Changes to Legal Aid come in to force today

Today is a sad day. For the first time in many years our advice centres in Brighton, Eastbourne and Hastings may have to turn people away.

While changes to the NHS, welfare reform and the ability of Iain Duncan Smith to live off £52 per week are dominating the headlines, changes to who has access to legal advice and representation come into force.  The CAB has on its website a clear summary of the changes to legal aid

Of course, everyone has the right to access the law, but as Judge Sturgess once said, “Justice is open to everyone in the same way as the Ritz Hotel”. The reality is that many people who might need advice and representation might, as of today, not get it.

If you feel you might need advice, do find out whether you are eligible. Thanks to support from Brighton and Hove City Council, Eastbourne Borough Council, and Hastings Borough Council, we may still be able to help.

You can find contact details for our advice centres here.

Drug and Alcohol Conference 5th July 2012

The Drugs & Alcohol Today exhibition co-hosted with the 16th Annual Sussex DAAT Drug & Alcohol conference

Thursday 5th July 2012               Holiday Inn, Brighton

The event features a full programme of CPD accredited seminars and the exhibition of local, regional and national organisations and projects.

Only £30 to attend, with free places available to people currently using drug and/or alcohol services, unwaged, full-time students and volunteers.

How to register to attend

Exhibitors include

  • ADFAM
  • Pavilion bookshop
  • Brighton & Hove Drug & Alcohol Action Team
  • Frontier Medical Group
  • Action for Change
  • Blithe Computer Systems
  • Phoenix Futures
  • Kenward Trust
  • Open University
  • Trust the Process Counselling
  • Illy Systems

Seminars include

  • Drugs strategy update: the current landscape
  • Unpicking the alcohol recovery agenda: how can local authorities combine responsibilities and resources to maximum benefit?
  • The long view: what does the future look like for the sector without a national champion?
  • Managing substance misuse during pregnancy
  • What does recovery mean for families?
  • Prevention, alcohol, and young people
  • Transitions for young people
  • Case Study: Delivering an effective early intervention model for drugs & alcohol – Nottingham DrugAware Programme
  • Resilience
  • Recovery Pathway
  • Case Study: The Frequent Flyers Project
  • Case Study: The hostel-based Clinical Nurse Pilot
  • Peer mentoring, SMART and volunteering
  • Drug & alcohol consultations in A&E
  • Workforce support & development
  • Case study: Operation Street
  • Joint commissioning for substance misuse
  • The role of GPs in recovery

Speakers include

  • Martin Barnes, Chief Executive, DrugScope
  • Eric Appleby, Chief Executive, Alcohol Concern
  • Carole Sharma, Chief Executive, Federation of Drug & Alcohol Professionals
  • Richard Pike, South East Recovery Community Coordinator, CRI
  • Joss Smith, Director of Policy and Regional Development, ADFAM
  • Andy Winter, Chief Executive, Brighton Housing Trust
  • Mark Gilman, National Strategic Recovery Lead, National Treatment Agency
  • Sergeant Richard Siggs, Sussex Police
  • Nicola Singleton, Director of Policy Research, UKDPC
  • Tom Scanlon, Director of Public Health, NHS Brighton & Hove

Good news on the plans to help homeless people being discharged from the Royal Sussex County Hospital

I spoke too soon.  Something is happening to ensure that there is better links between local hospitals and homelessness organisations.

Following on from my post a couple of days ago about homeless people and hospital discharges, I have been made aware of Penny Johnson who is the newly appointed Homeless Persons Nurse Practitioner based in the Royal Sussex County Hospital. She is employed by the London Pathway project which has very successfully improved outcomes for homeless men and women.

She is keen to find out how the NHS and organisations like BHT can work together to ensure see what measures are put in place to ensure smoother transition from primary-secondary-primary care. She will also be running a research project looking at standard and enhanced models of care. She and Chris Sargeant (a GP specialising in Homeless Persons Care/addictions) will be holding weekly meetings for all interested parties to attend to discuss perspectives and involvement , although dates or times have yet to be agreed.

Should hospitals be doing more to help homeless men and women before discharge?

I recently quoted some research from Leicester that homeless men and women are six times more likely to attend at A&E than the ‘housed’ population, four times more likely that they will be admitted, and are likely to stay twice as long.

Today on the radio I heard that the cost to the NHS of treating a homeless person is five times that of the housed population.

In a previous post I reflected on the medical interventions at First Base Day Centre, and how they prevented the need for A&E presentations and hospital admissions.  The savings to the NHS must be far greater than the cost of running the whole of the service at First Base which has a deficit each year of between £50,000 and £100,000.

Today Homeless Link published an excellent guide for hospital staff and managers “From Hospital to Home: Steps for hospital staff – identify need and take action”.

Homeless Link says “When someone who is homeless is admitted to hospital, their stay will often last longer, and become more complex and costly for the NHS, than your other patients.

