The Challenge of offering a spectrum of alcohol services to homeless people. Pam Campbell
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1 The Challenge of offering a spectrum of alcohol services to homeless people Pam Campbell
2 Aims Brief overview of the work of the homeless healthcare team Assessment of alcohol use with patients, and frequently presenting health problems Detoxification End of Life
3 Homeless Alcohol Pam Campbell
4 History of the Homeless Healthcare Team 20 years Hostels Rough sleepers and sofa surfers Complexity of need Multi-disciplinary Team Detox beds in the city
5 Outreach Hostels Streets and parks Squats Refuges Approved Premises
6 Team Configuration Nurse-led GP registration Community Mental Health Nurses, Health visitors and homeless Families Nurse Practitioners and GPs Expertise in health and benefits Working with strategic partners
7 Hostels and Wet houses Changing landscape of permissive drinking Dry accommodation provision; risk of repeat street homelessness if housing is linked to sobriety Hostel management of excessive alcohol intake
8 Conditions frequently seen among Homeless people Mental Health Problems:-Psychoses, anxiety and depression. High risk completed suicide Respiratory problems:- infection TB, asthma, Chronic Obstructive Pulmonary Disease (COPD), Crack lung Skin:- infestation, Trench foot, infection, abscesses Blood:- blood borne viruses, anaemia, infection Gastrointestinal:- Ulcers, oesophageal varices, malnutrition, pancreatitis Substance Misuse:- alcohol, heroin, amphetamine, crack, prescribed medication Cardiac:- Abnormalities associated with methadone prescribing, bacterial endocarditis associated with injecting practice, arrhythmias associated with stimulants Hypothermia Assaults and Abuse
9 Home
10 What s in an home? Leaving home Going home Building homes Home thoughts from Abroad Security Acceptance Relationships as well as hearth
11 Meaningful Relationships
12 Societal Influences on alcohol consumption Legislation-licencing, drinking control areas, MUP, D and D Public perception of homeless people Night time economy and rough sleeping Changing patterns of substance misuse and the legality of alcohol TAP
13
14
15 No Recourse to Public Funds EU nationals-difficulty establishing who qualifies for benefits Destitute asylum seekers- Section 4 Trafficked individuals High profile street presence Effectively ruled out of the possibility of detox either through lack of accommodation (safety) or access to health budgets
16 Assessment Holistic Thorough going alcohol assessment, AUDIT/SADQ Breathalyser Bloods and screening for BBV Depression and anxiety Knowing units and strengths Brief interventions Chemical markers of damage along side physical and cognitive assessment Assess motivation Establishing goals- menu of options Opportunism vs. next visit
17 The New Wave of tests LFTs and GGT Fibrosis markers Referral for endoscopy and hepatology review. Always check Blood Borne Viruses Physical Presentation
18 Liver Fibrosis
19 Liver Fibrosis Markers Developments that help shape our knowledge of an individuals prognosis Beginning to prepare for the end Those that are able to change the course of things
20 Established Liver disease When to refer range of views from local GPs What messages are patients given about their condition What are our expectations of secondary care when someone is continuing to drink Research from MacMillan and St Mungo s
21 Our foray into detoxing homeless people Alcohol Day Detox Service Why do it? Engagement, engagement, engagement.
22 Referral for Detoxification Assessing motivation to change Pre-detox preparation Relapse prevention post-detox Accommodation- during and post detox Support
23 Perils of detoxing individuals in homeless hostels Pros Opportunism and building on motivation New starts 24 hour staffing Exposure to reality if you can make it here you can make it anywhere Cons Environment not always conducive to sobriety Risk of relapse Not a detox facility relies on good will of staff
24 Alcohol related end of life Average age of death 45 for homeless men 42 for homeless women Surprised question and difficult conversations Advanced Care Planning Message in a bottle Importance of multidisciplinary meetings with people individual wants involved Making peace Choice
25 Gold Standard Framework and honest discussions Client centred care Dignity, privacy and respect.in a hostel End of life discussions and motivation to change Predicting End of Life Working with our partner agency, hostel staff especially Planning end of life care not just end of life Advocate for access to services
26 The End
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