Bristol Wet Clinic: An alternative approach to alcohol addiction. Dr Emma Mastrocola

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1 Bristol Wet Clinic: An alternative approach to alcohol addiction Dr Emma Mastrocola

2 What is addiction really? It is a sign, a signal, a symptom of distress. It is a language that tells us about a plight that must be understood. Alice Miller (2008) 1 Swiss Psychologist

3 What is a Wet Clinic? A service for people who are alcohol dependent and are homeless or at risk of becoming homeless. Alcohol is allowed on site.

4 Why is there a need for a special service? Street drinkers are one of the most vulnerable groups in society. Many have chronic ill health.

5 The struggle to engage... Struggle to access mainstream services. Different relationship to health and wellbeing. Crisis management only. Difficulty in achieving continuity of care.

6 The struggle to engage... Personal Barriers Substance use and chaotic lifestyle Poor memory or mental health Lack of knowledge of services Structural Barriers Cost of transport Distance to healthcare provision Cost calls to make appointments Adapted from Mastrocola and Chew-Graham (2012) 2

7 The struggle to engage... Personal Barriers Substance use and chaotic lifestyle Poor memory or mental health Lack of knowledge of services Structural Barriers Cost of transport Distance to healthcare provision Cost of phone calls to make appointments Professional Barriers Judgement from healthcare professional Lack of trust and rapport Lack of empathy Adapted from Mastrocola and Chew-Graham (2012) 2

8 The struggle to engage... Personal Barriers Substance use and chaotic lifestyle Poor memory or mental health Lack of knowledge of services Structural Barriers Cost of transport Distance to healthcare provision Cost of phone calls to make appointments Professional Barriers Judgement from healthcare professional Lack of trust and rapport Lack of empathy Adapted from Mastrocola and Chew-Graham (2012) 2

9 When accessing alcohol services, clients are most often required to abstain from drinking whilst on the premises.

10 The Bristol Wet Clinic Pilot Wet Day Centre set up in 2008 This included a Wet Clinic provided by Compass Health and delivered by Dr Clare Flemming. Runs twice a week at The Compass Centre and The Wild Goose Cafe on Stapleton Road.

11 Aims of the clinic A place of refuge in a non-judgemental setting. Aims to address issues in: Addiction Health Social circumstances Safety Criminal justice

12 Why is it unique? UK study 3 identified nine Wet Centres across the UK Having a GP on site allows for opportunistic access in a non-threatening environment.

13 Addiction has biological, chemical, neurological, psychological, medical, emotional, social, political, economic and spiritual underpinnings. To get anywhere near a complete picture we must keep shaking the kaleidoscope to see what other patterns emerge. Gabor Mate (2010) 4 Hungarian-Canadian Physician

14 The Bigger Picture Concurrent addictions Criminal justice involvement Poor Mental Health Unemployment, debt and other financial difficulties Alcohol Addiction Homelessness or vulnerably housed Social Isolation Chronic ill health History of abuse or current abusive relationships

15 Services Offered Detox planning, advise and referral Advise on social issues e.g. housing and benefits Minor injuries treatment General medical treatment and advise Harm Reduction Liaison with mental health services Vitamin prescriptions Immunisations and BBV monitoring Reasonably priced food at the cafe

16 Importance of the MDT Complex needs must be met by a number of professionals from a number of organisations. Close links are forged with: Community groups Third sector organisations Secondary care health services

17 Case Study of JB 29 years old Released from prison near Bristol Given train ticket to home town but was assaulted and all possessions stolen Scared of returning to home town because she had also been assaulted there Decided to stay in Bristol No personal connection to the city BCC had no duty of care to house her Sleeping rough

18 Case Study of JB cont... Alcohol dependent, PTSD, chronic depression and anxiety and Personality Disorder. Anxiety and frustration has deteriorated due to homelessness and loss of identity. Verbal aggression and inability to access mainstream services. Wet Clinic has been working with JB where she can be accepted in a welcoming and empathic environment. She can meet with a number of health and social care professionals in the same place. Helps JB to know when and where to come for help with all her problems. Helps those involved in her care easy and convenient communication to help plan care.

19 Case Study of AM 55 years old Long term alcoholism and history of physical trauma and violence. Does not trust others and refuses help. Instead she tries to help others which has led to severe physical, verbal and financial abuse.

20 Case Study of AM cont... Moves round the country, sleeping rough and sofa surfing. Low self esteem and unable to prioritise her own health needs. Stays away from doctors for fear of rejection or being treated rudely. As a result has a number of significant, untreated medical problems. Through persistent kindness and encouragement by staff at The Wet Clinic, AM is beginning to work through her difficulties and is aiming to complete detox.

21 Links with Night Shelter Spring of Hope Ladies Night Shelter. Build trust and identify those that need help. Signposting. Using the healthcare professionals as a resource.

22 Case Study of CB 30 years old Using the night shelter for three months. Staff overheard her say that she enjoyed a drink and sensitively enquired about her alcohol consumption. CB confided in staff member that she was drinking hazardously. Suggested attending Wet Clinic the next day. CB attended and engaged with professionals at clinic.

23 Challenges with the Wet Clinic Model A wet centre can only cohere into an effective force for change when seemingly contradictory elements are made to interlock when challenge and control promote care rather than exclusion and care enables challenge rather than encouraging stagnation. Crane and Warnes(2005) 5 Sheffield Institute for Studies on Aging

24 Trying to do meaningful work with a person that is intoxicated. Service users often only present because they want a place to drink or socialise. Commissioners want to see positive outcomes around recovery, work and education and reduction in anti-social behaviour.

25 Empowering Others Whilst Looking after Ourselves Purity and impurity belong to oneself. No one can purify another. Buddha The Dhammapada.

26 Thanks to... Dr Clare Flemming GP for the Wet Clinic, The Compass Centre Lindsay Popham Specialist Nurse in Homelessness, The Compass Centre Val Thompson Manager at Spring of Hope Ladies Night Shelter

27 References 1. Millar, A. Breaking Down the Wall of Silence: The Liberating Experience of Facing Painful Truth. New York: Basic Books Publishing; Mastrocola E, Chew-Graham C. Management of long-standing illness in women involved in street-based prostitution: a qualitative approach. Currently in Progress Crane M, Warnes N. Wet Day Centres in the United Kingdom: A Research Report and Manual. Sheffield Institute for Studies on Aging Mate G. In the Realm of Hungry Ghosts: Close Encounters with Addiction. California: North Atlantic Books; Crane M, Warnes N. Planning and setting up Wet Day Centres in the UK. Drug and Alcohol Findings. 2005; (12): p

28 I still don t accept that things are hopeless for any human being. I believe there is a natural strength and innate perfection in everyone. Gabor Mate (2010) 3 Hungarian-Canadian Physician

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