Source: http://www.smes-europa.org/D-&-W_profiles-EN.htm
Timestamp: 2019-04-20 08:42:41+00:00

Document:
In the summer of 2011, I observed several times a about 45 year old woman at the Main Library and in the center of Copenhagen. I tried to contact her, but she chose to ignore me completely. I tried both in Danish and in English, but she just returned back to me and was not happy. A month of many meetings later she told in English with a French accent that: She has previously worked at a restaurant here in Copenhagen, but have lost their jobs, have been in Denmark for 4 years, have no proof of identity, studied 2-3 different languages ​​and have family in Belgium, France and the United States. We do not know who she is or where she is from. European appearance.
Madeleine seemed rather chaotic. Her movement pattern was very nervous and chaotic. Her clothes were very eye-catching, and it seemed as if she had too many clothes on. She dragged always around some very large bags. Her whereabouts in the streets has attracted considerable interest. She was striking, and by a very special dress, which gave the impression that she had too much clothes on, and by that she constantly carried around in big bags and finally she could often be seen sleeping partly on benches.
INTERVENTIONS : what kind of intervention – in health + social field - success of non success depends of …; description – what devices were put in place? With what results and difficulties?
After some months of hospitalization was Madeleine medically ready to be printed. She told him that she was French , born in Paris . She also tells her real name and other data.
Via Project Outside 's international network we contacted a shelter ( a riverboat in Paris) for mentally ill homeless. We provided shelter with a detailed description of Madeleine's situation like we got translated printing the letter from the psychiatric ward - for use in the continued treatment at home . The shelter was happily prepared to receive Madeleine and after much red tape with the French Embassy and the Danish authorities could we at the beginning of March 2012 to board a scheduled flight to Paris. At the airport we were greeted by a waiting staff from the hostel , which drove us to the river boat where Madeleine was embraced and where we dumped enrollment procedures. After a relaxed atmosphere and the purchase of small needs we said goodbye and I returned to Denmark.
4. WORKERS & NET : description of workers and of their role in interventions.
5. PROPOSALS : what kind or pathways & priorities can be generalized, translated, adapted? Or only specific to you ?
Meeting the homeless where he/she is and accept it could take long time to get in contact.
Have the needed time for the meetings.
Have and use a professional network, built up over years.
Continue the contact until the case is finished.
1. BACKGROUND: status - profile of the person in relation to the social conditions/health of "Dignity and Well-being" what part attributed to the time dimension, rupture of the social cohesion - abandonment, lack of care?
Fred is a man of 59 years. Danish. He has the last 4 years been living in a forest 15 km north of Copenhagen. He has built himself a den of plastic sheeting. He lives here year round, receives no public services and have nothing but what he can earn by singing in the streets of Copenhagen and selling bottles he finds in dumpsters.
He has since he was 30 years old lived without permanent residence. He moved around in Denmark, Sweden, Norway and Germany, and lived on nothing. I was made aware of him by his sister who knew me from the time I had contact with her and Freds father, who lived on streets in Copenhagen in the 1990s.
Father and son are similar in appearance as well as psychologically.
Fred has not been enrolled in any address in all these years. The municipality he is now staying in, will not recognize him as a citizen of the municipality. He is no possibility of getting social services (including money), and healthcare.
I visit him several times in the forest at his cave. He is aware that I have known his father. He has a number of strange and unrealistic ideas about how he can be recognized as a Danish citizen again.
Later I visit him mostly at the local library where he spends the day reading and let his flashlight and radio up.
Along with an outgoing social worker from the municipality we make a strategy/plan, we visit him regularly. I make a medical claim for a pension. We complain about the municipality's rejection of him as their responsibility. After 1 ½ years, I write to the mayor. Then he receives social security benefits get a health card and offered a home.
Here I end and letting the outgoing social worker to help and support him in the future.
The social work has been done in collaboration between me (psychiatrist Project OUTSIDE) and a local outgoing social worker.
Sometimes it may be necessary to involve the top political system at a local individual problem, and by this solve the problem, and produce new workflows in the public authority.
1. BACKGROUND and environment: profile of the person in relation to: the conditions of " health and dignity "
C. is a Danish man and had been evicted from his apartment and himself thought that it was a temporary situation .
He believed that Copenhagen municipality had a big problem because they had put him out of the apartment. 27 nations would come to object and he knew a lot of prominent people who would personally appeal to the municipality.
C. had done many different things in his life. He had been a painter 's apprentice and also had a student graduating from 1979. He was enrolled at the university in 1980 and graduated as MA . mag . in history in 1989. Had worked in hairdressing school and other schools. Also had written a critically acclaimed book about the Paris Commune, published in 2010. Now he was on the road with another book, supposedly for release in autumn 2012.
He was apparently silted up in his apartment and had lived there without electricity and water since sometime in early 2011.
Carsten has been psychiatric examined in the street by psychiatrist. Symptoms of mania. Former manic-depressive episodes.
