The day’s second session explored the countless benefits and opportunities of partnership working.
‘I’ve lost a lot of people who drug treatment doesn’t work for,’ harm reduction content creator at Cranstoun, Alistair Bryant, told delegates. ‘If you can get to any of our doors, you’re already halfway through what you need to do. I think it’s time to work with that community who can’t come to us, or who are just happy where they are – it’s not on us to tell them what to do. So how do we do that, and how do we embrace harm reduction as a whole?’
Cranstoun’s Worcestershire service had developed a peer-led naloxone team, PACKS – ‘peer-assisted community knowledge and support’, he said (DDN, April, page 16). ‘They have keys to the community that we don’t have. I can now take harm reduction and support to people who need it the most – that’s why we all need to start working with the people on the other side of our door.’
Cranstoun had recently launched a pouch containing two naloxone injections, and designed to be visible. The commissioners had been impressed and provided further funding, and the PACKS team then packed ‘an entire room’ of the pouches. ‘We probably packed 500 pouches, and we got them out there. It was amazing to see the potential of a group of people who treatment, volunteering and peer mentoring has ignored for the last ten years. There are damn good people with skill sets who treatment haven’t embraced because they “might be too risky”.’
PACKS videos on social media had now had more than 1.5m views, he told the conference, with the content most popular among 18 to 35-year-olds. ‘In Worcester, that’s the age range who don’t stay in treatment because they don’t find it meaningful. Yet the appetite for being safe is very much there.’ It was also vital to pay people, however. ‘If you want people to do something, pay them to do it. Pay peers, rep the underdog, and change the system.’
Cranstoun was also piloting a new app-based service to reach those people ‘not inside the treatment doors, and behind their own closed doors when they use drugs’, said his colleague, assistant director for business development, Luke O’Neill.
More than half of people who died a drug-related death died alone, he said. ‘We looked beyond our shores and took inspiration from safer injecting services, from the ‘Never Use Alone’ helpline in Australia, and the software developer in Canada who first designed the digital solution called Brave.’ Cranstoun asked if they’d work with them to develop a UK version of an app they’d first developed in Vancouver, he said – the result was Cranstoun’s Buddy Up (DDN, May, page 5).
Buddy Up was a low-threshold harm reduction app that had been created specifically for people using drugs alone, to put them in touch with someone who could send help in case of a suspected overdose. The service was anonymous and private, with callers able to create multiple rescue plans if they used drugs in different locations. While the pilot currently used paid staff, volunteers and peers would have a role to play in scaling up and improving it, he said.
Discussions with the organisation’s insurance broker about ‘what is essentially a digital safer injecting service was an interesting one to navigate’, he told delegates, and there had also been ethical considerations. ‘At the moment our supporters will send an emergency ambulance response in the case of an overdose but in North America people can nominate a rescuer’ – such as a next-of-kin.
‘There’s scope to do that here, but we need to think carefully about how we get opt-in and consent, and make sure they feel supported and safe if we’re informing them of an overdose and potentially sending them to an address they might not know much about, and where they may be risk factors that we’re not aware of.’
Cranstoun was also putting in an application to a mobile network for 500 SIMs loaded with 40G of data per month for six months to support and encourage people to use the app. Sharing and promoting it would now be the focus, he stressed, and there was potential for building in other elements like naloxone ordering and access to drug checking services. ‘We’ve all got an ambition to reduce drug-related deaths, so work with us to promote this service and make it available in your area,’ he asked delegates. ‘Too many people are dying behind closed doors, and no one needs to die alone.’
People with lived experience had been central to setting up treatment services, from the 12-step fellowships onwards, said programme manager for alcohol and drug treatment and recovery at the Office for Health Improvement and Disparities (OHID), Laura Pechey. ‘The key is relationships, authenticity, and honesty.’ The government was committed to supporting thriving recovery communities and networks of recovery organisations, she said, along with more peer support workers.
