Caritas Malta pioneered work in the field of drug rehabilitation in Malta and opened its first centre in Floriana in 1985. Through the experience gained during the last 20 years, the Caritas drug programmes have evolved according to the changing needs of its clients.
The latest addition to the Caritas Malta drug services is the only shelter for homeless persons with a drug addiction on the island. Situated in Floriana, the shelter opened its doors to its first clients in November 2004.
The staff are all professionals with years of experience and have recently undergone intensive training in running a Harm Reduction Shelter. These people are dedicated as well as highly-motivated and where possible, encourage clients to begin a process of rehabilitation.
At this shelter, clients find a homely and caring environment which gives them the stability and support which does not exist in their lives. The shelter was specifically intended to look and feel like a home, with the set-up and décor being deliberately as non-clinical as possible. An important aspect of the shelter is that it can also be used as a drop-in centre for several hours every day. Clients who are not residing at the shelter may still drop in for a snack or a shower. They are offered a warm welcome and if interested, can also receive counselling and support.
The Harm Reduction Shelter provides a support and counselling service to an average of 10-15 clients per day and, presently, accommodates up to 10 homeless persons with drug addiction per day.
What is a Harm Reduction Shelter, and why have one?
The primary and immediate objective of a Harm Reduction Shelter is not to help clients attain total abstinence from drug use since clients are not usually ready to do so yet, for various reasons. The primary aim is to help clients minimise harm to themselves and others, while providing them with basic needs. Gradually, each client may be helped to reach that stage where she/he can decide to opt for full rehabilitation.
Harm reduction clients have a specific profile: they tend to indulge in polydrug abuse (that is, using more than one illicit drug concurrently), live an extremely chaotic lifestyle and, typically, lack any sort of family support. Very few of these clients have stable housing and tend to make arrangements for their night’s shelter on a day-to-day basis with friends and acquaintances. Many harm reduction clients tend to have an array of psychological as well as physical difficulties. Many would have been prescribed psychiatric medication and often suffer from malnutrition, untreated injuries as well as other ailments.
Some of these clients are homeless. Existing shelters for the homeless do not accept persons with a current drug addiction since their staff is not sufficiently trained to deal with drug users. As a result, these persons have no alternative but to live and sleep in abandoned cars in fields, makeshift shelters and so on. Many of the persons whose drug-related death reaches the media and national attention belong to this category of persons with drug addiction. They are usually found to have suffered severe physical deprivation from lack of food and over-exposure to adverse conditions such as rain and cold.
Clients who fit into the above-mentioned profile are not able to be immediately referred to the San Blas Residential Drug-Rehabilitation Programme since the programme requires clients to have achieved and maintained freedom from illicit drugs for a period of at least one month and if using methadone replacement therapy, to have reduced their intake of methadone to a maximum of 20mls per day.
Entry into the San Blas residential programme is also impracticable for clients who have imminent court hearings for drug trafficking. In Malta, according to current legislation, the minimum sentence for drug trafficking is six months imprisonment. If clients are found guilty of trafficking, these must necessarily be given a prison sentence. Thus, entry into a residential programme is counter-productive for these clients as well as potentially disruptive and emotionally disturbing to the rest of the residential community.
What does the Caritas Malta Harm Reduction Shelter offer?
The Harm Reduction Programme aims to offer support, structure and intensive therapy to clients. Close contact is sustained with other professionals such as probation officers, medical doctors, psychiatrists and so on. Clients who reduce their methadone intake to a specified level and are motivated to becoming abstinent from drugs are referred to the Outreach Centre, with a view to embarking on the residential programme at San Blas.
Homeless clients now can take up temporary residence at the shelter until more permanent accommodation can be arranged. Clients also participate in a structured day programme which helps to stabilise their chaotic lifestyle while offering them intensive psychotherapy.
Therefore, the ultimate objectives of the Harm Reduction Shelter are:
• To perform crisis interventions, provide support and therapy to clients who are suitable candidates for the Harm Reduction Programme (that is, not yet suitable for other residential or non-residential programmes).
