By Dr Jenny Drife
My favourite question in this year’s Pathway conference came at the start, from a newly qualified doctor, who asked how she could make her colleagues see the importance of inclusion health. She explained that they don’t feel it’s relevant to their work: “They just laugh, and say, ‘but what does that have to do with the kidneys, Miriam?’”
I felt a swell of indignant sympathy and support from the audience, but the question served as a jolting reminder that not everyone thinks like we do. It’s a long time ago but I remember the bemusement from others early in my career when I explained what I wanted to specialise in. These days, in my work in a mental health team for people sleeping rough, we are mostly insulated from such views and if we do encounter them, we shrug it off, enjoying the camaraderie that comes from working together on something we feel passionate about.
We’re passionate because we know how important it is. I caught myself thinking that if Miriam’s colleagues aren’t shocked that the average age of death for a homeless person is 30 years younger than it is for the general population, then perhaps medicine isn’t the career for them. What could be more relevant to a doctor than preventable deaths? More charitably, perhaps they aren’t aware of this, or the other statistics which trip off our tongues: 70% of people experiencing homelessness have a substance misuse disorder; 68% physical health problems; 82% mental health problems. If we want to reverse the inverse care law, medical training should emphasise inclusion health needs a lot more than it does. I loved Dr Lindsay Crawford and Dr Nic Dickson’s account of medical students joining a recovery café in Glasgow: more like this, please.
As always, the conference was a place to be inspired by others and to talk about what solutions can look like. For me, the big ask of politicians is to think holistically, with the person at the centre: treatment of mental and physical health, and substance misuse, all in one place and trauma-informed. At the conference the passion made that seem achievable: we heard countless examples of good practice. Another highlight for me was hearing about Hestia House, a care home for people experiencing homelessness in Liverpool – more like this, too!
But the conference was topped and tailed by notes of caution. Amy Stevens opened with an ominous reminder that the rise in far-right politics will hit the marginalised groups we work with hardest; in the closing plenary Paul Corrigan reminded us, talking about the NHS 10 year plan, that the outlook is difficult for everyone, not just our patients. Perhaps the future is not quite so bright.
And back at work the next week, reality is quick to set in. My first patient shows me that she’s managed to request blood tests but is bewildered by the form she’s been given – it turns out that she needs to scan a QR code, and enter an email address, to get an appointment. I Google the phone number she needs and explain the situation to the receptionist. They are kind, but it’s clear that digital exclusion is not something that’s occurred to them. In the office our own GP registrar, studying for exams, remarks quietly that in the weeks she’s been with us she’s seen signs and symptoms that she’d previously only read about, such is the delay with our patients getting medical care. I review the notes of a man suffering from psychosis and see that he was referred to mental health services seven times in a single year, and rejected each time because of his drug use, before he became homeless and came to us. The optimism I felt the previous week dims a little more.
On outreach in a sunny park the patient I’m looking for has left for the day but his sleep site remains: a soiled duvet on a scrap of tarpaulin. A few yards away a mother and toddler throw crumbs to the ducks, laughing. You call this a lifestyle choice, I think to myself. How dare you.