Supporting the homeless and vulnerable during lockdown
“I do wonder if we hadn’t been open what would have happened to these people,” says Susan Grant, who runs the Salvation Army’s Niddry Street Wellbeing Centre in Edinburgh, a drop-in facility for people affected by homelessness or alcohol and drug addiction.
While the current situation is hard for everyone, it is particularly difficult for many of the people the centre supports and Grant had serious concerns about making changes to the services.
“Although there’s nobody that we work with who has been directly impacted by COVID – they’ve not contracted it – actually, it’s the indirect impact that’s been the biggest concern, the reduced services, the concern about not having that connection with people.
“In the centre here … we work with so many people who have been through so much trauma in their life and they have issues with attachment, so we spend such a long time working together to build those connections and those relationships based on trust and then all of a sudden, it almost feels like you’re re-traumatising people because we’re saying, well, we can’t work with you in the same way we did before.”
The centre has been awarded funds by the Scottish Recovery Consortium to buy smartphones with unlimited data, which they have given out to users to enable them to stay in touch, a gift Grant says has had a “positive impact” on those they work with.
Early intervention support is continuing over the phone, with staff working from home, while support groups have moved online. But one of the key concerns is about the long-term effect on people’s mental health, and so the centre is still open for one to one support in person.
“It’s really important to point out that the third sector colleagues who work in homeless services, like Streetwork, Bethany, Salvation Army, that’s their job to be there in these homes and houses and hostels, and if they weren’t there, then these people wouldn’t get fed. They might not be able to manage this kind of way of living,” says Dr Joe Tay, a GP specialising in addiction.
“[Staff] try to keep their social distancing and they’ve got the same level of PPE that let’s say a GP has, but they don’t have the option of kind of going, ‘Okay, I’m just going to self-isolate at home and keep my distance’, etc, because that’s literally their job. And I don’t know if actually they’ve had enough recognition for the risk they’re taking on behalf of all of us, really.”
Tay runs a twice weekly clinic in the wellbeing centre as part of wider NHS primary care addiction outreach that also includes a six-day a week clinic in a hotel that is being used to house homeless people.
While the plan to offer addiction services on an outreach basis to help deal with the difficulties homeless people might have in accessing services had been made before the coronavirus outbreak, it has come into its own now.
In the Niddry Street drop-in they offer methadone or buprenorphine treatment and Naloxone training. They also test for the blood-borne viruses HIV and hepatitis C and run a needle exchange, which is very important because there is an ongoing HIV outbreak among the homeless population in Glasgow and these other diseases do not go away just because of coronavirus.
There are concerns that under lockdown drug use may increase or that people may switch to other drugs. Grant notes that there’s been a big rise in “street benzos” in the last few weeks, which is probably because they’re cheap and people don’t have as much money for drugs because they aren’t out begging.
Social isolation can very challenging for the people Grant and Tay are working with. Grant notes that they often have “an ambivalence for their own lives anyway” and are taking a lot of risks through addiction.
There’s also the state of accommodation. Many bedsits, B&Bs or even tenancies may not be very pleasant and “the worst thing for them is to be told that they need to stay in the house”, Grant says.
“Just giving someone a physical place to live that’s clean and dry and all that kind of stuff, that isn’t necessarily enough to stop someone needing to, or feeling the need to, be out in the streets,” says Tay, adding that being in accommodation with other people can be “quite traumatising” for those who are used to their own space.
However, there is good news too. Tay talks about two people he is working with in the hotel who have managed to come off alcohol because of the extra support they now have during the outbreak.
“They have never, ever been in a situation where they could actually even think about coming off alcohol … and so they’re in this place, it’s dry, it’s clean, they have regular food, people care about them and …. both of them have remained off alcohol now for about six weeks. And that’s the first time in their lives that that has ever happened.”
That is due to the accommodation and support that have been put in place for rough sleepers due to coronavirus, and the hope for everyone working in homeless services will be that there is no rollback to the way things were before after the outbreak is over.
Tay says: “I think that in many ways that’s really up to all of us, because as a society, as people who pay council tax, as people who pay income tax and stakeholders and voters, in many ways it is at least partly up to the rest of us to realise that it’s possible, firstly, and secondly, are we prepared to fund it, because that is really the bigger question.
“It is also interesting because it raises this other thing as well. So, if you were not able to do this for the most vulnerable of us all, of course they will come to harm – they have a lot of comorbidities, they have concurrent illnesses that would put them into a higher risk group – and so that in itself is a tragedy already, but also it reminds all of us as a society that actually if you can’t help people in that group, you’re not going to help yourself either.
“Your social distancing and self-isolating and all that kind of stuff isn’t really going to work if a significant number of the population can’t do it.
“So, my hope, really, is going forward that people will realise, actually, when we help the weakest and most vulnerable of us, we’re actually helping ourselves as well.”