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“Care for people”

Drug and alcohol services have shown they can adapt their ways of working with people experiencing multiple disadvantages. Our National Advisory Panel tells us how this trend can continue.



“Policing out and medicating out has never worked - you need community.”

Member of National Advisory Panel

Many drug services have responded positively to coronavirus. Rapid prescribing has been offered to people experiencing homelessness, allowing them to receive support at the time when they need it. People have been trusted to receive higher quantities of prescriptions. Phone call engagements have focused on developing relationships. Services have taking the support that people require to them.

“We took all the drug services to them (rough sleepers in hotels). Rapid prescribing, didn’t have to see a doctor, needle exchanges took to them, safe boxes for the methadone. Had to do rapid prescribing and a telephone buddy. Treat people like adults.”

Member of National Advisory Panel

“Prescribers have been more flexible, some have been given weekly pick-ups instead of daily and has given some a feeling of being trusted where they weren’t before.”

Member of National Advisory Panel

“People have enjoyed the phone calls. The workers have had time to build relationships, not just urine tests, not daily prescribing at the chemists. Drug deaths have reduced dramatically.”

Member of National Advisory Panel

“Treatment is the whole person”

For our National Advisory Panel (which includes many people with experience, either of attempting to access services or of working in them), positive stories have not always been the case.

Services can offer delayed, infrequent appointments at fixed times, which require an unnecessary level of financial and organisational resource from individuals. People can receive little choice on the type of support they receive.

“Too many barriers to appointments - the times and (physically) getting there. Services need to be more flexible!”

Member of National Advisory Panel

“4 years ago it was you have to join a group. People can’t handle groups! Then it moved to NHS model of care, where you treat them as patients. There is no feeling! It’s never “Have you had a traumatic experience?” Treatment is the whole person, it cannot be broken off.” Member of National Advisory Panel

“I was in a massive hostel. I wanted to stop injecting heroin and crack. They’re plan for me was go to a place in [Location]. Take a ticket like at a cheese counter. Expected to do it every day. Why do it when I can go out and beg for £10? … In the end I just reduced… (I thought) “I’m not being humiliated like that!””

Member of National Advisory Panel

Support that is available can be dehumanising, focusing on ‘deficits’ of individuals rather than their strengths and goals. A focus on commissioned outcomes can also lead to undue emphasis on levels of drug use, rather than on an individual’s holistic well-being.

“It’s punitive. It’s controlling. You do as you’re told, or you’re not getting your meth script.” Member of National Advisory Panel

“Support meetings are too structured, just focused on reducing drug use, not around addressing trauma. There’s a number of mitigating factors.”

Member of National Advisory Panel

“There is an over obsession with data. A lot of assessment forms are tick boxing, and forms shape the conversations.”

Member of National Advisory Panel

“It’s outcome focused, it’s not person focused.”

Member of National Advisory Panel

“It shouldn’t be about case notes and risk assessments. It should be about care for people.” Member of National Advisory Panel

Staff attitudes can lead to stigmatising approaches and un-even power dynamics between worker and ‘service user’ - in turn leading to a lack of honesty and accountability.

“I know someone who would come all the way in, and say **** it (and leave), given that some member of staff was on.”

Member of National Advisory Panel

“You need to feel like you can speak to the worker… I spoke to the person who helped with the job stuff etc.”

Member of National Advisory Panel

“They recommission services every year. All these services change, but the people are the same. They’ve been there for years, haven’t, or can’t change their ways. Don’t care. You can recommission services, but you’ve still got all these people in services that work the same way they did 20 years ago.”

Member of National Advisory Panel

“When I was in treatment, I just wanted a script. Yeah, probably sold it. I was in treatment for about 18 years, got the script and toddled off. Left. If you wanted to see a drug worker, you had to go somewhere else. Now you haven’t got a separate person to speak too, someone to say that you ****ed up etc… The drug workers have control of the script. Everyone is lying so they get the script.”

Member of National Advisory Panel

Our Asks

The response to coronavirus has shown what can happen to help people thrive. We urge Government to consider these areas to ensure drug services are fit to engage with those experiencing multiple disadvantages:


1) Ensure all people experiencing multiple disadvantages receive housing as the basis of their support so they can realistically engage in treatment where they choose.


“Just giving them a roof, and free food, and not paying bills, was the biggest thing for them to stabilise their treatment.”

Member of National Advisory Panel


2) Increase the choices of support available which is trauma informed and meets the needs and aspirations of the individual.

“There needs to be more choice, it’s not all about prescribing.”

Member of National Advisory Panel

“Most positive is harm reduction, needle exchange on the street. It’s the best intervention.” Member of National Advisory Panel

3) Organisations should also reach out and support people with lived experience into their workforce. All staff should be effectively trained around the experiences of people with multiple disadvantages to an agreed set of standards.

“There should be a strict set of standards, and we need good staff members who know they are right in challenging these attitudes to have the information to hand on why they are right.” Member of National Advisory Panel

“Too many times we still hear that people have to deal with substance misuse and not recognising that for some it’s a way of self-medicating.”

Member of National Advisory Panel

“They should employ more people with lived experience. When you have been through the process you can understand it a bit… You just connect with people. If you haven’t done it… You just feel that it’s them and us.”

Member of National Advisory Panel

“It’s about building up a relationship that is stronger than that with the drugs.”

Member of National Advisory Panel


Our full submission to Independent review of drugs: part 2 ‒ prevention, treatment and recovery (call for evidence) can be found here: https://www.expertlink.org.uk/policy-research-influencing

 

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