S O C I E T Y & C U LT U R E
PROFILE
Family intervention,
health and wellbeing
Steve Hackney, of Tower Hamlets Family Intervention Project, discusses how the
project aims to provide families with help and support around their physical and
mental health in order to address their multiple problems and issues
W
ould you be able to concentrate on reading this
article if you had not eaten this morning? What if
you also hadn’t eaten last night? Would your ability
to focus upon the words on this page be hindered if you were
physically unwell? What if you were seriously so? What if you were
depressed and your every day blighted by a sense of unrelenting
helplessness, hopelessness and crushed self-esteem?
Now picture instead that your task is to find a job after being
unemployed for many years, to address your crippling financial
debts or to attend a meeting about your threatened tenancy
following your son’s antisocial behaviour. What if the day ahead
demanded you address all three issues?
For many families supported by the Tower Hamlets Family
Intervention Project (FIP) these situations are a painful reality.
These families have to address multiple complex and entrenched
problems while at the same time suffering from poor physical and
psychological health.
the basic biological needs
‘ofAddressing
a family acts as the starting point for
our interventions. For those with none,
we provide food. For those who cannot
pay for their medication, we buy it.
’
The trajectories into these problems are multiple and
multifaceted, as are the approaches used by FIP to address
them. Notably though, the roles of adverse psychological
health and physical ailments in the manifestation of such
issues are all too often described by families trying to make
sense of their circumstances.
Stress, depression and anxiety disorders within our families are
commonplace as they try to address the issues facing them.
Fortunately, suicidal ideation and attempts are less prevalent but
are still worryingly present in a small amount of cases. Such
conditions can leave families feeling overwhelmed, helpless,
isolated and without a vista or hope. The burden of this can hinder
a family’s perceived ability to manage their finances, address their
debts and pay their rent. In addition, it can cruelly affect the way
they see, and interact with the world and others around them.
Hierarchy of needs
Maslow proposed that humans have a ‘hierarchy of needs’ and
that our basic biological, social and emotional needs must be
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met before we can achieve our true potential. This hierarchy of
needs acts as a theoretical guide to much of the work undertaken
by FIP. Addressing the basic biological needs of a family acts as
the starting point for our interventions. For those with none, we
provide food. For those who cannot pay for their medication, we
buy it. For families whose homes are unsuitable for their needs,
we advocate for them to be moved. For families whose homes are
unhygienic and unsafe we help them clean and report repairs.
Neglected health issues are addressed.
Appointments with medical specialists are made and jointly
attended to ensure professional support is not only in place, but
accessed consistently. The adoption of healthy lifestyle choices is
actively encouraged and substance misuse and abuse is targeted.
By intervening in this way, families are helped to prioritise their
physical health and support is put in place where none exists, is
limited or is not being utilised.
For families for whom we have concerns around the mental health
of one or more of its members, practitioners take time to carefully
listen to their stories of how they became unwell. They explore the
impact their poor wellbeing has upon their day-to-day functioning,
offer an insight into mental health conditions and discuss the
range of treatment options available. Practitioners adopt the
Rogerian principles of being empathic, genuine and offering
unconditional positive regard. They are kind, non-judgemental and
skilled in the art of relationship building, communication and in
knowing how to engage and motivate families.
Generic intervention skills such as problem solving, solution
focused and motivation techniques etc. are delivered by
experienced FIP practitioners. Referrals are made to relevant
professionals (for example, general practitioners, counsellors or
mental health services) and families are supported to attend
appointments. Working systemically and holistically within the
family, the needs and views of other family members about the
impact upon the family is also sought and addressed.
A helping hand
Take, for instance, the case of ‘Richard’. His story is typical of the
families we support in that although his poor physical and mental
health were not the primary reasons for his referral us, these were
the needs that had to be addressed before we could deal with the
issues that brought him to our service.
Richard was referred to our Rent Support Programme
(www.Kineara.co.uk) due to excess rent arrears by his housing
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S O C I E T Y & C U LT U R E
PROFILE
provider.1 Upon meeting him we discovered he was a vulnerable
adult, lived alone and was hard of hearing and short sighted. He
had mild learning difficulties, spoke of previously having suicidal
thoughts and said he felt incredibly low and extremely isolated.
