Hope, control and opportunity

An e-mail from Central and North West London Foundation Trust had introduced Thea as a senior recovery trainer and psychologist, as well as sitting on the Healthy London Partnership’s Homeless Health Program Board. It raised several questions. Does personal experience help in working with clients, and how does someone move from ‘revolving door patient’ to clinician?

After a short rainy walk from Kings Cross I found the Recovery and Wellbeing College in Wicklow Street (temporary accommodation while their actual offices are refurbished). It can be a desolate area, but Thea gave me a warm welcome and we settled down to talk. She turned out to be a passionate communicator on the role of trauma and mental illness in homeless people’s lives, as well as the dangers of labelling.

‘I feel lucky that I can use my life experiences in a helpful way’

What does the Recovery and Wellbeing College do? ‘It’s a trust-wide service – the third one of its kind to open in the UK. It was launched in 2012. It runs courses and workshops and is based on the idea that people with mental health difficulties should have the same opportunities as anyone else. It covers five boroughs, as diverse as Brent and Westminster, and has pockets of services in other areas.’

The college also seeks to help people build community tools, breaking down dependency on services, promoting hope and personal autonomy, and helping them escape the identity of an ill person. ‘Most of our courses and workshops are run out of colleges, universities and libraries – community buildings which are not health- or illness-related,’ Thea says. ‘People mostly self-refer, and our courses are open to anyone. No one has to self-disclose and the services are free to people using Trust services or carers of people using Trust services, including staff working in the Trust.’

When did you start working here? ‘My occupational therapist brought me here six years ago as a student after a long period of health problems relating to my eating disorder. I saw that the staff treated students as people, not just as a label. As I’ve since learnt, the college uses an educational rather than a therapeutic model. It can be summarised with three words: hope; control; opportunity. Language is critical. How clinicians talk about issues give messages and make judgements; ways of speaking imply authority and power. Labelling is a problem in many areas we deal with, not least the ones I experienced and am now working in – homelessness and eating disorders. So, you can see why the attitudes and culture here were a revelation to someone who had, by that stage, accepted homelessness and anorexia as my identity. Four years ago, I applied for a peer support role in Westminster and got the job. I also got a role in training out of my lived experience.’

A little over a year ago, Thea got a role here at the Recovery and Wellbeing College as the Physical Health and Wellbeing Lead. ‘The underlying idea is you can’t have physical health without mental health, and vice versa. We talk about personal recovery in addition to clinical recovery, and help people think about changes they would like to make that would support their recovery and wellbeing. And I suppose now I cover two roles – one by virtue of my life experiences, one because of my master’s in health psychology.’

Do the two aspects get in the way of each other? ‘Far from it. I feel lucky that I can use my life experiences in a helpful way. They create an atmosphere in which trust develops more quickly and the person I’m talking to is less fearful that they’re going to be judged because I do have personal experience of at least some of the things they’re going through.’

How could I help others if I couldn’t help myself?

Something has been bugging me. What is your accent Thea? ‘I was mistaken for Irish the other day but I’m Canadian; born in Vancouver. I had a difficult childhood. “A dysfunctional family” was a term I became familiar with. My mother moved us around a lot after my parents went through a particularly messy divorce when I was very young. It was a hard time for everyone, and we all struggled to cope. Things happened that were outside of my control, that took a long time to recover from. Apart from anything else all these experiences interested me in psychology. I began to ask myself “How come these adults are making these decisions? On what basis?”.’

You sound an intelligent child. ‘I was bright but tended to hang around with kids that were less academically minded. Living in Spain I went to Spanish school for a short time, ostensibly to learn the language and the culture we were living in. I was bullied quite intensely for looking and sounding so different.’

Having lived in Spain from the age of 8 to 15 it all got too much. ‘I started telling myself repeating phrases: “I have no one”; “Life is not worth living”; “If I do not leave, I will never recover”. So, I left. I’d saved up enough money to get to London, hoping to speak with my father and to be able to live with him in Canada. That didn’t happen. I spent a short time finding places to bed down where it felt safe. In the end, my father got me a place in a boarding school in Birmingham through relations who lived there. Because of that I was able to do my A-levels. My eating disorder was already taking hold, and I had all the traits that typify someone who develops one. I was partly very self-reliant but also incredibly childlike and naive, with no effective coping strategies.’