“When they leave, more than 70% will be discharged straight back onto the streets, further damaging their health and all but guaranteeing their readmission.

“Housing is key to a ‘safe discharge’ from hospital, as well as to reducing the ongoing burden on your service. There are steps you can take to help.”

Here is the Homeless Link guidance:

On admission, identify homeless patients and those living in homelessness services:

  • Ask if people have accommodation, whether they can return and if they risk losing it
  • Contact the patient’s support services – this can prevent them losing their accommodation

If a housing need is identified, know how to respond and who to refer them to

  • Find out who to notify within the hospital and externally – is there a named contact?
  • Know how to make a referral to the local Housing Options team
  • Ask for training on the assessment and referral of homeless people
  • Keep an up-to-date contact list of local agencies such as hostels, outreach and drug and alcohol services on each ward.

If homeless people discharge themselves:

  • Alert local services
  • Record the self-discharge and the reason

Ensure patients can access ongoing care

  • Complete a social needs assessment
  • Notify the GP and relevant agencies about follow up treatment
  • Provide a copy of the discharge plan and medication

Help people return to their accommodation

  • Let the housing agency know when the patient is returning to ensure they can get in
  • Avoid out of hours discharge
  • Help the patient get home – they may need travel expenses

I wonder if there is a champion in local hospitals ensuring that these good practice guidelines are being implemented?

Real Life Stories: Sue’s Story

This is the second in a series of Real Life Stories, the experiences of BHT clients in their own words:

“I am at last writing to you to inform you of how Homeworks has helped me over the past 18 months.

“In September, 2010 I experienced a period of severe clinical depression which necessitated me leaving my job, and therefore the accommodation that was tied to that job. I had minimal input from the Mental Health Teams despite two suicide attempts in a week, but I was given a Homeworks leaflet.

“On contacting Homeworks, I met Mandy, who instantly facilitated looking into my options. She linked me in with Housing Benefit and Employment Support Allowance, which was something I had absolutely no prior experience or knowledge of.

“I quickly moved in with relatives, after my landlady staged a break-in at the cottage I was soon to vacate, in order to encourage me to move out quicker than the four week notice period. I eventually moved in with my Mother, with my 2 children, to a rented house in Eastbourne and thanks to Mandy’s advice added my name to the tenancy which then permitted me to claim Housing Benefit, facilitating a level of independence. She also suggested applying for Disability Living Allowance, which was granted. I used the first payment, which was back-dated to September, to pay for a week’s respite at Forresters in Southampton, again Mandy’s idea, which was a really useful break.

“Mandy helped me to navigate the Mental Health Teams, which was something I just could not manage, and liaised between the acute and community services, which at that time did not appear to communicate, in order to find out where I was on the list for Cognitive Behavioural Therapy, and which list I was on; a list I had been added to at least a year earlier before I became acutely unwell.

“I saw Mandy weekly and provided a huge amount of emotional and practical support. She sorted out all my Benefit applications, which was further complicated by divorce proceedings and imminent sale of my part of the marital home. We used the Eastbourne Advice Centre on a number of occasions to clarify matters relating to Benefits. I would not have been capable of any of this without Mandy’s help and support.

“At this time Mandy also supported me through making a complaint to the NHS regarding the lack of mental health care I was experiencing. Having written to the NHS Trust and getting no reply, I eventually wrote to my MP, Norman Baker, detailing my experiences, who contacted the Trust on my behalf. Mandy and myself subsequently attended two meetings, one with an Acute Services Manager and one with the ‘Adult Mental Health Recovery Team’ Manager, and ultimately received a written unreserved apology from the Trust.

“Since contacting my M.P. the care I have received has been good, with regular support from a Clinical Psychologist for several months, followed by a course of Cognitive Behavioural Therapy, and regular follow up with a Consultant Psychiatrist.

“Again, Mandy’s support was instrumental in pushing to get the mental health support I needed, and which was not forth-coming until I complained. She helped me to stay calm enough to get my point across when I was finding everything very difficult.

“In March 2011, my Mother needed to move on and I became homeless. Mandy supported me through submitting a Homeless Application, which was accepted by Lewes District Council. I moved to a series of Bed and Breakfast accommodation, to Seaford for a weekend, to Jevington Gardens, Eastbourne for a couple of months, then to Hanson Road, Newhaven, for three months. Mandy supported me through all these moves, which were stressful, unsettling, expensive and a bureaucratic ordeal, as each move required a new Housing Benefit application, requiring new evidence etc. At Hanson Road, I managed to persuade the Council to allow my 2 cats to be returned to me, by supplying a “cat reference” and supporting letter from my GP, which again were Mandy’s ideas.

“At each step Mandy’s gentle insistence that all the options be looked at, gave me the feeling that I could make the decisions regarding my future, which was very difficult due to my mental health problems at the time. She facilitated my independence when I felt very low and unable to mentally juggle all the issues that were immersing me.

