Supporting those who traditionally don't engage well in services — this is where Nuwan Dissanayaka's power lies.
He is a consultant psychiatrist working for the Assertive Outreach Team in Leeds. He is also on the rehabilitation faculty for the Royal College of Psychiatrists.
Consultant psychiatrist in Assertive Outreach Services
Assertive Outreach Teams are part of community mental health services. They are specialist teams that are set up to work with adults with mental illness or personality disorder, especially those who find it difficult to engage with services.
"For me it's any sort of psychological problem that's really debilitating and limits somebody's ability to function and survive out there."They don't engage very well with services. So they end up becoming repeatedly unwell and readmitted to hospital."
Other problems they may have are violence, self harm, substance abuse, or homelessness.
Why patients become homeless
For Nuwan, homelessness is a reflection of the people's difficulty in coping in multiple areas of life.
"Functioning well means being able to do the things that most of us take for granted. So, looking after ourselves, paying our bills, the usual things. The group I see struggles to do some of those things."
It does not help that navigating the systems that accompany housing and money is difficult, too.
"It's difficult to do for people who aren't really poorly. So for those people who are really poorly it's even more difficult."
How do assertive outreach teams support homeless patients?
Therefore, the assertive outreach team supports the patients in finding and securing housing.
For Nuwan, it's about mental health services that reach out to people who are facing homelessness in order to try to help them to navigate the systems.
"It's not just about whether help is available if somebody chooses to go to an office. It's also what can be taken to the person where they are, so that they can be given that support to actually manage that very stressful process with somebody on their side."
But over the years, there has been a reduction in the number of Assertive Outreach Teams.
They no longer exist in all areas of the country as some have been disbanded.
"I think what's happened is that we've seen a decline in the outcomes for the group of people that I see."
He says that when people don't have adequate support and housing, then they are repeatedly admitted to hospital. Ultimately they might end up in Out of Area Placements, often hundreds of miles away from their homes.
"If you have somebody who's repeatedly detained because the support they have in the community including housing isn't there, then that can be the pattern."
For Nuwan, this means looking at the support the patients have at home — to prevent relapses and readmissions.
What needs to change
When supporting patients with their housing, one barrier Nuwan often comes across is the limited availability of suitable accommodation.
"You can have lots of support in terms of trying to find you a house and do the difficult things like bidding for properties online. But if there isn't the supply of housing, then there's a problem."
He also notices that the accommodation is often short term. This means that people are only offered a placement for six to nine months. In other more supported places, the stay is limited to around three years, says Nuwan.
"The illness is long-term and the problems are ongoing, yet the offer is often short term. For somebody who got an illness that might be lifelong with needs that are lifelong, that simply might not do the job for them."
He would like to see more access to mental health rehabilitation services which would be there to try and help people develop the skills they need to live in more independent accommodation.
"But that's something that's been cut very drastically over the years in terms of mental health provision."