PHOENIx for severe and multiple disadvantage

Every year, approximately 5,700 people in Scotland experience three severe disadvantages at the same time: homelessness, drug addiction, and criminal offending. Most people facing these Severe and Multiple Disadvantages (PSMD) have suffered trauma during childhood, report lower quality of life and have poor health outcomes. They repeatedly offend, and die on average 30 years earlier than people living in mainstream society. Glasgow, Edinburgh, North Ayrshire and Dundee have the highest numbers of PSMD and drug death rates in the UK and Europe. An important barrier to improving outcomes is that PSMD struggle to access services. PSMD experience multiple problems like unmet health conditions, unsafe accommodation and lack of supportive relationships, preventing purposeful community connections. Their problems are rarely adequately dealt with by different services. Unmet health and social care needs increase the risk of overdose, emergency service use, and offending behaviour. The costs of caring for PSMD are 4-5 times higher than for people in mainstream society (due to criminal justice and emergency health care utilisation). Third sector (Charity) homelessness organisations tend to be trusted by, and accessible to PSMD, especially when going to where PSMD are (i.e. providing outreach). They offer help with accommodation, and vocational opportunities. However, many treatable opportunities are missed because healthcare professionals rarely go on outreach with them. If NHS clinicians were to join workers from charitable homeless organisations (many of whom have experienced SMD) to visit PSMD, the combination could help address many of the multiple health and social care problems experienced by PSMD. Such a collaboration (which we have called PHOENIx: Pharmacy/nurse Homeless Outreach Engagement Non-medical Independent prescribing) could potentially treat PSMD holistically on outreach. They could treat physical and mental health conditions, and drug addiction. They could also address welfare benefits, housing and encourage pathways to contribute to their communities. PHOENIx could improve health and, reduce reliance on crisis-focussed services, while reducing offending behaviours. This could address the social and economic disadvantages experienced by PSMD. Improving these outcomes is a UK homelessness research priority. In a successful small-scale study, PHOENIx appeared to delay time to non-fatal overdoses, Accident and Emergency visits, and hospitalisations. It appeared to improve quality of life and community connections. PSMD highly valued the PHOENIx intervention. Larger scale research is necessary to prove whether PHOENIx really does make a difference. Aiming to identify a solution that promotes economic and social prosperity for PSMD, our study will be set in Glasgow, Edinburgh, North Ayrshire and Dundee. We will randomly assign (like tossing a coin) 372 participants to either: (1) Usual care; or (2) PHOENIx in addition to usual care. PHOENIx participants will receive additional weekly visits from prescriber clinicians and third sector workers, for nine months. We will find out whether PHOENIx reduces the risk of fatal and non-fatal overdose, improves health, and community connectedness for PSMD. We will also find out whether it reduces Accident and Emergency visits, hospitalisations, criminal activity. We will look at what aspects may help or hinders delivery and rollout of PHOENIx across the UK, and whether it is value for money. If the study results are positive, we will use these results to drive a policy and practice change to improve the way we care for PSMD. This will make a big difference to PSMD, health services, social care, criminal justice systems and communities.