“There’s not one day that I don’t wake up and reach for a can instead of a cup of tea,” says Stephen, (see case study) one of 10 clients currently residing at Oak Mount, the only residential care home in the UK providing ‘wet’ accommodation. This means there is no restriction on the amount of alcohol clients can consume.
For a referral to be accepted at Oak Mount the client must be male, single, with significant chronic alcohol use, homeless or unsuitably housed and in need of care and support due to their physical and/or mental health. Common health problems include Korsakoff’s syndrome (a brain disorder associated with heavy alcohol consumption), a dual diagnosis with mental health problems, physical issues that pre-date their alcohol use or are as a result of it, mobility issues, withdrawal seizures, and peripheral neuropathy, which involves damage to the nervous system. Clients are generally aged over 40, but there are exceptions depending on individual circumstances. At the moment, the youngest client is 37 and the oldest 75.
Run by not-for-profit organisation Horton Housing, Oak Mount was set up in the Manningham area of Bradford in 1993 with 10 bedrooms. At the time, a large number of homeless street drinkers were using Horton Housing’s local day shelter; but when that closed at 5pm they went back to sleeping on the streets. Oak Mount was established to address this issue and it has been so successful that in October 2014 the care home was moved to purpose-built premises on the edge of Peel Park, with an extra two bedrooms to meet demand.
Indeed, an independent evaluation in 2013 by Bradford Council for its new quality assessment framework gave the home its top level A rating across all standards. And as a registered care home, Oak Mount comes under the scrutiny of the Care Quality Commission: it passed all the standards in its last full CQC inspection in September 2014 – it is yet to be inspected under the new rating system.
Situated in a quiet residential area of terraced houses, there is little to single out the sprawling bungalow as a care home other than a discreet sign. Fully accessible, it has a shared kitchen and dining area, lounge, bathroom, 12 single ensuite bedrooms and, at the request of clients, a pool table area (see photo right).
There is ramped access to the front door, handrails and grab rails throughout the building (not purely to help those who have disabilities, but also to steady the men when they are walking around the home intoxicated to prevent falls), a bath lift, accessible toilets/showers and an intercom call system.
As the UK’s only residential wet home, some might question its philosophy which is to reduce harm rather than promote rehabilitation. But, for a small minority of long-term, heavy drinkers, services won’t work because they don’t want to stop drinking, says head of service Jayne Higgins.
“Our clients have been through lots of detoxes, have often had periods in prison, and have all been unable to keep a long-term tenancy even with quite a lot of support because of their alcohol intake and chaotic lifestyles.
The thinking behind Oak Mount was that if we don’t impose any restrictions on alcohol intake we can work with them to address other areas, such as rough sleeping, poor diet, health issues, and access to GPs. By reducing the harm we enable them to live settled lives, sometimes for the first time.
“I get that it’s an interesting concept and we have had medical professionals who have been a bit shocked at the idea; I think it’s easier to understand from a social model than a medical one. If clients reach a point where they want to address their drinking then we help them with that, but that has only happened on a couple of occasions. It’s not why they’re here.”
Instead, the idea is to minimise harm – to them and those around them. Homeless drinkers who continue to drink at dangerous levels whatever interventions are put in place, are vulnerable to violence and abuse on the streets, and having their money stolen or used by ‘friends’. It affects their families, friends and neighbours. It’s also a drain on public resources with inappropriate hospital admissions, visits to A&E departments, and the impact on police and courts’ time.
“The harm to their physical and mental health, and the consequential societal drain makes it a far bigger picture than just that one person,” says Higgins.
In the US, where wet houses are more common, research in 2012 backs up the concept. A team from the University of Washington studied 95 long-term homeless people (94% were men) with severe alcohol problems and found that in one year they cost taxpayers more than $8 million in hospitalisations, detox centre treatments and incarcerations.
In the first year of the group living in Seattle’s Housing First program – supported housing where they were allowed to drink and the first project-based Housing First model in the US to be scientifically studied – the same group cost $4 million in taxpayer money.
