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The Hardest to Help

The hardest 50+ groups to help

Teh hardest to help

Some groups of people over 50+  are chronically excluded from employment and have complex needs.  They may be homeless, have alcohol problems or a criminal record and are thus deemed among the hardest to help.  Nevertheless, there are success stories.  St Mungo's, Addaction and Nacro, three voluntary sector organisations who work with these groups, have contributed their specialist knowledge and advice to the Guide.

 

1. Working with the homeless

St Mungo's (opens in new tab or window) supports homeless people in their recovery - opening the door to safe housing, drug and alcohol support and physical and mental health care. 
We run street outreach, hostels, specialist hostels, training flats, and shared housing.  They help homeless people gain a range of life skills from independent living skills through to work if required. They help some 3,000 people a year, many of whom are over 50.

Understanding 

This group faces many barriers: physical, societal, and structural, such as declining health, addiction, debt, broken family relationships, housing problems, feeling they are on the scrapheap and a loss of dignity. They may look physically ravaged by time and events. They are likely to have been through the ‘revolving door' too many times and cannot face the effort needed to try again.

The excluded over-50s will often have a poor or mixed view of the value of work. Their perceptions can be influenced by the media and they may hold negative views of employers (thinking employers will discriminate against them) and believing they have negligible employment prospects. They are likely to know little about good employers and where to find them. They usually lack recent experience of the workplace, know little about the demands of work and little about employee rights such as the right to request flexible working.

Staff need to be careful not to be patronising or insulting. They could be speaking to someone who has been very successful in life or someone who has never made anything work. Equally, they may be talking to someone who has developed, over a life-time, a network of contacts completely outside the social norm (legal or otherwise).


Credibility

Knowing how fast to proceed and how to direct change through empowerment and a recovery approach (pdf, 16KB opens in new tab or window) is important. Staff training is usually needed here. We seek to empower a resident to take control of their life by adopting a customer-centred approach which looks at the individual and focuses on helping them make their own recovery rather than letting them become too dependent on services such as St Mungo's.


Engaing and building trust

 

Staff need to take time to engage, maybe by offering cups of tea, cigarettes, for example. They need to smile, offer a greeting or comment about daily life and what others are doing, providing tempting bits of information. They have to build trust and mutual understanding and at all times provide whatever professional services that are expected.

If a staff member succeeds in doing this, the next stage is easier. The role of housing and health provision staff are key during these stages because in addition to their own professional abilities, they are well placed to be in the right place at the right time. A good project allows its staff time to engage with residents.

Typically one of two things may happen at this stage:

Either

1. The customer wakes up one day and asks for help. It is crucial to be able spot this and offer appropriate help (this could be years after they join a project). What is offered must be easily achievable and followed through with support.

or

2. The staff member chooses to push the relationship and suggests an activity, maybe a very small one, maybe larger. It is absolutely critical that the customer can achieve it and feel it was worthwhile. The right staff member will carry this off by sheer personality and drive. Managers need to cultivate staff with these abilities.

However, it is important to acknowledge that some residents are too far down the road of ill health to ever return to the mainstream world. St Mungo's provides a place for such individuals to live out their life in some form of dignity (as do many other charities).

Following through

At this stage, staff may now have some tenuous engagement. They need to listen and absorb the issues that are holding someone back. A tailored response is needed in most cases. A dose of realism and brutal truth may well gain respect at this point. Staff may suggest an introduction to a project working with a similar group of people (see the case studies below.)

Staff need to be aware of the risks that their customers face in going back into work.

Customers can end up highly stressed, hungry and in debt if this stage is handled badly. It is not unknown for some to end up back on the streets as a result of doing what society expects of them (paid work). We usually advise fairly long periods of volunteering before moving to paid work as volunteering helps them establish regular sleep patterns, undertake regular physical activity, eat regularly, make social contact, and become more relaxed. It generally leads to an improvement in health. Volunteering does not involve financial risk, exposes them to opportunities and the mainstream, and helps them give something back to the community. When everything is in place and working successfully, we can put them in touch with a job coach to help them make the difficult but now achievable step back into paid work. When this group is motivated to move into work, we can and do in most cases, succeed in finding them paid work.
 

2. Advising people with a criminal record

This information has been put together by Nacro (opens in new tab or window), the crime reduction charity.

