The following set of seven interrelated polarities are presented as a way of framing some of the learning from the peer approaches project drawn from the focus groups and interviews. These polarities characterise journeys out of homelessness and highlight the role of peer support as an enabler on the journeys.
Isolation < – > Connection
The people we talked to during the project described homelessness as an emotionally, mentally and physically isolating experience. This is also backed up by the literature. The lack of a steady base, a safe place to live your life, is exhausting and can drive people further away from any existing support networks. The nature of some rural areas, as described in the Huntly focus group can be seen to compound isolation:
‘I was stuck out there, nobody to speak to, no transport, no communication – I’d no phone… I don’t think I would have survived much longer…’ (Des, interview)
Those we spoke to indicated that once they started to connect – with people who share similar experiences, with support services, friends and family, and themselves – they felt less isolated. Isolation is not a rural issue but this can compound it. Des talked about how isolated he felt before he made connections, particularly with Cair Scotland. His feelings of isolation were mitigated despite his location remaining the same.
Connectedness between services providing support is also essential in addressing isolation. One connection can make a huge difference to a person’s life. It can be life saving. For Robert, it was his psychiatrist who put him in touch with Combat Stress which provided specialist support for his Post Traumatic Stress Disorder. As Robert explained, his psychiatrist ‘wasn’t doing his job’ when he made this referral. It was beyond what was expected of him, but this connection was crucial for Robert to get the right support. Similarly, for Des, the connection with a worker at Cair Scotland was a lifeline:
‘I was very, very close to just doing away with myself… I ended up going to the social worker and explaining how I was feeling bad… And that’s when I got put onto this to see Diane [from Cair Scotland], and then a course and then to carry on from there. And if I didn’t do that I’m pretty sure I probably wouldn’t have been here today.’ (Des, interview)
Importantly, peer supporters can act as a vital bridge or buffer between people experiencing homelessness and other support services:
‘We are partly boosting their confidence and also acting as a bridging point between the service we’re approaching and the client and trying to help them access the service.’ (Douglas, interview)
‘Because for individuals in homelessness and addiction that’s probably the most vulnerable time in their life and they don’t always have the communication skills to be able to advocate for themselves so it’s important that you have that buffer between them and NHS or their GP or the benefits system.’ (Jason, interview)
Individual < – > Community
Connectedness can lead individuals into communities – whether it’s their local community or communities of people with shared experiences.
A particular feature of the rural focus group was the community focused approach taken by the Aberdeenshire Alcohol and Drugs Partnership (ADP) who are ‘trying to get away from the idea that doctor knows best, social worker knows best, addiction worker knows best. The folk that know best are communities.’ (ADP worker, Huntly)
People with lived experience told us how they felt portrayed negatively – as loners or outsiders – by their communities when they were homeless, and how they themselves self-stigmatised. Becoming peer workers turned this perception around and allowed them to take up roles in their community which enabled them to ‘pay back’ to society:
‘I see it as I owe society something… I’m repaying for all the things I’ve done over the years… I’m not proud of it but it happened and I’m not able to a change it.’ (Stuart, interview)
Peer approaches can be a way for individuals to access communities of people with shared experiences and find a sense of belonging. It can also provide much needed occupation. The literature on personal outcomes for people identifies ‘things to do’ as a cornerstone of wellbeing and quality of life:
‘… I’d rather keep active and keep doing things in the community… it keeps me out of bother and keeps me on a straight and narrow path […] You haven’t got time to think of the past, you’re focusing on the future now.’ (Des, interview)
‘I think it’s an invaluable way of spending my time. I was lacking purpose and I was using this as a springboard to get into this industry. It is unfortunately a growth market.’ (Douglas, interview)
Exclusion < – > Inclusion
There is a wealth of research linking homelessness and exclusion. Multiple-exclusion homelessness (MEH) recognises where people have experienced homelessness and one or more of several domains of ‘deep social exclusion including: institutional care (prison, local authority care, mental health units); substance misuse (drug, alcohol, solvent/gas misuse); or participation in street culture activities (begging, street drinking, ‘survival’ shoplifting or sex work).’ (Fitzpatrick, Bramley and Johnsen, 2012).
In the Glasgow focus group, isolation and exclusion were seen as increasing the risk of harmful behaviours for people on release from prison. Both focus groups identified that a key strength of peer approaches was facilitating engagement with excluded people. The community focused approach described in the Huntly focus group aims to promote inclusion. One of the people with lived experience in the Huntly discussion agreed that ‘these community groups are so inclusive’. Inclusion is part of bringing ‘people out of the shadows’ (ADP worker, Huntly), a first step in connecting them with support.
Worthless < – > Valued
A sense of worthlessness was a common feature in the focus groups and interviews. Low self-esteem, low self-worth and lack of confidence were described as part of the homelessness experience. Opportunities to get involved in peer work were credited by people with lived experience in the project as helping to rebuild personal value. The experience of having their knowledge and perspectives valued by others was instrumental in building self-esteem, self-worth and confidence.
