Contacts
Case study:
06 December 2010
Allowing clients choice in a ‘continued use’ hostel
Key points
- Staff at St Mungo’s hostel in St Pancras have seen several clients die because of their lifestyle
- All clients at the hostel are allowed to continue drinking or taking drugs while there. Some manage to move on to lead more independent lives but others do not
- Two clients died last year. Both deaths were sudden.
Staff at St Mungo’s hostel in St Pancras Way, London have seen several of their clients die in recent years because of the lifestyle they have chosen.
The St Pancras hostel is ‘continued use’ hostel which means all 21 clients at the home are allowed to continue with their drink and drug habits while staying there. The principal aim is to provide them with a safe space while offering support to help them move forward in their lives.
Most staff will work with a small group of clients agreeing objectives – such as getting into meaningful activities, training or employment, moving into permanent accommodation or accessing health services – and then doing what they can to support them to achieve their chosen goals.
Given their substance abuse, health problems such as liver damage in particular are never far away and while some do manage to move on to lead more independent lives, others do not. Last year two of the hostel’s clients died – one at the hostel and one in hospital.
In each case the end came quite suddenly – although staff had seen signs they were declining for some time before. The problem, says Danielle, a project worker, is that most of her clients, being at the pre-contemplative stage, tend to deny what is happening to them so rarely have much time to prepare for their death.
One client was drinking heavily and vomiting and then bleeding. But every time he was admitted to hospital he was patched up and then discharged without any specific advice or support. “The only thing the doctors said was that of course he was going to be like this because he was drinking so heavily.” The man was eventually referred to the St Mungo’s palliative care service while his health continued to deteriorate.
The hostel always tries to make clear their choices, says Danielle, but sometimes they decide they don’t want to stop drinking. “But it’s difficult to see the decline and not to be able to do anything about it.”
Staff do also see signs of improvement among other clients and many move on to more independent lives.
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