DDN Magazine November 2020 | Page 8


On the margins

Peter Keeling hears from April Wareham of Working with Everyone about how marginalised communities have been coping during lockdown

Working with

Everyone is a group of people with lived experience of drug use and treatment who initially came together to use their expertise to improve the drug treatment and recovery systems . As time went on they realised that many problems existed way beyond drug treatment and affected other marginalised communities , and so the scope of the organisation was expanded .
April Wareham is leading research for NHS England and the University of Bradford on how marginalised communities – who are disproportionately impacted by health inequalities – have coped under COVID-19 restrictions . Over the summer , April and her team interviewed 150 people from marginalised communities , including people who use drugs , people with lived experience of the justice system , and people who are or have been street homeless .
Tell us a bit about Working with Everyone and how the research came about ‘ One of the reasons we ’ re called
Working with Everyone is , as a group of people with lived experience of drug use and treatment , we have all made different decisions about our own lives . Some of us are abstinent , and some of us aren ’ t . We want it to be about everyone , so if someone presents for treatment they can get what they need , whether it ’ s clean syringes or full blown , bells-andwhistles rehab .
When lockdown started , we knew quite quickly that we wanted to capture the stories from marginalised groups about their experiences – we ’ ve already worked with these groups quite a bit . NHS England approached us to do a piece of engagement work and suddenly the project grew legs when the University of Bradford also got some funding to interview refugees .’
When we talk about ‘ marginalised groups ’, who do we mean ? ‘ We work with everyone from sex workers and people who use drugs to armed forces veterans and people who are street homeless , but they have so much in common around their experiences of healthcare . We ’ re all really small groups so we ’ re much stronger if we can say together , “ This is the
problem ”. And in any case there ’ s often significant overlap between these groups , as well as with refugees and travellers .
We originally went through the list of groups that had poorer health outcomes , and crossed off the ones that had existing mechanisms to interact with the system . So we were left with what looked like a very random group of people . And , I ’ ve got to say , I thought it would be a disaster – I thought no one would talk to us . But it wasn ’ t , it was really good . So we had people from the refugee community sitting next to people who have enormous criminal records and have used drugs all their life – people had so much in common around their experiences of healthcare .’
What was it like for marginalised groups ’ health and wellbeing before the pandemic ? ‘ We have an incredible burden of both physical and mental health in these communities . People identify to us as someone who uses drugs or as a refugee , but they could very often be classed as physically disabled . And the mental health diagnoses – they are just at
phenomenal rates . Many people we spoke to weren ’ t even registered with a GP at the beginning of the pandemic . And people also change GPs a lot , sometimes because they are living a transient lifestyle but also because they ’ re having to move around to survive . We ’ re talking about people who will say they only approach healthcare when it ’ s either that or die . People have actually told us , “ Everyone hates us and we know it – so we ’ re not going to engage ”.’
Services had to adapt their support offer rapidly during the crisis . Has the greater use of telephone and digital support worked for marginalised groups ? What are some of the challenges ? ‘ It ’ s been a bit variable . Some people have literally said they ’ ve never had so much contact with their keyworker , because an effort has been made to reach out to people . I came across one case where they had mobile data and they had the tech , and they wanted to change GP . And the GP said , “ Great , we ’ ll send you forms so you can print them out and sign them ”. Well , I might have a smartphone , I might have data , but I