A successful script for supporting vulnerable Tasmanians

How a mobile health service is helping people experiencing homelessness access vital medications

As the housing crisis worsens, more and more people are forced into housing instability and homelessness. The number of Tasmanians estimated to be homeless in the 2021 Census was 2350, up from 1622 in 2016.  

According to Primary Health Tasmania’s needs assessment report*, people experiencing homelessness have significantly higher rates of premature death, disability and chronic illness than the general population.  

With the current waits on social housing, the stigma associated with asking for help and the rising cost of living, it is becoming increasingly difficult for vulnerable people to prioritise their health.  

A medication program for homeless people aims to help address this issue. It’s a national program funded by the Australian Government and delivered by organisations around Australia that provides access to free Pharmaceutical Benefits Scheme (PBS) medicines for people who fit criteria of primary and secondary homelessness. 

In the Greater Hobart area, the program is delivered by Moreton Group Medical Services, which runs a mobile primary health clinic helping vulnerable people access health care.   

The after-hours component of the mobile clinic is funded by the Australian Government through Primary Health Tasmania to provide interim primary health care at no cost to the patient after 6pm, Monday to Thursday. The Tasmanian Government funds afternoon clinic sessions, Monday to Friday.  

At the mobile clinic, patients can access a free consultation with a GP or nurse practitioner, have their health needs addressed and essential medications prescribed and sent directly to one of five participating pharmacies. The patient then goes to the pharmacy, which will dispense the medication at no cost to the patient as the co-payment is paid by the Australian Government.  

Kristina Mullins is a nurse practitioner and the coordinator of the mobile clinic, and explains that there is a multitude of barriers to accessing medications, making this kind of service vital. 

“When you’re living rough, you might lose your medications, or they might get stolen,” she says. 

“A lot of these people do have mental health issues, unstable housing or have been pretty poverty stricken growing up.  

“Cost is obviously a huge barrier. Especially for some of the medications.  

“Hepatitis C is a great example. The treatment is cheap, but it’s still more expensive than a lot of these people can afford. So being able to provide that free of charge is just fantastic. 

“If they’re getting their health needs addressed, they’re not passing (hepatitis C) on to other people, so it’s a public health benefit.” 

One person who has been helped by this service is Allie Bracken. She says both the mobile clinic and the medication program are making a real difference to people’s lives, helping them manage their health so they can find stable housing and a better life.   

“If I don’t get my psych meds, I’ll get a bit loopy. So, if it wasn’t for Kris, I’d be (redacted),” Allie says.   

“I was homeless for five years, up until about a year ago, and she’s been there for me all the way through.   

“If it wasn’t for Kris, I wouldn’t have a doctor to prescribe my medication, then I wouldn’t be able to keep my place because I wouldn’t be stable enough. So yeah, it’s a really important service.” 

Kristina says helping people experiencing the most challenging conditions of their lives takes a whole-of-healthcare-system approach and all medical professionals need to work together. 

“It’s amazing when people come together, how much better the care is. It’s just fantastic,” she says. 

“We’re seeing the positive benefit of having a collaborative approach to healthcare and that’s what it needs to be done.  

“We often get pharmacists ring us saying ‘we’ve got this person here today’ and we liaise with them and organise Webster-paks, so we work really closely with them to achieve medication compliance and positive outcomes.  

“The participating pharmacies do Webster-paks for a lot of the places, the shelters and interim accommodation, and the services they offer are just fantastic.” 

Kristina says the clinic has seen an ‘astronomical’ increase in need.  

“Nearly three years ago when I first started with the mobile clinic, we were seeing around 50 people a month. Now we’re seeing well over 150,” she says. 

“People living in sheds and cars who aren’t often visible; people who’ve worked their whole lives and end up on the street at 55 due to rental instability.  

“In the last six months I’ve seen a lot more children, which we haven’t traditionally seen. A few weeks ago I helped a 13-year-old that was living on the streets – and we’re seeing that more and more.” 

Kristina says that health professionals need to work together, but also need to wrap support around people experiencing homelessness to address all their areas of need.  

“It needs to be all services working together because (just) one thing like getting someone a house is not going to address the problem.  

“You’ve then got to address the behaviours, determinants of health and the physical health of the person. So, it’s not just one solution, it’s got to be a collaborative effort. 

“Annie, who is with the Salvos, comes out with us every Monday night, making sure people have access to support, Medicare housing and much more.  We work with a lot of services like the community houses, Salvos, Uniting Church, City Mission.  

“I’d love every patient to have a primary GP because we know that gives them the best chance of a good life.  

“We’re quite happy as well for GPs to refer to us for medications or other services if they do know patients that need that extra support.  

“A lot of people aren’t in a place to engage with a primary provider.. So we’re trying to get them ready to be engaged.” 

Kristina says the clinic is actively seeking other practitioners to provide the mobile health service, as well as pharmacies to be involved in the medication program. 

The mobile clinic team currently comprises Kristina who is full time and coordinates the services plus three GPs, a GP registrar, and another nurse practitioner who work part time, as practitioners have the option to choose their hours.  She says it’s incredibly fulfilling work.  

“In the model of care that we use, we’ll use and need any practitioners, but especially social workers, drug and alcohol workers and physicians,” she says. “We all work together to provide collaborative care. We are training registrar GPs as well through the Australian college of rural and remote medicine to educate the next generation of the issues surrounding health in Tasmania. We’ve got physios helping out, foot care nurses and other allied health to ensure all aspects of health are addressed. 

“It’s traumatic, it’s stressful, it’s heart wrenching. And it’s really challenging because the health system in Tasmania is really siloed.  

“But the clients make it worthwhile. They’re great. They thank us. And you do get some really positive results; it happens more frequently than you’d think.”  

Kristina says it’s important for the clients to know that someone’s got their back; that someone does care. 

“One day, hopefully, they’ll get to a space where they don’t need you anymore – and that’s really fantastic,” she says.  

“But we’ll be here in the meantime.” 

*Click here to find our needs assessment report.

This story features in Issue 18 of our Primary Health Matters magazine. Click here to read the rest of the issue.