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Dual force

February 01 2022

When it comes to mental healthcare for the homeless community, services have to acknowledge addiction as the mental health problem it is, says Charlie Radbourne

With dual diagnosis, they seem to have it arse about face.

All NHS Community Mental Health Teams (CMHTs) say you have to sort out your drug or alcohol addiction problem before they can help you sort out your mental health problem. Strange, but I thought by its own definition that addiction is a mental health problem.The root cause of most addiction is a mental health problem. So how can you fix the addiction without first fixing the mental health problem?

CMHTs will say that people with addictions are disruptive, even unreliable and chaotic, that they cause problems in the waiting rooms and for other patients, and that they’re concerned about the safety of staff and patients. Then they’ll go on about the cost.

I can understand to a degree what they’re saying, but I don't agree with how they handle the problem. I say with a little vision and cooperation, there is an easy solution – follow a different system, one that’s already being used by some GP surgeries in this country.

In a few towns and cities, such as Winchester and Liverpool, GPs run a weekly clinic at a local day centre that homeless and other vulnerable people attend. This has a fantastic impact as it enables them to easily access a doctor, especially those who aren’t registered.

So why not do the same for mental health services and open mental health clinics in day centres one day a week?

See, surgeries feel uncomfortable with addicts and homeless people coming into their waiting rooms. Just as addicts and homeless people feel uncomfortable going into waiting rooms because they feel unwelcome and know stigma follows them. So the day clinics work well because they’re based in day centres that homeless people are already going to. So everyone feels more comfortable and those in need are more likely to attend and get help.

           © Michelle Christopher

But sometimes even this isn’t enough to reach some homeless people with mental health and addiction problems. Rough sleepers often don’t want to use day centres or are just passing through and don’t know about local services. So how can they be reached?

There are some mental health teams in parts of Birmingham who have the answer. They send out psychiatric nurses and practitioners with outreach teams to target rough sleepers and assess them, give them a diagnosis and offer a treatment plan. Hats off to them.

My message to those who go on about the cost? If you are giving people the correct type of help, putting their recovery on a sound footing, targeting them as individuals, following a personcentric approach, think about this:
The cost of day clinics, of having people accurately diagnosed with addiction and mental health problems and getting the correct help for both conditions at once is far outweighed by the savings:
- They spend less time in primary care
- They call out ambulances less often
- They won’t end up in crisis in A&E
- They will spend less time in trouble with the police
- There will be a positive knockon effect for their addictions, their wellbeing and their housing situation.

I ask you this. Just take a moment of your time and think: If you had two severe medical conditions and they refused to treat one of them, how would you feel?