July 5, 2021

On the eve of the publication of the second part of the Carol Black review, delegates at a Westminster Social Policy Forum event debated the state of the sector and where we go from here. DDN reports.

People with drug dependency were ‘almost the equivalent of the cast-out lepers of former times,’ Professor Dame Carol Black told the told the Westminster Social Policy Forum’s Tackling drug addiction and substance misuse – latest thinking on prevention, supporting recovery, policy and findings of the independent review event (see news, page 4).

Drug dependency was a ‘complex, stigmatised problem’, she said. ‘Those dependent on drugs are not owned by any one department of state. You might say it’s too messy, too difficult, while at the same time of course creating personal, familial and societal misery and costing the government, we calculated, some £19bn per year.’

Failing system

Part one of the review had addressed supply and demand (DDN, March 2020, page 4), revealing a ‘failing’ system and increasing levels of drug supply, county lines activity and violence – a ‘dire situation’ that had then ‘met austerity’. Since 2014 there had been a 17 per cent fall in funding for adult drug services and a 25 per cent fall for young people’s services. ‘And in a few areas of the country, that fall for adult services has been as much as 40 per cent.’

There was ‘obviously a lot to do’, she stated. ‘This is a report about system change, and reflects the fact that drug dependency has never been tackled in a determined and coordinated way by six departments of state’ – the Department of Health and Social Care, Home Office, Department for Work and Pensions, Ministry of Justice, Department for Education and Ministry of Housing, Communities and Local Government. Rather it was each department trying to do a small amount but not in a way that was joined up, she said.

‘I spent many hours talking to people who are drug-dependent, and they tell you what they need to achieve recovery. Medicine is part of this, but then so much is jobs, friends and housing. I also want to ensure that thriving communities of recovery are a component of every drug treatment system, and this needs to be country-wide. People with lived experience offer so much to the recovery journey that clinicians are simply not equipped to do.’

Support and engagement

There were multiple ways that people in recovery contributed, but a critical one was creating and leading support organisations, said advisor to the review, professor of psychiatry at Stanford University and former drug policy advisor to Barack Obama, Dr Keith Humphreys (DDN, June 2012, page 16). ‘For most people, this is the work of years, which means there’s a need for organisations that persist in people’s lives and engage with them for a long time.’

Talking about recovery was the ‘exciting, positive, happy thing that happens in this field’, when so much discussion was around issues like illness, violence and death, he said. ‘It’s not just “I’m no longer using heroin”, but “I have a job, I’m back together with my family, I feel valued, I feel I’m contributing.” Those things take a long time to develop, but are critically important for health and quality of life.’

Recovery organisations had a different rationale for what made someone an expert, he said. ‘The helping is reciprocal. When a doctor sees a patient it’s not appropriate to ask the patient for help with the doctor’s problems, but in these organisations one moment you can be the helper and in the next the helpee. One of the interesting findings in social support literature is that giving support is probably as good for our health as receiving it.’

Crucially, these services were also free, he said, or operated on a voluntary ‘coin in the basket’ model. ‘That makes them available to anyone, regardless of their economic situation.’ While some had a designated programme or philosophy, others were more general and by no means all were abstinence-orientated. ‘It’s good that there’s so much diversity, so people can find something that works for them. And it’s not just all about services, it’s also about cultural and political influence. We had a saying in the White House – “if you don’t have a seat at the table, you’re probably on the menu.” It’s very important that people in recovery are at the table in all discussions, and Dame Carol did a huge amount of outreach and involvement of people in recovery throughout her work. We need that expertise and that wisdom.’

The public component was also vital, he said, as could be seen with recovery walks. ‘If you’d said 20 years ago there’s going to be 500 people with drug problems marching down the street most people probably would have locked their doors. Now they come out and applaud. Seeing people who they previously might have crossed the street to avoid as successful parents, workers, citizens is very powerfully destigmatising and hope-inspiring.’

Key Ingredients

To deliver high quality, well-led services needed three key ingredients, said Dr Linda Harris, chief executive and clinical director of Spectrum Community Health CIC and chair of the health and justice clinical reference group at NHS England. ‘But they’re huge. We need a positive culture, a capable workforce with the capacity and headspace to care safely and with compassion while being able to train and supervise the workforce of the future, and we need a team of teams. There’s no one agency that can solve this issue, so we need to collaborate to continually improve and innovate.’

There was also a ‘post-pandemic societal context’, she added, with the move to remote and flexible working and the digitisation of service offers. Competition for talent was a key issue, with an ongoing health and social care workforce crisis – ‘we really have to get those sharp elbows out.’ Successful recruitment and retention meant competitive rewards and competitive terms and conditions. ‘We want substance misuse services to be that great place to work, and that also means training and development.

‘I think we can market our strengths,’ she told the event. ‘COVID has shone an enormous light on health inequalities and their root causes, and I think we can take our rightful place leading some of these population health interventions. I’m optimistic because I think this is a pivot moment and providers are ambitious and poised to push to new heights in quality improvement and achievement in the sector. But we do need to invest now.’

The Next Chapter

‘We’re really at the start of the next chapter in the history of our field,’ agreed director of Collective Voice, Oliver Standing. There was not only the second part of the Black review, but also technological innovation and the fact that the sector was becoming much more informed about the links between trauma and addiction.

‘We’ve had the £80m in funding, the Black review’s dominating all of our thoughts, PHE has been cut in twain with the senior jobs at the Office of Health Promotion being recruited at the moment,’ he said. ‘Then there’s the Comprehensive Spending Review in the autumn, the NHS reforms, and an addiction strategy probably at the start of next year.’ And all were contingent on each other to a greater or lesser extent, he stated.

‘Politics is all about momentum and we’ve got a window of opportunity here, but we need that political leadership. We need a robust political response to the review, and we need the funding to continue to support the work. We mustn’t forget we’re in the middle of a drug-related death crisis. This is a morally catastrophic thing, and we can’t ever forget that.’

Professor Dame Carol Black

Professor Dame Carol Black DBE FRCP FMedSci chairs the boards of the Centre for Ageing Better and Think Ahead, the government’s fast-stream training programme for Mental Health Social Workers. She is expert adviser on health and work to NHS England/Improvement and Public Health England and until August 2019 was principal of Newnham College Cambridge. She is a member of Rand Europe’s Council of Advisers, the board of the Institute for Employment Studies, the board of UK Active, and the advisory board of Step up to Serve.

She has authored three independent reviews for the UK government: of the health of the working-age population in 2008 as national director for health and work; of sickness absence in Britain in 2011 as co-chair; and of employment outcomes of addiction to drugs or alcohol, or obesity, in 2016. She is currently working on a fourth independent review for government, of illicit drugs in England.

Dame Carol is a past-president of the Royal College of Physicians, of the Academy of Medical Royal Colleges, and of the British Lung Foundation, and past-chair of the Nuffield Trust for health policy. The centre she established at the Royal Free Hospital in London is internationally renowned for research and treatment of connective tissue diseases such as scleroderma. She has been a trustee of the National Portrait Gallery.

As principal of Newnham, Dame Carol was on several committees in Cambridge University, and she remains a patron of the Women’s Leadership Centre in the Judge Business School, and a member of the university’s advisory board on student mental health. In 2018 she was appointed chair of the British Library Board. Biography at bl.uk/people/experts/carol-black

Make it stick

Features

DDN

July 5, 2021

Making sure naloxone is in the hands of everyone who needs it, whenever they need it, requires far more than simply handing it out from drug treatment services. DDN reports.

Read it in DDN Magazine

Despite all the good work that’s been done over the last couple of decades to fight the battle for naloxone and tackle the associated stigma, one key fact remains. As Judith Yates told DDN last month, ‘You need to have it with you’ (DDN, June, page 15).

A commuter reads a copy of a newspaper while waiting on the subway, a pharmacy carries posters in its window, Spanish language adverts on buses. In 2017 New York’s Department of Health conducted an advertising campaign urging people to carry Naloxone. Photos: Richard B Levine / Alamy

Release’s landmark Finding a needle in a haystack report made headlines when it revealed that while all but three of the local authorities who responded to the charity’s FoI request were supplying naloxone, they were doing it in such small quantities that the impact was negligible (DDN, March 2019, page 4).

‘This life-saving medication is not reaching those who most need it’, Release stated, with the document stressing the need for naloxone to be made easily available to people not in contact with mainstream treatment services, for example via pharmacies or peer networks. In many areas, take-home naloxone was only available ‘through the main drug treatment provider’, the report found, with a quarter of councils failing to provide kits to people in contact with outreach services for homeless populations, for example. If there was ever any doubt over the need for this, a St Mungos report from last year stated that in 2018 around 12,000 rough sleepers had gone without drug or alcohol treatment – the same year that recorded a 55 per cent increase in drug deaths among people sleeping rough. It also found that the number of rough sleepers with a drug problem had increased from 50 per cent to 60 per cent in just four years.

It’s about Harm Reduction

‘Getting out as much naloxone as possible to people who don’t necessarily engage with standard services is really important,’ says Megan Nash, team leader for WDP’s Redbridge outreach service, where all workers have carried it since the service’s inception. ‘That’s both because it’s getting a life-saving drug to the people most at risk of drug-related deaths, but it’s also starting a conversation about harm reduction. It allows you to have a short conversation about how to use it and about risk of overdose – what to look out for and how to prevent it.’

Crucially, it’s also about ‘giving someone something’, she points out. ‘I think that can be a really nice engagement tool. It just feels friendlier to give someone a little present, and people can then spread the word.’ This kind of harm reduction approach can be transformative when dealing with people with very complex needs, such as the Redbridge team’s clients. ‘It’s a way of showing you care about people, and a way of getting them in contact with services, which they may have struggled to engage with in the past as they’re expected to turn up at a specific time, and not intoxicated. I absolutely appreciate that it can be difficult for a lot of mainstream services to manage these kinds of clients, but just having that positive engagement and being told “we care about you”, that someone genuinely is worried about your safety and whether you live or die, is crucial for us.’

None of her team have ever had to administer naloxone themselves, she says, an illustration of how important it is to ‘get it distributed – because a lot of people will be using in hidden places. Often our service users tend to use in groups – in temporary accommodation and squats and things like that. It’s not as easy to see as an outreach worker, and you can’t be there all the time, so it’s really important that it gets out through people who will be in that situation.’

This kind of peer-to-peer distribution model is vital agrees her colleague Dave Targett, WDP’s operations manager. ‘We had a massive squat in the city centre in Chester a year or so ago and we kept giving it to people to take in there to give to others – targeting those high-population areas is really important.’

Inadequate supply

Another alarming finding from the Release document was that only half of prisons and one in five young offender institutions were actually providing naloxone to those leaving custody – this despite the up-to-eightfold increase in risk of a drug-related death the first two weeks after release, as a result of reduced tolerance levels. The amount of take-home naloxone being given out to people on release in 2017-18 was ‘wholly inadequate’, it said, with kits and training provided to just 12 per cent of opiate clients as they left custody. The report also called for take-home naloxone programmes to be extended to immigration removal centres and policy custody suites. A pioneer when it comes to the latter has been Durham Constabulary, where more than 200 police officers and civilian staff have so far received naloxone training (DDN, May, page 13).

Temporary chief inspector Jason Meecham — Temporary Chief Inspector Jason Meecham

The force began having naloxone onsite at its custody suites after a spate of opiate-related overdoses in 2018-19, and it’s now offered on release to anyone over the age of 18 who has a problematic drug issue, has had one in the past, or lives with someone who has one. ‘It’s no strings attached,’ temporary chief inspector Jason Meecham tells DDN. ‘They’re offered an opportunity to watch a video on how to assemble a kit but they don’t have to, and we run through a quick checklist of basic first aid stuff. We also provide them with details of local treatment services, but there’s no catch.’

So does everyone who’s offered it accept? ‘No, they don’t,’ he says, and while the force is looking at ways to drive up acceptance levels they’re also not expecting to be ‘giving away dozens’ every week. ‘Some people don’t want one. They’ve either already got a kit – and we’re more than happy for them to have another – or it’s not what they want, so we’re working with the county council to try to drive that up. The majority of people we’re in contact with are also in contact with local treatment services, which are very good, so they’ve probably already got access to it. There’s only a limited number of individuals we see in custody who don’t deal with GPs or drug treatment services.’

These, however, are precisely the people who need naloxone the most, and overall provision has ‘gone fantastically well, as you’d expect from a drug that’s simple, proven and effective,’ he says. ‘We now have a stock of it in all of our custody suites throughout the county’.

If we’re going to create a widespread culture of supplying naloxone in custody suites a key element is effective communication between forces to get it out there, he says. ‘I’ve got a phone call later this week with another force who are looking to introduce it, and what we also need is more widespread understanding over the legality of it, the guidance, the litigation issues, safety.’

While the force’s frontline staff could see the need for naloxone on the streets and had been asking for it, with some custody staff there had been ‘a bit of a lack of understanding, which is to be expected. We just had to provide that clarity over the safety, the integrity of it, the efficacy of it, just going over those worries people had about something unknown. But overwhelmingly it was, “We want this and can we as an organisation make it happen?” For the staff, it’s been overwhelmingly positive.’

One important factor for any other force looking to introduce it is Durham Constabulary’s close working with the public health team at the county council, he says. ‘Other forces could look at how that relationship is managed. We took a partnership approach and really worked hand-in-hand, and we really learned a lot because they were very familiar with naloxone. At the moment it’s about trying to ensure a continuous supply from the county council, and trying to ensure that when cops see someone in the street possessing it it’s not grounds for a stop-and-search. We have to make sure they know what it is even if they don’t carry it themselves – raising that level of awareness and confidence.’

