A complex trajectory, a mobilized network
Mr T., now in his fifties, was referred to us in 2019 by the CPAS, following a period of street homelessness and a psychiatric hospitalization. He had just moved into housing and was already receiving support from a mobile mental health team. The aim of the support was to consolidate his housing stability, while integrating it into a global and coordinated care approach.
His life trajectory is marked by great mobility, high aspirations and successive ruptures. After several attempts at higher education, particularly in a scientific field, he moved through various professional experiences and stays abroad, interspersed with periods of homelessness. Several hospitalizations punctuated his trajectory, including a long stay in a psychiatric hospital, followed by care in hospital and then in a day centre. The latter provided him with a structuring framework, conducive to his recovery. A diagnosis of paranoid psychosis was made.
Support that is rooted in the long term
When he moved into housing, Mr T. showed a high level of autonomy. The Housing First support was therefore initially light, complementing the psychiatric follow-up already in place. Later, during the transition to the MyWay programme, the intensity of the support was increased.
Mr T. then emphasized the importance of this presence in breaking isolation and supporting his daily points of reference. He became involved in the day centre and developed a volunteer activity in a school, providing educational support. His trajectory nevertheless remained marked by strong demands on himself and by high expectations in terms of personal achievement.
A weakened balance, a rupture in the network
A change in treatment, particularly linked to a shortage of injectable medication, led to a drop in adherence and, gradually, to decompensation. This was identified by the different actors in the network. An observation measure was decided.
This episode was experienced as particularly difficult by Mr T., especially because of the way the intervention took place. It led to a breakdown of trust with several professionals: stopping psychiatric follow-up, withdrawing from the mobile team and distancing himself from the day centre. The network, which had until then been stable and supportive, became severely weakened.
Mr T. was then hospitalized in a specialized clinic and initially accepted new psychiatric follow-up. However, he quickly expressed his refusal to place his trajectory within a long-term medical framework, favouring a personal and spiritual approach to his recovery.
Maintaining the bond in a context of disengagement
Gradually, Mr T. once again disengaged from psychiatric follow-up and stopped his treatment, leading to a new decompensation as well as a loss of contact with a large part of the network.
In this context, our team remained one of the last points of anchorage. The situation highlights several major issues:
- continuity of care, despite ruptures and refusals of follow-up;
- the limits of existing systems, often conditional on crisis situations or on the person’s adherence;
- the question of maintaining the bond, even in the absence of an explicit request;
- the need for strong intersectoral coordination between the CPAS, hospitals, psychiatric structures and housing support.
A new hospitalization made it possible to reactivate certain levers, particularly thanks to the hospital teams’ better knowledge of his trajectory.
Working together, within complexity
This situation illustrates how much the support of people living with mental health disorders and who have experienced street homelessness requires close collaboration between the social, housing and mental health sectors.
It also highlights the importance of systems that are able to operate over the long term, beyond crisis-driven approaches, and to adapt to fluctuations in the adherence of the person being supported.
Finally, it reminds us that, despite tensions and ruptures, maintaining a stable human bond remains an essential lever to allow, in time, support to resume.