What services are available for rough sleepers who have co-occurring substance misuse and mental health problems across Wales?
On 13 November I wrote a paper for and addressed the Equality, Local Government and Communities Committee at the National Assembly for Wales as it is currently undertaking follow-up work on its inquiry into rough sleeping
It is clear that there is much to do in this area and sadly up to this point little progress has been made. Read a summary of the beginning of my paper below:
Where we are:
There are no services that I am aware of that offer integrated care to support rough sleepers in Wales.
We know that there is a lack of accommodation for rough sleepers. Some, however, make a choice not to take up the hostel places that are available as they cannot cope with hostels where chaos seems to pertain because of the large numbers of people accommodated.
Rough sleepers are often denied access to drug treatment services because they do not comply with the demands of the provider. In Wales there has been an emphasis on recovery, creating a situation where we have those deemed worthy of deserving treatment and those not. We have been told to treat the ones committed to their recovery journey which is shown by the establishment of pre-contemplation groups and individuals attending various sessions designed to help them on their recovery journey. This can be difficult for Rough Sleepers as these appointments are restricted to the opening hours of the service. The other critical issue is identification, which is often verified by an address and, for a rough sleeper, can be a significant hurdle.
Rough Sleepers with co-occurring conditions often take drugs to deal with their condition. They are not being assessed by mental health services and are thus self-medicating. This is unacceptable for many prescribers and treatment is often withdrawn from people who consistently continue to use illegal drugs despite been prescribed.
The reality of drug treatment is often people are given lower doses than required. A person taking illegal drugs alongside prescribed ones should be permitted to stay on a treatment programme because evidence shows they are still safer in treatment. When providing a substitute medication, a delay in prescription should be offered if someone is not fit to take it when presenting and that instead of penalising the person there should be a conversation about whether the dose prescribed is sufficient with a look to increasing the dose rather than withdrawing treatment.
The Housing First initiatives could be really positive in helping rough sleepers with co-occurring problems and are only just emerging. In Gwent, additional funding has been made available to provide low threshold prescribing (prescribing with fewer rules in place to access treatment) for 25 people who gain access to Housing through Pobl’s Housing First programme. The link between housing, drug use and mental health is really key and these initiatives are very heartening to see. There are also some initiatives from Supporting People and a similar Housing First initiative is due to start in Swansea – both of which Kaleidoscope is supporting.
In Brixton, London there is also a one day prescribing service. The need for rapid access is particularly relevant to rough sleepers and the recognition of treatment access is now becoming a Welsh Government priority.
Treatment services need to be integrated with mental health services and must open at times that meet the needs of the service user. We also need to consult with rough sleepers about the service they want..
The continued increase in drug related deaths is a national emergency and I believe the biggest cause of death is the failure to provide even basic medical care such as substitute prescribing across Wales.
A summary of the second half of the paper will be out next week.
You can read the full paper and watch a video of the meeting here: http://www.senedd.assembly.wales/ieListDocuments.aspx?MId=5747&EVT=101&DT=M