• To perform crisis interventions, provide emergency shelter and sustenance to persons with drug addiction who, suddenly, become homeless.
• To work with external professionals (such as welfare officers, housing officials, probation officers, social workers) in order to find more permanent and stable solutions to the clients’ various immediate problems.
• To conduct a thorough and professional assessment of the clients’ physical, psychological, spiritual, social, family and legal difficulties in order to devise a holistic therapeutic treatment plan.
• To help clients find suitable work, thereby helping them to acquire the means to support themselves.
• To help clients achieve eventual sobriety and freedom from drug use, regain their dignity and establish themselves as useful and responsible members in society.
Rules of the Shelter
In order to function properly and safely as well as offer clients the best conditions possible so these can work positively towards their short and long-term goals, the Harm Reduction Shelter has the following fundamental rules:
• No drugs and/or alcohol on the premises.
• No physical, verbal or emotional violence on the premises.
• No sexual activity on the premises.
• No unauthorised medicines, weapons and other illegal material are permitted on the premises.
• Clients who have consumed drugs and/or alcohol to the point of significant impairment and/ or who are considered to be a danger to themselves or others will not be admitted to the Harm Reduction Programme for that day. Clients who are judged to be a danger to themselves or others will be referred appropriately.
No staff member resides at the shelter so that she/he can maintain her/his professional boundaries. Clients do most of the work around the house, including cooking and cleaning.
Conclusion
The Harm Reduction Shelter does not only help the clients who attend the programme but is a concrete means of containing the criminal activity associated with rampant drug use and homelessness.
The ripple effect, however, is much wider. It includes benefits to the overcrowded court system, our overstretched medical services and our overtaxed unemployment benefits system.
Therefore the shelter, directly or indirectly, benefits Maltese society as a whole.
The head of Caritas Malta Harm Reduction Shelter, Charles Miceli, concludes by saying “It has been a long-awaited dream to see the setting up of this low-threshold shelter. Thanks to this shelter we are meeting and helping those who are often the poorest and most in need in our society”.
Comments from
residents
(names have been changed to protect privacy):
James: “Staying at the shelter is important to me as it keeps me away from my negative friends. Here we go out only with staff members and, therefore, no one approaches you to talk about drugs.
“Having a structured day keeps me from thinking about drugs while living in a group teaches you to be more assertive and broadens your vision. Now I feel better and I am eating healthily since when you’re on drugs, food is not one of your priorities”.
Peter: “Before I entered the shelter I was going through a depression. Now I feel much better and the doctor agreed that I stop medication completely.
“After a couple of days at the shelter I started seeing the positive side of things and became more aware of all the good things we have inside.
“I believe there never existed anything like this shelter in Malta and it is giving people, like me, a chance to get on with life”.
Christopher: “The shelter is helping me think and feel in a manner I never thought or felt before. I feel calmer and I am learning to think before I act.
“I was using 1.5 grams of heroin daily, which amounts to about Lm60. It is impossible to earn that kind of money, so I did all kinds of illegal things. I have been trying to start a rehab programme for the last 10 years but there no organisation would accept me as a resident with 50 mm methadone”.
Stephen: “I am looking forward to entering the shelter – at the moment, there is a waiting list. Until then I’m sleeping in a sub standard room without running water, meaning there is no toilet. I attend the drop-in daily where I can have a meal and a shower and I feel more than welcome by the friendly staff members”.
Sandro: “Would you believe me if I told you that I felt like a ball being kicked around by everybody? For the last four or five years I have been squatting, sleeping in cars, on the streets, on the beach, in empty houses and newly built garages.
“The shelter has given me an opportunity to have a clean bed and regular meals. Now with the help of the staff I will plan my future and act accordingly”.
Ernest (staff member): “Even though we have been open for a few weeks, we have noticed that our clients are rapidly changing for the better.
“They look healthier and have learned how to respect themselves and others. They are also responding to a better structured life and are open to learn more about a healthy lifestyle – in fact, they keep asking for more group and individual sessions”.
Maryanne Swain is secretary-general at Caritas Malta while Marcette Busuttil is Public Relations Executive.