Thea stresses that she now has a good relationship with her parents and, also points out ‘Having a father with money helped me – he’s a lawyer – and my siblings are hugely important. That’s the sort of support any person who is homeless or ill doesn’t often have. In addition, Mum was a teacher and continually stressed education, which has also helped all of us.’

During a gap year living in Vancouver she waitressed. Was that related to her eating disorder? ‘I’m not sure it was in my case but there’s often a fascination with controlling both your own and other people’s eating. It’s a question of power, of control. If you can survive without eating and still seem to maintain your independence, to function, you feel invincible.’ She also looked after her grandmother who had multiple sclerosis. ‘This experience inspired me to study health psychology. She had a strong religious faith and I realised what a powerful tool this is to help her live some sort of life. A lot of people I work with have faith in something – sometimes, but not always, religion – and that literally keeps them alive. It gives them hope.’

Thea’s eating disorder was out of control and she stopped looking after her grandmother. She moved back to the UK and after a period of sofa-surfing she went to Southampton and did a degree in psychology. She then moved to London with two friends and saw a GP ‘who got me a bed in an eating disorders clinic urgently and I stayed there for a year and a half. I was discharged to a hostel, after which I was moved into a social housing flat. I still live in it.’

For most of the next 10 years Thea was in hospital, either in eating disorder clinics or in an acute psychiatric ward because of her self-harming. ‘To return to my earlier point about identity and treating a person as a person, I was being told that I would never recover and at best I would be a functioning anorexic.’ Every so often she would come out of hospital for three months but would soon have to return to hospital again. Remarkably, Thea completed her master’s in health psychology during this period. She also worked as a counsellor, an au pair and a play coordinator and got married. But she didn’t start working as a psychologist straight after she was qualified. ‘I felt a fraud. How could I help others if I couldn’t help myself?’

Things changed during her last admission. For a variety of family reasons, she had a row with her mum and ended up being admitted to hospital with internal bleeding. ‘I thought, “This is it. I can’t do this any more.” Then one of the care coordinators came to me, treated me like a human being and offered me some choices about how to cope with going out into the world again. And that was it! My recovery has been a process of losing things – my loved grandmother had died, my grandfather who I was very close to too, my marriage broke up, and I had developed very severe osteoporosis (my body finally protesting at all I had put it through). But I discovered things too – yoga and the college, and who I might be beyond my eating disorder. How I might be of some use in the world.’

Understand what homelessness means

What do you think Psychologist readers should know about those diagnosed as homeless? And what can they do?

‘First it’s important to understand what homelessness means. It’s not just sleeping on the street. People sleep on buses, in hospitals. They sofa-surf. There is a population of hidden homeless. Second, the effects are stark. Homeless men die on average at 47; homeless women at 43. Third, there’s a tacit assumption that homelessness is a choice. But in fact, there’s huge evidence that most people diagnosed as homeless suffer traumas and mental health issues before homelessness compounds those issues. A key characteristic of someone who finds him or herself as homeless is a failure of trust.’

Are there political and policy issues here? ‘Yes. I’m not particularly politically minded, though many of my colleagues are. The new Homelessness Reduction Act is a step forward but providing support based on labels rather than because of need does not help.’

Do psychologists have a role? ‘Yes. And as we’re realising in several areas it’s the relationship that matters, less the particular technique or approach you use. Kindness, hope, cooperation, the establishment of trust are key. That’s my experience both as a person who uses services and as a psychologist. Put simply, kindness works.’

If people want to learn more? ‘Look at the London Homeless Health Programme website and download More than a Statistic, which is the voice of people who are homeless in London. What comes across to anyone who reads these words is that we’re all just a few steps from being homeless.’

And your final hope? ‘That support should increasingly be given on a needs basis not because of a label. Diagnoses are helpful in getting support, but they can be divisive.’