The Inclusive Health Program (IHP) was established in July 2015 with the aim of increasing St Vincent’s Health Australia’s (SVHA) impact on servicing the needs of the poor and vulnerable. Through service innovation, research and advocacy into areas that intrinsically relate to our work in health and aged care, the goal of the IHP is to enhance our response to systemic and societal issues that affect the dignity of vulnerable people ensuring they are able to flourish. An attentiveness to their vulnerability is required if we take seriously the principle of the ‘preferential option for the poor’ so vulnerability is the key lens we are using to focus the work of the IHP.
So far, we have funded over 60 different projects both within SVHA and with external partners focusing on five specific groups:
– People with mental health concerns
– People with drug and alcohol addiction
– People with health concerns who are homeless
– Aboriginal and Torres Strait Islander people
– People with health concerns who are prisoners
In addition, the IHP extends its focus to people experiencing family violence and to the needs of asylum seekers and refugees.
One significant issue is the overlap between these groups and thus the level of complexity with which many live. This, in turn, highlights how the health system needs to respond. Two of our projects working with people who are homeless found that 66 percent of participants had an addiction concern, 71 percent identified mental health issues, and all had had involvement with police and the criminal justice system.
We have also found that the experience of trauma is a common, concerning history in the lives of most of the vulnerable. This means that vulnerable people who attend our services bring with them feelings of loneliness, unworthiness, intense emotional pain, and flashbacks of traumatic experiences coupled with a sense of hopelessness. It is with this understanding that services to the vulnerable must be provided, service users approached, staff equipped, and the health system built.
This model calls for time to establish relationships, acknowledgement of each person’s unique life story, and the high likelihood that each story will include a history of trauma as well as a history of surviving.
IHP seeks to address the particular needs of vulnerable people in order to overcome their barriers to health. This aim is deceptively simple but the steps required to address it are ‘complex’ due to the factors that bring about inequity and ‘complicated’ due to the layers of services, staff, policies and past traumas that impact on the delivery of care to the vulnerable.
These interdependencies and layers are not insurmountable, but do require a health system that is created and funded differently, and focuses on possibilities over limitations. When we see these significant challenges, we are reminded of the passionate thinking of our founder Mary Aikenhead: “Just because it has not been done before is no reason why it should not be done now”.
For this future direction to be successful, we acknowledge that it takes time to establish relationships, and to affirm each person’s unique life story. As the IHP continues to grow, we expect to develop a body of evidence along with practice examples and patient experiences that highlight how we can improve outcomes for vulnerable people.
SVHA and the IHP is in a strong, committed and well-informed position to support the ongoing advocacy that is needed to push for the broad changes in public policy that are required to respond better to those with complex needs. But more importantly we must remember the inherent dignity of every individual who comes to our services, and create health and aged care systems which ensure that person can flourish. In the words from one of our homeless clients who was engaged in the IHP:
“I wasn’t stranded anymore. You know what I mean, eh? They found me, and I could talk to people about my issues openly and not be judged.”