Homeless Step Down Pathway Case Study 5

Lucy – name changed.

Lucy is a 41yr old woman with a history of crack and heroin use. She was severely underweight and had not been adhering to her HIV treatment. She also had some gynae issues and needed a total tooth extraction due to severe decay.

She had been prescribed methadone by the external drug and alcohol service to help her to stop using heroin. As she stopped needing to buy heroin to avoid opiate withdrawal symptoms, this enabled her to stop buying crack as well. She then maintained a drug free status which enabled her to work towards going to rehab.

In order to be accepted into rehab she needed to detox from methadone. The external service organised the funding for her to complete a methadone detox in Guys and St Thomas. It was also agreed that due to Lucy’s other health issues she would benefit from a period of time here at Mildmay, where she would have the opportunity to stabilise and address some of the other health issues before going to rehab.

I was able to visit Lucy during her detox at GSST to introduce myself and to give her some information regarding her admission to Mildmay. She felt this relieved some of her anxiety about coming to a new place and having someone to meet her that she had met helped with the transition

On admission to the Mildmay hospital she was still struggling with some effects of the detox such as not being able to sleep and she had some vomiting. She was able to get her circadian rhythm back in the first few weeks and the vomiting past in the first days.

Lucy attended the relapse prevention group and 1-1 sessions that supported her in maintaining abstinence from drug use. Initially she was quiet and didn’t feel able to contribute much in the groups. She was concerned about how other people viewed her, but over the weeks her confidence grew and she became an active member. She was able to offer insight into some of her own issues, as well as supporting other group members, with topics that they had struggled with.

Lucy started taking her medication more regularly and attended her appointments at the dentist and gynaecology departments at other hospitals. At first I attended with her as she didn’t feel confident about going on her own but I stopped going when she felt strong enough and didn’t need me to be with her. Her trips out on her own went well with no issues.

Her stay here also provided her with the opportunity to see her daughters regularly, to improve the relationship with them. This was important to her as she felt that she would then be able to focus on herself in rehab.

She informed me that had she gone straight to rehab from the detox she may not have been able engage from the start, but now she is stronger and feels that she will be able to participate and get the most out of it.

She was discharged from Mildmay with no issues and went in a taxi with her external key worker to rehab as planned.

Theresa Hibbert

(Drug and Alcohol worker)