people living with SMI face continue to go unseen. No amount of lessons on what makes a healthy plate will make avocado cost less than crisps, and no knowledge of a healthy Body Mass Index (BMI) will reduce the intense effects of psychiatric medication.

And perhaps this is more of an issue than ever with austerity and the cost-of-living crisis exacerbating people’s struggles.

Increasing accessibility of affordable healthy food to adults living with SMI in Middlesbrough

With this perspective in mind, I was delighted to join the team working on this National Institute for Health and Care Research (NIHR) Communities study as a peer researcher. With co-production and the voice of lived experience running throughout the project, we are seeking to develop practical solutions for people living with SMI who face food insecurity in Middlesbrough.

The project is a collaboration, bringing together lived experience with the best bits of Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV), Teesside University and Middlesbrough Environmental City, a charity dedicated to promoting healthy and sustainable living.

Over a period of 16 weeks, we plan to co-design and co-develop a nutritious meal with surplus fresh ingredients from local Eco shops (social supermarkets) that would otherwise go to waste.

With the support of the food scientists at Teesside University, this will then be turned into a healthy ready meal and distributed back to Eco shops in Middlesbrough. Aiming to be an appetising, nourishing and accessible meal for local people battling severe mental illness, who for whatever reason may struggle to cook the fresh ingredients themselves.

Through the design and delivery group we are hopeful that there may be additional benefits for all participants and the collaborating organisations, for example:

• The opportunity to learn some cooking skills and explore recipes that are good to cook on a budget.
• The opportunity to develop peer relationships amongst the delivery group that support connection and foster hope for change.
• The opportunity for organisations to learn from one another’s strengths and take a fully bio-psycho-social lens on mental health difficulties.

We are currently in the recruitment phase for participants and a collaboration of this type has not been without substantial challenge. It is has not been easy to marry NHS language and expectations and academic protocols with how a community organisation runs. It has not always been easy to find middle ground between the clinical expertise and lived experience expertise. However, I look forward to sharing the progress we make as the delivery team becomes established.

 

Research published by the project team

This study published today explores food insecurity prevalence and the experiences of adults with Severe Mental Illness (SMI) living in Northern England.

This systematic review paper found that people with SMI are more likely to experience food insecurity.

Another recently published paper identified strategies to tackle food insecurity centred on making food banks more accessible and improving the quality of available food available.

Saying farewell to Fuse and celebrating its remarkable women on International Women's Day

Laura Ritson, Programme Manager, NIHR Three Research Schools, Prevention Research Programme, Newcastle University

We are marking International Women's Day by saying thank you and a farewell to Laura Ritson, who helped to establish Fuse in 2008 and has been integral to the Centre's success, while at the same time welcoming new Fuse Manager Agata Robertson.

In this post Laura talks about her journey with Fuse.

Celebrating Fuse's 10th birthday

After an incredible 16-year journey, the realisation that my chapter with Fuse has come to a close feels surreal. I am deeply grateful for the opportunity to have collaborated with an exceptional group of colleagues. Their contributions not only fuelled the growth of Fuse but also played a vital role in my personal development, fostering a continuous journey of learning and growth throughout this period.

Casting my mind back to 2008, I had the privilege of supporting Professor Martin White in spearheading an application to the UK Clinical Research Collaboration (UKCRC) for a Centre for Translational Research in Public Health. This ambitious venture united our five esteemed North East Universities in a unique collaboration dedicated to advancing world-class public health research. Our mission was clear: to enhance health and well-being and combat inequalities. Professors David Hunter, Charlotte Clarke, Janet Shucksmith, and Ann Crosland, among others, joined forces with us in this endeavour. The success of the application was made possible through the invaluable support of policy and practice leaders in Public Health, including Professors Peter Kelly and Eugene Milne. Their ongoing commitment to flying the Fuse flag is truly commendable. The Fuse funding was allocated for infrastructure to build public health capacity in our region. Securing funding alongside four other national centres forged close working relationships that have endured over the years. In 2009, I was delighted to be appointed as the Administrator for Fuse.

Reflecting on the past, our initial funding contract mandated a two-year review due to concerns about the complexity of our collaborative model, one which we passed with flying colours. Fast forward to today, and it's evident that collaborative efforts are now an integral part of our professional landscape. Embracing collaboration with practice partners and the public has been a significant aspect of our growth during my tenure with Fuse. How times have changed, and how exciting it has been to witness and contribute to this transformative evolution.