Carsten entering treatment for psychological symptoms. He seemed very motivated for treatment and was in favor of medicine.
The effect of the medical treatment soon proved. He said he slept better and he seemed no longer so chaotic, but with glimpses greater sense of reality .
description – what devices were put in place? With what results and difficulties?
I met C. in The Mobile Café for the first time a warm summer night in June 2012.
He seemed a bit from it and was pretty incoherent during the interview. He talked about all sorts of things and grabbed items out of the air. Told inter alia, that he was a writer, music agent and presenter.
A few days later I met again C. in The Mobile Café. He told me that he slept in Ørstedsparken . His sleeping place was close to a large sculpture . He also talked a lot about the bad weather , and complained that his stuff was wet . I gave him a tarpaulin.
The day after I got the opportunity to visit C. sleeping place in the Ørstedspark . I found it immediately after the description : close to a large sculpture . His stuff was packed into the trailer, I had given him the day before. It was neat and tidy , but he had Secretariat's relieve himself in the middle of the camp.
The next morning I woke C. in Ørstedsparken , where he still lay sleeping in his sleeping bag . He was happy to see me and was also excited about coffee and bread , which I had brought . We sat on a bench and started making small talk a little . We talked about everything from Woody Guthrie to the rights of blacks in America and had on the whole a really good talk .
The “I” in the text above is one social worker of project UDENFOR. He has a long experience working in the street. He has been supervised by among other of the staff and I in project UDENFOR. He has been using active the municipal system.
In The Mobile Café we decided to make a stop serving only for C.. With last week's event, where he had been beaten , in mind - and with our knowledge of his conduct that may seem provocative , it was the situation a good decision.
During sparring with psychiatrist in Project Outside we came up with that it would be appropriate now to make contact with the local homeless unit . Some suggested that C. had only recently lost her home. By acting quickly we might avert the exposure and reach to save his things. So I contacted Arne , the municipal street worker , met with him , bought some coffee and found C. in the park. He was still asleep when we got there , despite the fact that it rained , but was happy to see us , and there were no problems that I had taken with Arne .
Bente from Health team to inspect the wounds C. had on his arms. As C. had refused to go to the doctor , all I decided Health Team could be an alternative , why I got them put into the case. We agreed that they would seek C. in the park. He accepted happily Bente's offer of help, so she had looked at the wounds and gave him some penicillin. They also agreed that she could come back Monday to take some blood tests.
Next big challenge for Manny was to come to the bank and get an overview of his personal finances. When we got to the bank, it turned out that the newly granted cash was made ​​on an account that had been sent to a collection agency because of debt. C. could not withdraw from this account. We rang as the bank's debt collection department who told us that we should have created a new easy - account to which the bank could then shift the cash that was paid.
Finally, the Enghaven that now there was a room available for C. and I immediately took off to find him and tell the happy news. When I found him, he was completely soaked after a prolonged rain, as the tent had been unable to keep out . He was very happy, but was also surprised at how strong it was gone . We agreed to meet the following day when we would pack his things and clean up his place on the Citadel and then move onto Enghaven.
Next morning we packed all Carstens things. We had to throw some out that simply was destroyed due to rain and moisture. There was incredibly dirty in the tent and there were feces in front of the tent opening. C. would initially save his sleeping bag and tent, but it was so wet and moldy that I persuaded him to discard it.
4. PROFILE of : Mr V. Male, 2002 – 2013. not-Danish, 60+ years old.
Project OUTSIDE have known Mr V. since 2002, when he walked on Kultorvet with a shopping cart. He was originally from an area near the Ukraine in the former Soviet Union, but had stayed many years in Sweden. He had not always been homeless, but the display probably been married and had six children. Mr V. did not like to talk about his past, he was well satisfied with life as a homeless person who gave him a sense of freedom. He was usually in a good mood and worry free. He had no income, but living by collecting bottles.
According to Mr V. authorities had made ​​significant efforts to determine his identity, so he had allegedly served 3 months in Vestre Prison, while the authorities tried to identify him. He had on that occasion handed his fingerprints and had subsequently been 'tolerated stay' in Denmark, since they had not been able to find a country to deport him to.
Diagnosed: suffering from inguinal hernia and easier osteoarthritis of the knee.
Over the years we had regular contact with Mr V. , typically on his sleeping places , there was often a hollow , which he himself had built or container that he had ' taken over ' . Sometimes he needed help to clean up and on one occasion we helped him to renovate the roof of the container. Mr V. would of principle, have nothing to do with money, but he appreciated the necessities that we from time to time bought for him, it could be food , one primus , a tent or a pair of shoes .
In 2013 he sought so on his own initiative Homeless Health Team, where a doctor examined him and recommended him for surgery. The doctor had him also persuaded to come inside and found a vacant hostel room where Mr V. agreed to stay until the surgery.