Last year OHID had commissioned a national workforce census (DDN, April, page 6) and had asked treatment providers, local authority commissioners and lived experience recovery organisations (LEROs) about their workforce – there were 640 peer support roles in treatment services, four out of five of which were volunteers, she said. This compared to one in three of the lived experience workforce being volunteers. ‘Volunteering can be amazing – it can help the person who’s volunteering and certainly the people they’re working with – but when we did a consultation last year we did hear reports of people in peer support roles who didn’t have the right support and training to do that role and to benefit from it themselves.’
OHID had also developed guidance with recovery champion Dr Ed Day and the CLERO to try to give this part of the sector ‘its moment in the sun’, she said, and demonstrate the value of working together to develop these initiatives. The final section of the document would set out how local areas can do this – ‘getting those assets and building them, making sure things are safe and effective and supporting the funding growth.’ Another section was how to contract lived experience organisations, including minimum standards. ‘For commissioners, I imagine if they’ve never commissioned a lived experience organisation there’s a nervousness about that.’
Sometimes that was inevitably the result of stigma, she said. ‘It’s worth noting that contracting isn’t the only way to do this – we’ve heard a lot about building reciprocal relationships, working together to a shared purpose, and supporting each other.’
On the subject of asset-based community development, Ged Pickersgill from the Well Communities told delegates that it came down to ‘being given a handful of corn and being expected to feed 25,000 chickens with it – the very nature of where our organisation stems from means we have to use an asset-based approach.’ This meant focusing on operational delivery – service user feedback showed that a good quality service was more about treating people with honesty and integrity than having top-quality facilities. ‘Asset-based development is something we do with our community and for our community – everything we do is done with, not to. We’re led by the very people we serve.’
The commissioning process needed to take account of the feedback that organisations like his were getting from the ground, he stressed. ‘We know our community. We’re professional people, with lived experience. There needs to be a wider acknowledgement that we need to listen to what people need, not purport to know what they need.’
‘The community knows what the community needs,’ agreed Lanre Babalola, chief executive of BUBIC (Bringing Unity Back Into The Community). ‘We’re able to be creative.’ His organisation had built a strong relationship with commissioners and treatment providers, he added. ‘It’s not us and them – it’s us together – because the most important person is the client.’ In the early days of the organisation it had been challenging, however, said his colleague Adé. ‘The clients told us more than they told anyone else, but when we’d go meetings there’d be no data sharing.’ When his 81-year-old neighbour asked him to take the lid off a jar, said Ged Pickersgill, he didn’t say ‘where’s your risk assessment? I just take the top off the jar. We could learn from that.’
‘Eight years ago I was in a rehab thinking my life was over – I’m managing SUIT today,’ said Marcus Johnson of Wolverhampton-based SUIT (Service User Involvement Team). He’d started as a volunteer himself, and in the last 18 months or so his organisation had managed to get 30 of its volunteers into paid employment – something that was achieved through partnership working with local clinical organisation Recovery Near You. ‘We’re into our sixth year of working with them. Sometimes the partnership’s a bit like the Conservatives and the Lib Dems, but it’s getting better. And for organisations like ours to continue to exist, it’s all about funding.’
Everybody at SUIT had lived experience, he stressed. ‘They all bring something you can identify with. For me, the power of identification and lived experience saved my life. To be working with these people on a day-to-day basis is unbelievable.’ Staff with lived experience were able to be understand and be patient and get the best from each individual, added his colleague Sanjiv Kumar. ‘I’d really like to emphasise the opportunities that SUIT volunteers get – the opportunity to be innovative, be creative, and put your own personal touch into projects. It’s what I believe keeps organisations and their staff from becoming stagnant.’
Alcohol use in the South Asian community was a ‘massive’ problem, he said, and it could be hard to engage with this population group. Issues facing the community included older generations not understanding addiction, pressure to succeed in academia and pressure to enter arranged marriages. ‘People do turn to drink and drugs to relieve this pressure, and the language barrier is a big problem. I can speak Punjabi – having an understanding of where they’ve come from and being able to speak the language helps.’
SUIT volunteer Karolina Sowinska was able to use her lived experience to engage with the Polish and Eastern European community, she told the conference. ‘And I never thought I’d be able to make use of my lived experience.’ According to the 2021 census, 1.3 per cent of Wolverhampton’s population had Poland as their country of birth – ‘we’re immigrants, we’re parents, we’re people, we’re drug and alcohol addicts. But communication is a big problem.’
