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NO HELP FOR SMOKERS
Dr Lynne Dawkins of London South Bank University (LSBU) explained the strong link
between homelessness and tobacco use and looked at opportunities for harm
reduction. Smoking killed around 200 people a day in England and was responsible
for more than a quarter of cancer deaths – and with the average pack price almost
£10, it was expensive.
‘You’d expect people on the lowest incomes to be the most sensitive to price
changes, but that’s not what the evidence shows,’ said Dawkins. ‘Those who smoke
can least afford it.’ While there was a slow but steady decline in smoking in the
population as a whole, there were widening health inequalities in people who
smoked. It was estimated that 77 per cent of homeless people smoked, which could
exacerbate the onset of psychosis.
‘The desire to quit is no less in the homeless population, but attempts are often
unaided,’ she said. ‘In some cases, smoking cessation is discouraged as it’s felt they
can’t deal with it – that it’s “the only pleasure they have”.’
Evidence had shown e-cigarettes to be 95 per cent less harmful to health than
smoking, eliminating the tar and the exposure to 4,000 chemicals, including 60
carcinogens. They gave much faster delivery of nicotine than patches, could replace
the all-important hand-to-mouth activity, and didn’t feel like a ‘quit attempt’ to
many that tried them. So why aren’t we considering e-cigs for the homeless, an
extremely nicotine-dependent population, she asked.
NOTHING TO LOSE
Another problem that disproportionately affected homeless people was gambling,
and Dr Steve Sharman of the University of East London who had looked at whether
gambling was a cause or a consequence of homelessness. ‘Most gamblers have
problems before becoming homeless, but also a smaller proportion took it up
afterwards – so it’s more complex than we thought,’ he said.
He shared case studies which showed the gradual onset of a gambling habit.
Dean’s gambling had started when he was 14 and used to go with his father to
collect his mother from the bingo hall. Playing on the slot machines while they
were waiting became the start of a habit that led to stealing from friends and
family, spending all his wages, becoming homeless when his landlady evicted him
for not paying the rent, and two suicide attempts.
Tom was abused from a young age and in care at ten, discovering drugs and alcohol
as a way of escaping the negativity he was feeling. He and his girlfriend had a baby at
15, when his gambling career started with interactive tv games; before long he was
spending their child benefit in the bookmaker’s, committing burglary, street robbery
and violent crime to fund the habit, and became homeless after a spell in prison.
Using the information from personal stories, Sharman was developing a series
of tools including a resource sheet with immediate tips and safeguarding
measures (freely available at www.begambleaware.org). Fewer people were aware
of treatment services for gambling
than for drug problems, so the
challenge was to find those in
need of help, particularly if they
were ‘lost’ to the system.
BODY AND MIND
‘The problem is
not lack of
evidence, but lack
It’s a class
attempt to write
people off and
not think of them
as fully human.’
One of the other key areas for
review was effective treatment for
dual diagnosis, where poor mental
(and physical) health overlapped
with substance misuse – a
situation all too common in
homeless people. Using qualitative
research, Dr Hannah Carver of the
University of Stirling had looked at
what could be effective for people
in this situation.
As well as long-term, tailored
treatment that looked at underlying
conditions, it was found that peer
support and compassionate non-
judgemental staff were important
to outcomes. The right environment
and the right intervention needed to be paired with stability and structure, and
opportunities to learn life skills. ‘Services should be facilitative and friendly, treating
people “where they’re at”,’ she said.
Across every facet of healthcare there was evidence-based information that could
go a long way to improving the lives of people experiencing homelessness. But as
Dr Michelle Cornes of King’s College London demonstrated, the theory came to
nothing if multi-professional teams did not work as a unit around the person
‘The picture is very fragmented,’ she said. ‘We often talk of the need to get
physical health better before mental health.’ But pathway teams, including nurses,
GPs, housing workers, social workers and occupational therapists, needed to be part
of the care team – demonstrated in the case of hospital discharge. The
recuperation, rehab, resettlement and recovery were all part of intermediate care
that ‘has been shown to give enormous benefits’, she said. She introduced Darren
and Jo, experts by experience, who explained what happens when the care
pathway breaks down.
February 2019 | drinkanddrugsnews | 17