Mr V. is mentally ill, homeless , without known identity and probably older than 60 years. We've known him for 11 years. But we wonder if we have done the right thing in the time we have known him ? Should he have had another outcome than that which we have given him? Should he have been hospitalized, treated and rehabilitated ? In Project Outside we have regularly discussed the dilemmas that Mr V.'s situation has put us in. We have weighed the pros and cons between more straight intervention and harm reduction, for all the time to keep us in mind our values ​​and working basis . We find that we have succeeded in maintaining the relationship to Mr V., and that through the entire process has been able to maintain a respectful relationship with each other. We have helped necessities and have kept an eye on his overall situation so that we were able to intervene when and if the situation were to change for the worse. In this way we managed to align aid to his needs and have not let ourselves be governed by the prospect of results, which probably would have been impossible to reach before he himself was ready to accept changes.
The work with vulnerable homeless people living in the street must be based on ethical reflections.
5. PROFILE of Ms E. Woman, 55 years old.
Eve is female, 55 and homeless for the last 13 years. She now lives in Warsaw but comes originally from a town 200 km away. She used to be a tailoress there. Allegedly all of her family perished in some accident. She is very unwilling even to consider returning to her town of origin. She stays at the central railway station in Warsaw, spending much of her time just sitting in some unused corridor . She is quiet, clean and not in the least aggressive which is perhaps the reason why she is tolerated by the station’s security.
Her physical state of health seems to be more or less acceptable but her psychic condition seems to be determined mainly by anguish and fear. Because of some prevalent fear she is acutely disconnected with her past which finds its obvious expression in refusing to have anything to do with her town of origin. Real or imagined threat of being moved there prompted her to abandon institutions that took care of her. Eve is fearsome and depressive..
Eve has been several times to various shelters. Every single place she left of her own accord after spending a month or two there – even the shelter where she was allotted a single room. In the shelters she was offered typical assistance - regulating her legal and health insurance status, motivating for independent life and work which obviously was not relevant in her case. She spent some time in public hospital because of dermatological condition. Every time however she ends up in her corridor. On the other hand she appears at the weekly meetings organized in the vicinity of the railway station by the Community of San Egidio for sandwiches and some human exchange.
Eve stayed unsuccessfully in various shelters run by various organizations – Caritas, Chleb Zycia, Monar - but to little effect. There was no exchange on her condition between the agents and apparently not much effort in organizing untypical assistance – going beyond the motivating activities that can be effective only with an individual retaining basic self-awareness and basic resilience. Her stay at public hospital did not contribute to the improvement of her psychic condition as only narrowly specialist services concerned with dermatological condition were given and no attention paid to the underlying causes okf her misery. She stays in contact with the street workers of San Egidio who seem to be the most accurate in describing her actual condition.
Certainly effective psychiatric assistance, most probably including medication and perhaps a stay at relevant institution is needed. This requires however the person’s consent, which in turn can only be obtained by a worker whom the person would trust. This seems to indicate the need for a psychiatry that is working close to the person in need (mobile teams, street-psychiatrist) and that has its consistent continuation in less precarious environment, meaning some kind of specialist, not overcrowded shelter. .
BACKGROUND: status - profile of the person in relation to the social conditions/health of "Dignity and Well-being" what part attributed to the time dimension, rupture of the social cohesion - abandonment, lack of care?
Margaret is female , 50 and homeless for a dozen of years. She lives in the sewage system. She has children who are taken care of by their grandfather. She spends some time now and then in prison for failing to give her children alimentation. She is alcoholised almost all the time and changes partners often. She alternately is submitted to or exerts violence on them. She is one of the most derelict individuals among the homeless, in deplorable state. She sustains herself by gathering and selling bottles, cans etc.
Alcoholised almost incessantly. Sober periods mainly in prison. She seems to have already undergone some psychic and mental changes because of alcohol. Her overall state of health has probably never been diagnosed.
Margaret is well known to the police and the city guards. There were some attempts at detoxication e her but she always returned to drinking. She has never been willing to take advantage of a shelter – alcohol is not suffered there. She accepts some perfunctory assistance from street-workers in the form of food or clothing but does not appear willing to go beyond that. She is effectively hidden from and impervious to any offer of help because of her half-conscious alcoholised state. Hitting the bottom she sometimes expresses some willingness to change her ways but it does not last.
Margaret is out of reach of any sustained assistance as it is offered mainly in shelters where sobriety is a condition for admittance. Street–workers who reach out to her have hard time trying to get through to her.
It seems only some kind of compulsory treatment might bring about any substantial change in her behaviour. The destructive patterns seem to be deeply ingrained, the barrier erected against reality and other people very effectively stifles any contact. Compulsory treatment would be however hard to obtain in her case and there are no agents able to pursue this difficult case.
Joan is female Eve is female, about 50, homeless for assumedly many years. She lives with other homeless in summer huts. She appeared in the past before the court accused of murdering her child. The case was eventually dropped. Her other child is taken care of by her parents. She spent some time in prison – probably for theft. She drinks occasionally, not excessively by “homeless” standards. She ha s also spent some time in shelters. Nowadays she declares she would be willing to go to a shelter with her partner. No such possibility – for homeless couples – exists in Warsaw.
