Having spent 20 years talking to people with multiple needs, who are homeless or in the criminal justice system, it seems to me that there are two main pathways through life that might lead to someone ending up in that situation.
The first pathway starts in childhood. People in this group may reveal, through their words or actions, the deep and lasting impact that their disturbed childhood has had on them. The clues are often physical: the scars and self inflicted tattoos mixing with injection sores on a woman’s arm or the man with a broken arm and raw knuckles after repeatedly punching the wall of his new flat when the doors and walls silently closed in. Or behavioural: the repeated mistrust, aggression, avoidance or victimisation that destroys attempts to build relationships and accept help.
The second group are at first more puzzling. This seems to be someone who had a good childhood, who loved and was loved, who had a job, a home and the trappings of normality. But after a while inevitably a story emerges which reveals an incident or chain of events that have crashed into the person’s life, throwing them off course.
I’m thinking of a homeless ex-soldier whose shoes remain highly polished but whose avoidance of any “aggravation” kept him out of hostels and on the streets for years. And a business man who saw his wife and children die in a burning car for whom secretly smoking heroin became a refuge.
To ensure we offer the sort of help that is effective we need to understand what these life experiences do to a person.
To explore the science behind this I am reading Trauma and Recovery by Judith Herman. She describes the impact of war, disaster, atrocity, rape and childhood abuse.
She also highlights the links to substance misuse and breakdown of ties to family and community that can follow:
“It seems clear that traumatized people run a high risk of compounding their difficulties by developing dependence on alcohol or other drugs.”
Over the next few weeks I will write more about this book and Herman’s three stages of recovery: establishing safety, remembrance and mourning and reconnection with ordinary life. I will also point to resources that might help practitioners and policymakers including this guide published last year by the National Mental Health Development Unit.
If we are to offer real help to people with multiple needs we must recognise that for many trauma lies behind the symptoms. Our services, systems and policies must also understand what happens to traumatised people and offer the holistic help that can lead to recovery.