The average number of drinks consumed on the heaviest drinking day of the month decreased from 40 to 26 across two years, a decrease of 35%. The median number of drinks showed a change from 20 to 12 drinks per typical drinking day – a 40% drop.
Participants in the study said they were happy to have a home and happy that they no longer had to drink to stay warm, to put themselves to sleep, or to forget that they were on the streets.
The team at Oak Mount have noticed a similar effect. Once a client has settled in, has had an assessment and risk assessment, has a key worker and a support plan, knows that their money is safe in the office so it’s not going to be immediately stolen or spent by ‘friends’ – negating the need to binge drink it away – then improvements happen.
They start budgeting, talking to clients who have lived there a while who can have a positive influence, and often end up either drinking less, drinking weaker alcohol, or having their first drink later in the day.
“Having a home, some possessions and a room they can personalise makes them feel better about themselves and their drinking sometimes naturally reduces as a result,” says Higgins.
As an example, Higgins relays the story of a 73-year-old man who was being held inappropriately on a category B prison wing waiting to go to court after breaking an ASBO because he didn’t understand it. He was due to be given a custodial sentence but because of his age the court agreed he could move to Oak Mount.
“He had been appearing at the district court on a weekly basis, but was only in court twice in the first 12 months he lived here. When he did appear back in court – for going on a train without a ticket – the judge was astounded at how well he looked.”
Higgins (pictured left) has been at Oak Mount since it first opened, starting as a care worker, then support worker, manager and now head of service. “When we first opened we had guys sneaking bottles of cider in under their coats because they couldn’t believe we would allow them to drink, they thought they’d be thrown out if they were caught.
“They would often sleep on the floor in their bedrooms because they didn’t want to mess up the beds. One guy had a pair of pyjamas for the first time since he was 10 and it was such a big thing for him.”
It’s those simple things that make the work they do so worthwhile, says Higgins. Which was why she was so angered when someone once told her that it must be soul-destroying to work there and not see any success.
“It depends how you measure that success,” she argues. “The measurable outcomes are so individual, it depends on their backstory. If we have a client who has been sleeping rough, been beaten up, not spoken to his family for years and he lives here for six months with people who care for him, he gets in touch with his family and dies with some dignity, then that’s a success.”
Intended outcomes for clients at Oak Mount
- A reduction in harm arising from use of alcohol.
- A more settled and less chaotic lifestyle.
- Maximisation of income/improved access to welfare benefits.
- Access to specialist services and health care.
- Prevention of reoffending, reduced contact with criminal justice agencies and reduction in anti-social behaviour.
- Reduction in crisis driven A&E visits and hospital admissions.
- Improved social inclusion.
Referrals can come from anywhere, but are generally from social work teams, street outreach teams, mental health services, and voluntary sector providers. Very occasionally they are self-referrals. The relevant local authority funds the placement on a spot contract – though some are jointly funded with health – and the client’s contribution is calculated based on their income from benefits and/or pension.
Currently the 10 men living at Oak Mount have been funded by Bradford, Calderdale and Kirklees councils. Leeds Council and other neighbouring authorities have also funded placements in the past, as have local authorities in other parts of the country.
The offer of accommodation is on a permanent, long-term basis and, sadly, death is the most common reason that a client’s file is closed.
As well as Higgins, Oak Mount’s team comprises five support workers and five care workers, all with health and social care qualifications, a cook and manager Tracy Ellis (pictured right). Ellis, a registered social worker, says that her training dovetails well with the home’s concept, which is person-centred and focuses on the entirety of someone’s circumstances. Several assessments take place before someone is accepted at the home and once this happens a support worker works with them in a key worker role to draw up an individual support plan and help them achieve their outcomes.
There are common outcomes in these plans, says Ellis: “Re-establishing contact with family is always important; managing finances – some have accumulated debt and want support in paying that off and it helps them to plan their drinking around their budget; health issues and getting registered with a GP, which they can do now they have a settled address; and making sure they are on the right medication.”
Risk assessments also take into account visitors. Anyone who doesn’t live at the home and is intoxicated is not allowed to enter and if someone is considered unsuitable and staff want to bar them, this is discussed with the client.