She seems to be mentally handicapped to a degree. On her health chart she has: metal handicap, HIV, tuberculosis, hepatitis C. Mental disturbances cause some degree of aggressiveness.
She spent some time in shelters and has been diagnosed by volunteer-doctors (see health chart above). She takes sometimes sedative medication prescribed by them. She did not engage in the recovery process offered at the shelter, probably for the reason of her weak mental capacity. She does not seem able to cope with her multiple problems of herself but has not been proposed adequate treatment as it is tailored for people who can still essentially master themselves. For this she is too weak in mind (and body).
She stayed in shelters but to little avail – as far as the social work with her is concerned . In colder periods she tends to move to night shelters where only sleeping place and some food is on offer. Street workers stay in some contact with her and this seems to be the only link to the mainstream world.
Her mental handicap and multiple serious health problems qualify her for intensive treatment and special care that is not available. Again she is not a person who could take advantage of the mainstream offer for the homeless and she is left with occasional help from street-workers. It is really difficult to envisage how this person could be effectively helped with her multiple ailments all the more so that the factor of personal freedom also plays its role.
8. PROFILE of : J .
1. BACKGROUND: status – In the middle of the town, with a long history of drugs abuse, José was surviving begging for a coin after parking cars and sleeping rough in the streets.
2. HEALTH : Physical - psychic: additional information on the health situation (declared diagnosis or hypothetic)After having a psychosis crisis, with hallucinatory voices, things turned out even worse. He lost weight and became suspicious of everyone and unable to get money and food. The physical status was quickly deteriorated.
The 112 emergency took him to the hospital and he was admitted to the psychiatric hospital, with the diagnosis of paranoid schizophrenia.
It was not an easy way because José has many difficulties with rules.
As soon as the clinical status became better he asked to be discharged from the hospital and resumed the same way of living in the streets.
Some months later he arrived at the hospital crying and asking for food. He said that he hadn’t eaten for three days and he had two lunches in a hurry.
Against the normal and regular procedures, he was directly admitted to the psychiatric unit. This time he accepted the rules and it was easy to treat him.
José used to love working with wood and he entered in a rehabilitation programme at the psychiatric hospital where he could use that material every day. After the discharge from the psychiatric unit, he remained in this programme, which also includes psychiatric and psychological consultations, medication depot (flufenazine) and psychotherapeutic group.
In the same day he was admitted, the clinical team alerted all the other homeless teams (from public and private institutions) that already knew about this case, asking them in what way they could cooperate. Some didn’t answer back but there were a few (public and private) available to work together.
He entered in a public social centre where he had a room, meals, health and social care.
A few months later, he still attends the therapeutic programme at the psychiatric hospital in a non-regular basis.
We have to be flexible and work to a good relationship with the homeless patient, respecting his will. And work together with the network. It is also necessary to work hard in the key moments.
9. PROFILE of : M .
1. BACKGROUND: status – When Mary was young, she was selling flowers with her mother, in the centre of the town, in one square. When her mother died, she was already alcohol dependent. She had lost the house, 15 years before, but remained a charming woman and everyone liked to try to help her.
2. HEALTH : Physical - psychic: additional information on the health situation (declared diagnosis or hypothetic)Many times she entered in the emergency room of the hospital, leaving off a few hours or days later, again to the street.
As a homeless woman, there was a strong social pressure to take her off the streets. She entered in a housing first program, but she remained there only for a few days, going back to the streets, drinking every day.
Working together, health and social teams (from public and private institutions), it was possible the admission in an acute psychiatric unit. But again only for a few days, because she was always claiming for discharge and achieved it.
Two months later she was hospitalized again. This time was an involuntary admission. With time, it was possible to confirm a poor prognosis. She was with many cognitive deficits and it would be necessary a 24 hours/day care program. She was transferred to a resident unit in the psychiatric hospital and six months later she was still waiting for a social response in the community.
5. PROPOSALS : what kind or pathways & priorities can be generalized, translated, adapted? Or only specific to you?
In this case, perhaps the psychiatric hospital seems to be the best response, at least until the community has programs for heavy dependent psychiatric patients.
2) Currently with a mental illness, past contact with services, without any follow up, maybe one or more hospitalisations.
they died, and person ended up in the street.
4) Substance abuse problem and mental illness, and due to addiction there is a fall out in his family/personal/work life.
5) Schizotypal types, never really adapted to society, with alternating periods of living in the streets and in hostels, rooms etc.
Paranoid Schizophrenia, normally in a residual situation.
We haven’t detected a specific illness which predominates, but general health issues.
...The social workers will try and address the possibility of income, if no income, social services will offer either a hostel (which is paid by the service), or a “albergue” which is a specific sheltered accommodation run by either private NGOs, or by the town hall.
Our team will try and address the mental and general health problems, if the person accepts, with the objective in time of referring the person back to the statutory health system .