But if we’re going to be successful in making sure naloxone is in the hands of everyone who needs it – whenever they need it – then people working in the sector need to be the standard bearers, Dave Targett believes. ‘Ultimately, it starts with us. I was at a drug-related deaths conference a couple of years ago and when someone asked how many people were carrying naloxone only half a dozen or so put their hands up. Those are professionals in the sector who weren’t carrying it. We are the carriers of the message in the first instance, and I think we have to act how we want others to act. You can’t use it if you haven’t got it, and I think the best way to get people to carry it is for us to lead the charge.’

This article has been produced with support from Ethypharm, which has not influenced the content in any way.

Force of nature

Features

DDN

July 5, 2021

The healing power of the natural world is helping people in recovery in Devon to reach their full potential, say Kerrie Clifford and Allysa Hornbuckle.

‘When you look outside on a sunny day you can see that the world is a beautiful place. Before, my eyes weren’t open to that.’ Flourish in Nature is a project led by EDP Drug & Alcohol Services and funded by Sport England that focuses on people in recovery, encouraging them to volunteer their time while training to become activity leaders and/or peer mentors.

The programme helps people see and realise their full potential, engage with new hobbies, and discover what really matters to them, all while embracing the beauty of nature. Most of the much-needed face-to-face support that people in recovery were used to came to a standstill as a result of lockdown, but Flourish in Nature continued because they were able to maintain their nature walks as a group while keeping social distancing. The outdoor activities such as walking, cycling, tai chi, wild swimming, forest bathing and boxing have been hugely impactful for everyone involved because they’ve been able to continue with their support system and communicate in person with others who are experiencing similar challenges.

Flourish in Nature also offers Zoom meetings twice a week, where anyone can join to talk about what’s on their mind or issues they’re facing, and when there is a larger group of people they often engage in teamwork-based games. This helps them to stay connected with one another and encourages step-by-step development of their community. The programme has benefited a great many people, one of whom is Kelly.

Kelly was approached around nine months ago to see if she fancied trying out some new experiences and maybe gaining a few new skills. She was at a point in her life where there was a void and she was at a loss as to how to fill it. ‘But when Flourish in Nature came along it was a huge game-changer,’ she says. She thought to herself that there really wasn’t any other service quite like Flourish in Nature and that she ought to become a part of it. So for the past nine months she has been working hard to pursue her goals, and while Kelly has been in EDP’s Together service for the past 18 months, in just two months’ time she will be a fully qualified yoga instructor.

She began her activity training as a walk leader at the same time as training to become a peer mentor, and then pushed on to become an activity lead while juggling a yoga instructor qualification. This training has given her the necessary skills to be able to help other people. She already has a client base for when she accomplishes her yoga instructor training and is beyond excited to be able to help people with both mental health and overall wellbeing.

Kelly’s unique blend of skills in peer mentoring as well as in outdoor leadership has given her the confidence to speak up in situations where people may be displaying or talking about their risky behaviour and guide them towards safer habits and better decisions. Kelly knows that she has a way to go with her recovery but she continues to strive to be the best version of herself and thrive through sheer perseverance. ‘I have not wanted to use drugs now because I spent the past 25 years suffering from depression because what I was doing wasn’t making me happy,’ she says. ‘But I didn’t have a choice. Where now I am saving my money and I am planning things for the future.’

She has changed the course of her life and because of Flourish in Nature, her mental health has turned a corner. ‘I’m happy now. I see the world differently now and I don’t have a chance to get bored. When you look outside on a sunny day you can see that the world is a beautiful place. Before, my eyes weren’t open to that.’ With the walks that she leads she tries to instil the importance of becoming one with nature, embracing the soil under her feet and breathing in the clean air. ‘It creates a sense of solitude while being surrounded by others that perceive no judgement.’

Having the ability to have a support system that is present and non-judgmental helps to motivate everyone involved in Flourish in Nature. Recovery can mean many people being faced with a choice of giving up their past life, and this can include giving up friends. Very quickly an individual’s usual support system is gone but with this programme there is the opportunity to engage with a new support system, where everyone has the same goal – to become the best version of themselves within their recovery journey.

Kelly’s family and friends have all been affected by her journey and are extremely proud of her for what she’s accomplished and her determination for a better future. She will not settle for anything less. ‘I wish that perhaps something like this was around 20 years ago, then maybe life could have been different,’ she says.

‘In the past, my background would have always gone against me, and I thought instead of swimming against the current, I should go and run with it, use my past as a plus point and use it to help others.’ There has always been a stigma around addiction and the idea that a person’s history will always be held against them but with Flourish in Nature, Kelly is using her history positively to speak her truth and help others through their recovery journey. ‘I used to hide my background and wasn’t able to be honest with others because I always thought I would go back to it… Flourish in Nature has made me be more honest with myself, now I know I won’t go back so I can be proud of where I came from,’ she states.

Kerrie Clifford is marketing and communication manager at EDP Drug & Alcohol Services; Allysa Hornbuckle is Humankind intern

‘Something bad would have happened and that would have been an excuse to go back to it, but now I am not risking all that. I have accomplished and built so much because I have so much going for me.’ Flourish in Nature offers endless growth and continuous training allowing individuals to grow and connect with themselves through nature. It will also continue to tackle the stigma around addiction – as Kelly says, ‘People witness the members of this programme walking around and it is normalising the stigma and showing that we can do some good.’ This powerful message is a small but wonderful way of breaking down barriers. A last comment from Kelly, ‘I am so thankful and grateful for all the tools that they have given me. I kind of owe them to really do my best so that others can benefit too.’

Tracey McMahon is a Delphi nurse

Features

DDN

July 5, 2021

Tracey McMahon is a Delphi nurse who has developed her interest in mental health by working in a prison environment.

Read Tracey’s story in DDN Magazine

As a child travelling on the train with my mum, we would go past a large mental health hospital. In the ’80s this was referred to as an asylum and this intrigued me. I would ask questions and tell my mum I wanted to work there one day.

As I grew up I forgot about this and wanted to teach English in Africa, but at 18, returning from travelling and waiting to start university, I started working in an elderly care home with nurses. Inspired by their commitment, I decided I wanted to be a nurse.

I started my training at Salford University in 2005, qualifying in 2008. I then started working as a mental health nurse at a medium secure unit, where I worked for the next ten years with various client groups at various stages of their mental health recovery. It was during this time that I developed an interest in substance misuse. I started a new programme co-facilitating psycho-education groups.

With my ongoing interest in substance misuse, I applied for a job as an alcohol nurse in a prison, which became recovery nurse when the healthcare provider changed. I was helping patients within the prison who had varying substance misuse needs, mainly focusing on those who were new into prison and had self-identified as being dependant on alcohol or opiates.

I saw a job advert at the mental health hospital I’d been obsessed with as a child and applied. I was working with patients who had been detained for over 20 years, and they continued to struggle with their mental health. During my time there I saw many changes including the patient group changing dramatically – they became younger, substance misuse became more prevalent, and within the service it was identified that there was a lack of substance misuse knowledge and support. I, along with a few colleagues, became involved in offering interventions for those with substance misuse needs.

I attended various training courses and spent time with specialist substance misuse services. I also did a level 6/7 course in psychosocial interventions to complement the substance misuse knowledge I had gained.

Throughout my nurse training I had always felt better suited to secure settings and working with this client group, seeing their mental health improve, was rewarding. Many of them would spend time in the hospital setting, away from their families and community for many years, and being able to work with the same person for this long really does allow you to build up a rapport and help them holistically.

Seeing the dramatic change in a patient once they had stabilised on their opioid substitute treatment or completed their medically assisted alcohol detox was extremely rewarding. Not only was there a change to their physical appearance, but their whole outlook on life and positivity towards the future.

I completed the non-medical prescribers’ course in 2019 and started prescribing. I have enjoyed this new aspect to my role and the challenges it brings. I attend an inpatient detox twice a month to prescribe and gained a lot from working in a new environment with completely different challenges to secure environments, focusing on my clinical skills – an area of my nursing I hope to keep developing.

As team leader of the service, I find that each day – each hour! – is different. I can be prescribing one minute, offering clinical advice next, having a consultation with a patient or offering an intervention. I might then have a staffing or service issue that I need to look into, involving risk assessments, action plans and service improvements. Looking at the service and patient care and improving standards are a massive part of the role I play within the team.

The favourite parts of my job are my nursing/NMP role – spending time with clients, building a rapport, and getting to a place where you can have a laugh, be open and honest about their treatment, what they want and what is realistic. Talking is so important yet often underrated by services – I’m lucky enough to work for a company that realises how important the small things are and the huge impact they can have on a person’s recovery.

Working in the prison environment can be quite oppressive with its restrictions, but having a good team really makes your working day easier. Making a difference to patients is so rewarding, as are the challenges and problem-solving aspects of the job – from linking patients up with community support to transferring care from a secure setting to the community.

Nursing will throw many challenges at you and at times you will question if nursing is for you. But the positives outweigh any negatives and it’s such a rewarding job.

Better Together

Features

DDN

July 5, 2021

Two years on from their merger with Blenheim, Humankind’s work in the capital is going from strength to strength, says Manish Nanda.

Read it in DDN Magazine

It’s been just over two years since Blenheim CDP merged with Humankind across London. In that time, a lot has gone well, but a lot hasn’t been as straightforward as planned – not least due to the pandemic. We’ve moved our service delivery forwards and I’m really excited about what the future holds for Humankind across the region.

Joining a new organisation during a pandemic has presented some challenges and at times, I’ve felt too far removed from services – I would normally have been sitting in on groups, having a stint on reception and getting to know our staff in person. Instead, I’ve done my best to connect online and have been in awe of the remarkable response from our London teams.

Our staff, commissioners and NHS partners have all been amazing in the way they’ve looked after one another and the people who use our services. Everyone has been incredibly adaptable, and it’s really brought home the untapped potential of our sector. Call me biased but I truly believe drug and alcohol workers are amongst the unsung heroes of the pandemic, showing tremendous resilience and commitment to keeping services running while also transforming the way we deliver services as we go.

Building on Blenheim CDP’s legacy of social action, Humankind are ambitious for our services in London and what we can achieve together with our service users. I’ve thoroughly enjoyed my first year with Humankind and looking forward, as restrictions continue to ease (fingers crossed!), there are three key areas of focus in the year ahead.

Firstly, we’re continuing to build on what we’ve been learning as a result of the pandemic. Our blended approach to service delivery, combining what works well online with what works well face-to-face is really exciting. Taking a people-led approach has made a huge difference to our delivery – really taking the time to listen to the people who use our services has helped us to make significant strides in terms of how our services have adapted to the challenges that the last year has brought us. We’ve recently recruited two regional recovery programme coordinators to further support the development of our response across London, and I’m eager to see even more co-produced initiatives to ensure people who access our services can benefit from everything that’s on offer in their local community.

Secondly, here at Humankind we’re known for our collaboration and our ability to work in partnership with a broad range of other organisations. In London, we have particularly strong partnerships with a range of NHS trusts and this is something I want us to strengthen over the course of the next year. Working closely together we can deliver a lot more, and I’m very proud of the relationships we share. The third sector is well placed to support people with complex needs and multiple vulnerabilities and aligning with our NHS colleagues can help make the sum greater than the parts.

Thirdly, Humankind plans to further build and develop our multi-thematic offer across London. We deliver housing support services, social enterprises, and significant employability work in other areas of the country. An early example of this is our expansion of our More Time social enterprise across the London boroughs where we work – providing social value and employment opportunities for local people. We’re committed to doing more of this kind of innovative work, and thanks to the universal funding grant we now have some additional resources to help meet the diverse needs of the communities we serve.

For me, innovation and working together will have a big impact in the year ahead. As part of this I’m really keen to promote the environment at Humankind where the most talented staff across the region can put their skills and passion to use for the benefit of the people accessing our services.

If you want to be part of our journey in London you can find out more at humankindcharity.org.uk/careers

Services now ‘on their knees’, says Carol Black

News

DDN

June 28, 2021

Funding cuts have left treatment and recovery services ‘on their knees’, commissioning has ‘become fragmented with little accountability for outcomes’ and partnerships between local authorities and health and criminal justice agencies have deteriorated across the country, Professor Dame Carol Black told the Westminster Social Policy Forum’s Tackling drug addiction and substance misuse – latest thinking on prevention, supporting recovery, policy and findings of the independent review event.

‘I’ve said very clearly in the review that the money must be targeted and spent only on this area,’ said Dame Carol Black

The workforce, meanwhile, was ‘depleted and demoralised’, with a falling number of professionally qualified people and ‘insufficient support to peer workers who are so crucial to the recovery process’.

Part two of her review currently ‘sits with Number 10’, she said, and she ‘very much’ hoped it would be published in July: ‘I cannot of course give you the exact recommendations but I can address the areas I’m going to be focusing on.’ Services had been cut back, particularly inpatient detox, residential rehabilitation, specialist services for young people and treatment for cannabis and stimulant users, and ministers in different departments had not worked sufficiently well together ‘in a determined and sustained way’, she said. ‘I’ve said in the report that the current situation is intolerable and that significant changes need to be made in four big areas’.

These were radical reform of funding, commissioning and leadership; rebuilding of services and developing integrated systems of care and support; increased focus on prevention and early intervention, and improvements to research and science. Part two of her report offered concrete proposals, she said – ‘I hope many of them deliverable in this parliament.’

