Behind the Scenes Series: 451

Carol started her work with Jimmy’s as a volunteer, over time working her way to being a full time Support Worker at East Road. In 2022 Carol took on the role of Team Leader at Jimmy’s 451 centre. Historically a Controlled Drink Unit, 451 was relaunched in 2022 as a 9 bed complex needs service for people who have a dual diagnosis.

We sat down with Carol to find out more about who and how we support people at 451.

What is dual diagnosis?

Dual diagnosis is a combination of quite a lot of things. Primarily it is someone who has mental health and addiction needs, but it can also encompass physical, mental, dual addiction, alcohol, and drug addiction. In short, people with a dual diagnosis often have quite a complex series of health and addiction issues.

What proportion of people who are experiencing homelessness have dual diagnosis?

It has changed drastically over the last 5 years. It was clear from the outset that more people had complex needs as they were coming through the door. I would say the majority of people we work with now have more than one need.

Do you have any thoughts on why that has changed so dramatically?

Mental health is talked about more than it was five or ten years ago. People are more aware of their mental health, anxieties and stresses. There are more diagnosis’ than there was twenty years ago.

But, it is not easy to get diagnosed especially when you are also dealing with addiction. But, what we have learned is that people are often masking their mental health issues with alcohol and drugs. Once you are in that cycle it is very hard to get a diagnosis for mental health.

What are the obstacles when trying to seek support for someone who has a dual diagnosis?

The obstacles are how the mental health services are set up. If someone is using drugs or alcohol, you can’t get them into mainstream services as they won’t be treated whilst using. Usually, the drugs and alcohol are used to mask the mental health, so it is a vicious cycle. We do have a Dual Diagnosis Street Project in Cambridge. It’s a service outside of Jimmy’s we partner with to support our residents. They do a brilliant job but there are only two people in the team so their capacity is incredibly limited.

When someone arrives at 451, have they come from another part of the Jimmy’s service?

It is 50/50. We are commissioned by the council, so whilst we take people from inside Jimmy’s we also receive referrals from many of our partners working across Cambridge to help those experiencing homelessness. There is a waiting list based on priority need, so if a room comes available it is assigned to the person who needs it most on that day, wherever they are based previously.

What does their arrival look like?

Depending on where they have come from, they usually arrive themselves. A room is made up, so it’s clean and tidy with a full set of toiletries, as well as a towel and sheets. Everything is ready to go. Our aim is for it to be homely and look like a place you would want to sleep.

Someone who comes in off the streets may struggle to put a duvet on, which is why we make sure the bed is made up. We want people to feel welcome. It is a two year stay project, some will leave earlier because they will be ready, some slightly later, because they are not. It can also depend on availability for move on options.

People who come tend to have an addiction of some kind. For some, they want to get totally clean, and when they leave they are. It is a personal choice though. We have people right now who have been in the same circle for 30 years, addiction will always be part or parcel of their life. We just teach them how to manage so they can live and work around it, so they can enjoy their life, so they aren’t a slave to it anymore.

Can you talk about that further, how can you live your life when you are addicted to a substance?

Addiction looks different for different people. For example, we have a resident who is a long-term drinker who now averagely only drinks four cans a day, one in the morning to help him cope until lunchtime, another can around lunch, one late afternoon, and one before bed. These four cans keep him ticking over and that is all he needs. If he didn’t have these drinks, he would rattle, be sick and lethargic.

Would Jimmy’s not try to encourage him to detox?

No, he doesn’t want to. 451 is about choices, not dictating how people live. If that person wants to drink in a safe way we will support them to reduce harm.

Do you want them to stop drinking?

If I had a magic wand, I would love to see them regain their lives. I see so many people who have talents, skills and are generally nice people. Sadly drugs and alcohol has stolen that from them. It steals everything; personality, job, family, lifestyle. If I can help them regain any of that, we have done a good job.

It can take several attempts to succeed, what happens when it does go well or when it doesn’t?