Securing employment with a criminal record can be difficult. Some employers will automatically refuse to employ anyone who discloses a record, no matter how old or how minor it is. However, most employers, including those who carry out Criminal Records Bureau (CRB) checks, will consider individuals on their merits. Older people can be attractive to employers, regardless of criminal records, as they tend have a lot to offer in terms of skills, experience and, often, a long work track record.

Top tips on advising someone with a criminal record

• Make sure you know about the Rehabilitation of Offenders Act. To download a leaflet about the act, go to useful resources on the Nacro website.
• If they are applying for a job covered by the Act and their offences are ‘spent', because of the length of time since they were sentenced, they do not have to disclose them to an employer. This is their legal right.
• If they have to disclose, either because their offences are unspent or because the job falls outside the Act - is ‘excepted from the Act, usually because the position involves working with children of vulnerable people - coach them to disclose in a reassuring way.
• Wrap that disclosure up in messages about ability to do the job. 
• Seek advice from the Nacro helpline at helpline@nacro.org.uk or telephone 020 7840 6464. Helpline advisers have extensive experience about disclosing criminal records in different circumstances. The helpline can also advise ex-offenders and people working with them about other matters, such as housing and insurance. 
• The Nacro-run Resettlement Service Finder site, can also help by providing advice resources and details about specialist services in the community for ex-offenders.

3. Alcohol Addiction

You may be concerned about someone who is over 50, and who you suspect may have a drink problem. Knowing what to do about this, or what to say, can be difficult.

This information explains what an alcohol problem is, why people drink too much, the signs to look out for and what you can do to find help.

By being informed, you can pass on the best kind of advice to the people you're working with.

What is alcohol?
What we commonly refer to as alcohol is actually ethanol. Ethanol is a psychoactive ingredient that results from the fermentation of sugar by yeast.

Alcohol is classed as a depressant, meaning it depresses the central nervous system and is an effective painkiller.

The term unit is used to describe the strength of a drink and each unit generally equates to that drink containing 8g of ethanol. A typical pint of strong lager or large glass of wine contain both contain around 3 units of alcohol,

When does drinking become a problem?
Alcohol use can be described as hazardous or harmful depending on the volume of alcohol they are drinking, the frequency that this happens and whether they feel the ‘need' to drink regularly.

A hazardous drinker is defined as someone who regularly drinks 5 units a day for men, or 3 units a day for women. This is described as ‘risky' drinking and may lead to alcohol related harm.

A harmful drinker is defined as someone who may have developed a dependence on alcohol and it is having a significant impact on their physical, psychological and behavioural well-being. A person drinking at this level may require medical help to reduce their alcohol intake.

There are screening tools available which can be used to identify an alcohol problem. These include the AUDIT (World Health Organisation) or CAGE (Ewing, 1984)

Why do people drink too much?
Some people aged 50 or over may have been drinking problematically for a number of years. For others there may have been a ‘late on-set' of drinking, which can happen for a number of reasons. Family breakdown, redundancy or any stressful event could have led to someone using alcohol as a coping mechanism.

Reasons that individuals may drink too much include any of the below:

  • Social isolation
  • Mental health Issue
    Family breakdown
  • Bereavement
    Sleeping difficulties
  • Financial worries
    Anxiety/fear
  • Redundancy
    Pain Management
  • Retirement
    Alcohol dependency
  • Boredom

The impact of alcohol
Depending on the frequency, amount and history of alcohol use the effects of someone's drinking will vary greatly. It will also depend on the individual's body (their sex, height, weight and metabolism will all play a factor). However, it is important to remember that alcohol can lead to adverse physical and mental health conditions, and this may impact on someone's ability to engage in a ‘back to work' process.

Alcohol can lead to a number of health problems, including:

• Cancer
• Stomach problems
• Incontinence
• Anxiety
• depression
• Heart disease
• Anxiety
• Strokes
• Pancreatitis
• Liver damage
• Nerve damage (commonly ‘peripheral neuropathy' which can affect balance)
• Alcohol-related brain damage

For older people, a number of other factors may be affected by alcohol use. These include:

• Lower amount of body water so higher Blood Alcohol Concentration (BAC)
• Decreased ability to develop tolerance
• 3 x more likely to display depressive symptoms 
• Heavy alcohol intake may lead to cognitive impairment 
• Increased risk of falls and injuries 
• Disruption of sleep patterns 
• An impact on any medication they may be taking, as alcohol activates enzymes which break down toxic substances - including prescribed medicines.