‘This government must strengthen its national leadership of work to tackle drug misuse’ and hold departments to account, she said. Also essential was an increase in funding to provide an effective treatment and recovery system. ‘Funding at this time is of course difficult – it would be foolish of me to pretend otherwise – but we’ve been doing everything we can to ensure the Treasury understands that it would be money well spent with a substantial and early return on investment’ – leading to less crime, fewer murders, a safer society and better treatment outcomes.

‘I’ve said very clearly in the review that the money must be targeted and spent only on this area. Ringfencing isn’t popular but I believe it’s absolutely necessary,’ she said, while acknowledging that ‘ensuring coordinated local delivery encompassing several different elements was ‘extremely difficult’.

‘I think some people think that treatment is just about clinical services, but that’s only part of the story. We need a strong recovery community, trauma-informed services, and good mental health services.’ Good housing and employment opportunities were also ‘absolutely part of the treatment package,’ she said. ‘You only have to talk to those who are drug-dependent to understand that. We also need to acknowledge that drug dependency deserves parity with other conditions such as diabetes.’ The comorbidities associated with drug issues, including lung disease, liver disease, infections and mental ill-health also needed to be dealt with ‘in a timely manner’ she said. ‘I would go so far as saying that trauma-informed care is woefully lacking, and if you can’t provide that then it’s very, very difficult for people to come off the drugs they’re taking.’

It was also vital to improve the offering to non-opiate users, she stated. Many people thought there was ‘nothing available for them’ and that services were exclusively about heroin and crack. ‘That cannot be the case,’ she said. ‘I also want to ensure that thriving communities of recovery are a component of every drug treatment system, and this needs to be country-wide. People with lived experience offer so much to the recovery journey that clinicians are simply not equipped to do. We must also improve the pathways in criminal justice settings and enable diversion of drug users into treatment,’ maximising use of community sentences with treatment requirements and making sure that prisoners were able to access treatment ‘during the very vulnerable period’ immediately after release.

‘Finally, we need to improve research and science and have informed policy, commissioning and practice,’ she said. ‘I was really shocked to see how poorly served we are compared to countries like the USA, Canada and Australia. This needs to change, and it needs to be not only for the clinical service but for the recovery community which has had virtually no structured research.’

Recommend vaping to help people quit smoking, says NICE

DDN

June 25, 2021

Health professionals can recommend e-cigarettes as tools to help stop smoking, according to new draft guidance from NICE and PHE.

vaping woman — People should be able to use e-cigarettes as ‘one of several options’ to help quit smoking.

‘The evidence shows that nicotine-containing e-cigarettes can help people stop smoking and are similarly effective to other cessation options such as a combination of short- and long-acting nicotine replacement therapy,’ NICE states.

People should be able to use e-cigarettes as ‘one of several options’ to help quit smoking, said NICE’s expert panel, recommending that they are most likely to be effective in combination with ‘behavioural support’. The draft recommendations stress that people should be advised where to find information on e-cigarettes and that they are ‘substantially less harmful’ than smoking, but that their long-term health effects are unknown.

There are currently no medically licensed e-cigarettes and they are not available on prescription, with their efficacy and safety remaining controversial. While PHE has long maintained that e-cigarettes are around 95 per cent less harmful than smoking tobacco (DDN, September 2015, page 4), and that there is no evidence that they act as a ‘gateway’ to smoking for younger people, WHO’s position is that they are harmful and there is ‘insufficient data to understand the full breadth of their impact on health as devices have not been on the market long enough’.

The NICE committee recommends that further research be carried out into the short- and long-term health effects of e-cigarettes, particularly for groups such as younger people and pregnant women.

According to a survey commissioned by anti-smoking charity ASH, just 12 per cent of smokers were aware that that e-cigarettes were much less harmful than smoking, with a third believing they were ‘more or equally harmful’.

‘This new guidance offers a welcome “how-to guide” for reducing the harm caused by smoking including helping smokers to quit and preventing a new generation of smokers from starting,’ said PHE’s director of drugs, alcohol, tobacco and justice Rosanna O’Connor. ‘This consultation is an important opportunity for all our partners to help shape these recommendations.’

The draft guidelines were a ‘renewed effort to reduce the health burden of smoking and to encourage and support people to give up’, added director of NICE’S Centre for Guidelines, Dr Paul Chrisp. ‘Smoking continues to take a huge toll on the health of the nation and accounts for approximately half the difference in life expectancy between the richest and poorest in society. It is therefore vitally important that we reduce the level of smoking in this country. We need to use every tool in our arsenal to reduce smoking rates, including education, behavioural support, financial incentives, and e-cigarettes if people are interested in using them. Combined, we hope that people who smoke will feel enabled to give up tobacco products once and for all.’

Draft guidelines available for consultation until 6 August at www.nice.org.uk/guidance/indevelopment/gid-ng10086

Related articles

(Features, August 2023): DDN visited the Global Forum on Nicotine in Warsaw to hear about the challenges of mainstreaming tobacco harm reduction.

(News, August 2023): 40 per cent of smokers in the UK think that vaping is ‘as or more risky’ compared to smoking up from 27% last year.

(Features, February 2023): The genie’s out of the bottle – embracing tobacco harm reduction could end smoking within a generation, says Knowledge Action Change.

Read more articles on tobacco harm reduction, vaping and smoking cessation in the DDN archive.

A year on from launching our LGBTQ+ webchat service, what have we learned?

Partner Updates

DDN

June 24, 2021

Steph Keenan discusses how With You has evolved its offering to the LGBTQ+ community over the last 12 months, and built a more inclusive service.

Launching in 2017, With You’s Webchat offers a free confidential space for people to talk about their alcohol and drug use with a qualified professional. In 2020 we had over 21,000 people access our online support.

We know that webchat is an easier channel for people who have never accessed help before to reach out. People who are struggling with their alcohol or drug use have a plethora of reasons they wouldn’t want to access help, stigma and shame being the things we hear a lot.

Alcohol and Drug use among LGBTQ+ groups is higher than among their heterosexual counterparts, irrespective of gender or the different age distribution in the populations. However, this is not reflected in the people accessing our in-person services. In one of our services, only four people had identified as gay or bisexual since the beginning of the year out of 1490 registered. Evidence is limited as to why this is but it suggests there are specific barriers to accessing support.

There are limited available programmes able to address culturally specific LGBTQ+ issues within services. In a 2018 survey for the LGBTQ+ equality charity Stonewall, almost one in four patients (23 per cent) had witnessed negative remarks about LGBTQ+ people from healthcare staff while accessing services. When someone does access support there can be heteronormative side conversations that exclude LGBTQ+ people. The default questions if they are in a relationship, or who your next of kin forces the ‘am I safe to come out to this person’ thought process. Often they don’t see themselves reflected in the other people who access support. If there is a specialist service, it can be quite a distance to individuals in rural areas.

As part of a wider ongoing project to improve our offering to the LGBTQ+ community, we looked at how webchat could be more inclusive. Webchat gives a confidential space where a person can disclose as much or as little as they want to a trained professional. The team offers service without borders or the barriers sometimes found in our commissioned support.

First of all we noticed a gap in our knowledge and recruited specialists in chems. Not only did this help to upskill the team but we tried offering specialist sessions for online one-to-ones with Ben, a frontline recovery worker and member of the community. This enabled people to access specialist support from wherever they were comfortable.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by With You

Cannabis four times stronger than 25 years ago

News

DDN

June 24, 2021

Cannabis potency has increased by as much as four times since 1995, according to UNODC’s World drug report 2021, a period that has also seen the number of adolescents who perceive it as harmful falling by 40 per cent.

This is despite ‘evidence that cannabis use is associated with a variety of health and other harms, especially among regular long-term users’.

The percentage of THC, cannabis’s main psychoactive component, has almost doubled – from 6 per cent to more than 11 per cent – in Europe since 2002, and quadrupled from 4 per cent to 16 per cent in the US since 1995, the document states. The agency is calling for increased investment in research into both cannabis harm and the drug’s potential medical uses, along with a worldwide ban on cannabis advertising to ‘prioritise public health over private business’. In a survey of health professionals from almost 80 countries, 42 per cent said they perceived cannabis use was on the increase.

Around 275m people worldwide used drugs last year, 36m of whom have a ‘drug use disorder’, the agency states. The number of people using drugs has increased by 22 per cent in the last decade as a result of population growth, with demographic changes likely to mean an 11 per cent increase worldwide in people using drugs by 2030 and a 40 per cent increase in Africa. An ‘integrated, people-centred and human-rights based approach’ will be needed to empower African societies to ‘develop sustainable solutions to drug use’, the document says.

More than 11m people worldwide are now estimated to inject drugs, around half of whom are living with hepatitis C. The number of daily doses of methadone and buprenorphine has risen from 557m in 1999 to 3,317m, a six-fold increase.

In common with recent reports from EMCDDA and others , the document states that drug markets ‘swiftly resumed operations’ after the initial disruption caused by COVID-19, demonstrating traffickers’ ‘ability to adapt quickly to changed environments and circumstances’. Diversified cocaine supply chains into Europe were ‘pushing prices down and quality up’, it added, while major online ‘dark web’ drug markets were now worth upwards of $315m in annual sales.

UNODC’s executive director Ghada Waly, who took office earlier this year, stressed the importance of strengthening the evidence base and raising public awareness. ‘Lower perception of drug use risks has been linked to higher rates of drug use, and the findings of UNODC’s 2021 World drug report highlight the need to close the gap between perception and reality to educate young people and safeguard public health,’ she said.

Document at www.unodc.org

How the employability sector is creating thousands of new jobs

Partner Updates

DDN

June 23, 2021

The employability and skills sector is at the heart of the government’s Plan for Jobs strategy. New programmes such as DWP Restart and Kickstart, as well as the growth of traineeships, aren’t just supporting people into careers: they’re also creating exciting new job opportunities, says Forward’s Asi Panditharatna.

As reported in Personnel Today: ‘On top of the 27,000 work coaches [the government] plans to recruit for Jobcentre Plus branches, employability providers will need to recruit about 20,000 additional roles to support Restart and other employability programmes.’

This reflects our experience at Forward, where we have been busy recruiting new employability advisors, skills trainers and managers for our new DWP Restart service. This includes people who are new to the sector, whose lived experience gives them qualities such as resilience, determination, courage and hard work. They will be great role models to our clients and learners.

In previous blogs I have written about skills adjacency, where people who are un- or underemployed use ‘step into’ roles like these to develop adjacent or similar skills and knowledge required for a new career. We need to see more of this in the employability sector to recruit the work force we will need.

Becoming a Level 4 Employability Practitioner Apprenticeship provider

Training and development will be important for existing staff as well as those who are joining the sector this year. And as both an employability provider and employer, we are well placed to offer an apprenticeship journey based on our experience of working in the employability sector.

It is why we have become an approved apprenticeships training provider and deliver the Level 4 Employability Practitioner Standard. We knew we had the insight, experience, knowledge and know-how from delivering careers advice, vocational training, and employability and enterprise services. Many of our team have been working in this industry for a long time, and are keen to share experiences with colleagues who are newer to the sector.

It is also why we have joined the Institute of Employability Professionals (IEP). It enables us to offer membership to our staff, as well as opportunities to do the IEP Accredited Sector Induction Level 2 programme. This will help our staff enhance their knowledge and fine-tune their skills to deliver the best service to our clients or learners.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by The Forward Trust

Childhood trauma can alter response to opioids

News

DDN

June 23, 2021

People with a history of childhood trauma are more likely to have a euphoric response to opioids, according to a study by scientists at the University of Exeter. The findings ‘may explain the link between childhood trauma and vulnerability to opioid use disorder, with implications for treatments and the prescribing of opioids medically’, say the researchers.

The strong link between early trauma and problematic drug use in adulthood is long established. The ongoing adverse childhood experiences (ACE) study has found that people who experienced four or more types of ACE – including physical or emotional neglect or physical, emotional or sexual abuse – are ten times more likely to be involved in injecting drug use (DDN, March, page 4).

The University of Exeter study – thought to be the first of its kind – compared the effects of morphine on 52 people, roughly half of whom had a history of severe childhood abuse and neglect, as measured by the widely used childhood trauma questionnaire. Those who had no history of childhood trauma were more likely to dislike the effects of the drug and report feeling nauseous or dizzy, while those who had experienced trauma ‘felt more euphoric and had a stronger desire for another dose’. Childhood trauma may ‘sensitise individuals to the pleasurable and motivational effects of opioids and reduce sensitivity to the negative effects, providing compelling evidence for individual differences in opioid reward sensitivity’, the study concludes.

Lead author Dr Molly Carlyle from the team at Exeter University

One explanation for the different responses in the two groups could be childhood trauma’s effect on the endogenous opioid system, a pain-relief process that is sensitive to chemicals such as endorphins – ‘our natural opioids’. Childhood trauma may ‘dampen’ this system, the researchers state. ‘When a baby cries and is comforted, endorphins are released – so if loving interactions like this don’t happen, this system may develop differently and could become more sensitive to the rewarding effects of opioid drugs,’ said lead author Dr Molly Carlyle. ‘There are high rates of childhood trauma in people with addictions. Our findings show that these sorts of experiences can actually change how certain drugs feel.’

The study was a randomised, double-blind trial where physically healthy participants aged between 18 and 65 attended two sessions a week apart and received either an active dose of morphine by injection or a ‘negligible’ control dose. While the morphine doses also increased pain threshold and tolerance, this ‘did not differ between the trauma and non-trauma groups’.

