james morris, the aerc alcohol academy alcohol and homelessness jsna and homelessness event 16th...

James Morris, The AERC Alcohol Academy

Alcohol and homelessness

JSNA and Homelessness event16th June 2010

Promoting excellence in local alcohol

harm reduction

The AcademyA social enterprise that:Aims to ‘promote excellence in local

alcohol harm reduction’Workshops, networking, best practice

sharing for strategic leadsConsultation and policy advocacyTraining for practitioners and front line

staff


harm reduction

Alcohol and homelessness

Homeless Link (HL) 2009 SNAP survey found alcohol problems within:39% of clients in an ‘average’ homelessness

project56% in day centres 54% in Direct Access

hostelsLeicester Homeless project found 45% of

deaths has alcohol implicated as a cause4% of those in alcohol treatment were NFA, a

further 11% had housing problems (NATMS 2010)


harm reduction

A 2003 survey of homeless in LondonResults from a Survey of Homeless People in

London (NAC 2001) found of 389 people:25% were dependant on alcohol63% said drug or alcohol use was one of

the reasons they first became homelessOverall, drug and alcohol use and

dependency increased the longer the respondents had been homeless

Initiatives to tackle homelessness must simultaneously tackle substance use

‘Rough sleeping, substance use and service provision in London’ NAC 2001


harm reduction

‘Sobering facts’ 2009 report13,872 NFA hospital admissions over the

last five years for drug or alcohol misuse Total drug and alcohol related admissions

of homeless people have risen by 117 per cent since 2004

‘it is essential that the over-availability of cheap alcohol is addressed’

‘ensuring that local GP services are linked with homeless organisations and charities in the area…better access to primary care

Sobering facts: The Impact of Drugs and Alcohol on England’s Homeless Population Conservative Homelessness Foundation 2009


harm reduction

The challenges

Alcohol can be both a symptom and a cause of homelessness

But is rarely an issue on its own – mental/physical health problems, offending behaviour, drug use, damaged lives

Finding a balance between enforcement and support

Providing support or interventions that may be palliative or respite only

The cheap and ready availability of alcohol


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Street populations?


harm reduction

Central & Eastern Europeans (A10s)A8 countries joined EU May 2004 (A2 in

2007) to allow ‘free movement of workers’ i.e. economic migration

Transitional arrangements until 2011 to ‘regulate access to labour market and benefits’

A10s have filled labour gaps; most are young, without dependants and plan return

No access to benefits, homelessness assistance or social housing unless 12 continuous months employment


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Central & Eastern Europeans (A10s) issues

Housing and employment:Street populations: rough sleeping, street

drinking, begging Houses Multiple Occupation (HMOs)Work: exploitation/gang masters

Access to services: primary care onlyCrime? Inter-community crimes and

victimisation un-reported, Drink Driving


harm reduction

A10s – future alcohol-related issues?Future implications for alcohol trends and

impacts like other migrants have? E.g. Irish immigration of 1950s impact on longer term alcohol and mental health issues (www.icap.org.uk)

-40 -20 0 20 40 60

Black Caribbean

Black African

Indian

Pakistani

Bangladeshi

Chinese

Irish

White

Male>4 Female>3 Male>8 Female>6


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Alcohol-related hospital admissions trend


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A10s – responses

Though secondary care is not technically available for homeless A10s, many PCTs/LAs have been flexible/innovative in responding e.g.:Providing access to certain treatment and careEstablishing specialised services ranging from

employment, language skills, alcohol treatment, housing etc, Migration Impact Fund projects

Specialised homeless approaches such as A10 outreach workers and ‘reconnections’ projects

Homeless Link guidance and resources available www.homeless.org.uk/cee-guidance


harm reduction

Cheap alcoholWe know price and consumption are

directly correlated but…We don’t know the impact of pricing on those

who are already dependantWe don’t know whether the scare stories

about ‘white cider’ are true, but the anecdotal reports are worrying

30 years ago, encouraging street drinkers off meths was a common harm reduction approach


harm reduction

‘Continuing drinkers’There is a recognition that for some

individuals, their level of alcohol dependency and circumstances means only ‘controlled drinking’ seems achievable

Therefore carefully planning alcohol consumption and managing risk-factors is the focus as a ‘harm-minimization’ approach e.g.:

Drink diaries, supervised drinking, alcohol selection, timing with meals are common wet hostel approaches


harm reduction

Further issues and options?


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Enforcement Vs Support?

What is the balance between enforcement and support?

A staged approach is required to ensure support and treatment is available, followed by staged enforcement measures

Strong local partnerships are imperative in ensuring successful multi-agency working


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Improving alcohol treatmentWe need to improve access to alcohol

treatment that can meet a wide range of needs

Improve alcohol treatment pathways and ensure access is appropriate e.g. risks of ‘multiple respite detoxes’

Primary care access and support to meet the needs of homeless

Hospital alcohol health worker/rough sleeper discharge posts


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A staged enforcement approach

Low level Anti-Social Behaviour interventions: Controlled Drinking Zones, dispersal powers, ABCs etc.

Individual enforcement measures: individual case management, ASBOs, Alcohol Treatment Requirements (ATRs not for NFA)


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Multi-agency partnership

Street population or partnership

lead


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A staged approach: U.S model

1. Outreach and engagement

2. Motivational interviewing

3. Intensive case management

4. Stabilization & therapeutic communities in shelters

5. Transitional and supportive housing

6. Confronting barriers

NIAAA Social Work EducationModule 10D


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Conclusions


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Thank you

www.alcoholacademy.net www.alcoholpolicy.net

James Morris, AERC Alcohol Academy

[email protected] 450 2930

james morris, the aerc alcohol academy alcohol and homelessness jsna and homelessness event 16th...

Documents

alcohol use

alcohol problems

aerc alcohol academy

challenges alcohol

alcohol treatment

alcohol misuse total

homelessness homeless

homeless organisations