Female focused

More than 20 years ago, I worked in a community prescribing service in Tottenham. We had a woman in our service who would frequently attend having been recently assaulted, with black eyes or a swollen lip. She was homeless, and part of a wider street drinking community.

We had an amazing nurse join our team, who worked with her completely on her terms – just seeing her whenever she made it into the service (giving her as much, or as little, time as she wanted, no set appointments and no punitive practice for missed doses). Eventually she made it into rehab and, somewhat against the odds, she stayed.

In those days, six months of funding was a minimum, so she was there for the best part of a year. I can recall how delighted we all were when one day she came back into our service to say thank you to her key worker. She was barely recognisable from the woman we’d become used to seeing.

One of the things I reflect upon now is how oblivious we were at the time to her trauma, and her experience of trying to navigate life as a woman within the drug-using community. Her vulnerability was not an abstract idea – it was the lived reality of being surrounded by dangerous males. We saw the ‘chaos’ of her life but failed to understand it through the lens of her as a survivor of male violence. I have found over the years though that once we begin to view women – our lives and our experiences – through that lens, there is no way to unsee it.

It seems that our drug and alcohol treatment system may be slowly changing – like the proverbial oil tanker, time, effort and momentum are finally creating a shift in direction, and we’re increasingly talking about women’s needs and experiences as being different to men’s. This is not to say that there aren’t similarities (there are) or that men’s needs should be in any way overlooked while we think about women’s (they should not). Moreover, it’s a recognition that, at times, we’ve applied a generic approach to drug and alcohol treatment, and in doing so we’ve failed women.

In our new report Time held gently we wanted to understand women’s residential rehab journey. We wanted to hear from women currently in rehab and women who’ve completed. We also spoke to staff and to professionals working in the wider sector.

We heard some compelling testimonies – in particular about the impact of 12 weeks funding. Women told us that it takes time to land, to start to build trust. When you know that you’re likely to be leaving a few weeks later, you don’t dare ‘open the box’ and start to work on some of the underlying issues – such as childhood trauma or domestic abuse. I think back to the woman from my service – 12 weeks would have been woefully insufficient for her.

We heard about how women were juggling caring responsibilities whilst in rehab – such as trying to secure contact with very young children, or navigate the needs of older ones. What was crystal clear was that women were rarely in a position to focus solely on their own needs – life ‘outside’ rehab required their emotional energy and attention.

It was interesting to pick up that our current system is missing data around women who are mothers – we only collect data on women with parental responsibility, overlooking the needs and experience of those who do not have their children in their care.

We heard about things that could improve the experience for women. Some women told us they were required to write a letter to the rehab funding panel detailing their life history in order to justify being funded for care. Women felt like their trauma was being judged, and we’d like to see this practice abolished.

We also heard some wonderful stories of hope and connection – a reminder that residential rehab, an often-overlooked part of our treatment system, can offer people the chance to start anew. For people seeking support for addiction, that fresh start can feel impossibly out of reach, yet rehab makes it possible.

We’re looking forward to sharing the report – we hope that we can use it to generate some conversations within our sector. We hope that it will help us to continue to ‘turn that oil tanker’ as we try to improve our response for women.

Hannah Shead is at hannahsheadconsulting.com