No home and all alone – the complicated lives some of those in need

It’s 3am and the red phone rings.

Four rings before someone answers – this is bad, it shouldn’t be more than a second, but the department is heaving and no-one is around. I look at the nurse in charge as she takes down the vital signs – male, late 40’s, intoxicated, head injury, reduced GCS (conscious level), he’s barely breathing and his heart is pumping away at 150bpm.

We exchange glances, purse our lips and pull together the best people available to try and save this man’s life. Then suddenly the ambulance crew burst through the doors reeling off vitals and any information they’ve gleaned. It’s a familiar story – he was found at the bottom of a stairwell with an empty bottle, he looks unkempt and probably hasn’t had a bath in a few weeks. There is a large gash at the back of his head and he’s not responding at all. A scan reveals a large bleed in his brain, so he is transferred to neurosurgery in the hope they can save his life.

It’s Sunday morning three months later and he’s here again, this time with an overdose of his antidepressants; this time he ends up in intensive care and may not survive.

It turned out that he had lost his job due to depression, and an accumulation of events had led to a breakdown. The system, it seems, had failed him. His is a familiar story:

• Seven years previously his GP diagnosed low mood and anxiety and offered him counselling.
• Three months later he received a letter for his first counselling session, by that time he had already taken four weeks off sick.
• Six months later he quit his job as he felt unable to cope. He attempted to claim benefits but it was over five months before he started receiving payments.
• Unable to keep up with mortgage payments, he declared bankruptcy and went into temporary housing.
• This proved to further hinder his benefit claims as he had no fixed address. He eventually became homeless.
• Soon he started committing petty theft to pay for an alcohol addiction and after frequent A&E visits with alcohol intoxication, someone recognised he was clinically depressed, started him on antidepressants and referred him to an alcohol rehab team.
• Sleeping rough every night meant he never received his clinic letters, so he continued to drink, which meant he forgot to take his tablets: his depression remained untreated, he continued to drink.
• Eventually he tried to end his life, a point that he reached more than once.

As a doctor working in A&E I often came into contact with people with this kind of story, but the disconnect between Whitehall policymakers and people working on the front line seems to have increased since then. In policy terms there appears to be provision in place for vulnerable individuals with complex needs, but too often they end up on the streets or in prison.

In my current role in DWP I advise policy officials on medical issues, and have a better understanding of both sides of this divide. I joined the Connecting Policy with Practice programme to see what the voluntary sector offers individuals with complex needs, and if there was a better way of working together.

Through the programme I was partnered up with Carol, who works for Freshwinds, a charitable organisation based in Birmingham. Freshwinds provide services for those who are socially excluded as well as those facing life-threatening illness. As part of our work I visited them in Birmingham and spoke to a support worker, Hugo, about his work and how he engages with clients with complex issues, interacting with lots of different public services. Hugo described how he manages risk to help clients like my patient, to prevent them from ending up on a resuscitation bed in A&E, and how he tries to help them find a way to rebuild their lives.

Next: read about Hugo’s experience of the backstreets of Birmingham, how he knows which hangouts to look for his clients in, and one of his success stories.