James Morris, The AERC Alcohol Academy Alcohol and homelessness JSNA and Homelessness event 16th June 2010

Promoting excellence in local alcohol harm reduction The Academy A social enterprise that: Aims to ‘promote excellence in local alcohol harm reduction’ Workshops, networking, best practice sharing for strategic leads Consultation and policy advocacy Training for practitioners and front line staff

Promoting excellence in local alcohol harm reduction Alcohol and homelessness Homeless Link (HL) 2009 SNAP survey found alcohol problems within: 39% of clients in an ‘average’ homelessness project 56% in day centres 54% in Direct Access hostels Leicester Homeless project found 45% of deaths has alcohol implicated as a cause 4% of those in alcohol treatment were NFA, a further 11% had housing problems (NATMS 2010)

Promoting excellence in local alcohol harm reduction A 2003 survey of homeless in London Results from a Survey of Homeless People in London (NAC 2001) found of 389 people: 25% were dependant on alcohol 63% said d rug or alcohol use was one of the reasons they first became homeless Overall, 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

Promoting excellence in local alcohol harm reduction ‘Sobering facts’ 2009 report 13,872 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

Promoting excellence in local alcohol 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

Promoting excellence in local alcohol harm reduction Street populations? Street drinking Work seeking BeggingDrug use Rough Sleeping

Promoting excellence in local alcohol 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

Promoting excellence in local alcohol harm reduction 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 only Crime? Inter-community crimes and victimisation un-reported, Drink Driving

Promoting excellence in local alcohol 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 (

Promoting excellence in local alcohol harm reduction Alcohol-related hospital admissions trend

Promoting excellence in local alcohol harm reduction 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 care Establishing 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

Promoting excellence in local alcohol harm reduction Cheap alcohol We know price and consumption are directly correlated but… We don’t know the impact of pricing on those who are already dependant We 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

Promoting excellence in local alcohol 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

Promoting excellence in local alcohol harm reduction Further issues and options?

Promoting excellence in local alcohol harm reduction 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

Promoting excellence in local alcohol harm reduction Improving alcohol treatment We 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

Promoting excellence in local alcohol harm reduction 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)

Promoting excellence in local alcohol harm reduction Multi-agency partnership Mental health Police Outreach/ reconnection Community Safety Housing Treatment services Street population or partnership lead

Promoting excellence in local alcohol harm reduction 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 Education Module 10D

Promoting excellence in local alcohol harm reduction Conclusions

Promoting excellence in local alcohol harm reduction Thank you James Morris, AERC Alcohol Academy