To what extent are integrated mental health and substance misuse services accessible and how can such services be delivered more effectively to address the specific needs of rough sleepers in particular?
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 second half of my paper below:
Where we are:
The key problem we face as an agency is that mental health services will not see people who are either drug or alcohol dependent.
There is little evidence of integrated services that combines mental health and substance use across Wales and no official support service that is specifically for rough sleepers with co-occurring mental health and substance misuse issues.
In Gwent there is close working with GSSMS (Gwent Specialist Substance Misuse Service) who try and support the most challenging clients. The integration of services is probably the best in Wales but even GSSMS struggle to make referrals to the mental health services. To be with the specialist service GSSMS you need to have support from the primary mental health service (CMHT) and have a Community Psychiatric Nurse.
The situation in Gwent is much better than elsewhere in Wales but it still is not good enough. The link between Criminal Justice Services needs to be properly integrated with the NHS treatment system with rapid access into mental health services.
In Swansea and Western Bay we see increased drug related deaths but with little strategy as how to tackle this issue. The current system is not fit for purpose where access to rapid and low threshold treatment is vital.
The accommodation on offer for people with co-occurring issues is sub-standard. There is a need for specialist provision with trained workers in small cluster housing that offer long term support. The concept of big hostels, with workers barely paid above the minimum wage, with relatively poor training programmes is not acceptable.
Another key service needed is rapid access into detox provision. The problem faced by many rough sleepers is that they struggle to enter treatment at all, so a referral to detox is extremely unlikely. This issue is compounded by a commissioning regime that wants a plan as to their long term recovery. The rough sleeper who is only planning from day to day is going to struggle to meet these goals. We need to think differently about pathways to this basic health care intervention. In the Wirral they have a unique system where A&E can make a direct referral to the detox centre and it is seen as the pathway for chaotic drinkers. This takes the pressure off A&E but more importantly means the client gets the direct support they need and can be assessed by a professional team of specialist doctors, nurses and drug workers.
The accommodation provided for people who are rough sleepers also needs to have a wet provision, meaning they can take alcohol in a safe way. We also need to consider safe places to consume drugs as too many people are evicted for taking drugs in hostels. A drug agency will give people a needle knowing they are in emergency accommodation where drug use is forbidden, either risking being evicted or taking those drugs back on the street.
In effect we need a systems approach to tackling the issue rather than solving one problem but creating a number of further problems.
Read the summary of the first part of the paper here: https://www.kaleidoscopeproject.org.uk/2019/11/14/martin-addresses-welsh-government-review-part-1/
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