‘Our findings that people who have been traumatised as children are more likely to enjoy morphine might help to reduce stigma around heroin use,’ said leader of the research group, Professor Celia Morgan. ‘Many opioid addicts are people who were traumatised in early childhood, but it is still widely believed that addiction is a weakness and that addicts simply lack self-control. This research may be a step towards treating heroin addicts with more compassion, as we would children with histories of trauma. Our study also highlights the importance of interventions aimed at high-risk children and adolescents to protect against opioid use.’

A randomised, double-blind study investigating the relationship between early childhood trauma and the rewarding effects of morphine, published in Addiction Biology at https://onlinelibrary.wiley.com/doi/10.1111/adb.13047

One in six Scottish ambulance callouts alcohol related

News

DDN

June 22, 2021

One in six ambulance callouts in Scotland is alcohol-related, according to research by the University of Glasgow, rising to one in four during weekend evenings.

Researchers used data from the Scottish Ambulance Service (SAS) to build an algorithm to search paramedics’ notes for references to alcohol, and found that almost 87,000 callouts in 2019 were alcohol related, at a cost to the service of more than £31m.

Although the impact of alcohol on the Scottish Ambulance Service was known to be high, the 2019 rate of more than 230 alcohol-related callouts per day is three times greater than was previously estimated. Age was found to be a significant factor, with alcohol related to more than a quarter of callouts for under-40s but less than 7 per cent for those aged 70 and above. Twenty per cent of all callouts to the most deprived areas were found to be alcohol related, twice the rate for the least deprived areas.

The algorithm was found to be 99 per cent accurate when compared to the judgement of professionals reviewing the same patient records, and means that SAS will now be able to routinely monitor alcohol-related callouts, the researchers say. The study, however, did not identify whether people had been drinking at home or in licenced premises. Recent research found that Scottish alcohol consumption fell to its lowest level ever in 2020 – the year after the period covered by the SAS study – driven by price increases in off-trade premises post-MUP and the closure of pubs and restaurants during lockdown periods . The SAS research, published in the International Journal of Environmental Research and Public Health, was co-authored by colleagues at the University of Stirling, University of Sheffield and SAS.

‘We have shown that there is a high burden of alcohol on ambulance callouts in Scotland,’ said professor of medical statistics at the University of Glasgow’s Institute of Health and Wellbeing, Jim Lewsey. ‘This is particularly true at weekends, for callouts involving younger people and for callouts to addresses in areas with high levels of socio-economic deprivation. These data can be used to monitor trends over time and inform alcohol policy decision making both at local and national levels. Further, our methodological approach can be applied to other contexts for determining the burden of other factors to the ambulance service.’

Niamh Fitzgerald, professor of alcohol policy at the University of Stirling.

‘As we emerge from the COVID-19 pandemic, we all want to protect NHS services for when they are most needed,’ added professor of alcohol policy at the University of Stirling, Niamh Fitzgerald. ‘It is timely therefore to consider whether it is acceptable that over 230 ambulance callouts every day are linked to alcohol when we have policy solutions that can reduce this burden. We are also conducting further research to understand what types of callouts and drinking locations give rise to these figures and how they are experienced by paramedics.’

Estimating the burden of alcohol on ambulance callouts through development and validation of an algorithm using electronic patient records here

Introducing: the ‘More Than My Past’ film academy

Partner Updates

DDN

June 21, 2021

‘More Than My Past’ tells the inspirational life stories of people who have overcome addiction or crime. Now The Forward Trust is putting the power to tell these stories into the hands of their ambassadors.

Who knows recovery better than those in recovery themselves? Who knows the cycle of crime more than people who’ve been to prison? That’s why we wanted to get people who have lived experience of crime and addiction involved in filming real life stories for our More Than My Past campaign.

More Than My Past is our national campaign tackling stigma towards ex-offenders and people in recovery from addiction. It showcases the inspirational life stories of those who’ve had challenging pasts but have since turned their lives around – our campaign ambassadors – in the format of written stories, films and podcast episodes.

Until now, we’ve had our professional filmmaker, Max, make films for the campaign, and he’s done a fantastic job. However, now we’re turning the campaign into something ‘for the people, by the people’ – putting the power of creation into our ambassadors’ hands.

Not only does this mean our ambassadors get access to top-notch training in film-making, but it will help the campaign grow, reach more people, and, hopefully, transform more lives.

Max, our More Than My Past filmmaker, says: ‘It’s a real privilege to be involved in this project. What we’re doing here is monumental. As filmmakers and storytellers, we’re always striving for authenticity. And by working with those in recovery and who have been through the prison cycle, we’re going to start telling these stories through a whole new lens, whilst equipping our students with transferable skills. It echoes everything More Than My Past is about and what we have built to date – capturing honest and genuine stories that transform perspectives. I have huge ambitions for this first cohort and what we can achieve in the future.’

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by The Forward Trust

Keeping that human connection during the pandemic

Partner Updates

DDN

June 18, 2021

“Glasgow from Queens Park” by Ian Dick is licensed under CC BY 2.0.

With You’s drug and alcohol work in Glasgow is all about relationships, and we’ve worked hard to keep that human connection without face to face support, says Tracy Morrice, service manager, With You North East Glasgow Recovery Hub.

At the beginning of March 2020, Rob was referred to our drug and alcohol services after trying to take his own life. Rob had experienced issues with alcohol for a long time. He’d tried various treatments before and at this point wasn’t particularly interested in addressing his drinking habits. This all changed when he met his latest support worker Maggie at our hub in Glasgow. They made a connection right away and Rob began opening up about his past.

Human connections like the one between Maggie and Rob are central to the work we do in our recovery hubs. We know positive relationships are an important part of recovery from drug and alcohol issues. We work hard to help people build these relationships whether that’s between our staff and people looking for support or between the people who access our services.

In normal times, both our hubs in Scotland are buzzing. There’s always something going on with loads of activities for people to get involved with. But when the pandemic first hit, all of that changed. One person described the first lockdown as a black cloud appearing over his recovery. Everything he was doing that was good for him just completely stopped overnight.

With all hands on deck and a lot of hard work from all of our staff and volunteers, we found a way to lift that cloud. Together with our partners in the local recovery communities, we were able to get our seven-day-a-week group programmes up and running online within 24 hours. We quickly began to offer one to one sessions via phone and we added additional support wherever we could. To ensure our groups continue to be engaging, we developed a real variety of sessions, from an arts and craft session to a cooking club — that have built up a great peer support network.

We’ve also explored new ways to provide support offline. We started finding ways to help people access food, clothing and toiletries in lockdown. We also began distributing Naloxone — a lifesaving medication to reverse opioid overdose — door to door and providing doorstep training.

The end result of this hard work is that, despite everything, we’ve maintained consistently high referrals and have continued to keep people engaged with the services. At the same time, we’ve found some of the things we’ve started doing cut down the time between when someone contacts us and when they start getting support — we’re now able to help people almost immediately. We’re also seeing more people seeking support for the first time; an average of 58% of people accessing our services between May and December of 2020 had never engaged with services before.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by With You

Rising levels of violence associated with county lines activity

News

DDN

June 18, 2021

County lines activity is being characterised by rising levels of extreme violence and sexual exploitation, according to a report by the University of Nottingham’s Rights Lab.

young girl mobile grooming — Young girls are being coerced into gangs via online grooming and use of control through the harbouring of sexually explicit images.

Professionals interviewed for the report described both an increase in the incidence of violence and ‘shifts in the types of injuries and their severity’.

One respondent described an increase in the number of males under 21 attending A&E after being raped, while others also noted increases in self-harm and suicide attempts among children and young people admitted to hospital.

The report, which looks at the impact of COVID-19 on county lines activities, says more and more health professionals are warning that young people are being coerced into gangs via online grooming and use of control through the harbouring of sexually explicit images, with an associated increase in self-harm among young females. While males still represented the majority of violence-related A&E admissions in connection to county lines gangs, the injuries sustained by female victims were becoming ‘more severe and sexual in nature’, with victims ‘passed around the wider network as a reward’.

Levels of county lines activity have increased exponentially in recent years, with a January 2019 report from the National Crime Agency finding that the number of dedicated mobile phone lines had risen to 2,000 from just 720 the previous year (DDN, February 2019, page 4).

While COVID-19 had not led to any reductions in county lines activity, one noticeable impact of the pandemic had been a shift from public transport to private hire vehicles, the Rights Lab document says, particularly via 28-day ‘rolling rentals’ organised online. This had led to associated increases in both ID fraud and A&E admissions as a result of accidents, police car chases and ‘vehicles used as weapons’. The increased levels of privacy associated with COVID-related visiting restrictions in hospitals, however, had meant some young people felt safe enough to disclose more about their injuries and experience of exploitation.

‘One person who I met in A&E, he had been quite heavily involved in county lines and he was in the hospital that night for trying to drink a litre of bleach,’ stated one respondent. ‘He said, “I just wanted to get out of it because this particular day, they was gang raping someone’. When he refused to get involved they beat him up and now they were after him because he wouldn’t get involved in that gang rape.’ A youth worker, meanwhile, described the injuries they’d seen as including ‘fingernails pulled off, hair pulled out, even the stabbings… whereas before COVID-19 you may have seen one or two injuries on a young person, now they will be repeatedly stabbed. So we’re talking five, six times is kind of an average amount of stab wounds.’

Among the document’s recommendations are for all A&E departments to have youth workers in place offering support to young people attending with violence-related injuries, and for criminal exploitation and county lines training to be a national requirement for people working with children, young people and vulnerable adults. Face-to-face meetings – rather than telephone or online contact – between professionals and young people should also resume as soon as possible, the document stresses.

‘These latest findings are extremely concerning – taken together with the fact that professionals’ ability to identify signs of exploitation and safeguard vulnerable young people are being hindered by COVID-19 restrictions, it is a very alarming picture,’ said research fellow in modern slavery perpetration at the Rights Lab Dr Ben Brewster.

Covid-19, Vulnerability and the Safeguarding of Criminally Exploited Children available here

Why gender matters in drug and alcohol treatment

Partner Updates

DDN

June 17, 2021

The Government closed its call for evidence to inform its forthcoming Women’s Health Strategy this week, amidst recognition that a system designed for men by default leads to health inequalities for women. Vicki Ball, head of housing and homelessness services at Phoenix Futures, explores what this means for drug and alcohol treatment.

Here at Phoenix Futures, we believe that the strategy must take wider determinants of women’s health into account, including access to universal and specialist services, and experiences of services, which will be different among different groups. Gendered inequalities fostered by service design are compounded when women have multiple health and social care related needs.

For example, it is widely acknowledged that access to statutory mental health services is severely curtailed if an individual is experiencing drug or alcohol dependency. Likewise, people with mental health conditions can struggle to jump through the hoops required to access drug or alcohol treatment.^[1] Women are particularly disadvantaged by these strictures because women are more likely to experience mental ill health than men.^[2] They are also more likely to have caring responsibilities, to live in poverty, or to experience interpersonal violence in the home, all issues that can cause health problems as well as impact on ability to access services that provide treatment.

Phoenix Futures worked with nearly 4,000 women across our community, housing, and rehab services last year. All were using substances problematically. 66% additionally were experiencing mental health problems, a proportion that rises to 90% amongst women who accessed our residential rehabs.

Rehab operates as a particularly good treatment setting for people who are experiencing multiple needs, taking away some of the challenges inherent in delivering treatment in the community to those who may lack a stable base or support network, struggle to attend structured appointments, or who require additional treatment.

For those women facing the most complex needs, time in residential rehab affords the opportunity to receive intensive support across a range of areas in addition to drugs and alcohol, including mental health, housing, offending, and family support. Treatment is delivered within a supportive community. Time away from stressful lives gives participants the opportunity to reflect, contemplate, and affect change. It is an evidence-based treatment and it is effective.

In 2015, following consultation with women we worked with in HMP Holloway, we opened a gender-specific residential rehab in London, developing a trauma-informed psychosocial programme alongside highly personalised access to mental health treatment, including specialist eating disorder support and one-to-one clinical psychology input. The women we worked with had multiple, and often complex, needs. 71% had a mental health need for example. Almost half were homeless at admission. 39% had a history of offending.

A significant number of them were also mothers, and this was central to their identity. They had found it impossible to access and coordinate the range of support they needed in the community – residential treatment was a must for these women. The service was inspected by CQC, who rated it Outstanding. It was among the very best in the very small sector of rehabs for women.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Phoenix Futures

Three quarters back tighter gambling ad restrictions

News

DDN

June 17, 2021

More than three quarters of adults and two thirds of 11-17-year-olds back a ban on gambling adverts on TV and radio before 9pm, according to a YouGov survey of almost 12,500 people.

More than 60 per cent of adult respondents and 53 per cent of younger people also said they would back a complete ban on advertising for gambling products.

chair of the Gambling Related Harm All Party Parliamentary Group, Carolyn Harris MP — Chair of the Gambling Related Harm All Party Parliamentary Group, Carolyn Harris MP

Three quarters of adults and 64 per cent of younger people were also in favour of stopping gambling ads before 9pm online and on social media, with 65 per cent and 54 per cent respectively backing a ban on sports sponsorships. Three quarters of adults also supported a requirement for the industry to pay a levy to finance efforts to tackle problem gambling.

