FDS Insight Newsletter Jul-Sep 2020

37 A Managed Alcohol Programme is a harm-reduction initiative that offers regularly dispensed alcohol alongside medical care, financial, housing and social support to people who have been drinking for many years, and who move between homeless hostels, hospitals and the criminal justice system. Key dimensions of MAPs also include primary care services and clinical monitoring. MAPs were created in Canada in the late 1990s to deal with a crisis situation when three men froze to death in Toronto. Since then, a further 23 MAPs across 13 Canadian cities have been established providing vital support to vulnerable people. Bernie Pauly and colleagues at the University of Victoria in British Columbia have been looking into the effectiveness of MAPs in Canada. Their findings show that MAPs improve the safety, stability, mental and physical health, housing, relationships, life skills and self-esteem of programme participants. They can reduce alcohol-related harms and, in some cases, consumption. Importantly, MAPs are also beneficial to the state in terms of significantly reduced ambulance call outs, hospital admissions and time in police custody. We recently conducted a study to explore whether MAPs could be implemented in Scotland. We believe that similar services are urgently required in Scotland, and in the UK more widely, particularly during the current coronavirus pandemic. Coronavirus and MAPs in Scotland In Canada, MAPs operate in a variety of guises – drop-in programmes, shelters, hostels and permanent accommodation. Alcohol provision also varies in relation to timing and quantity of dosing, from an hourly standard drink to a daily ration. Programme rules are similarly diverse with emphasis on staff management of clients’ alcohol consumption. MAPs run community activities and may serve meals, given the importance and challenges of good nutrition, and provide healthcare professionals on or off site to monitor participants. Our own study involved in-depth interviews with three groups: those working in government and the NHS, charity services and those who would potentially benefit from MAPs. We also examined the case notes of 33 people in eight charity homelessness services to gain a better understanding of people who might be eligible for MAPs in Scotland. Our findings highlight key components that services would need to take into account if MAPs were to be implemented in the current pandemic, and more generally. In terms of settings, as with Canadian services, MAPs could be provided in either residential or drop-in places, depending on the needs of a specific group, and what was available. While coronavirus has meant many homelessness services