In a recent article we talked about our day centre, the leading centre for rough sleepers in Wales, engaging with those on the streets and the many achievements that our clients have made. The feedback on this highlighted substance misuse support as being a high priority for rough sleepers within the city. This is something we need to talk more about and we felt it useful to explain the work that we do to help people with substance misuse issues, recognising that it is both vital and often contentious.
“You are the most constant thing in my life, no matter how much s*** I throw at you”. These are the words of Susan (not her real name) who has been on the streets, punctuated by short periods in hostels and prison (mainly for persistent shop lifting), for the last 17 years. Susan found herself on the streets after being sexually abused by a family member and no-one believed her. Suffering from post-traumatic stress disorder (PTSD) and a bipolar disorder, Susan started self-harming and turned to drugs to help her cope. Susan admits she has not been easy to work with and struggles with chronic addictions and anger management. Engagement with accommodation provided and support services has often been short lived and regular recalls to prison, often for breach of probation orders, has only added more complexity to Susan’s life.
Throughout this period Huggard’s support to Susan has been a constant. Taking opportunities to engage, provide harm reduction advice, accompanying Susan to hospital, the GP, probation appointments, pharmacies etc. Susan can’t cope with waiting rooms, so we helped develop strategies that can help including rehearsing appointments beforehand and even taking a selection of her favourite books with us to help her manage her frustrations. Whenever Susan gained accommodation elsewhere, we maintained contact, as we knew that it may be very short term. Continuity and building trust had to be important.
We spoke at length with Susan about the abuse she had suffered and how this, and the fact she was never believed, had impacted on her life. Susan decided to go to the police. The CPS brought charges and the Crown Court sentenced Susan’s abuser to a prison sentence. This has gone some way to helping Susan move forward and we now have negotiated a regime with the probation service that better meets Susan’s needs and have been able to secure a maintenance prescription for methadone which has significantly reduced her dependence on heroin. Susan is now residing in an accommodation and support project run by an excellent partner agency that is providing fantastic help to her and we shall continue to ensure that we are always there to help her when and if she needs us.
We don’t have all the answers and Huggard can’t work alone. No organisation helping people with complex needs can. Working together we can have a really positive impact on peoples’ lives. We are proud to be involved with many partners working with the Substance Misuse Area Planning Board and, in relation to substance misuse, we are on the Cardiff & Vale Harm Reduction and Recovery Group, Psychoactive Substances Task and Finish Group, National Steering Group for Enhanced Harm Reduction Centres and the National Implementation Board for Drug Poisoning Prevention as well as a multi-agency group to seek to address the issues related to locally discarded needles, as well as others. Sharing expertise and developing good practice is vital if we are to respond to the changing needs and dynamics of substance misuse.
In the month of August, Huggard’s substance misuse service provided individual support to 54 people like Susan. We helped 8 people to engage with treatment services. We undertook 738 needle exchanges with harm reduction advice. We had 8 new people register on our needle exchange database which is a positive drop in new people from previous months. We support people to reduce the risks to themselves and others, reducing the transmission of blood borne viruses and helping to manage, and get treatment for, what can often be life threatening infections. We provide a monthly sexual health clinic and work closely with the health service including the nurses for the homeless, GP services and the Hospital’s emergency department. We are the main assessment and referral service for Pabrinex treatment for long term alcohol users in Cardiff. We collect and safely dispose of a large volume of used drug paraphernalia. We also have our own in-house team of First Responders, trained and supported by the Welsh Ambulance Service. We are trained in advanced First Aid and resuscitation techniques. In August we attended 5 opiate overdoses and administered naloxone, the antidote to opiate poisoning, interventions that can save lives. We are never complacent.
This work, linked to a centre providing a wide range of engaging services, is vital. It is an important part of a wider programme of substance misuse services within the city. We need this if we are to maintain engagement and seek opportunities to move people, with chaotic lives, forwards and toward treatment services while minimising the harm they can cause to themselves and others.
We need to get injecting off the streets and we really need to talk more about how we can achieve this. Substance misuse creates victims and isn’t something that anyone finds acceptable. It cant simply be swept away and it won’t disappear just because we want it to.