The Royal Society for Public Health (RSPH) is calling on the government to tighten gambling ad regulations as part of the Department for Digital, Culture, Media and Sport’s ongoing review of the Gambling Act. There have long been calls for a compulsory tax on the industry to fund support for people with gambling issues (DDN, June 2019, page 5) , while last year the regulatory bodies overseeing the industry were branded ‘complacent and weak’ by a parliamentary committee (DDN, July/August 2020, page 4).

‘Advertising is a powerful force in our society – it not only influences what we buy, but it also tells us what is normal, and what we should aspire to,’ said RSPH chief executive Christina Marriott.

The DDN guide on gambling addiction helps identify problems and the available treatment options.

‘Given the harm that gambling can inflict on individuals, families, workplaces and communities, we need to take a stronger stand against it being embedded into our social and cultural lives. We no longer allow air time to other products which harm our health, like tobacco products: gambling should be no different.’

‘There is strong public and parliamentary support for a ban on gambling advertising,’ added chair of the Gambling Related Harm All Party Parliamentary Group, Carolyn Harris MP. ‘Gambling companies claim there is no evidence that gambling advertising causes harm. In fact, there is extensive evidence that shows how harmful gambling advertising can be and, in particular, the impact gambling adverts can have on children. Gambling advertising should be banned to protect children and those at risk from gambling harm.’

Meanwhile a new evaluation of the gambling support service delivered by local Citizens Advice centres in England and Wales has been published by GambleAware, with inconsistencies in screening and perceived stigma identified as barriers to success. While the expertise of Citizens Advice staff – and the organisation’s respected status – helped to uncover and support people experiencing gambling-related harm, there was an opportunity to improve the screening programme by embedding it into regular advice and further increasing awareness, said the report. The organisation screened around 30,000 people for gambling harm between October 2018 and March 2021.

See jobs in gambling treatment on DDN jobs

‘This thorough evaluation has evidenced Citizens Advice’s important role in providing advice for people at risk of or experiencing gambling harm and signposting them to help,’ said GambleAware’s evaluation and monitoring director, Helen Owen. ‘Alongside this it has helped identify the main barriers to success for the gambling support service. With this understanding we now have a clear view on what opportunities there are to improve the service. The learnings from this evaluation have contributed to the commissioning of the new process and model, at a national Citizens Advice level.’

Evaluation of the gambling support service, England & Wales at www.begambleaware.org

Scottish alcohol consumption falls to lowest level ever

News

DDN

June 17, 2021

Scotland’s population-level alcohol consumption has fallen to its lowest level since records began in 1994, according to Public Health Scotland.

‘This is a good indication that minimum unit pricing is having the intended effect,’ Chief Executive of Alcohol Focus Scotland, Alison Douglas.

Based on retail sales figures, last year saw 9.4 litres of pure alcohol sold per adult, says the MESAS (Monitoring and Evaluating Scotland’s Alcohol Strategy) report 2021. However this still equates to 18 units per adult each week, the agency states, exceeding the government’s low-risk drinking guidelines by four units.

The average price per unit of alcohol sold in off-licences and supermarkets rose by 1p to 63p between 2019 and 2020, compared to 59p in England and Wales. More than two thirds of the alcohol sold in Scotland was between 50p and 64.9p per unit, compared to 32p before the introduction of minimum unit pricing (MUP) in 2018. The number of people exceeding the 14-unit guidelines has also fallen by 10 per cent to 24 per cent between 2003 and 2019, with those in the lowest income brackets likely to consume the most.

Alcohol is still a leading cause of illness and early death in Scotland, said Public Health Scotland, with ‘significant inequalities’ in both levels of consumption and associated harms. More than 1,000 people died of causes ‘wholly attributable’ to alcohol in 2019, with the death rates far higher in the country’s most deprived areas. Despite the price difference since the introduction of MUP, Scots still bought 6 per cent more alcohol per adult than people in England and Wales, the report states, while alcohol sold in the UK overall remains 73 per cent more affordable than it was in 1987.

‘Today’s MESAS report shows population-level alcohol consumption in Scotland has fallen for the third consecutive year, with the reduction from 9.9 litres per adult in 2019 to 9.4 litres per adult in 2020 representing the largest year-on-year decrease in Scotland in the time series available,’ said Public Health Scotland’s public health intelligence adviser, Dr Elizabeth Richardson. However, it was likely that the closure of licensed premises during lockdown periods had played a part in the lower levels of consumption, she acknowledged. In 2020, 90 per cent of all alcohol sold in Scotland was via off-trade premises, compared to 73 per cent the previous year.

‘An average of 20 people per week die as a result of their alcohol consumption, and whilst this latest figure represents the lowest rate since 2012, again it is those in the most-deprived areas that are more likely to be hospitalised or die because of an alcohol-related harm,’ she said. ‘Like all harm caused by alcohol, this is preventable.’

‘We’re really pleased to see that as a nation we are drinking less for the third year running and that alcohol consumption is at a 25-year low – this is a good indication that minimum unit pricing is having the intended effect,’ added chief executive of Alcohol Focus Scotland, Alison Douglas. ‘Although the restrictions on pubs and restaurants for much of 2020 will have affected consumption across the UK, it is notable that the reduction in alcohol purchases in Scotland is greater than in England and Wales. But given nearly a quarter of Scots are still regularly drinking over the chief medical officers’ low-risk drinking guidelines, we can’t afford to take our eye off the ball where preventing alcohol harm is concerned.’

Report at:

www.publichealthscotland.scot/publications/mesas-monitoring-report-2021

Pathways residents learn cooking skills

Partner Updates

DDN

June 16, 2021

Four SIG Pathways to Independence residents have started a six-week cooking course, run in partnership with Ashdown and Medway Trust who run a housing related support hub in Chatham.

The purpose of the training is to give residents life skills to help them to be independent when they move on to their own accommodation, as well as during their stay in Pathways accommodation. The course not only teaches residents a range of cooking techniques and skills, but also how to cook on a budget.

Many residents often rely on local soup kitchens for meals, so this course will help them to develop the confidence to cook healthy meals within their budgets. The course also concentrates on training residents in the promotion of cooking and eating healthy food.

Pathways have previously put 12 clients through this course, which is run in AMAT’s state-of-the-art kitchen complex.

The residents will make a range of main courses and desserts over the coming weeks and are also able to take home and enjoy the fruits of their labour!

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Social Interest Group

What to do if you have Long COVID symptoms

Partner Updates

DDN

June 15, 2021

Turning Point offers some advice about managing the symptoms of “Long COVID”.

Feeling unwell for a long time can be distressing – and for some people, coronavirus (COVID-19) can cause symptoms that last weeks or months after the infection has gone. This is sometimes called post-COVID-19 syndrome or “Long COVID”.

As you find yourself recovering from COVID-19, you may still be coming to terms with the impact the virus has had on both your emotional and physical health. Some symptoms can get better over time, some may take longer than others, but there are things you can also do to help.

What are the Long COVID-19 symptoms?

If you’ve had COVID-19, you may find that you have continuing symptoms that last for weeks or months. Amongst others, these can include:

Breathlessness
Extreme tiredness (fatigue)
Pain in the chest, joints or muscles
A cough that’s been ongoing since you’ve had COVID-19.

Other common symptoms can include:

Distress
Anxiety
Low mood, depression
Fear of further illness, watching out frequently for bodily symptoms
Nightmares or flashbacks
Poor sleep
Fear of being stigmatised
Fear of contaminating others
Memory, attention and concentration problems.

People who were admitted into intensive care due to COVID-19 may find that recovery takes longer than people who weren’t; ongoing research is being conducted to better understand recovery.

However, it is also important to note that not all aspects of recovery from COVID-19 are negative, and not all individuals will experience difficulties. In fact, many individuals who have had severe illness experience positive psychological changes, e.g. a sense of appreciation or gratitude and the desire to help others.

What can I do if I have Long COVID symptoms?

People can experience different symptoms, either at once or at different times. If your symptoms are causing you concern or limiting your activities, you could speak to your GP or a healthcare professional (e.g. many pharmacies have a private consultation room where you can discuss your symptoms). They can discuss the care and support you might need and if appropriate, signpost you to a specialist who can help with the specific symptoms you have – for example, a physiotherapist, a dietitian. A GP can also refer you, or you can refer yourself directly to an NHS psychological therapies service (IAPT) without a referral from a GP.

There are also other things you can do to help yourself. The following ideas might help.

If your energy levels are affected:

Pace your activities. You may not be able to do everything at once or at the same pace you used to. Allow yourself to slow down; or, think about which activities you find most tiring and spread them out across the week, with plenty of time to rest in-between.

Plan ahead. If you find that your energy levels drop at certain times of day, try to avoid engaging in challenging tasks or activities during these times.

Take breaks. Build regular breaks into your daily tasks and between activities. Resting is important in helping you to recharge your energy.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Turning Point

Duterte crimes against humanity investigation moves a step closer

News

DDN

June 15, 2021

The International Criminal Court’s (ICC) outgoing chief prosecutor Fatou Bensouda has formally requested an investigation into ‘the situation in the Philippines’, she has announced.

The ICC had been analysing the country’s situation since early 2018, she stated, and ‘on the basis of that work I have determined that there is a reasonable basis that the crime against humanity of murder has been committed on the territory of the Philippines between 1 July 2016 and 16 March 2019 in the context of the Government of the Philippines “war on drugs” campaign’.

At least 6,000 people are known to have been killed under president Rodrigo Duterte’s anti-drugs crackdown, although campaigners believe the true figure to be far higher. Duterte, who was elected after promising on the campaign trail to ‘fatten the fishes’ on the bodies of dead criminals (DDN, October 2016, page 8), withdrew his country from the ICC after it began its preliminary examinations in 2018 and has said it would not cooperate with any investigation.

Amnesty International called the move a ‘landmark’ step that brought justice closer for bereaved families. ‘This announcement is a moment of hope for thousands of families in the Philippines who are grieving those lost to the government’s so-called “war on drugs”,’ said secretary general Agnès Callamard. ‘This is a much-awaited step in putting murderous incitement by president Duterte and his administration to an end.’

The ICC’s intervention must ‘send a signal to the police and those with links to the police who continue to carry out or sanction these killings that they cannot escape being held accountable for the crimes they commit’, she added. ‘State-sanctioned killing and incitement to violence by government officials has become the norm under the Duterte administration. Considering the Philippine government’s role in these ceaseless killings and the absolute impunity which prevails in the country, the ICC investigation is a crucial step for justice to move forward.’

Registered Nurse – Worcestershire

Featured Jobs

DDN

June 14, 2021

London gets first dedicated detox unit for homeless people

News

DDN

June 10, 2021

A new detox unit for homeless people will open in London next week, PHE has announced. Based at St Thomas’ Hospital in Lambeth, the Addiction Clinical Suite will also feature a full holistic support programme including access to psychiatrists and psychologists.

London Mayor, Sadiq Khan: ‘The health issues experienced by people who are homeless are often complex and entrenched, and there are no quick fixes.’

The facility will ‘plug a known gap in treatment facilities dealing with serious alcohol and substance dependence’, says PHE. A report by St Mungo’s published last year found that at least 12,000 people experiencing homelessness had gone without drug and alcohol treatment in 2018, a year when drug poisoning deaths among this population rose by more than 50 per cent (DDN, February 2020, page 4). Around 60 per cent of people sleeping rough now have a drug or alcohol problem, the report added, while the average life expectancy for someone sleeping rough in England is now 44.

The hospital setting of the new facility will help people to receive the wide range of care they need, says PHE, including essential screening, vaccinations, smoking cessation and healthy eating. The agency’s partners in the initiative include the Greater London Authority, Guy’s and St Thomas’ NHS Foundation Trust and London boroughs, with funding from both central government and local authority treatment budgets. Local councils will also ensure that those supported by the service ‘have somewhere suitable to go after their detox period has been completed’, states PHE.

‘The window for helping those with addictions can often be incredibly small and ensuring immediate access to appropriate detoxification and treatment can be life changing,’ said London mayor Sadiq Khan. ‘The health issues experienced by people who are homeless are often complex and entrenched, and there are no quick fixes.’

‘We are delighted to have been able to lead on the creation of this fantastic new unit that will provide life-changing and life-saving treatments to some of London’s most vulnerable homeless people,’ added head of alcohol, drugs and tobacco at PHE London, Alison Keating. ‘Joint working with some of the city’s leading organisations has helped us to provide this avenue off the streets and out of addiction. We will continue to work across organisational boundaries to build on this innovation and make a real and sustained difference to London’s most vulnerable populations.’

Forward ‘Reach Out’ service praised by HM Chief Inspector of Prisons

Partner Updates

DDN

June 10, 2021

The Forward Trust’s online chat service, Reach Out, was judged ‘notable positive practice’ by HM Chief Inspector of Prisons (HMCIP) following an inspection of HMP High Down in March and April 2021.

Reach Out was launched in May 2020 to provide advice, support and reassurance to people affected by or concerned about drugs, alcohol and related issues. Operated by a team of specially-trained staff and volunteers, the service has helped over 3,000 people.

In a report following its inspection, HMPCIP said of Reach Out:

‘The Forward Trust had set up an online chat service for prisoners on release and their families who had concerns about drugs and alcohol or housing and benefit needs. This was a positive initiative.’

HMCIP defines ‘notable positive practice’ as:

‘Innovative practice or practice that leads to particularly good outcomes from which other establishments may be able to learn. Inspectors look for evidence of good outcomes for prisoners; original, creative or particularly effective approaches to problem-solving or achieving the desired goal; and how other establishments could learn from or replicate the practice.’