Normally it will need a lot of time before any of the previous can be achieved .
(it has to be understood , that while the person is in the street, refusing help, but contacted by our team , she is under “treatment” in a general way of thinking, because the person is undergoing a treatment plan.) This is important to acknowledge, specially when we have pressure from “the society” to take action. Before deciding on a compulsory admission, we try to engage the person in different ways and this may take a lot of time.
The social services have a specific program in Barcelona for the homeless people. This program is funded by the social services of the town hall.
-Street workers, which go around the streets detecting the homeless.
-Follow up social workers , which will do the follow up of people which accept help.
Our team works with all these social workers, in fact they are our social workers, since we don`t have any.
The person in the street is detected by the street workers , and they will refer them to our team. The nurse in our team will do the first contact, and eventually will introduce me to the person. This can take time and depends on different factors.
There are different NGOs which don’t depend on the town hall, which also have street workers. And some of them will refer patients to our team.
There is a major need for further coordination between different NGOs, services, programmes and teams. This should be properly structured, so that we can have common pathways/treatment plans etc.
No homeless person should be discharged from hospital without establishing a proper treatment plan and follow up, who will place it into action, and who is responsible of making sure its done.
There is a major lack of housing resources. Not only the access.
Our current economic situation has done a very important impact on resources.
1. history and environment: the profile of the person in relation to the conditions of " health and dignity "
The user of 35 years, Croatia, is known by our social emergency since January 2008, due to his poor hygiene and due to his poor physical condition. During this first period was reported daily by citizens alarmed by his condition as "homeless" extreme. Presented with long hair, dirty, with a mode of rasta, tattered clothes, colorless, almost glued to the body and sneakers with socks, lace perfectly ... but without soles or funds socks to wear due to continuous running around the city. Despite his young age seemed devoid of sphincter control, and it will get worse with his way of postponing current concerns for his health.
Mood and reserved, unlike other chronic users, he stopped to talk with us kindly, so elusive, and the tension continues to leave his interlocutor. 's something that repeats today which recognizes operators and welcomes it is called after a certain time, in broken Italian ":" You see, you see, "as he tries out for a break from the relationship.
In 2008, thanks to a hospitalization in a psychiatric ward you had a diagnosis of psychosis. had no other major health problems.
As I mentioned in June 2008, after about six months of repeated but futile attempts to do admit (as the boy walked away before the arrival of emergency medical services), we were able to do after surgery difficult with prescription drugs TSO to the fate Bene Fratelli Hospital Emergency Department in Rome.
Incredibly long and controversial has been the talk of us workers and the psychiatrist CSM Hospital psychiatrist who was to confirm the request of the TSO is in the street. He believed that the user, not an event psychological distress, but rather a "lifestyle choice." Only after a "user exhausting negotiations, was admitted to the fate Bene Fratelli SPDC.
Ward boy was treated and subjected to drug treatment, to which he responded pretty well, and then relations with our mobile unit operators, who went to see him every day, were more open and sociable. However after about two weeks Stilos. was released early by us and escorted to the center for the homeless, who moved immediately. Since then, he began to walk barefoot through the city and this day is still running, do not stop, nor cold nor hot asphalt bitterest hottest month.
4. OPERATORS and NETWORK: description of operators and their role in interventions.
This guy, sweet and left to her was very impressed with the sensitivity of our service, which over time have been able to establish a relationship of trust and mutual sympathy.
The intervention of involuntary solicited by us for months has been achieved through the work of networking and collaboration with the municipal police, NAE (base marginalized support), the first group and one psychiatrist Centre for Mental Health (CSM) Via Palestro, M. Realacci.
At the time of his hospitalization, we contacted the Croatian consul who stalked the mother, who had initially said she would pick him in Italy, but later told his Consulate of not being able to be able to accommodate, due to its difficult socio-economic conditions.
Over time, the child's mother was contacted several times by our service, but has always maintained that he could not take the child.
After admission, the boy has not ceased in one place, goes all around the city, walking or public transport and so today it is more difficult to meet, state clothing and degradation are the same as then: tattered clothes and parasites in the hair. Sometimes constantly trying to change her dress, but he never agreed to come with us for a shower or a dorm . few months ago, we tried to remember the mother, by the Croatian consulate but the phone found.
Without a realistic action and seems difficult to find a solution for this case, however, is unacceptable to think and passively accept their living conditions.
Psychiatry often does not intervene in such cases, for both the classical discourse of "choice" of life, both because he speaks stabilized chronic cases, what appears to be unnecessary. However, in this as in other cases, this chronic disease is actually a slow suicide, that should be stopped with care and appropriate places where you can set the foundation for a new way of living.
The difficulty with this person ... is to be able to set up a shelter, because the user does not have a fixed site parking and concrete is no longer possible to implement a shelter, it which requires for its realization two hours for the arrival of the medical brigade and emergency psychiatric follow.Unfortunately we lost during the last hospitalization in which the user to enjoy his stay in the hospital had to remain hospitalized longer, then transferred to the clinic. (after 15 days of hospitalization gave unexpected results) It is only then that we could transfer to a shelter or to assess the Consulate with the assumption of a well in Croatia.