Overall, there were 10,000 people in Wolverhampton whose access to services was limited by a language barrier, she pointed out – ‘Punjabi, Polish, Czech, Slovakian, Lithuanian.’ While previously, there were just two Polish people – from a local population of more than 3,400 – in local services, since SUIT’s outreach work with Karolina, four had been registered in June alone. ‘The Ethnic Community Project has given us the chance not only to get more people assigned to services, we’ve created much more – we’re giving hope. And I hope in the future I can make those numbers much bigger.’
Recovery through creative and collective processes was also encouraged and celebrated at SUIT, said volunteer and PhD student Christiane Jenkins. ‘Lived experience is a source of inspiration and proof of successful recovery. We can all be described as recovery carriers, enabled and empowered to share our wisdom and inspire others.’
Peer-led support could show that transformation was possible, she said. ‘Unlocking people’s talents and providing opportunity through positive change in a social group will profoundly develop success in recovery. Recovery is contagious.’ SUIT had now also developed a creative arts collective, she said. ‘Exploring the arts can mean discovering lost skills, identifying emotions and communicating our feelings – especially for people coming from multiple disadvantage.’ It was the ‘outreach of opportunity’ to those who would otherwise be excluded, she stated.
‘SUIT’s creative space is DIY, it’s grassroots, and it’s co-produced. It provides creative freedom and a sense of place. It’s through individual support and collective action that we can push through to policy development and contribute to challenging and transforming dominant modes of policy intervention and care.’
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Cranstoun presentations by Alistair Bryant (Packs Team) and Luke O’Neil (Buddy Up). More information: cranstoun.org
Partnership working Dr Laura Pechey, OHID in conversation with Ged Pickersgill, The Well Communities and Lanre and Adé from BUBIC.
BUBIC: Bringing Unity Back Into the Community – Breaking cycles of habitual behaviours through peer support and engaging with communities to create inclusion and cohesion: www.bubic.org.uk
OHID, Office for Health Improvement & Disparities: www.gov.uk/government/organisations/office-for-health-improvement-and-disparities
SUIT – Wolverhampton’s drug and alcohol service user involvement team has supported vulnerable adults in the city for over 15 years: www.wvca.org.uk/suit
The Well Communities – Lancashire based Lived Experience Organisation supporting people in recovery through therapy, counselling, peer mentoring, employment training and social activities: www.thewellcommunities.co.uk
Other useful links:
Abbey Care – Offering detoxification and residential treatment services in Scotland and Gloucestershire: www.abbeycarefoundation.com
Archer Resourcing – Providing staffing solutions to the criminal justice, nursing, substance misuse, social care and housing sectors: www.archerresourcing.co.uk
Changes UK – Birmingham based Lived Experience Recovery Organisation that supports people in both residential and community settings: changesuk.org
Druglink – Substance misuse charity based in Hertfordshire whose objective is to change the future for people affected by substance misuse through treatment, housing solutions, education and training: www.druglink.co.uk
Exchange Supplies – A social enterprise working to improve the harm reduction response to drug use by developing products and information for injecting drug users, drug services, and needle exchanges: www.exchangesupplies.org
Generis (ADS) – The Alcohol & Drug Service works in partnership to support people affected by substance misuse to make positive change: ads-uk.org
Naloxone Man – Who knows who he is and when he may appear? But you may be able to contact him via the award winning trainer and consultant George Charlton: georgecharlton.com
Rite to Freedom – From their Devon base they offer opportunities for creativity, nature connection and meditation, supporting a thriving addiction recovery community to live with meaning, purpose and joy: ritetofreedom.org.uk
Steps Together Group – A collection of addiction treatment services, providing a combination of residential and outpatient addiction treatment & therapy services for individuals and their families: stepstogether.co.uk
Turning Point – Social enterprise, delivering health and social care services in the fields of substance use, mental health, learning disability, autism, acquired brain injury, sexual health, homelessness, healthy lifestyles, and employment: www.turning-point.co.uk