“I can’t believe half the things I’ve been through,” says Joseph as he calmly sows chilli seeds in the tranquil garden of the place that has been his home since August 2015.
“It’s been rough and bumpy and I hope it gets better.
“I was sleeping rough in Liverpool Street station and woke up and the pigeons had messed all over me and I had to go to the washroom to clean up.
“I was out in the cold for eight months in 2014, I nearly died of hypothermia… I tried begging. I was in the West End; some people treated me kindly, I got food from the American Church. I just used to put my sleeping bag out at night on a bench near the hospital. “It wasn’t too bad in the summer, but it got really cold. The rain woke me up one night and I ended up in University College Hospital with hypothermia.”
But he also has strong and good memories of a disabled friend in a wheelchair he supported on the streets. “He couldn’t use his hands and I’d get him a straw to drink through… He could only grunt. We looked out for each other …”
Joseph had his own flat in south London, “but my neighbours were trying to hurt me”. For three years he slept in a park, in the shadow of the flat he had lived in for 18 years. “I used to sneak back at five in the morning to make a cup of tea. I didn’t want to go back because it was menacing,” he says.
The fear of being bullied has haunted Joseph for most of his life. He was born with learning disabilities and sent away to boarding school when he was 10. “It was a really brutal school and I was forced to wear steel toe cap boots. I had to put up with it for four-and-a half years.. When I ran away they deducted about five shillings pocket money from me.
“I had to do the gardening, which was therapeutic.” And he adds that he enjoyed the school outings to Wales, Northumberland and Northampton.
When he was 16 he wanted to ” fix and repair” and started an apprenticeship as an electrician in a toy factory. Once again he had to contend with bullying; this time the workmate who was responsible for his training, “he squirted oil at me, locked me up in a battery room full of poisonous fumes, and tried to pick fights.” He didn’t finish the apprenticeship “he killed it off for me and I was discouraged…”
Joseph puts his mental health issues down to these tough times and the lost opportunities. He started to suffer from paranoia and hearing voices and was admitted to St Thomas Hospital and diagnosed with schizophrenia in 1971. He had ECT (‘electric shock treatment’). “When you wake up from that you can’t walk… ” adding that eventually he “felt more energised”.
Joseph rediscovered his love of gardening as an out patient at Tooting Bec hospital between 1983 and 1986, “we used to sell plants; I planted geraniums, took cuttings – that was therapeutic.”
More bouts in hospital followed and losing his mum, who had been his carer, pushed him to the edge. As she got older she became more dependant and passed away in a nursing home in 2012. Joseph had been living independently but this broke down and his mental health symptoms became so intolerable that he started to sleep rough and eventually became street homeless. He ended up in hospital and this is where he was when Lambeth’s IPSA ( Integrated Personalised Support Alliance) initiative moved into his life in 2015.
Things started to change for Joseph when he moved to the Turrets – more home than institution, the 7 bed-service provided by Certitude is supported by voluntary sector staff who provide day to day support and personalised activities, such as healthy eating, exercise, and developing living skills. Access to a psychiatrist, occupational therapist and psychologist is also on offer as part of the intensive community rehabilitation package for 6 months.
Occupational Therapist Sue Anne Williams is one of this dedicated team who has walked alongside Joseph on this challenging journey. She explains that the ‘extra care’ service is designed to bridge the gap between hospital and community for those with more complex needs.
“We offer intensive reablement in the hope that the individuals will regain or develop the required skills to reestablish themselves and potentially increase their independence,” she explains.
The IPSA initiative is part of the Lambeth Collaborative’s vision to do things differently by addressing its big three outcomes for those with enduring mental health conditions
To recover and stay well
To make their own choices
To participate on an equal footing in daily life
When I first met Joseph at the Turrets, though anxious, he is happy to sit down and have a chat and wants to share his story. I find a sensitive, wry man who over the months reveals hidden depths, talents and resilience.
The Turrets is a welcoming place… bright and airy and the sun is streaming through the skylights on my first visit. The tiny office gets crowded with staff, and residents pop by to sort out their daily needs. The site has an interesting history (charted in the Lost Hospitals of London archive). The Turret was established in the 1930s as a hostel for ‘mentally handicapped young women’ capable of being trained for work who needed a degree of supervision. That ethos towards independent living continued until it closed in 1985 and was eventually demolished.
Sitting in the homely living room Sue explains that over the months of living here Joseph’s mood and behaviour have stabilised. “He appears more calm and less anxious, and his voice hearing and feelings of persecution/paranoia have reduced,” she says.
She highlights that Joseph has slept in his bed every night and no longer associates himself with the homeless community. This she says is the most telling aspect having made himself homeless a number of times due to his heightened anxiety and exacerbation of his symptoms.