Rome, you can make a box of harm reduction homeless in night shelters or improve their condition with the possibility of a shower and change of clothes in his wanderings, but the user does not wish to accept all it.
What is needed is a social integration and effective health that is able to meet the needs of people in the street multifactorial. All this, as already demonstrated that you could do without any financial outlay and with the least expenditure energy and certainty improved results.
Women LN resembles the classic homeless woman, dressed in long skirts and woolen hats who lives in the historic center of Rome for more than thirty years. Now it has about 80 years, it is always busy looking after his carts full of clothes and all she needs to live in the street and it is a real asset for you. This is a person of a certain cultural level, very polite and courteous relationship and maintains a large personal dignity.
Pavia, in the past worked in the Bank for a few years later, probably due to mental health problems such paranoid (thought to be poisoned), he left work and family, maybe he looked in the past, but is not currently more interested in her. The woman who follow several volunteers, some for years, others were gradually added over time. assistance in small things, but she tries not to ask anything. During the years, he never wanted anything from our service, even if some of us have established a meaningful relationship. We are greeted with pleasure, but do not want to be contacted too often. has never accepted in night shelters or other forms of assistance.
The woman has no particular health problems, except those which are common to women of her age, in respect of mental illness does not appear to have ever been diagnosed and get on some occasions, and in any case it is certainly not one that can change his lifestyle.
Unexpectedly, a year ago, we have the opportunity to go into a nursing home, and surprisingly kept faith in his request to follow us all the bureaucratic procedures in Before You Begin. From the arrangement of its papers at the request of the board, but when we finally visited the nursing home there was a clear rejection of inclusion in the place.
The motivation was that he could not leave his cart, or in a nursing home could eat with others, why would he buy his food separately (the fear of being poisoned?).
4 NETWORK OPERATORS and: description of operators and their role in intervenanti.
Search the nursing home was made to network with the following volunteers, and the guy with the houses of the rest of the Hotel de Ville, the city of Rome, as the Sisters of Calcutta, our sign is gone several times to see her, but she never agreed to enter into their shelter.
The volunteer network and services, and follow-up work of our mobile unit can monitor the health status of the elderly, for the rest, unless you come in more serious situations that require intervention, even against his will We believe that we can not wait for the moment to make a decision and that alone can make new requests we'll be ready for.
What does not stop to ask also a restaurant that is not a house, where to put his chariots, and perhaps (this is not explicit) where I can move too. But kind of legitimate First House? There are many questions that we do and where we do not know to give us answers.
. every winter with bad weather and frost, we offer hospitality to shelter from the cold, and every year, he replied: "I am 38 winters step on the road and I'm still here." It is difficult reproduce the proof.
This makes us think that certain lifestyles, but caused by uncomfortable and not freely chosen, must be observed when age is so advanced, but that does not mean do not treat, but continue to expertise services network to monitor the situation (involving the CSM, although in some cases it is not easy), to have a shared thought and attention, and particularly vigilant about the case ..
1. States history and places: profile of the person profile as regards the conditions of "the dignity and well-being"
which part attributed to the dimension of time, the rupture of the social bond - the abandonment, neglect ?
In September 2012, we, street workers are challenged by C. It has a deterioration of his mental health, putting his life in danger. She refuses care, such as referral to a hospital, a place to sleep, a place to receive personal care. Sometimes the face becomes too aggressive for bystanders, residents, businesses and professionals who have offered to help. Through the help of the local population, even been in a first observation time. She responded well to treatment administered by injection, but left the hospital quite quickly (after 15 days), and no longer continued injections, after probably a poor coordination of care. It will be under observation several times thereafter under different identities.
• An isolation, mistrust and a stall. Ms. leaves no room for dialogue.
• Concern for residents and traders. .
3 INTERVENTIONS Description: This is the device - what the results and difficulties?
Ms. worried, we have established a network of vigilance in the region to work with retailers and be attentive to the significant physical and mental deterioration. stakeholder network and vigilance, we noticed that its major psychiatric disorders it is impossible to get in touch with Ms. She refuses any care, contact, she became verbally aggressive.His health, physical and mental deterioration leaving a real danger to itself. A ME requested by IDR the network. -> ME ? non-emergency visit and justice in the streets: Mrs went to a psychiatric hospital in 2013 A good director has been set up for the same income can benefit from the CPAS. Hospital treatment is implemented and responds very good at it. Indeed, it was possible to get in touch with and even dialogue. At the end of the EOM, even returned to the street.
4 NETWORK & SPEAKERS: description of stakeholders and their role in interventions.
IDR provides contact and observation of the general condition diogenes Asbl (physical and mental) allows contact and SME relationship: support the cell and coordinate meetings.
