Specialist support to build trust and engagement

Jim* is a 26 year-old male with a history of mental ill health.

He has been known to substance misuse services in Nottingham since early 2022. He has an unconfirmed diagnosis of Emotionally Unstable Personality Disorder and Split Personality Disorder, and has also been assessed for Autism. Jim has previously been detained under the Mental Health Act.

The Rough Sleepers Drug and Alcohol Treatment Team (RSDATT) has worked with Jim since late 2022. Previous to this Jim had been in contact with other services, particularly mental health services.

On commencing engagement with RSDATT, Jim was rough sleeping in Nottingham City and using various substances including Mamba (spice) and Heroin. He had repeatedly refused mental health support, and the mention of ‘mental health’ or even words such as ’emotion’ were a significant trigger for him.

Offering Jim support was difficult to start with. He was very paranoid and suspicious, and displaying significant trauma. RSDATT identified that Jim’s mental health was very poor, and that any approach to support needed to be taken with this as a key consideration. Support for Jim’s substance use was discussed with Doctors at Nottingham Recovery Network, to ensure where an appropriate plan was in place.

RSDATT focused on building up a working therapeutic relationship with Jim,  establishing trust and clear communication. Their psychologically-informed approach has proved highly successful.

Jim has been attending appointments more regularly and has engaged with services and support regarding his drug use. His Support Workers were also able to step in and intensify support when Jim displayed a notable increase in drug use.

Jim’s demeanour and mood has started to improve. He seems more able to engage in communication and some points appears more relaxed at appointments.

There are still challenges with housing for Jim, and RSDATT continue to look at options. They are also providing sensitive encouragement for Jim to engage with the Homeless Mental Health Team.

Most importantly, they now have a clear understanding of Jim’s support needs and how to best identify a way forward given his very particular circumstances. There is now a dynamic working relationship between RSDATT and Jim and the plan is to maintain this and provide ongoing, person-centred support.

*Name has been changed for confidentiality.

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