City Street Health takes harm reduction to the CBD streets

Posted on 8th August 2023
A City Street Health worker wearing a face mask and white t-shirt talking to someone wearing a black tank top

City Street Health is cohealth’s seven day-a-week outreach team that takes harm reduction and health and social support to people sleeping rough in Melbourne’s CBD.

For people who are drug dependent and living on the street, the risk of overdose and other harms is very high. There is a need for accessible harm reduction services where people need them the most, which is what City Street Health provides.  

For people experiencing homelessness and substance dependence, it can be difficult to access health and other support services due to stigma, fear of judgement, or inadequate resources.

The City of Melbourne has the highest number of heroin overdoses of any LGA in Melbourne, with an average of one person dying every month due to heroin overdose (Coroner’s Court of Victoria, Victorian Overdose Deaths, February 2022). 

Victorian ambulance data also reflects the ongoing drug harms in the CBD. There were 390 heroin-related ambulance callouts last financial year, a 21 per cent increase over five years. 

At our Central City drop-in clinic, we see a steady stream of people dropping in every day looking for help. They might need to see a doctor, nurse or allied health professional. They may be going through withdrawal from drugs or alcohol. They might just need someone to talk to.

However, we know that some people in the CBD who need support won’t make it Central City, or any one of cohealth’s 32 sites in Melbourne’s north and west. They may feel intimidated about visiting a health service or maybe the demands of daily survival prevent them from making it in. 

To engage those people and connect with the support they need, we knew we needed to engage in proactive outreach. 

a City Street Health worker wearing a cohealth backpack and walking in the CBD streets. City Street Health takes harm reduction to the CBD streets

Supporting people in CBD with problematic substance use 

There is greater acceptance from the community that law and order responses to complex social issues such as rough sleeping and drug use do not work. We know that demonising and criminalising people only pushes them further away from the help they need.  

Health-based, harm reduction services are the key, but the challenge we faced was how to make these services accessible. 

State Government invests in a new enhanced outreach program for the CBD 

coheath was asked by the Victorian Government to establish an outreach service in the CBD. This became City Street Health.

City Street Health launched in December 2021, and since then it has supported members of the CBD community who use drugs and alcohol and want health and social support.  

Homelessness and drug harms don’t stop on weekends or at night, so the outreach team operates 7 days a week, with both daytime and evening shifts. 

The purpose of the team is not only to provide immediate health responses, but also to help address underlying issues by linking people to other services such as accommodation and drug treatment.  

The City Street Health team is comprised of: 

  • community nurses 
  • Harm Reduction workers 
  • alcohol and other drug workers 
  • peer workers 
  • a dual diagnosis clinician 
  • an addiction medicine specialist  
  • an Aboriginal Health Worker  
  • a Recreation and Inclusion worker  

They all work to reduce drug-related harm and connect disadvantaged people to health and social supports.   

The City Street Health team has a big impact. In 2022, the team engaged with 1,428 people in the CBD, with 75 per cent of those people experiencing homelessness.  

Of the clients treated by the cohealth addiction medicine doctor, half haven’t been able to access a mainstream GP service in the recent past. 

A City Street Health worker talking to someone who needs support in the CBD


Supporting the whole CBD 

The City Street Health team and other street-based outreach programs provide a go-to for CBD residents and traders who are worried about someone doing it tough. 

People often don’t know who to call, or what to do, and police or local council may be the first point of contact. 

The City Street Health mobile number is distributed to traders and other stakeholders in the city as a point of contact if they feel someone may need help. 

Holistic care key to success 

The multidisciplinary nature of the City Street Health team, and their capacity to build relationships and trust have been key to their success. The team works with people to identify what is important to them and walk alongside them to achieve their goals.    

Although the solution to homelessness is always safe, affordable housing, the lack of housing means we must find ways to support the health and wellbeing of people living on the street who face barriers to accessing health and social support services. 

The Government’s investment in the City Street Health team is part of efforts to improve the health of the entire CBD community, and everyone in it, and improve. The purpose of the team is not only to provide immediate health responses, but also to help address underlying issues by linking people to other services and supports such as accommodation and drug treatment services.  

 A longer version of this article appeared in Parity Magazine’s July 2023 edition ‘Responding to Rough Sleeping’.

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