One of only two examples noted by HMCIP in its report, it is welcome recognition of the important work carried out by the Reach Out team, as well as the value of innovative digital services for supporting prison leavers and their families.

Forward also provides substance misuse, careers advice (IAG) and family services at HMP High Down.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by The Forward Trust

COVID fails to dent ‘resilient’ European drug market

News

DDN

June 9, 2021

The European drug market has ‘continued to adjust’ to disruption from the COVID-19 pandemic, says EMCDDA’s European drug report 2021: trends and developments.

Traffickers in a ‘resilient and more digitally enabled’ market have adapted to border closures and travel restrictions, as reflected in changes to trafficking routes and less reliance on human couriers.

While street drug markets were badly affected by early lockdown restrictions and there were localised shortages of some substances, sellers and buyers have increasingly migrated to encrypted messaging services, social media platforms and the dark web, says EMCDDA, with the result that ‘a long-term impact of the pandemic could be the further digitalisation of drug markets’.

Cocaine remains the second most-used drug in the EU after cannabis, with purity remaining at high levels. A record 213 tonnes were seized in 2019 and preliminary data from last year suggests that availability has not declined during the pandemic. A recent Europol report detailed how Latin American criminal networks were increasingly moving into the European cocaine market, attracted by the higher prices and lower risks than in North America (DDN, May, page 5).

Almost 50 new NPS were reported in 2020, including potent new synthetic cannabinoids and opioids, bringing the number being monitored by EMCDDA to 830. While purity levels of MDMA powders also remained high – along with the availability of pills with high MDMA content – demand had declined during lockdown.

‘Evidence shows that, in the early lockdown periods, there was less consumer interest in substances usually associated with recreational events – such as MDMA – as people stayed at home,’ says the agency. ‘However, analysis of wastewater samples (available for some European cities) suggests that levels of use of most drugs bounced back as restrictions on movement, travel and social gatherings were eased in summer 2020. Among the worrying developments linked to the pandemic are signs of a possible increase in crack cocaine availability and use in some countries.’ A rise in benzodiazepine misuse was also noted, including in prison populations, reflecting high levels of availability and low cost of the drugs, while cannabis cultivation appeared stable.

There were more than 500,000 clients in opioid substitution treatment in 2019 in the EU, with opioids accounting for more than a quarter of all drug treatment presentations and involved in three quarters of fatal overdoses. However, among first-time clients entering treatment with heroin as their primary drug, 23 per cent reported injecting as their main route of administration, down from 35 per cent in 2013.

‘We are witnessing a dynamic and adaptive drug market, resilient to COVID-19 restrictions,’ said EMCDDA director Alexis Goosdeel. ‘We are also seeing patterns of drug use that are increasingly complex, as consumers are exposed to a wider range of highly potent natural and synthetic substances. We need urgently to recognise that not only is a wider variety of people now personally experiencing drug problems, but these problems are impacting on our communities in a wider variety of ways. This is why I believe it is crucial, across the areas of social, health and security policy, to develop the evidence-based and integrated responses envisioned by the new EU drugs strategy’.

Report at www.emcdda.europa.eu

Time to end ‘tobacco epidemic’, government urged

DDN

June 9, 2021

A report by the All Party Parliamentary Group (APPG) on Smoking and Health has called on the government to make smoking ‘obsolete’ by 2030.

It wants to see a consultation on raising the age limit for tobacco sales to 21 and funding for tobacco control initiatives to come from the industry itself through a ‘polluter pays’ principle. Targeted investment is also needed to help people quit in the regions and communities where smoking has the most impact, it states, such as people in manual jobs or social housing as well as pregnant women.

Half of the difference in life expectancy between society’s richest and poorest is the result of smoking, the document points out, adding that ‘for every smoker who dies another thirty are suffering serious-smoking related diseases’. A recent report found that on average smokers will need care support for everyday tasks ten years earlier than people who’ve never smoked. ‘Although in 2020 COVID-19 killed around 80,000 people prematurely in the UK, smoking kills on the same scale every year, and will go on doing so for many years to come unless we make smoking obsolete,’ the report states. ‘We are taking the necessary steps to end the coronavirus pandemic; we must do the same for smoking.’

The document wants to the see the UK take its place as a ‘global leader in tobacco control’, and revise its targets if not on track to be smoke-free by 2030. Legislation should also be introduced to put health warnings on individual cigarettes, it adds.

‘Our report sets out measures which will put us on track to achieve the government’s ambition to end smoking by 2030, but they can’t be delivered without funding,’ said APPG chair Bob Blackman MP. ‘Tobacco manufacturers make extreme profits selling highly addictive, lethal products, while government coffers are bare because of COVID-19. The manufacturers have the money – they should be made to pay to end the epidemic.’

‘We all applauded when the government announced its ambition for a smokefree 2030,’ added ASH chief executive Deborah Arnott. ‘But that was two years ago, the time has now come to deliver.’

Delivering a smokefree 2030: The All Party Parliamentary Group on Smoking and Health recommendations for the tobacco control plan 2021 here

WDP celebrate their incredible volunteers

Partner Updates

DDN

June 8, 2021

Our incredible volunteers give up their time to make a difference to the lives of our service users.

Read some of their stories and find out why they volunteer at WDP.

Zoe

WDP Peer Mentor

Without WDP I would undoubtedly still be in active addiction. WDP has given me the tools to control my addictions rather than let my addictions control me. I’ve achieved this by engaging with courses such as Giving Something Back and peer mentoring. I am now a NOVA course facilitator, basically repeating what I have been taught to others. Nobody recovers on their own, it’s about unity. I get so much satisfaction from being a part of somebody else’s recovery and to me that is immeasurable. Service users have thanked me for my help and that gives me nothing but inspiration to keep doing what I’m doing.

Ray

WDP and IRU Volunteer

‘Volunteering at WDP has been a truly great experience, and I’m amazed at how much I’ve been able to learn. I’ve been co-facilitating one of the groups at a local service and gotten to work alongside people with decades of experience in this field. As someone who’s always had a keen interest in psychology it’s given me the opportunity to learn and apply a lot of what was only an academic understanding up until this point. I’ve been struck by how friendly and helpful the staff here at WDP are, and the compassionate approach they take towards clients has definitely given me something to aspire to.’

If you are interested in volunteering at WDP and would like to find out more, visit our Volunteeringpage.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by WDP

Past its sell-by date

Features

DDN

June 7, 2021

The latest APPG for Drug Policy Reform meeting was held on the 50th anniversary of the Misuse of Drugs Act – legislation that was very much no longer fit for purpose, delegates heard.

‘The Misuse of Drugs Act was introduced at a time when a woman could be legally sacked for being pregnant, smoking was normal everywhere from cinemas to doctors’ waiting rooms, and The Black and White Minstrel Show was a staple of prime-time BBC,’ Transform chief executive James Nicholls told an All-Party Parliamentary Group for Drug Policy Reform event to mark the act’s 50th anniversary. Held in collaboration with Transform and the Drugs, Alcohol and Justice Cross-party group, the meeting reflected on the act’s legacy and what needed to change.

‘One of the most important areas of social policy is still bound by legislation passed 50 years ago,’ said Nicholls. ‘That’s a long time for any legislation to stay in place without amendment or reform’ – particularly as so much had since changed around issues like use, attitudes, harm and availability.

It wasn’t just that the act was out of date, he said. ‘It’s not fit for purpose, and most obviously it’s failed dramatically to achieve its own aims.’ Aside even from drug death rates, there had so far been 1.8m convictions under the act across the UK, and three million criminal records including cautions – ‘that’s a lot of people who’ve been criminalised.’ Despite all the evidence of failure, however, there remained ‘an extraordinary political taboo on discussing how we got this policy so wrong and the changes we can introduce to rectify things. To say that “this is the best we can do” is to accept that the failures we see all around us should simply remain in place.’

Making it worse

The current laws ‘paradoxically make things worse’ in that they encouraged the use of more harmful substances, said chair of Drug Science and former ACMD chair Professor David Nutt. ‘Alcohol isn’t the most harmful drug to the user, but it’s the most destructive drug, by far, to people who don’t use it.’

Drugs that caused relatively less harm to the user – and vanishingly small harm to society – such as ecstasy, LSD and mushrooms were subject to harsh legislation, with the UN conventions that the UK ‘followed slavishly’ seriously damaging research into the potential benefits of psychedelics, for example in treating depression and other conditions. ‘It’s the worst censorship of research in the history of the world,’ he stated. ‘Never has access to a research tool been so effectively demolished by any kind of control. You might argue that these controls are necessary to reduce recreational use or harm, but there’s virtually no evidence that they have. It’s the worst of all worlds.’

Ray Lakeman, campaigner for Anyone’s Child, told the meeting how both of his sons had died from an MDMA overdose. ‘When I talked to their friends at the funeral, one of the things that came across was that although they were shocked and saddened they weren’t going to stop taking drugs,’ he said. ‘They just wanted their drugs to be safer.’

At their inquest pathologists, police, and the coroner were discussing ‘recreational’ doses of MDMA, he continued. ‘So the authorities knew this drug could be made safe, but because the drug was unregulated my sons had no way of knowing what they’d taken. People are going to take drugs, so we should have policies in place that protect them. The only way I can see of doing that is regulating the drugs that are available.’

A blunt tool

When it came to policing, it had been neither fair nor evidence-based, said Katrina Ffrench, founding director of Unjust CIC, which challenges discriminatory practices in the criminal justice system. The Misuse of Drugs Act had, however, been used ‘for decades to over-police black British communities’ she said. ‘And although those communities aren’t more likely to use drugs than their white counterparts, they’re much more likely to be stopped and searched – research shows up to nine times more likely.’

This ‘blunt policing tool’ compounded the damage by putting more people into the criminal justice system and harming the relationships black, Asian, ethnic minority and white working-class communities had with the police, she stated. ‘It results in a toxic distrust. The narrative that’s put out is that it’s all about protection, when actually it’s about marginalisation and alienation.’

Ruthless policy

Former undercover drugs officer, Neil Woods, shared some of his often-harrowing experiences as an undercover drugs officer. ‘I used to seek out the most vulnerable people, because they were the easiest to manipulate,’ he said. ‘If that seems ruthless, it is – that’s the essence of a punitive drug policy.’

After being arrested, one person had ended up on minute-to-minute suicide watch in his cell. ‘He thought I was his one friend in the world, someone he could open up to about his abusive father and the reasons for his problematic heroin use. My betrayal tipped him over the edge. I was aware I was causing emotional harm, but I carried on doing the work because I’d rationalised that the end justified the means.’ This ruthlessness was a key part of drug policy at every level, he said – ‘the belief that we can cause harm in order to achieve some victory.’

Later he infiltrated a notorious drug gang that used gang rape as part of their ‘reputation building’, he told the meeting. ‘They were doing the normal gangster things like kidnappings and maimings but they were most notable for their sexual violence.’ After seven months of highly dangerous work he’d gathered evidence on almost 100 people – ‘the six main gangsters running the supply and 90 of their back-up staff, the runners, the sex workers, the people stashing the money and the drugs. I was jubilant – I’d literally caught everybody.’

The operation had involved police from five different counties and a ‘huge amount’ of resources, he said. ‘Then a week or so after the dust had settled I spoke to the intelligence officer tasked with finding out the impact. He said, “Yes, we managed to interrupt the heroin and crack supply – for two hours.” If you’re a problematic heroin user that isn’t even enough time to withdraw.’

The illusion of success

Every time a policing body claimed success in drug enforcement it was ‘an illusion’, he stated. ‘All it does is create an opportunity for a rival. And quite often a rival gang will use the mechanism of the system, through informants, to get the police to take out their opposition.’ While the police were ‘really, really good’ at catching drug dealers – ‘if you give them twice the resources they’ll catch twice as many’ – this never changed the size of the market, only its shape. ‘When you take out the gang that controls the drugs in one half of a city, the gang most able to take advantage is the one that controls the other half.’

Only health-based solutions could reduce the power of organised crime, he stressed. ‘The gangsters on our streets and around the world love the current system. The more hostile the system, the more they’ll thrive. The greater the threat of prosecution, the greater the violence to stop people informing. That’s the way it works.’

Punishing the vulnerable

‘If people are still dying in increasing numbers, the strategy clearly isn’t working,’ said head of engagement at the Royal Society for Public Health, Laura Furness. ‘And that’s before you start looking at other health harms – 60 per cent of people who inject drugs report skin and soft tissue infections, which can lead to limb amputation, kidney failure and death. The criminal justice approach we have is that we punish some of the most vulnerable people in our society.’

Public consultations had found that most people felt the current classification system was confused, inconsistent and arbitrary, she said – ‘and it means that opportunities to reduce harms by helping people to make informed choices and understand the risks are missed.’ Criminalisation exacerbated health and wellbeing inequalities, she said, while the criminal status of drugs deterred people from seeking help. ‘We want to see creation of evidence-based drug harm profiles to replace the existing classification system.’

‘Things should change, things can change, and globally things are changing,’ said Nicholls. ‘This act certainly won’t be in place in another 50 years’ time, so it’s a matter of when not if it’s reformed. We’re really hopeful that this year will mark a sea change and see the beginning of the end of 50 years not just of political failure, but also the political silence that has allowed that failure to continue unabated.’

Time to put things right

Features

DDN

June 7, 2021

How will we look back on our drug laws in another 50 years, asks Paul Townsley.

