Transcript Homelessness and Substance Misuse Report

International rapid evidence review of services
for homeless people with substance misuse
problems that considers models of service
delivery and outcome measurement within a
Scottish context
SDF User Involvement Response
We welcome this report and feel
the issue requires urgent
attention to save lives
No pre-conditions to receiving
housing
• We welcome recognition that
abstinence/stabilisation pre-conditions to
receiving housing may often be unhelpful
• Therapeutic relationship undermined when
people feel they have to lie about ongoing
drug/alcohol misuse problems
• If pre-conditions too strict people may
disengage which costs lives
Harm Reduction
• We welcome the recognition that harm
reduction interventions keeps service
users safe which is demonstrated by the
New York model Pathways Housing First
• Pathways Housing First philosophy accept
service users where they are at in their life
(no hoops to jump through!) and provide
long term intensive and flexible support
Meeting Needs
• You can’t tackle a chaotic drug or alcohol use
problem without stable accommodation!
• We think that it would be much better for service
users if all their problems –which may include
drug use, alcohol use, homelessness and
mental health issues – are dealt with by one
organisation at the same time such as the
Pathways Housing First model
• This would also allow the maintenance of
reliable relationships with worker/s from one
organisation and help build therapeutic alliances
Realistic Outcomes
• Realistic outcomes are helpful to both the
service provider and the service user
• Abstinence should not be viewed as the only
successful outcome
• Whilst the report recognises the value of harm
reduction, we were disappointed by the
language of the report in terms of describing
harm reduction goals as “more limited"
• Keeping people alive is not a limited goal!
Funding
• We feel that short term investment will
only ever achieve short term goals
• You can’t put a time limit on recovery
• Uncertainty for the future of the service
provider means uncertainty for the future
of the service user
• We agree that there should be long term
investment to sustain long term, intensive
and flexible interventions
Parents and children
• Report is good but it would have been
helpful if there had been more detail on
good practice relating to services for
parents and children
• We would support the development of
more addiction and homelessness
services for parents and children in order
to keep families together if this is
assessed as the best outcome for all
Rural Areas
• Report is good but we feel it could have
investigated the issue of providing
effective services in rural areas in more
depth
• Peer research required to find out what the
service users in rural areas really want
Service User Involvement
• Service Users should be involved in all
aspects of their own recovery including
agreeing their treatment goals
• Service user involvement groups should
be involved in the planning,
commissioning and development of
addiction and homelessness services
Conclusions
• No abstinence/stabilisation pre-conditions
• Harm reduction interventions save lives!
• Pathways Housing First accept people where they are at
and provide flexible support for as long as necessary
• All problems should be dealt with at the same time
• Realistic outcomes
• Long term funding
• Parents and children - need to know more about what
works
• Rural areas – peer research
• Service User Involvement – at all levels
Action!
• We have read reports like this before
which have ended up in filing cabinets and
forgotten
• The SDF National User Involvement Peer
Research Group would like to see the
findings from this report discussed at the
most senior level and consideration given
to establishing Pathways Housing First
type projects across Scotland!