Help available 
Some people's alcohol problems may be so pronounced that they experience withdrawal. This can occur within only a few hours of not having a drink, and symptoms can include anxiety, shaking and tremors and even hallucinations. In extreme cases people may experience seizures so severe as to be fatal. If someone is considered a ‘harmful' drinker, they should seek medical advice before cutting down or completely stopping their alcohol use.

Many people however will find a psychosocial intervention or ‘talking' therapy enough to help them understand why they are drinking problematically. They may also benefit from one of the many ‘peer-led' meetings provided for free throughout the UK. In these meetings, people with similar problems meet to share experiences, learn more about their problems, and to offer each other support. They include AA meetings (which adopt an abstinence model) and SMART meetings (which help people to develop coping strategies).

To find out more about alcohol and how it can affect the over 50s, visit www.addaction.org.uk.
 

4. Mental illness 

RBLI has provided this case study which describes how an adviser helped a man diagnosed with paranoia get back to work and stay in work. 

Case Study 

Harry (53) had been diagnosed several years previously as paranoid.  He had not worked for nine years.  He had had periods of severe illness but through his referral to a condition management programme via RBLI’s Pathways to Work programme he was finding ways to cope with his illness.  Harry’s Pathways adviser understood he could not function in groups and could only be seen on a one to one basis. 
 
Harry was convinced every conversation he heard or saw taking place was about him.  His problem also meant he extrapolated generic facts to be about himself, for example when he heard on the news that 25 per cent of incapacity benefit claimants were obese and reliant on medication, Harry perceived himself as to be overweight and a drug addict.
 
He regularly cancelled his appointments as he was convinced people were watching him leave his house.  Because of this, his adviser arranged home visits, or met him in his local coffee shop which was a familiar environment.  When his adviser visited him at home, Harry would lock him and the chaperone in and draw the curtains.
 
After every advisory interview, Harry insisted on having the notes read back to him to be sure that nothing derogatory had been written about him.  Through taking an open, honest and transparent approach, his adviser managed to establish a relationship with Harry over a number of weeks.  The contact was intense in order to keep the momentum going and to stop doubts and negative thoughts creeping into Harry’s mind.  Harry had formerly worked in groundskeeping and held good qualifications, but he had had an incident which had led to him being been sectioned.  Although the incident had taken place a long time ago, Harry was still extremely nervous about returning to work. 
 
After some time, Harry started his own self-directed job search and applied for a host of vacancies. His adviser, after checking the first few applications, was convinced he had good job search skills and wasn’t self-sabotaging.  Harry gained an interview for himself, and attended an intensive interview preparation session with his adviser the day before the interview.  Harry was offered the job and asked to start immediately.  However, it became apparent that he hadn’t disclosed his mental health condition and so his adviser arranged to speak to Andy, the site manager.
 
 Andy had some concerns initially but Harry’s adviser went into detail about Harry’s condition and how it could be managed.  As Harry was present during this discussion, the transparency and trust which had been established was maintained.  Harry’s honesty with his employer and Andy’s support at this stage helped foster a stronger relationship between them. Andy arranged for a colleague called Joe to induct Harry into the company as Joe was to be Harry’s dedicated work buddy and they would work in the same team on site.  Harry and his adviser described Harry’s symptoms and what to look out for if he started having a hard time or feeling overwhelmed by paranoia. 
 
Andy and Joe were the only people in the company who knew about Harry’s condition and they changed some protocols to accommodate him.  These included giving him fixed hours to ensure he could continue to attend his condition management programme (CMP) without being challenged by other staff about leaving early, and arranging for Joe and Harry to work together every day together instead of being in different teams.  It was important to Harry and his well-being at work that the other staff didn’t know he was attending CMP or the Pathways programme.
 
Harry received in-work support calls every other day for the first two weeks.  These then reduced to a weekly and then fortnightly basis.  Joe says that now he knows about Harry’s condition, he has learned to spot any early warning signs and can intervene when Harry feels others in the team are whispering about him.  Joe believes he has prevented a number of situations which may have led to Harry being sacked.
 
Harry still attends his CMP and feels the coping strategies he has learnt there are proving invaluable.  The CMP is also Harry’s first point of contact if he gets stressed at work, followed by his RBLI adviser, and his GP.  Harry comments:  “Without RBLI’s support, I’m sure I wouldn’t be in work. The help and arrangements they have made are keeping me happy working every day.” 

 
 

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Co-financed by the European Social Fund