Nikki Francalanza is a Maltese expat who’s currently working as a substance misuse link worker in London. After graduating with an MSc in Clinical & Public Health Aspects of Addiction at King’s College London, her first job as a support worker in an inpatient drug and alcohol detox unit gave her extensive hands-on experience, which led her to a post as an outreach worker in Westminster and a recovery worker within and out of London.

What does the role of link worker entail?

As a substance misuse link worker within the FLIC Team, I work with several individuals who have multiple, complex and unmet needs due to mental health, alcohol and/or drug use, offending behaviour or homelessness. I provide intensive support to encourage and enable each client to better navigate the pathway to their recovery. My ultimate goal is to improve their stability, confidence and capability to lead better lives through supportive services. Link workers find out as much as possible about the difficulties clients have had and the barriers they’ve faced when engaging with services in the past in order to work with them and to help change things in their future.

You encounter a lot of strife and tragedy on a daily basis. Does it ever get a bit too much?

Here are just a few scenarios which I’ve encountered along the way. I once returned from a short holiday break to find out that one of my clients was stabbed to death on the streets. I once found a client lying on her couch, covered in dirt, bloated from head to toe. After I called for an ambulance, she passed away in hospital. One of my service users had died on the streets from a drug overdose after being injected by others. I’ve been followed and touched inappropriately by a drunken client while crossing the main road in King’s Cross. I’ve seen men locked up in prison banging the bars begging to be let out. I’ve had a client looking at a passing coffin and remarking, “I want to be in that coffin. I’d lead a better life when I die. That’s my current wish.”

Yes, I witness hardship on a daily basis, and I treat this as normal. Internal strength is vital in this field of work. I’ve learnt to deal with these experiences, and I separate work from daily life by going to the gym and exercising as a coping strategy. It can be hard, especially when a client dies. On occasions, especially after the death of a client, it can be hard; I have to seek support from team members and managers. But I just keep going.


Left overs at a rough sleeping site


How does the London drug abuse and homelessness context differ to that in Malta?

Having left Malta in 2007, I’m not fully aware of the current statistics of homelessness. However, I’m aware that there are a few hundred homeless who stay in shelters, and another many households that are at risk of becoming homeless. Despite this, there are no visible signs of homelessness similar to what can be seen on the streets of other European cities. There’s no official recognition of homelessness and thus no programme to alleviate the problem, which is often is hidden under the façade of strong family ties, community cohesion and the benevolent state.

London has some of the UK’s hotspots for drug crime and is a trend leader for new narcotics. Research indicates that London has the highest amount of cocaine use amongst younger adults than any other city on the continent. More than 15 million Britons have taken illegal drugs. Legal highs are easily accessible in London, and are hence becoming increasingly popular amongst the younger generation. On average, drug users have their first experience of illegal drugs aged 19. Unfortunately, I’m unable to compare this to Malta’s situation, however I believe that although drug abuse here is on the rise, it tends to be hidden, and this could mainly be linked to the country’s close knit community, which may resultantly lead to stigmatisation.


Typical rough sleeping site


If you could eliminate one factor in society which you think is one of the main causes of substance abuse and homelessness, what would it be and why?

There’s a great overlap between substance misuse and homelessness, therefore separating the two is hard. Sadly, many people view these as the result of personal failings, and believe that if the economy is going well, there’s no excuse for it. But this belief is belied by the facts, which show that there’s a complex interplay between a person’s individual circumstances and adverse structural factors outside of their direct control, including unemployment, poverty, lack of affordable housing, housing policies and the benefit system. These problems can build up over the years until the final crisis moment when a person hits rock bottom and finds themselves struggling with no support.

There’s a need to eliminate stigmatisation in society and develop more coordinated services to deal with individuals’ issues systematically. There’s a huge cost when people with complex needs are passed from one service to another without having their problems fully addressed. These are people who’ve invariably experienced significant life traumas, and with the right support and care, they too can lead fulfilling lives.