NDARC Technical Report No. 260 (2006)
Gorman House is a 20-bed, non-medicated, in-patient detoxification service attached to St. Vincent’s Hospital, Sydney, and located in the inner-city suburb of Darlinghurst. Gorman House, which was established in 1982, aims to provide a safe and reassuring environment where persons dependent on alcohol and other drugs can detoxify and have their health and social welfare needs addressed. Gorman House has traditionally cared for the needy inner-city population of men and women with high rates of mental illness and homelessness. The Gorman House service model has never been evaluated and the ability of the service to attend to the needs of the population it serves is largely unknown.
This report describes the findings of a process evaluation conducted to determine the extent to which Gorman House meets its aims and goals and the needs of its residents. The evaluation was based on information derived from interviews held with 80 consecutively recruited residents, 12 months of data of admissions to Gorman House, anonymous staff questionnaires, an audit of clinical notes of a random sample of participants, and telephone interviews with 15 selected key informants.
It is important to note that although Gorman House had traditionally provided a service seven days per week, during the period of this evaluation and throughout the previous twelve months its days of operation were reduced to five per week only. The findings of the evaluation, therefore, relate predominantly to the residents who were admitted during this period of restricted days of service operation.
Based on admissions and interview data, Gorman House residents may be described as predominantly Australian born, alcohol dependent men in their fifth decade who live alone, are homeless or marginally housed, receive disability pensions or temporary benefits, and have had previous residential or in-patient admissions for detoxification. Poly-drug use is the norm rather than the exception.
Two-thirds of residents who consumed alcohol had severe alcohol dependence. Dependence scores for residents who used heroin, cocaine, amphetamines and cannabis were substantially higher than accepted cut-off scores. Over half the sample reported having recently experienced severe withdrawal symptoms. Most participants expressed their intention to reduce or quit their drug of concern or had already made some changes towards this goal.
Physical health was impaired in two-thirds of residents and there was substantial health service utilisation during the previous four weeks for substance-related problems. Most residents had mental health impairment. Rates of anxiety, depression and psychological or psychiatric distress were substantially higher than those found in the general community in Australia. The experience of a range of traumatic events was frequently reported.
Within the constraints of a five day service operation, the median duration of admissions was three days. Two-thirds of residents were assessed by staff to have completed their substance withdrawal during the period of their admission; one-third of residents did not complete withdrawal. Heroin dependent residents, compared with alcohol dependent or methamphetamine dependent residents, were two and a half times more likely to ‘leave against advice’ before completing treatment. Two-thirds of residents were referred elsewhere for ongoing treatment. Of these, one-third were sent for treatment of acute medical or psychiatric conditions, and others were sent to residential drug and alcohol treatment and other extended treatment or care.
There was generally high participant satisfaction with Gorman House. Residents revealed that one of the most appealing aspects of Gorman House was the staff and their care. Program characteristics, however, received compliant as well as approval. Restricted opening hours and non-medicated withdrawal were other less appreciated aspects of Gorman House.
All staff believed that withdrawal management was conducted adequately and that residents were satisfied with the services they receive. Some staff, however, would like to see educational or living skills programs introduced. Most praised the medical care provided to residents through clinic access. Treatment planning was generally regarded as being carried out adequately, as was referral to ongoing community care. Some staff saw shortcomings in the provision of psychiatric care. Five day opening was a concern to many staff. Most staff felt their training and skills prepared them well for work at Gorman House, although they noted an absence of ongoing training and supervision.
Interviews with key informants provided independent feedback on many aspects. Key informants viewed Gorman House very favourably, stating that it provides an important role in caring for a very disadvantaged group. There was reasonable consensus on who should or should not be referred to Gorman House. There was also consensus that to operate optimally Gorman House needed to return to its seven-day opening. Members of staff were described as having extensive knowledge of their field and as being well regarded by consumers. The ready access to Gorman House and its basic services were viewed as appealing to its needy consumers. The need for the service to develop further, to keep abreast of the complex needs of its current consumers, was acknowledged; as was the need for clearer delineation of the clinical capacity of Gorman House and for greater integration with existing services.
Conclusion and recommendations
Gorman House is one of few services in Sydney providing detoxification to a group of very disadvantaged individuals, who in many cases do not meet criteria for admission to other detoxification services. It occupies a very important place in a treatment environment in which there are now very few beds for supervised detoxification. Gorman House performs its demanding role with limited resources and a capable staff very committed to their work. The views expressed by residents, staff and key informants in this evaluation broadly converged on several aspects of Gorman House that may need some attention. The areas of improvement and recommendations identified in this evaluation and enumerated below may assist Gorman House to achieve its goals even more successfully.
Citation: Silins, E., Sannibale, C., Larney, S., Mattick, R.P. and Wodak, A. (2006) A process evaluation of Gorman House detoxification service. Sydney: National Drug and Alcohol Research Centre.