I was two years old when the Misuse of Drugs Act (MDA) became law. It has overshadowed my whole working life. Working in treatment services, it can be easy to disconnect from the law and its impact on the people who use our services – and indeed the way we have to work as a result. We react to the effects of the law, and its intended and unintended consequences, but without pause to consider the bigger ramifications or constraints that treatment is under.

Many of the people who use our services use a mixture of legal prescribed and non-prescribed drugs and illicit drugs which are made by the pharmaceutical industry, organised crime or the alcohol industry with tax revenue going to HMRC. This complex interplay between a broad range of psychoactive substances is not reflected in the act in a meaningful, rational and logical way. The criminalisation of, and stigma towards, people who use a range of drugs creates a hypocritical approach from the get-go.

Throwing out the act in its entirety isn’t practical though. At this point, it seems there isn’t the political will or the public appetite for that to be our initial goal. From my perspective, the next best thing would be for the MDA to be updated to be fair, evidence based and reflect the needs of the UK in 2021 – not 1971. Throwing out the act without a developed alternative position may create unintended consequences. But it’s important to agree in law and practice that the criminalisation of people using ‘illegal’ drugs is a flawed model that ultimately punishes rather than protects and helps people.

One way to ponder the validity of the MDA is to wonder what things would be like in 2071. Would we be reflecting on 100 years of the act and the ‘war on drugs’? What might that world look like, and what would be better?

To state the blindingly obvious, to be politically acceptable we must create the pressure, conditions, and pathway to change and move from binary discussions of ‘for and against’ to what’s in the best interests of everyone in society in the long term. We need to be pragmatic about what can be achieved, but also recognise that things are changing and we need to push that door open more widely. The increasing harms caused by alcohol, the increase in drug-related deaths and waste of resources sentencing people and their families to a life within the criminal justice system all demand urgent change.

We have a window of opportunity to take some radical steps forwards, with a new government committed to invest and the impending release of the second part of the Dame Carol Black review. We need to take a public health approach to treatment and rehabilitate people caught up in the criminal justice system – instead of referring people on in criminal justice settings we need to embed public health interventions in these settings. For people caught up in using, dealing and committing crime we need to make sure they are rehabilitated and get treatment first and foremost – not punishment.

We need to improve and protect the skills of staff working in both specialist and non-specialist settings so that people get the help they need when they are either motivated to change or require basic health and social care interventions. Senior figures in both police and probation services are stepping up and saying let’s do something different, as they can see that the MDA does nothing, save from reinforce the revolving door of custody-release-custody. As treatment providers we need to make sure our voices are as loud as others and improve treatment outcomes as we apply the evidence base of what works.

New investment needs to rebuild what has been lost over the recent years of cuts and look to the future to make sure we work with as many people as we can with the resources available. We have a once in a generation opportunity to go with the evidence base rather than what’s politically tolerable in the short term. Early intervention potentially breaks the cycle of trauma and deprivation altogether.

My hope is that in 2071 people can look back at a well-intended but flawed approach to drug and alcohol use and the moment that came when we as a country bravely changed course and moved towards decriminalisation and a public health approach.

Unlocking the Past

Features

DDN

June 7, 2021

Opening up the topic of childhood trauma in DDN has resulted in letters from prisoners that give penetrating insights on cues we are missing. Here is a selection of extracts

Twisted world

I am a very average man. I have never personally known anyone who did not suffer childhood trauma, abuse and neglect. Rich kids suffer from over-indulgence as poor kids suffer from deprivation. Most adults have coping mechanisms to deal with their problems. In this twisted modern world there are multitudes of problems. Every person’s pain is unique to them. We can sympathise, pretend to empathise and indulge their phobias, fears and fantasies. Any addiction is a temporary illness Ð madness.

Some people need help, some people give help. Some people only take Ð another addiction. Like the song says, ‘some people like to abuse, some people like to be abused’. We really are all equal in as much as we are all potential victims.

Telling people they are victims encourages them to be victims. We need a solid combination of love, care, help, tough love and complete honesty. Psychology can be used by qualified counsellors not wannabe do-gooders Ð cheap watered-down care is useless.

Childhood trauma and experiences are for life, they should be used as learning structures not crutches. Mental health problems are for life, but addictions can stop. People need to realise addictions are prisons and the pursuit of drugs is slavery.

Childhood trauma cannot be cured by drugs. Personal support and understanding should go a long way. Seventy per cent of all drugs in prison are from the NHS. Prison health care teams seem to lose something and take the easy routes. Some prison medical staff are beautiful people, but they go with the flow. It is far easier to control a mental health problem than to treat it.

Once a criminal always a criminal Ð it’s hard to get a job unless it’s Timpsons or drug dealers. We are what we lived through. We all need help. Get rid of the pretenders and help each other take the goodness from the past. Leave the crap to the wrongdoers. Do not give people reasons for failure. It’s easy to fail. Hard work can be very pleasant and rewarding Ð do not let childhood trauma maketh the man-woman.

Yesterday’s gone. Let’s start from now.

PS It’s my first time in prison. What do I know.

Richard

It’s OK to be honest

As a child growing up I knew that I wasn’t the same as other kids. I never really mixed with others, I had very little confidence and didn’t know how to start a conversation. I would always say the wrong things or my words wouldn’t come out.

That’s when I started getting bullied and when I started primary school it got so bad that I would get physically punched, kicked and robbed of property. It was most of the lads in the class but ended up being just one person for all of my time at that school. I left primary feeling scared, but I did feel stronger in a strange way.

The same thing happened all through secondary school. At home my dad suffered with severe depression and would be very angry. Me and my mum used to feel scared around him – he also had a bad addiction to gambling. When I was about 19 my anxiety was so bad I just wanted to sleep and not wake up and hope that when I did I would feel content and happy to be able to get on with life.

I was too anxious to even go to the doctors and tell them how I felt. I used to go with my dad to the pub around about when I was 19 and that’s when I discovered alcohol. As soon as I drank my first few pints all the anxiety, all the past things that had happened went away and my confidence came. I felt confidence for the first time in my life.

That was it for me. From then on I said I’ll come for a session whenever my dad was going to the pub – not because I was going to have a good time, because at that time I was suffering from anxiety and depression, but because of the way alcohol made me feel. It took the dark thoughts away, and the anxiety, and gave me confidence so I could enjoy myself.

I will have to cut this short now because I could be here forever writing. All I really wanted to try and say was my experience of alcohol abuse came from a deep-rooted cause from a young age, and that for anybody that’s reading this it’s ok to be honest and by being honest with yourself you can start to get well and concentrate on the things that triggered the drink addiction or substance abuse.

I am now 33 years old and I am serving a short sentence for abusing alcohol and all my previous times in prison have been alcohol fuelled. I am currently still battling with anxiety and depression and I am on medication for this and continue to try everything to get over it because I now fully know the reason why I have depended on alcohol for such a long time.

I believe that tackling the root cause of dependency, that’s when you can concentrate on staying clean and it can be hard but it’s worth it if it can give years of happiness and joy. The first thing I was told by the substance misuse team was… step one, we admitted we were powerless and our lives had become unmanageable.

Chris

A Means to an End

I am now 56 years old and in prison. From the age of six to 13 I was abused by my father, physically, emotionally and sexually. I have been in and out of prison since I was 20 for theft, robbery and deception. It was always a means to an end, to get money for alcohol.

Prior to the start of this sentence I never spoke about what happened to anyone except for once. I finally went to my doctor to say I wanted to stop drinking BUT I had to find a way to deal with ‘stuff in my head’.

I was referred to psychiatrists, mental health teams and as I had a few attempts at suicide, even crisis teams. Every single team or person I met said exactly the same thing Ð ‘we can’t deal with your mental health until you deal with your drinking’. I had this for two years. I even woke from an overdose in hospital to be told I would finally get some help and then psychiatrists ten minutes later saying they will do nothing because of my drinking (around three litres of vodka a day).

Nobody understands or helps with the fact I drink to mask what happened. I have been diagnosed with complex PTSD and when I came into prison I knew alcohol would be taken away. If I came in as a heroin addict I would get methadone but as an alcoholic I got nothing.

So, when I came into prison I was asking for help with PTSD. On day one I saw the GP who categorically stated, ‘I do not know why they sent you here as we can’t treat PTSD.’ Since then I have been on various ACCTS (self-harm documents) and passed around various departments but all say they can’t help. When I ask about a pathway for anyone coming into prison with PTSD to get treated it seems impossible to get any answers. I accept it is a bit more difficult as I am convicted of a sexual offence.

Finally, a year later, I managed to access CAT [cognitive analytic therapy] with a lady who comes in from outside the prison. This, for me, is exceptionally hard work confronting a lot of what happened but has finally started to look at why I drink.

In nine weeks I am due for release and the plan is to go to a rehab eventually for a 12-week period. My therapist wants to do some referrals for when I am released, to include EMDR [eye movement desensitisation and reprocessing], but with things as they are I’m told I’m not likely to know where probation want me on release, so they cannot do any referral without knowing the area I am going to.

So I fear that as I will only have a few sessions prior to release, I will end up drinking again as the reason I drink is still there, albeit partially processed.

Why is it so much of a problem for people to understand it. It took me years to get my head in a place ready to talk and then I felt dismissed by everybody due to drinking. Yes, I feel a failure but also that I have been failed.

Garry

The long road

Features

DDN

June 7, 2021

Despite recent advances and lots of passionate campaigning, there’s still a long way to go before everyone who needs naloxone has easy access to it. DDN talks to a couple of early pioneers about the ongoing struggle provide this life-saving drug.

‘The distribution of naloxone to opiate misusers should be seriously considered for trial and evaluation. While the problem of heroin misuse grows worldwide, the problem of deaths from accidental overdose is a problem we can address today. We have the opportunity to gather great potential health gains from tools already in our hands.’

So said a BMJ editorial co-authored by Professor John Strang – exactly a quarter of a century ago. The June 1996 article covers the points – not least naloxone’s ‘negligible’ potential for misuse – that have been debated endlessly since, and concludes by saying ‘We may even wish to consider its legal status so it could be sold over the counter by community pharmacists’.

naloxone posters — A national naloxone and overdose awareness campaign is using posters of people personally affected by overdose on posters all over the country. If you spot one, take a picture and tag @TalkingDrugs and @Release_drugs and they will share it on their socials. See the full range of posters at naloxone.org.uk

Yet despite much energetic campaigning – and spiralling drug death rates – we’re still a long way from that, or even from naloxone being in the hands of everyone who needs it. First developed in the 1960s, naloxone has been used to reverse opioid overdose by emergency services for more than 40 years, and in 2005 was made available under UK law to be administered by anyone for the purpose of saving a life. Despite the ongoing battle for coverage, the recent launch of a landmark national naloxone campaign using posters of people with lived experience to spread awareness and challenge stigma (DDN, May, pages 5 and 12) is a measure of how mainstream the naloxone message is now becoming.

We’ve come a long way

‘It’s come along leaps and bounds compared to how it used to be but for some reason there’s still reluctance in some places, which I’ll never understand,’ peer support lead at the Hepatitis C Trust and longstanding naloxone champion, Philippe Bonnet, tells DDN. ‘You’ve got some housing providers who still don’t want naloxone on their premises, for example. It doesn’t make sense to me. It’s legal, so what’s the problem?’

Drug services in England and Scotland were promised a belated financial boost earlier this year (DDN, February, page 4), and although it won’t replace the money lost through years of funding reductions, some of the cash is specifically aimed at widening naloxone provision. Ultimately, however, it’s still down to individual services to persuade people to actually take the kits away with them.

‘It’s how you sell it, the same as with hep C testing and treatment,’ says Bonnet. ‘We’ve got people who are really vulnerable being told, “You don’t want naloxone do you?” and they’ll say, “Nah, I’m alright” and off they go. I think local authorities could put so much more pressure on services where there’s been a death. It needs to be investigated properly – “how could we have averted this? Did they have naloxone? Why not?” If it says ‘naloxone offer refused’ on the note and nothing else, that’s not good enough. People allergic to peanuts don’t tend to refuse EpiPens, do they?’

Something that’s always been critical is having the right local champions in place, he stresses. ‘Somebody asked me how many kits I’d given out over the years – I had to think but I reckon it’s got to be 3,000 at least, and I must have trained 10,000 staff. That’s just me, so national coverage really shouldn’t be a problem. It’s about getting the right people on board who can fight your battle.’

Early champions

Another early champion is harm reduction campaigner and former GP Judith Yates, who first came across naloxone in 2009 when David Best and others were working on an early paper. This studied around 70 people who were trained in overdose recognition and management and then followed up six months later after being given naloxone. ‘Some of my patients got the kits,’ she tells DDN. ‘I remember one lad in particular, whose friend had died in his flat – he’d called an ambulance, tried CPR, done everything right. He later came back to my surgery waving a naloxone kit, and we both realised that if he’d had it at the time his friend would still be alive.’

Following the paper’s publication – Can we prevent drug-related deaths by training opioid users to recognise and manage overdoses? – the feeling among Yates and her colleagues was that it would inevitably lead to a ‘big national roll out’, she says. ‘Nothing happened. Then in 2012 we decided that Birmingham should get going, and we got the first 1,000 kits out by the end of 2013, but still no one else was doing it. Ever since then it’s been push, shove, push, shove, which is down to stigma, I suppose.’

Could the availability of nasal naloxone make a difference in improving access? Might the fact that it doesn’t involve a needle help to overcome some of those barriers? ‘I was delighted by nasal naloxone finally getting licensed,’ she says. ‘It’s such a simple thing to just squirt it up someone’s nose and see them start breathing. With nasal naloxone I also think there’s a case for having it available over the counter, which would also help to de-stigmatise it.’