There have been so many highlights that it’s difficult to know where to start, and impossible to cover them all!

We underwent a lengthy process to identify our name, debating between Fuse and Rede! The communications agenda has grown considerably since we first established Fuse, and we have produced this award-winning blog and our public partner led podcast, and found many other creative ways to share our research supported by Fuse Communications Manager Mark Welford. The Fuse network has expanded to 2000 members, and we now have a dedicated Public Partner network, thanks to the support of Fuse Public Involvement and Engagement Manager Ella Anderson.

Another jewel in the crown has been AskFuse, a rapid response and evaluation service for our policy and practice partners. Special thanks must go to Professor Janet Shucksmith and Rosemary Rushmer, who were integral to establishing the service, and Dr Peter van der Graaf, Lesley Haley, and Annmarie Ruse, who have supported the development and continued to lead the way with a service that has also inspired and influenced the development of other regional and national infrastructures.

Capacity building has been integral to the Fuse endeavour, and it’s been great to see the development of public health leaders of the future. I’ve witnessed Fuse PhD students progress to senior-level careers in local authorities, prestigious NIHR awards, and professorial appointments.

I have been delighted to be part of the founders and planning of the Fuse International Conference on Knowledge Exchange in Public Health, and I am looking forward to connecting with colleagues at Cornell in June for the 6th International Conference.

Receiving the Director's Award from Ashley at the Fuse Awards 2023

I’ve seen many changes over the years, including in directorship to Professor Ashley Adamson. Working with Ashley over the last 10 years has been truly inspirational. A successful woman leader, she has steered Fuse through two renewals of its membership to the NIHR School for Public Health Research (SPHR) and also successfully directed the national School since 2017, with the support of a fantastic directorate team at Newcastle University who I’ve been fortunate to work alongside. I’ve also been inspired by the work of Professors Eileen Kaner, Carolyn Summerbell, Clare Bambra, Susan Carr, Monique Lhussier, and Amelia Lake. All of them challenged and helped me grow in the Administrator role, which expanded considerably between 2008 and 2017, enabling a strong case for a promotion opportunity to Fuse Manager.

In 2018, we moved towards a Fuse sustainability model, transitioning away from research council funding and towards Fuse partner University contributions, one which took time, effort and challenging conversations. Sustainability funding covers core staff costs and non-staff activities, including successful research events that serve as a key opportunity for disseminating our research, engaging in dialogue about implications for policy and practice, making new and strengthening existing contacts, and building a dialogue around research results and potential future projects. These events are a crucial forum for knowledge exchange. There has also been the development of the Physical Activity network and Embedded Researcher network which attract national level engagement.

In 2020, I was an integral part of a Fuse-led application to the NIHR Public Health Interventions Responsive Studies scheme, in which PHIRST Fusion was established. The Fusion initiative takes an evaluability assessment approach to co-producing evaluation design that addresses the priorities of Local Authority stakeholders. Due to my experience with Fuse, I led the communications agenda for PHIRST at a national level and helped secure funding from the Department of Health and Social Care for a dedicated Communications Manager post, which we now host within PHIRST Fusion.

I’ve been dedicated to working with Fuse for a number of years, drawn by; the people, nature, and variety of the Programme Manager role, the difference public health research is making to the population, and the flexibility I’ve had during my career to bring up my children through a combination of part-time and flexible working and during a national pandemic. I was also enthused by the challenge each day brought my way.

I’ve been grateful to Cheryl Wiscombe for supporting Fuse Administration and, more recently, Ann Payne, who has supported me with Fuse’s membership in SPHR. 

I’m thrilled to have transitioned into the role of Programme Manager for the NIHR Three Schools Prevention Research Programme, hosted by the School for Public Health Research, all while pursuing a part-time MSc in strategic leadership. Considering the latter, I had never thought myself capable of undertaking such a commitment. However, thanks to the support and encouragement of close colleagues, I've grown in confidence to seize this opportunity.

I extend my heartfelt gratitude to everyone who has shown dedication to Fuse over the years. I wish Fuse the best of luck for the future under the leadership of the new Director, Professor Sheena Ramsay, and Programme Manager Agata Robertson. I am confident that the coming years will bring both joy and challenges, and I eagerly anticipate following your progress, including the expansion of Fuse into Cumbria and the reinvigoration of the Fuse research clusters.

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Visit the Fuse website to meet new Fuse Manager Agata Robertson, as she tells us about herself, her interest in public health, and what attracted her to working with Fuse.