Homelessness
Jo had been discharged from hospital to the street with a gutter frame to aid her
walking. She had no money and a 0.6 mile walk to her usual sleep site. She then had to
walk a total of 6.8 miles on her walking frame over the next two days – to the GP
surgery, the day centre to see if there was an emergency bed for the night (there wasn’t
one with disabled access), back to
the sleep site, to the ‘appointed’
chemist to pick up methadone, back
to the GP for assessment, back to
the chemist, back to the GP, until
finally a taxi was arranged to take
her to an intermediate care bed in a
local hostel.
‘Why are we still discharging to
the street?’ asked Cornes. In 2012 a
report published by Homeless Link
and St Mungo’s suggested that up
to 70 per cent of patients who were
homeless were being discharged to
the street. In response, the
Department of Health and Social
Care had released a £10m cash
boost to improve hospital discharge
arrangements, which had funded
52 specialist homeless hospital
discharge (HHD) schemes across
England. King’s College had been
commissioned to evaluate the
schemes over three years, with the
aim of showing how to deliver safe
transfers of care.
The evaluation showed that
homeless people were not being
treated the same as others in
hospital – for example homeless older people were not being given the same delayed
discharge as a patient from a stable background waiting for a care home, to make
sure there was somewhere they could go. The intermediate care that had been shown
to give ‘enormous benefits’ was in very short supply, even though it was shown to be
‘far more cost effective’ in schemes that had it than schemes that didn’t.
Arranging help on the day of discharge could be invaluable in sorting essential
logistics – transporting belongings, registering at the drug service to collect
methadone, finding a tenancy that was safe and secure with some heating and
basic food ready for arrival, and making sure the person was not alone if they were
still feeling unwell.
‘Why are we still
discharging to
the street?’
‘We’re not that
interested in
methodology –
we want stuff
that helps us do
our job.’
MOTIVATION TO DRINK
When thinking about longer-term support, it was helpful to know more about
motivation said Mick McManus of Barking and Dagenham, who introduced a survey
18 | drinkanddrugsnews | February 2019
on street drinking in East London. ‘What was their background, what motivated
them to drink? Answers to these questions would help to mould our integrated
service,’ he said.
Dr Allan Tyler of LSBU explained how their 12-month programme – a
collaboration between Westminster Drug Project and LSBU, funded by the London
Borough of Barking and Dagenham – combined research and outreach to
understand patterns and motives.
The experiences that the team recorded were diverse and showed that not all of
the people street drinking were homeless. One important conclusion was that the
rich nature of people’s experiences meant that they were not going to create ‘types
of street drinkers’.
Among the findings were that many wanted to find a way out of their drinking
behaviour, but couldn’t find a path. Others felt stigmatised as ‘weak’ or were
excluded from programmes because of a violent past and time in prison. One
participant, when asked about giving up alcohol said, ‘Why would I do that? To be
the healthiest homeless person in Britain?’
THE HUMAN TOUCH
Throughout the conference academics shared their findings, but they were
illuminated throughout by the contributions of people with lived experience – more
relevant than ever representing a population considered ‘hidden’.
‘Your past is not a life sentence,’ said Kevin Dooley. ‘Human beings are capable of
change and I’ve lived on second chances all my life… These people are valid and
have a voice. These are the ones we need to help us move forward. We can go
further and dig deeper – people with experience can contribute to the research and
the analysis.’
Lucy Holmes, research manager at St Mungo’s also issued a challenge to
researchers – to make their work accessible and easy to absorb.
‘We’re not that interested in methodology – we want stuff that helps us do our
job,’ she said, and this could be aided with checklists and toolkits, such as the recent
kit on naloxone. Through a lively presentation she urged researchers to get in
contact with St Mungo’s, to work together.
‘We do a lot of lobbying, influencing work,’ she said. ‘We sit on project groups,
talk to commissioners every day, and we want our messages to be research led. If
you want to have real-world impact, talk to us. We talk to the public a lot.’
‘Your research today must reach the coalface,’ agreed Dooley, before chair Tony
Moss gave his final thoughts. ‘It’s a relationship between complexity and
compassion,’ he said. ‘The more you engage, the more complicated it becomes – but
that’s important, because otherwise research is technically inaccurate. Good quality
research can start to unpick complications.
‘The sooner you realise a person isn’t in a situation because of the decision they
made, the more compassionate you become,’ he added. ‘A whole lot of things in life
are out of your control.’ DDN
Addressing complexity: homelessness and addiction was organised by the Centre
for Addictive Behaviours Research and the London Drug & Alcohol Policy Forum,
and held at The Guildhall, London.
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