‘… for most individuals like myself, they would have arrived there in the same condition – poor self-esteem, low confidence, low self-worth… other people I suppose, start to believe in you, it allows you to start believing in yourself doesn’t it? That’s sort of positivity, that no you can do it, you are worth it, you have got something to offer.’ (Jason, interview)
‘When I was in the jail I had two drug workers… Audrey and Adelphine in the jail believed in me when nobody else did and before I actually believed in myself […] The first barrier and the hardest one that I have overcome, is the one in your own head. It tells you over and over again you are nothing but a useless bloody addict.’ (Stuart, interview)
‘It’s difficult for normal people to believe but you can be 100% ego driven… and yet at the same time have a feeling of total and utter worthlessness’ (Robert, interview
The ADP’s agenda is specifically about engaging with ‘people who may feel marginalised, folk who might not feel any sense of worth… to make them feel appreciated, welcomed and most importantly valued.’ A good example of this in practice is that Des and Stuart, people with lived experience of homelessness, hold roles in the ADP – Des is the vice-chair of the Central ADP Community Forum; Stuart is the joint-chair.
Motivation for peer workers is building people’s personal value:
‘… if you feel good about yourself and worth, you feel you are worth something… what we do as well is record it all, so I’m able to sit down with the peers when I’m supporting them and say, ‘Look what you were doing a year ago and look where you are now’. When they are able to see that actual journey that just builds hope and confidence in people. That’s what drives me.’ (Jason, interview)
Baggage < – > Experience
Peer approaches can provide opportunities for people to reframe their ‘negative’ life events (unhealthy relationships, time spent in prison, addictions, homelessness) and channel their lived experience to help others. These experiences can also be put to positive use to inform the design, development and delivery of support services. In this way, people can repurpose what they might think of as their ‘baggage’ into a valuable experience. As described by one of the Huntly group with lived experience, peer support roles provide opportunities to ‘turn that potentially negative experience into a positive strength.’
Robert explained his perspective on reframing his past as equipping him with tools to help people:
‘I’m 64 years old and I have just had the best seven years of my life. Now that would frighten most people to say that, ‘What did you waste the other 57 on?’. Well, I know what I wasted it on and I can accept that. I don’t regret it because all those lines that were drawn over those 57 years have created the picture that I am living in now and I like where I am now. So I don’t regret the past, I don’t want to shut the door on it because I can use it…’ (Robert, interview)
Purposefully reframing the notion of having ‘baggage’ as having unique knowledge and experience injects value into the lives that people with experiences of homelessness have lived. What might have previously been considered ‘wasted time’ is now contextualised to bring meaning, focus and hope into the present and future. This wilful appreciation of all experience, in turn, offers support to others via the peer support programmes.
Burden < – > Asset
Peer approaches value lived experience as an asset; a specialised knowledge that can lead to transformative change for those delivering and receiving it. Assets- or strengths-based approaches represent a shift away from deficit models which focus on what people can’t do and their ‘problems’.
‘Strengths-based approaches concentrate on the inherent strengths of individuals, families, groups and organisations, deploying personal strengths to aid recovery and empowerment. In essence, to focus on health and well-being is to embrace an asset-based approach where the goal is to promote the positive.’ (Iriss, 2012)
Asset-based approaches are collaborative as people accessing support and those providing it, work together to identify strengths. The peer workers involved in this project described their conversations with people they support as collaborative which builds trust and facilitates engagement and empowerment:
‘… you don’t know how that feels for somebody else to be making all the decisions.. that can be a barrier…that goes away with a peer mentor…’ (Peer mentor, Glasgow focus group)
Both the focus groups and interviews touched on the importance of recognising people’s lived experience as an asset, the growing tendency to employ people with lived experience to offer a type of support that no organisation can match, and the need for financial investment in it to make it sustainable:
‘We need investment in service user involvement. You need to have them involved in your strategic planning groups right from the very start. It needs to be grass roots up instead of like most organisations… it’s top down. That doesn’t work. That suits the service and you meet all the outcomes for the service. You don’t meet any outcomes for the individual when you have that model.’ (Jason, interview)
‘The only way things and services could be improved would possibly be funding. It would just be the economic side of things. And more people getting involved, the more people getting trained to pass this information on. We seem to have managed to have the skills to keep this ball rolling and it seems to be working.’ (Des, interview)
Break up < – > Build up
The breakdown of relationships either as a trigger for, or consequence of, homelessness was a common feature of the stories shared with us. Experiences of homelessness that surfaced in our discussions were characterised by fractured relationships and the break up of support networks, often due to addiction:
‘That’s the thing with using…I lost everything, my family… and since I headed off the methadone my mother has accepted her son again, my other family members are slowly getting round to accepting me back in again… ‘ (Stuart, interview)
Making connections, building relationships and re-establishing lost ones, were highlighted by some with lived experience as indicators of their recovery:
‘… people that knew me well, my own children for instance, started to include me back in their lives because I was changing to somebody that they wanted back in their lives. Whereas I had pushed them away.’ (Robert, interview)
Stories about recovery from homelessness were characterised by a focus on building people up from some very broken places. Peer support roles were ways people with experience of homelessness could build up their support networks, self-esteem, confidence and skills:
‘…being able to build more meaningful, caring relationships with family, partner, friends… whereas before I wasn’t able to do that because I was missing the fundamental ingredient and that was having a foundation to build it on because when I was homeless and stuff it was very much just about surviving day to day… It was about what’s going to happen between now and tomorrow morning and how am I going to survive.’ (Jason, interview)