Publication: European Network of Homeless Health Workers (ENHW) Newsletter Issue 22

The Salvation Army Social Services have been involved with the UK Rough Sleepers Initiative to house the most chronically homeless people in their own accommodation. Between 1998-2008, I had the opportunity to develop these services and test out different models to best assist homeless drug addicts.

One of the key issues coming from the statistics that we collected was that most of the people who had been chronically homeless and living rough on the streets had complex needs. Most street homeless people have addiction and mental health problems, very limited social skills and a variety of other health and social problems. Whilst conducting service user assessments we asked a question about their housing history. The interviews showed that many people had very unsettled housing history. Their history was often very chaotic and difficult due to rent arrears, problems with neighbours or just not being able to cope with independent living and keeping the flat or accommodation in a state of acceptable cleanliness. We also asked what was the happiest and most settled place they had lived in and it was heart breaking to discover that most chronically homeless people had never experienced a period of settled family life. Therefore it was important for us to teach very basic attitudes and social interaction skills to foster good relationship with neighbours and landlords. We all learn through experiences and when these experiences do not exist it is harder to build a life from scratch.

People with a history of street homelessness at this time were generally heavy opiate users and on top of this anti-depressants were highly abused. Many people on the streets also had strong addiction to Benzodiazepines. This made it difficult to help them to detox. In addition to this, homeless people faced a major obstacle in not being able to access substance abuse treatment without an address. Therefore The Salvation Army developed an innovative initiative. They developed a detox and rehabilitation unit that was attached to a homeless hostel, thereby allowing the target group, the most excluded homeless people, to access addiction treatment and services.

During the initiative it was discovered that there needs to be a phase before entering detox. It was too hard for many service users to jump from street homelessness to a detox program and be expected to make this jump from a user to a sober and housed person within 10 days. Physically the body copes, but mentally and emotionally it was far too big and difficult a change. To respond to the emotional needs a preparation unit was developed which involved a three month programme where clients received motivational interviewing to support the change process. They also began to reduce their drug intake and some of them moved to prescribed methadone use that was slowly reduced as detox approached. Regarding drug detox it has always bothered me that the hardest task was to reduce the use of benzos. While these are prescribed medicines they are very widely misused and it takes very long time to detox from them. Many people could not enter detox as their benzo use was too high. The preparation unit was a great invention and proved successful and the outreach work amongst people in this programme showed excellent results. Those moving to detox from the preparation unit had over 80% completion rate to their detox.

Another challenging aspect of the initiative was to house the preparation unit, detox and rehab centre in the same building with a homeless centre where there were also active drug users in a different part of the building. Security was good and areas were separated but an environment of active drug users surrounded them. I believe this environment suited the most chronically homeless people as this is their reality and this is typical of the situation many of them needed to develop their skills to cope in. This was particularly important as it was extremely rare for a client to return to a settled family home that was detached from social problems and drug abuse as our experiences showed. Through hard work and learning to make right choices many of these people who completed their treatment managed to build a new life for themselves in a housing estate where they had perhaps grown up. They had to learn the skills to continue a sober lifestyle whatever their surroundings. It was very important for clients to become aware of their rights as citizens, learn to behave with good social skills and demand safety and order in their neighbourhoods. To achieve this, an emphasis was placed on demonstrating that this responsibility to keep their home and keep sober was not solely on their shoulder but they should rely on the structures and supports within their communities and society. To realise this goal, and ensure effective integration back into society, it was very important that the resettlement and integration work continued as a two year support programme from the support team that arranged regular home visits to support clients.

For the future I hope that in the homeless sector we realise the different life journeys which various homeless people experience and approach them with a sense of understanding, and not try to fix complex issues and needs with a single ‘one size fits all’ support package. In my opinion tailor-made approaches have the best outcomes.
Writer Anne Babb – Worked 10 years at Salvation Army Homelessness and Addiction Centre in Bristol. Since then she has worked in the same field in Finland and is now the Secretary General of International Blue Cross that works in 40 countries around the world in the field of addiction.

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