Street Work Nursing as an innovative strategy in the care for dually diagnosed individuals: reflections on a pilot study
This presentation addresses the implementation process of a Street Work Nurse project for individuals with mental health illness and co-occurring alcohol or other drug abuse disorders, living in a small city in Flanders (Belgium). It is well known that dually diagnosed individuals have a higher risk of becoming homeless resulting in an accumulation of both social and physical problems (Rahav & Link 1995) whilst eluding all treatment efforts (Mayes & Handley 2005; Ley et al. 2002; Henwood, Padgett & Tiderington, 2014).
The aim of the pilot project was to improve the overall care of dually diagnosed individuals who were either shunned from treatment or who had renounced treatment, by providing low-threshold primary health care on the street. The psychiatric street nurse used ‘harm reduction’, ‘outreach’, ‘recovery’ and ‘in situ’ as guiding principles and largely invested in networking with general welfare and (mental) health care services.
A feasibility study was conducted to outline the barriers and facilitators of the project. This involved 10 follow-up interviews with the psychiatric street nurse over the course of one year, brief interviews with 6 dually diagnosed individuals who at one point in time received medical health care by the Street Work Nurse, and two focus groups with in total 12 professionals from welfare and (mental) health care services. Data were analysed using thematic analyses.
Findings suggest that Street Work Nursing empowers dually diagnosed individuals to take better care of themselves and to accept medical care more easily. Involved welfare and (mental) health care services predominantly described Street Work Nursing as a win-win situation because it not only facilitated the accessibility for the target group to their services, it also supported the services in managing the more difficult cases and/or assured a better follow-up of care. Nevertheless, implementing Street Work Nursing was at times challenging and demanded continues reflections in redefining the current care approaches for dually diagnosed individuals while developing and managing the boundaries of Street Work Nursing as a new profession.
This study illustrates the potential of Street Work Nursing in providing basic care and support to individuals who are often resistant to traditional care services or who were not always heartily welcomed.