Different views on the hospital where the "danger" that even he was. fieldworkers were to maintain the hospital as a hosting solution has not been found. But since Ms., "said she was ready "to return to the street, the hospital let him go saying she was no longer in danger to herself.
In the street, a treatment has not been established. degradation is likely to occur when the psychiatric treatment will have no effect on it.
-> Prepare a plan b! see below. What will we do when even leave the hospital? Prepare properly for this kind of action!
-> Avoid care circular fashion: the street, ME, degradation, the ME ...àMake sure that the hospital provides solutions, structures other than ST Provide relevant long-term project at the entrance to the hospital ...àStreet, ME, degradation, MOE a plan B. ..
-> agree on a vision from the outset between field staff and the hospital ... have no surprise.
-> know in advance stakeholders will have an impact on decisions and ensure their presence at + / (psychiatrists, etc..) - long term.
13 . PROFILE: Ms Justine V.
. 1 States history and places: profile of the person profile as regards the conditions of "the dignity and well-being"
In March 2010, we find even in the street in a park in extreme poverty. Lying under a blue tarp in private. It is a concern because it's cold. Ms. setting often do not want to go to a warm place , poor hygiene. Ms. already under observation.Unfortunately, we did not know. Every winter, a PEO is required ... but it has always refused any treatment ... without any "visions" long term is implemented. His condition causes anxiety utilities and citizens of the city ... that is why the Prime Ministry of the Environment was possible. since Mrs. wants a home and the money ... but it was impossible for the moment to move with her ​​to make a move. .
- Ms. is psychotic. However, despite his delirium, we see that keeps things very well, understand what is said. This can range from "reality" phase "unreality" very quickly.
- Ms. himself a "God" and believes that we are his soldiers.
- Ms. has a very dirty disturbing hygiene, does not change, a strong odor, dirty clothes and inadequate climate.
- Since the beginning of 2013 even starts drinking alcohol, which greatly increases its psychiatric disorders: Moves cries endangers on the road and meet men (risk of sexual assault).
3 . INTERVENTIONS Description: This is the device - what the results and difficulties?
- 2013: Request for street intervention asbl tractor specializing in psychiatry and psychotic team.
- 2013: The right to CPAS income (800 euros / month) and home savings was implemented + credit card .
4 . NETWORK & SPEAKERS: description of stakeholders and their role in interventions.
* Be proactive in today!
* Meet with the medical team of the hospital where it will be put under observation.
* Organize visits street network / EOM.
* Continue to follow the road and to ensure their physical and mental state.
Mentally ill we know since December 2009. This is a 62 year old man, diagnosed as schizophrenic for years. His career now extends to a psychiatric hospital, where he stayed a few weeks to two months, and the street where he spent the rest of the time, until someone believes it is no longer able to stay in the street and it was made ​​under duress at the psychiatric hospital where services Mr. known. .
- On July 19, 2012: Applications of the therapeutic community.
- 2013: return several times to the psychiatric hospital.
* Monitor a long-term treatment and an appropriate structure sir. .
JC, 57 years, Burkina Faso, Africa.
J., the young left Burkina Faso in 1978 to study medicine in Italy in a northern city. Through the medicine you're stuck on an examination and has since stopped studying. To live, he tried to play in some rooms, then as a laborer in both the north and south. Discuss aggression and physical violence. For many years he lived in a park in Rome, where he was followed for many years by a group of volunteers and some citizens. He lived in a trench newspapers, covered with a sheet, in all seasons and at all temperatures. He never asked for anything, and spoke very peu.Il has never agreed to leave the park and be housed in a residence, or to meet family members who came to see him, and he never agreed to be supported both physically and mentally. For a long time was followed by volunteers in the park until it was violently expelled from the park because it was necessary to build a sports club. He then moved under the bridge of Rome's ring road in a very dangerous condition. E 'at this moment that you decide to implement a compulsory hospitalization (TSO) at a psychiatric ward of a public hospital.
For many years, presented a serious framework paranoid schizophrenia (ICD.10: 295.30, DSM-IV-TR: F20.0x) with themes of influence and grandeur. At the same time themes presented delusional "Cotard" ideas, or refusal of body parts and each somatic physiology. The conversation with him was totally fragmented and immediately communicated to delusional themes. There was no possibility to link the parameters of space and time.
