mentally disordered homeless ‘rough sleepers’.The first factor contributing to the vulnerability of mentally disordered ‘rough sleepers’ is marginalization. This is a process whereby individuals or groups are silenced, excluded, isolated, pushed out to the margins, ignored, or not taken seriously (Larkin) resulting in people being denied access to economic, political, social and cultural, and at different levels, individual, households, country and global regions (Ryden).
In practice, Ryden (20??) identified this powerful process as one which resulted in practitioners taking ‘problem based’ rather than individualised approaches to care.
Strategies and Interventions
The first vulnerability factor of marginalisation was discussed specifically in terms of the exclusion of the person from decision-making in terms of any health or social care needs that person might have as a person who is a mentally disordered ‘rough sleeper’.
In terms of the vulnerability factor of marginalization as characterized by a lack of decision-making, the chosen intervention is legislation (Larkin 2009), specifically the Mental Capacity Act (MCA) (DCA 2005 cited in Larkin 2009).
The reason for this is that the MCA was specifically written to be, unlike any other legislation, a decision-making tool (Griffith & Tengnah 2010). This is because the MCA is about supporting people accessing services to be decision-makers in exercising the capacity to make specific decisions at particular times (DH, 2007). Patients who were previously pushed to the margins of any decision-making are now put at the centre of all decision-making (DH 2007).
The MCA was intended to be used in decisions and decision-making involving a service user in requiring health and social care, and also when financial issues or issues involving finances were required in relation to a service user care (Brown & Barber 2015).
Using the statutory principles of the MCA, the Mental Health Nurse must include the service user in decisions about the service user, even where that service user has been assessed as not having the capacity for the specific decision at a particular time.
mentally disordered homeless
This process is carried at all times that any adult accesses any public service, and so, must be used by the Mental Health Nurse acting in the role of a public servant (Avery 213), as part of the documented, care-planned work (DH 2007). The Act and the use of the Act as a problem-solving decision-making tool (DCA 2005) involves both service users and all clinicians and practitioners acting in a public role (Jones 2016; Kong & Keene 2018).
The decision-making process of the MCA is that a person is assessed as not having capacity if they fulfil two questions of assessment (DCA 2005). The first is that the person has an impairment or disturbance of functioning of mind or brain (Avery 2013). The second stage of capacity assessment is that this impairment or disturbance impacts on the person’s ability to make whatever decision is required (Avery 2013).