Stigmatising language doesn’t have to be obvious to do harm, says Liam Ward.
At Phoenix Futures we have been thinking a lot about stigma, rights and treatment access, and we hope these will be key themes in Dame Carole Black’s forthcoming review. There is a sense that we could be on the verge of a period of positive change. But that change can only be maintained if we reflect on some key underlying structural and societal considerations.
Phoenix have been highly vocal on the issues of access to detox and residential services. Over 50 per cent of English local authorities refer fewer than five people a year to rehab, and there is zero access in more and more local authority areas. We know the ‘postcode lottery’ is unfair, but in some parts of the country there is total exclusion from NICE-approved, clinical guideline- recommended treatment.
We are optimistic that the coming year will see a strong upturn in the number of rehab placements across the country, made possible by the government’s commitment to invest a further £80m in drug services in addition to the existing budgets available to each local authority. The sector has received this news favourably on the whole, but there is a collective appreciation that this represents a good start rather than a solution. The funding falls far short of the £900m across three years reportedly recommended by Dame Carol Black, and represents only half of the £160m cut from drug treatment services in the last decade (DDN, February, page 4).
The spending review in which the new funding was announced took the cautious approach of outlining the spending for just one year in light of the ongoing pandemic. It is hoped that a more robust commitment over a prolonged period will follow to give the sector some security when putting long-term plans in place.
There is, rightly, a focus on stigmatising language in the sector. Language frames the way we think, and while non-judgemental language is important to reduce stigma, it’s equally important that we consider the subtle use of language that disempowers, judges and marginalises the people who use our services. Here are some of the common arguments we hear to justify the de-funding of residential services:
There’s no demand
This simply isn’t true. When we speak to people desperate for rehab, we’re told they have had to ‘fight’ and ‘beg’ to even be considered for a placement. We know the lack of demand is due to lack of awareness, and that is understandable – why would frontline treatment staff make people aware of a treatment option that isn’t funded? The ‘no demand’ argument places the blame firmly on the people seeking treatment. It sounds like a simple statement, it passes in conversation as if it offers some form of insight, but it is just blatant victim blaming.
Rehab’s too expensive
People with multiple needs require more comprehensive treatment – this is true in almost all forms of healthcare. The ‘too expensive’ argument is nothing more than a moral judgement and the subtle implication is that some people are worth more than others.
We can’t put everyone in rehab
This is one we hear often, and often where there is no suggestion that rehab is for everyone. Behind it is a classic use of passive language that creates an image of people waiting to be put somewhere, like pieces on a chess board.
Rehab is not right for some people
The UK clinical drug treatment guidelines make it clear who rehab is most likely to be suitable for, and this statement deflects from the reality of rehab being underutilised by subtly implying that the treatment on offer would be ineffective for those who miss out anyway.
Rehab providers should do more to market their services to funders
A seemingly innocuous statement, but behind it is the implication that defunding is always someone else’s problem and not a systemic issue.
All these statements feed a narrative that addiction is fixed, that addiction is a choice, that people can’t or don’t want to get better, that people are passive and helpless. The combined message is ‘it’s your fault that you are not well and you are not worthy of help’. If we are to improve treatment access for people with multiple health and social disadvantages we need to confront this subtle stigma-driven language. We need to return to the simplest of concepts, namely that people should be made aware of all treatment options and that health is a human right. The NHS was on the principle that good quality healthcare should be accessible regardless of wealth, but people with mental health and addiction treatment needs are still waiting for that to ring true.
The continued underfunding of the sector means that every year more and more people are excluded from rehab. If we are to make the most of the possibility of a genuine end to austerity for the treatment sector we must address the subtle stigma that shames and blames people seeking help, and move on from a funding-led approach, not just to a demand-led approach, but to a rights-led approach to healthcare. The Care Act, Equality Act and Human Rights Act offer rights to people with mental health and addiction treatment needs, and we sincerely hope that the Dame Carole Black report will support the upholding of those rights.
Rehab can be fun despite being tough
Behind the stigmatising views that often exist lie groups of happy, positive and motivated people working hard and committed to overcoming a multitude of problems. Photos courtesy of Phoenix Wirral residential rehab.