Helping those on the outside of society

Started in 2013, Outliers works with individuals from across London who have heavily complex needs and are often barred from other services. “Imagine the worst case scenario in your head,” says Outliers caseworker Anthony Kelly. “That’s what we deal with.”

The referral criteria states that individuals need to have at least three needs to be eligible – the long list includes mental health issues, drug and alcohol problems, homelessness, regular Accident and Emergency admissions and contact with the police. According to David, the Senior Caseworker on the project, most clients will tick all the boxes on the list.

One such person might be ‘Robert’. After being discharged from a mental health unit, he has retreated to his flat – on which there are currently increasing rent arrears - and sleeps on a urine soaked mattress covered in his own urine and faeces. He fails to wash or clean the flat which is infested with flies. His condition has deteriorated since his mother died. He rarely ventures outside and when he does it is usually to shoplift a sandwich. The smell from his flat is shattering. Despite David successfully lobbying for a mental health assessment, he is not considered to be mentally ill. Aside from a few carers, Outliers are his lifeline.

“He had so many issues that we had to chop them up amongst the team – one of us dealing with his benefits, someone else dealing with something else etc, etc until we unravelled them all,” says David. “We made progress and managed to arrange a professionals meeting to discuss his case.” However, this was kicked into the long grass when all but one of the agencies due to attend failed to show. So now the team are watching and waiting, still keeping ‘Robert’ on the radar until his arrears mean he loses his flat and they are able to make a case to the authorities once again. Regrettably, it is only when things have reached crisis level action might ensue.

Outliers is so-called because it works with people who lie on the outside of society. From a vulnerable trafficked woman to a 76-year old man sleeping rough and with a serious offending history, the team navigate the maze of statutory services for those whose needs make them unable to do this for themselves. But their work does not stop there.

“What we are finding is that when we are presenting our client’s cases to places like the homeless person’s unit, we don’t just advocate anymore but we actually have to investigate their histories to make a case,” says David. What this practically means is liaising across the spectrum of professionals – mental health teams, GPs, probation and police – to gather “prima facie” evidence of someone’s vulnerability to ensure they receive the right support and services.

In the case of the 76-year old this meant David gathering facts, engaging a solicitor and then escalating the case to managers at the local authority – who had deemed him ‘not vulnerable’ - to get him somewhere to live. Not an easy task given that the man had a history of aggression and this - together with the nature of his offences - made him tricky to house. However, it was vital that he was given a roof - both for his own safety and potentially that of others if his situation had deteriorated further.

David and Anthony are the team’s two paid caseworkers, supported by a handful of trained volunteers. Both agree that they are probably just working with the tip of the iceberg. Given the severe and complex needs of each of the clients, active caseloads are kept relatively low to ensure intensive support for very needy clients, with the team checking in regularly with clients who are more settled.

Outliers picks up the pieces - lack of aftercare for people discharged from mental health units, hospital and prison, plus often decades of chaos and abuse in their clients’ lives. David says that many suffer from a condition known as Korsakoff Syndrome which can be brought on by years of heavy alcohol abuse. This distressing condition means that the people suffer from a form of Alzheimer’s which can cause memory loss, confusion and a host of other problems.

Working with this client group requires unusual levels of patience and persistence and burnout is a risk. What do David, Anthony and the team have that makes them able to do this?

“Lived experience” is stated. All the team have experienced issues such as homelessness, addiction and time in prison.

“We have empathy and understanding and are able to put our heads where the clients’ heads are at,” says Anthony.

“Also a sense of injustice,” says David. “We see someone in a situation who shouldn’t be there.”

The team are also Level 3 qualified, highly skilled professionals who use this – along with a mix of their personal insights – to offer a service which reaches the some of the most vulnerable, disengaged people in London. The ultimate aim is to help clients stabilise their lives and become independent. Given the highly complex issues they need to untangle and resolve, this does not happen overnight. But despite this, out of the 26 clients initially referred to the project there have been heartening successes including employment.

‘Tania’, a 52-year old woman sleeping rough, who was subjected to multiple sexual assaults and with drug and alcohol issues is now thankfully settled in a hostel and looking to go into rehab. “What a change,” says Anthony. “She used to come in with black eyes and all over the place. Now she comes in smartly dressed and she’s taking care of herself.” According to David, tracking the costs savings to the public purse of this project would be a challenge given the highly chaotic nature of the clients. However, the cases described above show that the team’s role in being the ‘mover and fixer’ for vulnerable people who cannot make things happen for themselves must prevent further costly and tragic incidents further down the line. The state did not come round a table to discuss the case of Robert – the vulnerable man deteriorating in his own waste in his flat. He is behind closed doors and not harming anyone but himself so he’s not a problem. But when things go into a messy and potentially costly freefall, Outliers will step in. Likewise with the 76-year old, “Where would he be now if Dave wasn’t working with him?” says Anthony. “He’d be on the streets, vulnerable and possibly re-offending.”