Excellence in Ending Homelessness - Adults Nominee
Program - Better Health for Homeless Men at Mission Australia Centre
Please give your reasons for nominating this program.
Mission Australia Centre (MAC) - Better Health for Homeless Men was established to identify health needs and improve access and equity to healthcare for homeless men. Between 0.4 and 1.5% of the NSW population is homeless (1)). In SESLHD this figure is more towards the 1.5% end, with a higher percentage sleeping rough. Measuring patient information prospectively from the commencement of the clinic to understand their health needs we have developed new and relevant systems of care. The innovative component of this project is the provision of care to the homeless on-site, not expecting (unrealistically) that these men would be able to attend separate hospital clinics. By bringing the blood collecting capability, the portable liver fibroscan device and subsequently Hepatitis C drug treatment and mental health care on-site, we have been able to provide an innovative whole person medical care program. To the best of our knowledge this is the only medical service for the homeless that has combined on-site general medical, liver screening & Hepatitis C and mental health care in one package. Team involves: homeless men residing at the MAC; staff at the MAC; doctors and nurses from St. George hospital. We have been able to meet the requirements of this service as they developed through documentation of each patient’s health needs; we learned that in particular we needed Liver and Mental Health clinical expertise. We teamed with various health professionals from St George Hospital to provide these on-site clinics. Care is consumer focussed, integrated and locally provided, and operates across these professional boundaries. This innovation aligns with all three directions of the NSW State Health Plan: towards 2021: Keeping people healthy – by targeting a high risk group and providing easy access to medical and mental health care on-site; 2) The health care is of high standard, provided by specialists; 3) This is integrated health care, “Right Care, Right Place, at the Right Time” with strong local hospital and community partnerships.
What outcomes were delivered as a result of this program?
We have treated 228 men to date, half <45 years old. 79% smoke, 48% misuse alcohol, 67% have other substance misuse. 61% have depression, anxiety or psychosis; 41% have metabolic syndrome features, 36% cardiovascular disease and 29% hepatitis C, mostly undiagnosed previously. These men would be unlikely to have had such comprehensive medical assessment and care without development of this on-site service. We are respectful of their lives and have identified and treated very high rates of mental health disorders (63%), Hepatitis C (29%) and cardiovascular risk factors (30% with an established cardiovascular issue such as hypertension or ischemic heart disease and 42% with obesity and/or abnormal lipid or blood sugar profiles). Hepatitis C can be eradicated in upwards of 90% of patients today with drugs that we can administer on-site over a 12 week period. Most men stay at the MAC for longer than this time whilst seeking housing and rehabilitation back to family and a working life where possible. Our assumption is that this comprehensive treatment of Hepatitis C, general medical issues and mental health issues leads to a longer and healthier life with less need for future hospital admissions, the same assumptions that are made in routine clinical practice in hospital clinics.
The clinics established at the Mission Australia Centre have been very effective in addressing the clinical needs of people subject to homelessness, many of which have highly complex health and social care problems. This innovative model provides the opportunity to these people to make a substantial difference to their health and wellbeing. Taking services to those most in need enables individuals who tend to have difficulty navigating the health system an opportunity to lead more healthy and productive lives. Everyone should be given the opportunity to reach their potential and offering these diverse on-site clinics is important in that it enables these individuals to have their needs met in a safe and trusting environment. Prof Mark Brown was instrumental in championing the development of an equity strategy in SESLHD - the first we have had. This commitment and desire to address the needs of some of the most disadvantaged people in our society resulted in the strong collaborative partnership providing diverse on-site outreach clinics at the Mission Australia Centre. The values of social justice, equity and social inclusion are at the core, coupled with specialised clinical skills. This partnership should be congratulated and celebrated as a lead in this area of clinical support within a community setting. We are extremely proud of this award winning outreach clinical service.