Why are we sending people miles away to rehab instead of supporting them to survive in their own community, asks Mark Gilman.
In his 2017 book Poverty Safari, Darren McGarvey explains how stress is often the engine room that fuels addictions and mental health issues: ‘For those living in poor social conditions, stress is all consuming; it’s the soup everyone is swimming in all the time.’
So, why is it a bad thing to be sent 300 miles away from home for a mental health issue, but a good thing for someone with a substance use disorder?
People with a substance use disorder (addiction) are still sent out of area to residential rehabilitation. I had never heard about residential rehabilitation until 1984 when I was interviewing young heroin users in the North of England. I knew a lot about drugs and had been using them myself since my first encounter with benzodiazepines in 1969 at the age of 12. Until 1995, I had known many people who had died from drugs (barbiturates and opioids) but I had never seen anyone ‘recover’ from ‘addiction’.
In September 1985, I was employed by Lifeline as the manager of one of the first community drugs teams in Trafford, Greater Manchester. I never understood the fixation on sending people away to residential rehabilitation. Some of the rationale included getting the ‘client’ away from ‘triggers’ in the places where their problems had originated. I didn’t get this because by then I had started to develop my own alcohol problem. As I sat watching TV during one of my countless DIY detoxes, I had to sit through alcohol adverts.
I had to walk past pubs, shivering and knowing that I had the money to go in and order a large brandy and port and a pint of stout (my favourite morning tipple). I could never understand why ‘addicts’ had to be sent away, out of area, to residential rehabilitation while ‘alcoholics’ like me (I never admitted this till 1995) were sent to the local psychiatric hospital for a detox and then sent home.
My perspective has been tainted by the fact that I have always lived in Bury (apart from a brief exile in Bradford and now in Burnley) and mix with people I grew up with on an almost daily basis. When I first sought help for my own alcohol problem it never even occurred to me to go anywhere other than 12-step mutual aid. I knew some real alcoholics (who I had drunk with) who had stopped drinking by going to Alcoholics Anonymous (AA). Residential rehabilitation, if discussed at all, was dismissed as a bizarre joke, but AA was treated with a degree of respect because people had seen the change in people like ‘Terry from Bury’.
Fast forward to 7 September 2018 and I am sat in the audience at the recovery conference and I hear David Best talking about building recovery communities by connecting people to hope. He seems to say, or I choose to hear him say, that sending people out of area to residential treatment is harmful because it doesn’t add to the local therapeutic landscape. I get excited and start to tweet. In my haste to tell the world that one of our leading, bone fide academics on recovery is presenting evidence that says ‘keep it local’ I fear I may have over egged the pudding. If I have, I want to publicly apologise to David Best for misquoting him.
However, I do want to state, for the record, that I certainly think that if people do need residential detoxification and residential rehabilitation they should stay as near to home as they can. We do recover and we can get well where we got sick. When we are ‘recovered’ or ‘in recovery’ and walk through our local shopping centres, people who know us, who drank and used with us but are stuck in the madness see us and they can connect to hope. They can’t do this if they are recovering 300 miles away on the Recovery Riviera.
Finally, I want to dedicate this rant to ‘Terry from Bury’ who planted a seed of hope in me that grew roots and 23 years later sprouted, and gave me a life beyond my wildest dreams.