Drink and Drugs News DDN February 2019 | Page 18

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. www.drinkanddrugsnews.com