Diet and nutrition is important, most clients have had years of eating little or nothing when intoxicated. So there are no set meal teams and although there is a set meal every day, the cook can be preparing meals up to eight times a day to accommodate everyone’s requirements if they don’t want the set meal. Some just want snack food like a sandwich because they are not used to eating a meal. And as well as the main kitchen, there is a residents’ kitchen that clients can use if they want to make something to eat or drink themselves.
Days are flexible, clients can come and go as they please without having to ask permission. There is no timetable of activities but outings to places of interest, shopping trips and visits to families are organised. They have had quiz nights, entertainers and events at the home. Sometimes a dog is brought in for clients to pet and that has proved very popular. They can also take part in training in life skills and IT at one of Horton Housing’s training centres.
Clients spend time with each other and alone in their rooms, and visitors can see them privately in their room rather than in the communal areas. Those residents who are very ill spend most of the time in their rooms.
During the day up to five staff may be on duty and a minimum of two staff are on duty at all times. Support workers run the shifts, hold the keys for medication and petty cash, deal with admin, phone calls, and appointments and are the key workers. The care workers do the hands-on personal care, clean and tidy rooms, and do the laundry.
There is a licence agreement that all clients must agree to which sets out the rules they must abide by, such as how staff and other residents must be treated. As clients are allowed to drink you might expect there to be a lot of aggression and/or violence, but despite the fact that currently all staff are female, this doesn’t appear to be a problem.
“If someone becomes aggressive or hostile in a communal area, often the clients will manage it between themselves and tell them to calm down,” says Ellis. “If staff have to intervene we ask them to go to their room. Generally when things flare up they quickly settle down.
“Staff are all trained in managing violence and aggression, and we use de-escalation techniques that are about your approach and tone of voice. We don’t use any physical restraint or sedative medication. We try to negotiate with them and say something like ‘you are putting me in the position where I will have to call the police’. This gives them a choice of what to do next and we rarely have to call the police.”
You might also expect there to be a lot of falls in the home due to intoxication, but plenty of seating areas, hand rails on walls, and staff looking out for them, keep incidents low, says Ellis.
There are client groups who are still seen as undeserving and I think this is one of them.
“So I get a sense of satisfaction knowing the impact the service is having. I know there are 10 men living here who would have been street homeless, or involved in the criminal justice system, or lost contact with family and friends and leading chaotic lives. But they are settled, cared for, and part of a community and that’s important.”
Stephen, 48, grew up in a comfortable home with loving parents and three siblings. He admits he was a tearaway, and started smoking and drinking when he was about 11 and getting involved in petty crime.
By 14 he was taking cannabis and in a detention centre for the first time. Two years later he was back.
Petty crime turned into something more serious and by 21 he was a con, as he puts it. He’s burgled warehouses, lorries, and shops, as well as having other offences including football violence and street fighting, exacerbated by alcohol, on his record. In total he has spent 13 years of his life in prison.
He is clearly ashamed of his past and says “it’s a part of my life I choose not to dwell on because it was a mistake”. But he says he learnt more about crime during his time inside than anywhere else and it gave him easy access to hooch, cannabis and heroin.
With a huge amount of self-determination, Stephen broke a crack and heroin addiction on his own, saying “it wasn’t a life that I wanted”. But his drinking was so dangerous that the Salvation Army hostel he was at referred him to Oak Mount. He has been at the home for three-and-a-half years and says he is happy there.
“I get on great with the staff here. It’s good for my family as well as me. They’re happy I’m here because they never knew where I was before.”
Stephen drinks 16 cans of lager a day – he is drinking from a can as we talk – but he has slowly reduced the alcohol content from 9% when he arrived at Oak Mount to 2.8%.
I don’t think I would have been able to do that if I hadn’t been here.”
His next goal is to cut down on the number of units: “Drinking is just something that I do, it’s a habit and I’m starting to think that I’m wasting my money.
“[Cutting down] won’t be easy. It wasn’t easy coming off drugs, but I did it because I knew that I had had enough, and I’ve had enough of drinking now.”
For more information on Oak Mount, phone Horton Housing on 01274 370689 or email firstname.lastname@example.org