Upon meeting him, it was clear he had neglected to look after
himself and his home. He was living in squalor and his home
was unsafe and unhygienic. Rubbish and cigarette butts covered
his floor and there was dirt caked on his windows and furniture
surfaces. Richard reported that he’d had several accidents within
the home due to its condition. His toilet was broken and his
bathroom and kitchen were unsanitary. Richard had been
unemployed for many months and stated he was unaware he
could claim benefits. He had therefore been living off the £10
(~€12) a week he received from his mother. As a smoker, half of
this money was spent on tobacco leaving him with only £5 a
week for food. His diet was inevitably incredibly poor. A
combination of the factors described above and a lack of
appropriate support had led Richard’s finances to spiral out of
control, which triggered his housing provider to refer him to us to
explore the reasons behind his rent arrears.
We are not health professionals:
‘rather,
we are the eyes and ears that
serve our community to identifying
and supporting society’s most
vulnerable individuals. It takes skilled
professionals and it takes time. Here in
Tower Hamlets, investing in both has
led to fruitful outcomes for the
families we support, our partners and
our stakeholders.
’
Although an extensive description of our intervention is beyond
the scope of this article, it was evident that Richard’s basic needs
were not being met. Therefore, it was these needs that were the
initial target of our intervention. Firstly FIP provided food bank
vouchers and took him to collect food donations so that he could
eat and we helped him to claim his correct benefit entitlement.
FIP then assisted Richard in cleaning his home to a safe and
hygienic standard. Integral in this was teaching Richard the skills
to do this himself and explaining the reasons why cleanliness was
so important. FIP bought Richard cleaning equipment, including a
vacuum cleaner, and other essentials to tend to his basic needs,
such as a kettle, toaster, pots, pans, and bedding. As the project
progressed FIP empowered Richard to take on more responsibility
to look after himself and his home so that he and it were safe and
clean. We showed him how to report repairs and organised for his
toilet to be fixed.
As a result of FIP co-ordination, Richard attended the dentist, got
his hearing aids fixed and received new glasses from his optician.
We helped him develop an awareness of healthy lifestyles and
encouraged him to take better care of himself by washing daily,
brushing his teeth, eating healthily and taking regular exercise. To
ensure these gains were maintained beyond our intervention, the
FIP made a referral to adult social care who then secured funds to
provide Richard with a support worker twice weekly.
In addition to the practical and emotional support given
throughout our intervention a referral to a local community group
helped reduce Richard’s isolation, lift his mood and get him reengaged with his local community. Once Richard’s basic needs
had been tended to, and his mood lifted, his home safe and
clean and his health optimal, FIP were then able to address his
employment, financial and housing issues. Richard said this of his
journey and the support he received:
“They were there for me. They became people I could turn to
discuss my problems with. FIP are not just people doing jobs, but
are friendly and supportive. When I first met FIP I was depressed
and lonely. I was depressed due to my isolation but now FIP
introduced me to social groups and got me support.
“I am more confident to be able to talk to people and get ‘out
there’. Having a support worker now in place will continue to
motivate me. I feel more confident. The support FIP has put in
place for after their project ends will help me continue to meet the
goals I have set myself.”
Here Richard gives a nod to his improved emotional wellbeing
that he attributes to the support given, and his re-engagement
with his community. Richard has maintained his healthy diet and
exercise regime and went on to quit smoking.
We are not health professionals: rather, we are the eyes and ears that
serve our community to identifying and supporting society’s most
vulnerable individuals. It takes skilled professionals and it takes time.
Here in Tower Hamlets, investing in both has led to fruitful outcomes
for the families we support, our partners and our stakeholders.
1 Emerging research from America (see Sweet, Nandi, Adam & McDade, 2013)
is highlighting the links between household debt as a socioeconomic
determinant of health and its impact upon physical and mental health.
Kineara’s Rent Support Programme aims to buffer the impact of such debt,
explore its root cause and encourage better financial management.
Steve Hackney
Family Intervention Project Practitioner
Tower Hamlets Family Intervention Project
tel: +44 (0)2073 644082
[email protected]
www.towerhamlets.gov.uk
Reproduced by kind permission of Pan European Networks Ltd, www.paneuropeannetworks.com
© Pan European Networks 2014
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