“In October 2011, I moved to a three-bed house in Newhaven, and am currently on a starter tenancy, with the full likelihood of going on to a secure tenancy. I have a house that suits my family’s needs, is affordable, and close to my children’s school in Seaford. Mandy’s support at every step of the way has enabled me to get to a point where I am again living independently and in receipt of Benefits that are enabling me to recover from my mental health problems.

“I cannot thank Mandy and Homeworks enough for the help and support that I received during a very difficult time. Without that help, I have no idea where I would be.”

Suicide is often not related to mental illness – defending local services

I have just been interviewed for an item to go out later in the week on BBC South Today. The item is aiming to highlight the number of suicides of those who have been in the care of NHS mental health services across the south. Compared to other localities, it appears that Sussex has a higher rate of suicides amongst those leaving mental health services.

The problem with Freedom of Information disclosures, on which this report is based, is that it is all too easy to conclude that this higher rate is due to failures on the part of NHS services. It ignores many other attributable factors such as the influence of alcohol and drugs, relative levels of social and financial deprivation and, critically, the varying means by which people kill themselves. On all these factors, Sussex is likely to fare worse than other areas. For all we know, the mental health services locally might be doing a better job in more challenging circumstances than their counterparts in Berkshire, Dorset and Surrey.

The area I know best, Brighton and Hove, is a mixture of affluence and deprivation. I believe that the services for those with mental health problems, offered by statutory and voluntary sector services alike, are better than at any time in the 25 years that I have worked in mental health and support services. Services work better together and there is more varied provision for those in most need.

That is not to say that more does not need to be done. The alcohol and drug problems in Brighton and Hove will result in higher mortality rates including those who are suicidal as alcohol is often associated with suicide and drugs provide the means.

Debt is also a major issue and is likely to become more so. The number of those who are ‘financially fragile’ is increasing and debt is a causal factor in suicide and homicide. No matter how excellent a mental health service is, unless the debt issues are addressed, the risk of suicide can remain. If someone with crippling debt is hospitalised because they are a risk to themselves, unless the debt can be addressed, they will still be facing a box full of unopened bills on their discharge. That could well tip the balance even if they have had the most excellent in-patient experience.

So what can be done? Number one is the need to address alcohol and drug misuse, both during inpatient episodes and in the community. The second priority is to ensure that our assessments focus on precipitating factors for suicide, such as debt, relationship breakdown, bereavement, and pain. Where support hasn’t been arranged around these issues, it must be put in place.

Thirdly, we need to recognise the excellent support services that are out there. BHT’s own Route 1 Project provides support and accommodation to those leaving hospital. This ranges from high support to much lower interventions. In the eight years that Route 1 has been operational we have not had a single suicide. This is an example of the excellent partnership work between Sussex Partnership NHS Trust and a third sector organisation, benefiting those who are most vulnerable.

Suicide isn’t usually to do with mental illness. Social interventions can often be more relevant than those provided by mental health services. I admire and respect the work services are doing locally and I know there isn’t complacency. But we must make sure that the right interventions are being provided in each and every case, and we must be careful not to blame NHS services when other factors are probably more relevant. I am not sure that this is the view that the BBC reporter was looking for.

The need for a sustainable approach to alcohol and drug treatment

When the Licensing Act 2003 was being considered by Parliament, many of its supporters said that, by allowing licensed premises to remain open around the clock, there would be a more laid-back, European style drinking culture in the UK.

How horribly wrong they have proven to be. Since deregulation came about in 2005, there has been an epidemic of alcohol related harm sweeping the country. Prof Ian Gilmour, president of the Royal College of Physicians, said last week, “The nation’s growing addiction to alcohol is putting an immense strain on health services, especially in hospitals, costing the NHS over £2.7 billion each year.” He said the sum had doubled in under five years and was no longer sustainable.

“The role of the NHS should not just be about treating the consequences of alcohol-related harm, but also about active prevention, early intervention and working in partnership with services in local communities to raise awareness of alcohol-related harm.”

For those of us who work with the victims of alcohol and drugs, we need to be aware that the economic climate is already seeing resources being targeted towards those groups deemed more worthy of support. So called ‘self inflicted’ problems, such as alcoholism and drug addiction, will not enjoy high political support and we must prepare for such an eventuality.

There will be pressure to ensure that those able to move away from addiction are supported to do so. Regardless of the economic pressures,I believe there is also be a moral imperative to do this.

BHT operates a range of alcohol and drug services which have an initial focus on reducing harm but, more importantly, there is an emphasis within the organisation for helping people achieve total abstinence so that they can be prepared for, and are able to secure and sustain employment.

Long-term employment is critical in addressing social exclusion and for ensuring that alcohol and drug treatment is sustainable.