Sadly, we have evictions, some lines cannot be crossed without consequences. But that doesn’t stop someone from trying again. We have a person that has tried twice already the past 12 months. He is back on the waiting list to try a third time; we won’t ever refuse anyone if they keep trying. Perseverance pays off in the end. In my experience it is not so much the older ones, but the younger ones who need to come to us four or five times before they make the headway they want to. It is difficult, they are very led by their peers, so if everyone is doing one thing, they will all try and do it. They will not want to be seen as different or ‘not fitting in’. It does not mean they always want to join in, but sometimes it is very difficult to refuse.

What are the dos and don’ts at 451, what gets you evicted?

Bringing drugs onto the premises is a big no, that is probably the one stark message I give out when people move in. We respect what they need to do outside. Also, harassment, bullying or abuse. If you are seen to be bullying other residents or staff, we have a warning and bans system we tend to use. We start with a verbal warning which then progresses to a written one. Somewhere in the middle we use a behavioural contract which is a notice to improve before heading to a final written warning. We rescind those warnings if a behavioural pattern changes. The idea is we don’t spend days punishing people for behaviour. If we change the behaviour, we change the mindset which changes the way the behaviour works. Over the course of time, they learn to live with other people and hopefully engage with things they have not done previously.

We encourage people to be honest, most people are very wary talking about their drug taking in front of staff. I encourage them to talk openly about their feelings, nothing will change if they feel ashamed. It is also harder to help someone closed off all the time. We have time to build up relationships here, and create a space where they can tell us what is going on in their lives without fear of being punished which may have happened in other places in the past, i.e. prison. For us it’s not about punishment; it is learning to live alongside people and learning to think before you act. Default can be swearing, anger, abuse, but it’s not designed to hurt you, it is designed to push you way so you’ll back off and leave them alone. We will leave them alone in the short term, but we’ll never back off completely. We must meet people half way so that issues can be dealt with.

You must have a lot of patience, what other qualities do you and Support Workers have?

Never thought of myself as particularly patient, but I can play the long game. You do break the barriers down little by little and that does take time and patience.

My support workers are extremely kind and patient people, they understand life can be very complex at times. Some of us have lived experience, some don’t. We want residents to come to us and when they do, we try to look at solutions rather than problems. Our residents have always been considered a problem but that’s not right. They are people. There is not a single person in this world, who doesn’t have a single problem or cause for sleepless nights.

The support workers are there for our residents. We understand that seemingly small things can be exacerbated because they are not very well. We know that sometimes residents react badly to situations but we also know this comes off the back of anxiety and fear of being rejected by family, jobs, children. They are always anticipating the next rejection, so they will push you away. If they feel they have done something they need to be spoken to about, we get adverse reactions, it is designed to push us away so they reject us first, before we have opportunity to reject them in any shape. I find that very sad. It’s something our support workers know how to manage and how important it is to handle well.

Tell us about when it goes right?

There are lots of heartwarming stories, little wins, such as when someone severely ill gets out of bed, the day they ask to make a breakfast, the day they start to come out into the garden and see the sunshine. So many little wins, so many warming moments.

Usually it takes people 6-8 weeks to start to settle down. During that time, they start to observe what goes on, bond with the support workers and feel at home.

It may not be that they trust you, but they start to have faith in you. Trust is a very big word and takes a long time to build up, but when things are going well, they start to have a little faith that what you say will happen.

And then comes some of the more unusual stuff that we try to make happen for our residents. For example, someone came to me and asked if they could build a soapbox and for the Red Bull Soapbox Race of which there are several in our local area. The residents looked at me with hopeful little faces, so I went home, sat on my sofa, looked at my partner and said, “How I do I make this work?”. He said, “Leave it with me.”. Half an hour later he came back and said “We have been offered a soapbox but it is in Shropshire.”. A chap was selling one on Facebook marketplace, he didn’t want a lot, and is also now delivering it to us, how kind is that!

We wanted to make this work, we know we can’t have welders and things here, but they can take the top and rebuild it to have the soapbox they want. I had photos sent to me which I have shown the lads that want to do it. It will have to be stored in my garage over winter until spring. We may find volunteers to help with bits and pieces. It is about making the magic happen in whatever way we can!

Refer to *Eddie’s* story.