Sue joined the service in late September 2015, on a one -year secondment from SLaM (South London & Maudsley NHS Foundation Trust). “At that time The Turrets service was still establishing itself and Joseph was our only IPSA client,” she says. “We spent the first few weeks helping the existing clients move on, and Joseph to settle. I was able to spend a large amount of time with him, doing day to day activities such as shopping, attending appointments, and looking for things he might like to do. One of the advantages of it being such a small service is that we do get to spend quality time with the clients, and because of the design of the building we can interact in a natural and unpressured way (saying hello when they pass the office, use the kitchen, spending time in the garden, watching TV in the lounge etc).”
Joseph says the journey from hospital to the Turrets was reassuring because of all those involved. Over the years there were lots of gaps in his care and he often lost touch with services when he was on the street. He feels he has built a good rapport with his care cordinator Helen, who played a large part in his move from hospital. She also helped him get a taxi to bring his things from his flat. The early trips to Sainsbury’s, with Team Leader Shaun, to get a sense of what the area had to offer was important. “I could talk to him at night if I couldn’t sleep… about the bad old days,” he says. Sometimes it was the little things that helped him get a sense of what it was to have a home again. “It was really useful learning how to use the microwave and how to put a duvet in the duvet cover, that was Adijat (key worker) who helped me.”
Clearly the time at The Turrets gave the team a greater understanding of Joseph and his needs. “Joseph is a self confessed loner and tends to shy away from social activity/gatherings,” says Sue. While he was living with us we became aware that he would agree to take part in things but would not sustain them. He is by nature a very passive and unassuming man, who will struggle on his own rather than ask for help.
“It was apparent while living with us that he started to trust us and would seek out staff for certain needs/support (but this tended to only relate to things he couldn’t do alone). ”
For Shaun, Joseph was a joy to work with. “He’s like a lone wolf who just wants to be left alone to do his own thing. We used to talk about 1970s’ TV programmes and music. I used to really enjoy talking to him and am pleased that his move has been successful.”
“This is Turrets’ success… this is the fruits of their hard work,” says Joseph proudly as he looks around his spacious new flat with large balcony and tree-lined vista. “I never thought I would get this; I was elated when I saw it for the first time.” He speaks fondly of visiting with his care coordinator and Tony, Support Planner/Broker, who helped bring the final stages of this journey to fruition. “They all worked together; Tony got this flat for me, he is very good at his job.”
Tony explains that his role is to meet up with clients and put together a Care package which will meet their individual needs and to support them to live as independently as possible.
“Most of my referrals come from the community mental health teams, where I will arrange to meet up and introduce myself to the client. We will then complete a Care and Support plan, which I with the Care Coordinator will then present to Panel for care package and budget. Once this has been agreed I will then go out and source services, which can work with the client to meet their individual needs.”
I see a different man each time I visit Joseph in his flat. He is walking taller, he has lost weight and he sits at ease in his armchair and talks about his books and other possessions from the former flat that once brought him so much grief. There are plans for planting out on the balcony, “maybe a hanging basket”.
His new accommodation is supported by Sanctuary Care and it is hoped that the support he received at The Turrets will help him to manage his new home, and keep himself well. His new PA Marcus is a gem, liaising between Joseph and myself so we can pick up the story once Joseph feels more settled in his flat. It has also been agreed that they can contact staff at the Turrets if they have any queries.
Joseph is acclimatising well and he says Marcus is a great asset. ” He helps keep the place clean, helps me get my medication and shopping”, and the budgeting support he got at the Turrets is “making my money last longer”. He still can’t believe he’s got the flat and though aware of his symptoms, “some days are better than others”, the meds have side effects and he gets tired… But the voices have settled and at least now, there’s time to reflect because he feels safe. He can even pop downstairs for a meal if he wants. But he cooks and is trying to eat healthily. He has been connecting with some of his family and is taking each day as it comes and setting ” immediate and short term goals”. Joseph was looking forward to his 63rd birthday this month, and hopes that in a year’s time he will feel settled and “that all my problems will have evaporated”.
Time to go
As she departs Sue says The Turrets gave the team an opportunity to get to know Joseph and to assess his longer term needs. “It also gave him a chance to rebuild trust and re-establish himself within a home environment.
“Over the time I’ve been here there have been many changes as part of the service evolving, this has brought it’s challenges as well as its rewards,” she says. “I leave seeing it as a well run service with a strong leadership. The staff overall are dedicated, knowledgeable, energetic, caring, and kind, and the clients themselves have all, in their own right, evolved and developed with the service. It is a joy to see the clients re-establish themselves and develop relationships with the staff, and begin the process of building their lives again after many months, sometimes years of hospitalisation. I will miss being a part of this, but I know the good work will continue and the service will go from strength to strength.”
For more stories see lambethcollaborative.org.uk