Mobile clinic for the vulnerable celebrates 10 years

Early on a frosty June morning in Canberra, on Ngunnawal and Ngambri Country, the dedicated team of Pathways to Assistance and Treatment (PAT) – or ‘Chat to PAT’ as it is known by locals – are rugged up and on the road providing healthcare to the city’s most vulnerable.
 
Operated by Directions Health Services, Chat to PAT is a mobile clinic providing multidisciplinary and holistic care to patients with barriers to accessing health services, including those experiencing homelessness or housing instability, mental health issues, substance dependence, and other complex health and social challenges.
 
And recently it celebrated 10 years of operating – having delivered more than 40,000 consultations to vulnerable patients across Australia’s capital.
 
The service is run by a multidisciplinary team which includes GPs, nurses, counsellors and mental health practitioners, providing primary health, mental health, drug and alcohol support and case management.
 
Dr Ben Harkness is one of the GPs on the team who provides typical general practice care, with ‘an overlay of substance use and major mental illness’.
 
‘We can do everything on the bus that you could do at a regular general practice ... but often because our patients are struggling with poverty, addiction, and all sorts of other psychosocial stresses, their priority is not always the same as our priority,’ he told newsGP.
 
‘So while we’ve got them there, we try and engage them with chronic disease management and prevention ... all the usual stuff you do in general practice.
 
‘And building up that trust with the community, which is often a challenge given their previous interactions with the mainstream healthcare system.
 
‘That’s super important: the ongoing continuity of care our patients get from seeing us each week.’
 
When it began in 2016 as a nurse-led outreach clinic to fill gaps in care for Canberra’s most vulnerable, Directions Health Services nurse practitioner Ali Loom operated the service out of a backpack, which then upgraded to a suitcase on wheels, when Dr Harkness joined the team.
 
Having worked with the vulnerable patient population since finishing his GP training, Dr Harkness worked as a GP at the Canberra jail before joining Directions Health Services eight years ago as it launched the outreach clinic and saw the need for a GP to complement the services.
 
‘I came on board about the suitcase time and we started doing an outreach to a medium-density public housing area with high levels of significant mental illness and alcohol and drug use,’ he said.
 
‘Then not much longer after that one of the wheels fell off the case, so we figured we probably needed to apply for some funding for something a bit more permanent, and we’ve now got the Chat to Pat van.’
 
Funded mostly by the ACT Government and local Primary Health Network, the mobile bus clinic now provides free health services across 11 sites, including low-income housing precincts and public parks, as well as T25 clinics for vulnerable young people aged 12–25.
 
‘Sometimes the outreach space can get a bit hectic and not particularly appropriate for a teenager to be at, so the dedicated service for younger people goes out to a lot of the high schools and colleges in the ACT, broadening our target,’ Dr Harkness said.
 
Chat to PAT also works with local peer support groups such as Canberra Alliance for Harm Minimisation and Advocacy and meal service providers.
 
The team uses those opportunities to engage people into ongoing healthcare, working to treat what may be ‘very long-term unaddressed healthcare needs’, Dr Harkness says, such as substance use, bloodborne virus screening, and mental health support.
 
And with the job comes rewards and challenges.
 
‘You get an incredible insight into the resilience of people who’ve had really unfortunate upbringings due to no fault of their own – seeing that resilience is pretty phenomenal,’ Dr Harkness said.
 
‘And working with them towards goals is very rewarding, although you do have to change your goal posts in terms of what you’re traditionally taught through your GP training.
 
‘What priorities are yours as a medical officer are often quite different to someone living with a lot of psychosocial vulnerabilities and disadvantage, so it’s really important to meet people where they’re at and working with them to look at their goals rather than your own.’
 
The challenging aspect is just as humbling.
 
‘Looking at the stigma some of our clients are up against when they’re interacting with mainstream society can be pretty challenging to watch,’ he said.
 
‘People’s journeys are pretty complicated, and can be met with pre-judgement when they try to engage with various services.
 
‘And generally, if you’ve got a long-term substance use disorder, your life expectancy is about 20 years less than mainstream society, so our clients unfortunately do die early due to marginalisation and complications from drug or alcohol use over many years.’
 
A 2022 evaluation conducted by the Australian National University found 67% of PAT patients reported having this access reduced their need to attend a hospital emergency department (ED), showing the service has ‘high acceptability and impact’ and reaches a ‘diverse range of people who would otherwise be disconnected from health services’.
 
Separate data from Capital Health Network suggests that 28% of Directions Health Services patients are at high risk of hospital admission in the next month, compared with 2% in a mainstream general practice population.
 
Chat to PAT is one of many mobile health clinics delivering care to marginalised communities across Australia, where for many, these clinics are the only connection to the wider health system, the PAT team says, adding that most people who access outreach services live with at least one chronic condition.
 
Ms Loom says EDs are often the ‘default option for people who have nowhere else to turn.
 
‘By providing timely, accessible healthcare in the community, we are helping people stay healthier while also reducing ED presentations and avoidable hospital admissions,’ she said.
 
As the service marks its 10-year milestone, Dr Harkness hopes the non-judgemental healthcare, support and connection can continue.
 
‘The fact that we made it to 10 years is testament to the fact that we’re doing something right,’ he said.
 
‘There’s always going to be a need for healthcare services that meets people where they’re at, both from a psychological but also geographical perspective.
 
‘So keeping the van on the road and the service running is obviously a goal, because we’re a not-for-profit reliant on generous funding, but the main goal is to make sure we can provide really good quality, holistic, ongoing care to our clients.’
 
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