outreach
Vital connections
Most drug-related deaths are of people not in treatment . DDN visits Equinox outreach team in Brighton to hear how they engage with a growing population of rough sleepers
Rough sleeping figures continue to rise . In the government ’ s latest report , local authority counts showed 4,134 people out on the streets in England on a snapshot night in autumn last year – up 16 per cent on the previous year ’ s count . Brighton is near the top of the league table with one in 69 people homeless , and the challenge is clear for the city ’ s outreach team .
Among the members of Pavilions , Brighton ’ s partnership of treatment services led by Cranstoun , Equinox are hard at work at the community base in Queens Road , a few roads up from Brighton ’ s seafront . There ’ s plenty going on as usual , and people buzzing in and out offices shared with many other agencies , from housing support to mental health .
While explaining what they do , they break off to deal with an urgent suicide threat nearby . One of the regular clients is threatening to kill himself , having been caught shoplifting again . Anti-social behaviour caseworker Kristina has rushed up there to help out , knowing that he will have been shoplifting to feed a drinking habit of 40-50 units a day . It ’ s a situation he ’ s been trying to escape , but he has a girlfriend who drinks and he ’ s finding it hard to change .
For this man , as with many other Equinox clients , there are no quick fixes . The team members know they are in it for the long haul , explains manager Jesse Wilde . The working model is ‘ assertive outreach with recovery at its heart ’. In practice this means going back again and again , taking the knockbacks and offering a friendly chat until one day it ’ s welcomed .
‘ These are people who will never make that call for help ,’ he says . ‘ Their life is often a web of chaos , often involving begging and jail . One day something will change – maybe they ’ ll have had a bereavement – and they ’ ll want to talk .’ The assertive outreach is the only way , as ‘ signposting isn ’ t going to work ’.
The key workers are obviously vital to what happens next , and Wilde explains that their training equips them to build rapport . ‘ Some people are avoidant , wary of intimacy or any interaction , even being told “ well done ”,’ he explains . ‘ So we ’ d keep it very business-like in this case , and chat on the way to appoint ments .’ In the textbook it ’ s called ‘ attachment theory ’; he calls it ‘ keyworking by stealth ’.
Outreach worker Scott Crossley is well versed in these techniques . He acknowledges that many clients can be ‘ chaotic , disruptive and challenging ’, but he rises to the challenge of gaining their trust , trying to look at the root of their behaviour , and working out how to offer support .
‘ It takes time to establish trust and a rapport ,’ he says , and the first stage is demonstrating reliability . They might have complex trauma and personality disorders , and a history of people saying they ’ re going to do something but not turning up . We ’ re always going to turn up .’ After a while you see people soften and reciprocate .
It can be a long road , and at the start ‘ the worker can be running around a lot , almost like a PA ’. But then you need to find a way of ‘ handing responsibility back , giving that power back ’, so they are not dependent on the worker and can take charge of their own life . The results can be life-changing : ‘ We ’ ve had people who screamed and shouted , and they ’ re now in their own accommodation , completely different people … but that takes time .’
The scope to work in this way comes from being part of Pavilions , Brighton ’ s network of support . The important parts of Crossley ’ s work takes place away from mainstream hubs , ‘ taking recovery to people who can ’ t do mainstream ’.
‘ You ’ ve got one person but lots of strands , almost like a spider web , for housing , mental health , whatever they need ,’ he says . Through multi-agency working , they can get a support package together , including OST at the right titration .
‘ We can get them so we ’ re holding them ,’ says Crossley . ‘ We ’ ve got a platform and can then do the good work of preparing them for a stint in rehab . If you put someone with so much trauma without preparation work into detox , all the years that drugs have suppressed – this filing cabinet of feelings – opens up and these feelings go everywhere .’
The involvement of mental health teams makes a vital difference , he believes . ‘ Before , we would do all the work to prepare them and leave them at the rehab
6 | drinkanddrugsnews | June 2017 www . drinkanddrugsnews . com