Measuring the whole person

November 26, 2015

In this blog, Jonathon Graham from Homeless Link reflects on a new review of research into experiences of multiple needs, and how it links with his work on Voices from the Frontline.

Understanding the whole person is a new literature review by the Revolving Doors Agency discussing the common concepts for recovery and desistance across the fields of mental health, substance misuse and criminology for people suffering from severe and multiple disadvantage. The review was supported by the LankellyChase Foundation.

As Understanding the whole person makes clear from its outset, positive change on the road towards recovery and desistance across the fields of mental health, substance misuse and criminal justice, stems from the individual. One of the fundamental aspects of this journey is the development of a “strong, coherent and positive personal identity”, based on the ability “to generate a sense of self which is not institutionally or externally defined”.

A Voices from the Frontline workshop in Nottingham
A Voices from the Frontline workshop in Nottingham

Working on Voices from the Frontline (VFTF), I have come across this theme on numerous occasions, particularly around the use of labels. One of the people I worked with during the writing of our latest publication, Solutions from the Frontline, told me of his objections to being characterised as having multiple and complex needs on the basis that “multiple needs is just a made up word!”

Yet, if so much of a person’s efforts to develop a sense of “responsibility, choice and self-reliance” come from decisions they make independently, what role does this leave for professionals and services? In reviewing the work of Helen Glover, Understanding the whole person presents us with one possible answer: their role is “not to get in the way of recovery”, but rather to play “an active part in validating people’s progress and offering emotional support.”

Many of the professionals with whom I have worked during VFTF understand and relate to this idea, building it into the way they interact with people every day. In explaining her work to me in detail, a participant at a workshop in Nottingham outlined her efforts to facilitate people’s progress: “It’s not just about doing stuff to get housed… we do nice stuff, everyday normal stuff. Go and look round the shops… Human stuff. Yes, we mess around… you need to mess around! It’s about being normal.”

Professionals have also found different ways of remaining flexible and responsive to people’s differing needs and personalities. This was best encapsulated in an off the record conversation with a support worker, who in response to the question of what they thought their job entailed replied, “I’ve no idea until I’ve met the person.”

However, despite the best efforts of individuals and services, there remain a range of systemic barriers in place, preventing us from engaging with these approaches more fully. One such issue is how we define success. Traditionally, support systems have been designed around the needs of aggregate populations, such as ‘ex-offenders’ or the ‘homeless’. As a result, we have created metrics to measure success, focusing on broad, general goals, such as moving into independent accommodation or finding employment.

Often these metrics fail to recognise a person’s individuality, preventing them from making genuine choices and engaging in “meaningful opportunities that are right for them”. This hinders their recovery, ensuring that services “get in the way”. With the prospect of a nationwide programme for people facing multiple needs currently being discussed, we must give serious consideration to what success should look like in this new environment and how we should seek to measure it.

The issue of success has been raised throughout VFTF, with people eager to suggest new ways of working. People have argued convincingly for a metric, which incorporates “distance travelled”, so rather than measuring “absolutes, you look at someone’s Outcome Star and see if they’ve moved from a two to a four.” In order to promote autonomy and choice, people have also advocated for an approach that allows people to define what represents a successful outcome for them, thereby acknowledging the very real progress made by “someone who before wasn’t able to turn to one appointment, but now they’ve turned up to four.”

Bringing each of the relevant sectors together to agree a new measure of success will be challenging, but not impossible. As Understanding the whole person highlights, there are crucial differences between the sectors themselves. On the one hand, “Literature on addiction recovery and desistance from crime focuses on individual change”, whilst on the other, writings on mental health will “often challenge institutions and structures” to adapt to the needs of those they support. As with so many of these hugely important questions, the answer is likely to lie in where we meet in the middle.