In a first time, and in recent years J. was followed in the park where she lived and attended by a group of volunteers who came to see him constantly. It is admitted that he had regained his balance in a situation very much decreased. The park had sufficient food and clothing, and he did not ask and did not accept another. When he was ousted in a violent way from the park to his condition of life has become very precarious and dangerous, the persistence of its total refusal to accept any form of assistance was decided nécessaire.C hospitalization is done in a hospital for about 6 days, during which he was visited daily by volunteers and began treatment with neuroleptic drugs to lower and middle doses. The refuge is continued for about two months in a psychiatric clinic agreement, where the shelter is only possible if a volunteer. During recent months has significantly improved the recovery of psychopathological ability to organize thoughts and to have a dialogue with others. He agreed to seek establishment run by Deaf S.Teresa of Calcutta, where he agreed to move and where it is still a client. In recent months, began to heal in terms of hygiene, and gradually assumed the habit of going out alone by the Institute of the Sisters. Could not be transferred to a facility that deals with the placement of young people in the neighborhood because they do not have a residence permit and for the Italian legislation has emerged as a stowaway. Last month, it was possible to obtain a residence permit for medical reasons and, therefore, will soon be transferred to the structure. In recent months, were contacted parents who live in Buikina Faso and are willing to accept at home.The working group decided to wait for the clinical improvement of the judge are sufficient for a full and adequate return home.
The surgery was only possible after organizing a network of partnerships between institutions and additional services that have occurred so far in isolation can not achieve an improvement in J. What worked and restarted the recovery process is that the judge was psychopathological social collaboration between social services, health and volunteering. It has been found that the mental condition of J. are much less affected than may appear at first as it is this great healthy parts of his personality and it is possible to envisage a complete mental recovery in even shorter time. Certainly, the coordinated action of a network is the result, in this case as in others made by the group in recent years, effective in terms of results and requires no additional source of income than those provided to each service.
The normative position that in such cases, under Italian law requires compulsory hospitalization (TSO) might be easier if possessed of some beds possible (one or two in the whole region of Rome ...) not necessarily psychiatric services where hospitalize patients, to assess the psycho-physical state and begin the first pharmacological treatment and formulate a first course of recovery of family and social network. The shelter under the TSO is certainly overdetermined for such patients after the initial obligation to leave the place where they are installed (street, square, garden, ...) could be happy to work on the draft recovery. In addition, current hospital services are not organized to help these patients in the health care and fitness in the screening assessment of a possible infectious disease which, if not diagnosed in time, can lead to serious repercussions throughout the hospital.
Physical conditions at the time of the first contacts were severely compromised particularly in personal care, Food and living conditions (living in a pile of plastic bags and newspapers) Lately, was visibly emaciated.
When he was contacted by our group could be a serious risk of death, particularly for medical reasons and exposure to the weather which was cold periods to periods of summer heat. Especially hazards survival rose sharply after the violent expulsion of the park and stopped in a small corner placed between the busy roads.
J. legally could not get any help both medical and social. It was not possible to obtain shelter under the TSO as psychiatric pathology was evident not so serious, however, did not could be treated as outpatients, as it is completely non-cooperative and diseases of internal medicine has not accepted (and was not able to join) any form of voluntary placement. Not having a license stay (in fact, which had in the past - when he was already very ill psychiatric floor - a decree of expulsion from Italy) could not be rehabilitated or residence or protected allocations Financial for possible projects. Currently obtaining a residence permit for medical reasons, you can have access to forms of economic subsidies and can be transferred to a facility where capacity enhancement and social integration opportunities. Up 'Now, all organizations, public health, those of the traffic police, and those in the voluntary sector - dealing with his case, they certainly have to assume greater responsibilities - including legal - boundaries its powers as provided by law.
Case 1: female 67, greek, sleeping roughly for about 7 years, since the death of her partner. She is quite social and extroverted. She is collecting rubbish and lives among them in the street. Very often municipality police cleans the space up due to complains received from the neighbours. Many times she had been simply asked whether she could apply for a shelter but she had been systematically refused. No other sources of income but from begging or from selling metals and bottles that she collects from the garbage. She has a son that he is also in homeless conditions and not able to support.
Case 2: Male, 24, living at inadequate housing conditions (no electricity and water), undocumented migrant. Has been in Greece almost a year and he wishes to travel to Sweden where he says that he has relatives. His income is mainly cash sent by these relatives or other family members. He often complains about voices in his head and he can become irritated easily. Due to his behaviour his friends had refused to share their apartment with him and he has not contacts with any of them over 4 months.
Case 1: psychiatric hospitalization lasting about a month this year, being diagnosed officially psychotic. She has bipolar behaviour and she refuses to comply with her medication.
Apart from the mental health issues she suffers heart problems and very often skin problems, all very much related with her living conditions.
Case 1: She has been referred to Psychiatric hospital, welfare state office, police, day centre for homeless.
She obtain her documents lost long time, a very basic pension she is entitled too, rented an apartment on her own, that she maintain in decent condition (no garbage in). She still refuses her psychiatric treatment. She has received support and care during her hospitalization that had a significant impact on her. However the income she had obtain is quite limited and if not careful with its “management” she risks to be at the street again. Is not an easy task for her given her instability in her mental health status.
Case 2: Voluntary emergency hospitalization. He had stayed overnight and then being signed off by two doctors that he is mentally stable and possible to exit. He had been provided with a medical description though. He has been referred to the one and only specialized shelter but he had not been accepted due to lack of space. He had applied for asylum. He has currently no risk to be expelled. However he is still sleeping roughly and he is not complying with his treatment or sessions.

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