‘There are a couple of issues with it,’ says Bonnet. ‘The price is one, but the other is bioavailability – it’s definitely not the same as intramuscular. Looking at the research, with intramuscular the bioavailability is much higher and it will stay in your system for longer. Having said that, I know some people will prefer it, especially a layperson. Service users won’t care – they inject anyway – but people like hostel staff may well prefer it, so it definitely has its place.’

Game Changer

Nasal naloxone has also been a ‘game changer’ for the police, says Yates – ‘they don’t want to be waving needles around’. However, while more and more forces are now running pilots and embracing naloxone’s potential (DDN, May, page 13) the issue is not without controversy. The Police Federation has expressed concerns about officers ‘being turned into paramedics’, while chair of the West Midlands Police Federation recently told Newsnight he was worried about members ‘being subject to lengthy and stressful investigations’ if someone still dies after naloxone is administered.

‘I remember a case five or six years ago where a police officer did CPR, broke a rib and got sued, so I can understand them being wary,’ says Bonnet. ‘But if you say, “What if the guy dies?” – well, if he’s going to die he’s going to die. Don’t you want to try to prevent that?’

‘It’s only the Police Federation who tend to say these things,’ adds Yates. ‘There’s no resistance from ordinary police – they’re the ones who find themselves in a car park with somebody blue at their feet and they’ve got to start doing CPR, call an ambulance and wait there. The police here in Birmingham have embraced it fully – they can save someone’s life and they don’t have to do fatal accident reports.’

On that note, it’s often been pointed out that – even putting aside every argument about compassion – naloxone makes sense purely on financial terms. It’s far cheaper to save someone’s life than for them to die, as more and more people are doing, year-on-year.

‘In our drug-related death group meetings in Birmingham I always flag up the cases of people who’ve been found unconscious but have then died in hospital of a heroin overdose,’ says Yates. ‘All of them could still be alive today if the person who’d called the ambulance had given them naloxone. Lots of my patients over the years who I see walking down the street, they wouldn’t be here otherwise. Now they’re with their families and getting on with their lives.’

Getting past the stigma

From a GP perspective, Yates has previously been exasperated that people happy to prescribe methadone and buprenorphine still wouldn’t prescribe naloxone (DDN, July/August 2015, page 15). ‘GPs give out EpiPens hand over fist to anyone who’s got a peanut allergy, but do they give out naloxone kits to everyone at risk of opiate overdose?’ she says. ‘No, they don’t.’

So how optimistic is she that we’ll soon be able to get it into the hands of everyone who needs it? ‘You need to have it with you, so even once you get past the stigma you’re never going to get 100 per cent cover. But there’s certainly scope for getting an awful lot more out there. It’s frustrating because it’s absolutely the only medicine of its kind that saves lives so quickly and cheaply. I can only think it’s because people have mixed feelings about people who use drugs, and whether they live or die. And sadly, of course, some people who use drugs can have mixed feelings about whether they live or die as well – they can take a Russian roulette attitude. But I’ve been working in this field long enough to see people come out of that pit and get on to enjoy the second half of their lives in their 30s, 40s, 50s. So never give up.

‘There is no other medicine like naloxone,’ she states. ‘There’s nothing in the whole pharmacopeia that saves a life in two minutes with no side effects and no contraindications. If someone has a heroin overdose they don’t need to die, and yet we’re still having these conversations. We’ll just have to keep nagging.’

This article has been produced with support from Ethypharm, which has not influenced the content in any way.

DDN June 2021

DDN

June 7, 2021

Drugs legislation is woefully out of date

Fifty years on, does anybody believe that the Misuse of Drugs Act is still fit for purpose? The verdict is not good (page 6). A dramatic failure, punitive (particularly to the most vulnerable in our society), neither fair nor evidence-based, a blunt policing tool that compounds damage… some of the words used in this issue.

So what next? Paul Townsley believes we have a window of opportunity for ‘some radical steps forwards’ (page 8). Carol Black’s latest report is keenly anticipated and there’s an appetite to bring a public health approach to the criminal justice system as well as all corners of society. Our letters from prisoners illustrate why this matters so much (page 16). Responding to our articles about early trauma, they are profoundly revealing. As much as they are a testament to the value of professional support, understanding and connection, they are also a reminder of the pot-luck outcomes of sending someone into the criminal justice system without knowing if the right threads will be picked up and pulled back together.

And a big shout-out to all volunteers (p10-11 and p21) as we celebrate National Volunteers’ Week. Lena’s story shows what can happen when we’re given the right environment in which to thrive – an opportunity which she’s now passing on to others.

Read the June issue as an online magazine or download the PDF

Claire Brown, editor

Email your letters and comment and keep in touch at @DDNmagazine

Forward delivers major new probation services to rehabilitate offenders

Partner Updates

DDN

June 7, 2021

The Forward Trust’s reach and impact are growing after winning contracts to deliver new probation services aimed at rehabilitating individuals and cutting crime.

Commissioned by the Ministry of Justice and delivered in partnership with organisations including the National Probation Service, Seetec, Kaleidoscope and the Lincolnshire Action Trust, the new services will tackle re-offending among male prison leavers and those on community orders aged 18 and above in both England and Wales.

In England, Forward’s new Personal Wellbeing Service will be delivered across the South East, East Anglia and the East Midlands. Working in partnership with Seetec and the Lincolnshire Action Trust, along with a wide range of local providers, the service will aim to strengthen clients’ relationships with families and significant others, improve lifestyles and networks, boost emotional wellbeing and increase social inclusion through a range of individual and group programmes, coaching and mentoring. This includes initiatives to reduce domestic violence, support stronger family relationships and better parenting, manage emotions and create positive identities.

In Wales, Forward will work with Kaleidoscope to deliver the Camau Accommodation Service. Camau – meaning ‘steps’ in Welsh – will empower clients to access and sustain safe, stable accommodation. The holistic support on offer will include a mix of training, advocacy, advice and guidance on housing and tenancies, relevant legislation and benefits, as well as peer mentoring.

Both services will begin working with clients on 26 June.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by The Forward Trust

Dedication and inspiration

Features

DDN

June 7, 2021

Volunteers Week (1-7 June) is an opportunity to celebrate the wonderful work of our volunteer workforce. Phoenix Futures and Forward Trust share their thoughts – and gratitude.

As the pandemic gathered pace in early 2020, Andy (above) moved into a role as a sessional worker and by the end of the year had become a full-time trainee recovery worker. ‘The work I did as a volunteer helped me learn quickly. I had to be proactive, and become a role model.’ Above left: Phoenix Harlow Allotment

Volunteers are a vital resource that need to be developed and nurtured, says Woosh Raza of Phoenix Futures.

As someone passionate about volunteering I’ve been looking forward to Volunteers’ Week as it always gives me an opportunity to appreciate our volunteers and reflect on their contribution to our work. This last year has been a huge challenge for everyone, and amongst all the bad times it’s been amazing to witness the crucial role our volunteers have played in helping us keep our doors open and provide much-needed support to those in desperately vulnerable circumstances. We are incredibly grateful for their dedication, loyalty and support.

The reason for my passion is that I’ve seen time and time again how volunteering can open up a world of possibilities and not just provide a stepping stone into part-time or full-time employment but into a new life. Whether it’s those who have recently completed a treatment programme and are looking to take the next step on their treatment journey, those seeking their first employment opportunity, students looking to gain experience or those returning to work after a break, the common thread is that volunteering opens so many doors to new life experiences.

It’s a testament to the great work of our teams in supporting our volunteers that I can share these stories with you. Stories such as Sarah, who joined Phoenix Futures in November 2020, during the pandemic. ‘I wanted to help individuals struggling with alcohol and to find a company that would provide me with the tools and skills to pursue a career in the field,’ she says. ‘With the assistance of my mentor and my manager, I was able to gain the confidence and skills to run my own groups and work one-to-one with clients. I’m always offered training courses which help me further enhance my skill set, and after volunteering for four months I successfully became an alcohol practitioner in the south of Essex.’

Andy’s story began in Scotland in February 2018. ‘I spent six months in the Phoenix Scottish Residential,’ he says. ‘I came with a 27-year heroin habit – I’d been in jail and on the streets. When I came in I was angry, but CBT helped me look at myself. I was always encouraged by staff, told I was capable. The department coordinator was always on my case saying I should come and volunteer.’

After completing his rehab programme, Andy remained in Glasgow and began volunteering at the residential three days a week. ‘It helped with my confidence. The coolest thing is someone saying thank you. The main idea about being a volunteer was to keep the tools I learned fresh in my head – I didn’t want it going stagnant.’ As the pandemic gathered pace in early 2020, Andy moved into a role as a sessional worker and by the end of the year had become a full-time trainee recovery worker. ‘The work I did as a volunteer helped me learn quickly. I had to be proactive, and become a role model,’ he says.

Ahmed is a member of the Phoenix Futures HR department. His route to volunteering began in Pakistan where he’d just completed his undergraduate degree. ‘After spending 22 years in my home country, I believed it was the right time to seek out another adventure and leave my comfort zone. I had very little guidance on how to study abroad, or even where to do this. I managed to get help from an international agent to proceed with my application and they suggested I apply for an MBA in International HR management from Coventry University in London.’

Ahmed struggled to find an internship for his final project before contacting Phoenix Futures, where he was offered a voluntary position with the HR department. ‘It was an interesting and challenging experience, and the team was very welcoming and happy to answer any questions I had,’ he says. ‘I appreciated that I was treated as a valued member of the team, and not just an intern who was there for two months. After completing my internship, I was fortunate enough to be offered a part-time role as a HR administrator which I accepted whole-heartedly.’

Della began volunteering with Phoenix after graduating from a community treatment programme. ‘I likened leaving treatment to having just passed my driving test. You know how to go forwards, reverse and stop but you haven’t a clue how you’ll perform in a storm or on an icy road. You have a handbook, a phone and a boot full of tools – it’s just a case of working out which tools need to be used to weather a particular storm. My tool is volunteering,’ she says.

‘I applied to become a volunteer and was invited on a volunteering skills course, and since then my interest and involvement in supporting people has just kept on growing. There are three main things I’ve noticed about myself on my volunteering journey – my self-confidence has grown, I no longer attach the feeling of shame to being honest about how I’m feeling, and my empathic opinions through lived experience are listened to and valued. I take pride in saying that I’ve just been employed by Phoenix Futures – I’m not ashamed to say I put the phone down and shed a tear because I felt that my hard work, my recovery, and me as a person are worthwhile again.’

These stories and many others like them drive my passion for building on our offer for volunteers. The events over the past year highlight more than ever the value of creating new opportunities. At Phoenix we’re committed to nurturing our volunteering communities to reflect our passion for recovery.

A leading role

Volunteers are a crucial part of The Forward Trust’s response to the challenges of the pandemic, says Valérie Ferretti.

Valérie Ferretti is recovery support team leader at The Forward Trust

Forward’s approach to volunteering has changed significantly over the past year, in response to the considerable challenges the pandemic has presented for our service delivery. Volunteering has always been a key part of our service offer, giving service users the opportunity to develop skills, build confidence and progress towards new, sustainable and productive careers. For example, we encourage people who’ve completed treatment to become peer mentors – they’re given accredited training to enable them to support those who are earlier in their recovery journeys and co-deliver programmes and interventions alongside frontline staff. Many progress to full-time paid work at Forward or other service providers. It was therefore important, both to the fulfilment of our mission and the delivery of our services, to ensure our volunteering programme continued to operate.

Our initial task was to ensure existing volunteers were supported effectively, in the face of the practical challenges of lockdown as well as its impact on volunteers’ wellbeing. The second was to slow down recruitment of new volunteers while finding new ways they could engage in our services. In addressing these challenges, we’ve not only been able to continue providing meaningful and rewarding volunteering opportunities, but volunteers have also made a significant contribution to our new and adapted service offerings.

For example, volunteers now play a key role in our digital and remote service delivery. Peer support networks and groups are central to our substance misuse services, and the lockdown forced us to innovate rapidly to ensure they continued through digital channels. Volunteers led new peer support groups via Zoom, and helped to engage service users using the Kaizala messaging app. They were also recruited and trained to deliver our new online chat service alongside permanent staff, which was developed to provide advice and support to people concerned about their drug and alcohol use and related issues during the lockdown.

Interestingly, some of the barriers to volunteering that might be expected did not materialise. For example, many people who want to volunteer with us tend to be most interested in opportunities that involve face-to-face contact. For obvious reasons, these became unavailable during lockdown, but this didn’t alter our volunteers’ interest or commitment – we actually saw an increase in demand for volunteering, including from people in employment.

The pandemic also presented an opportunity to review, improve and diversify our volunteering opportunities, as well as induction and engagement processes. We now have a greater range of volunteer roles, including new mentors for our employment service clients and young offenders, befrienders and volunteers involved in adapting training materials for digital delivery. We’ve also improved our training and induction offer – we now provide training using a more varied range of media, including e-learning, Zoom and online workbooks, giving volunteers more options. In addition, volunteers report feeling more connected to each other, and have built relationships with staff and other volunteers they wouldn’t usually have encountered in face-to-face settings – these positive changes are here to stay.

The pandemic has really brought home the importance of volunteers in everything we do. I’ve been struck not only by the unfailing demand from people wanting give up their time to support us but their immense commitment and passion. It’s been a rollercoaster of a year but, thanks to our volunteers and the changes we’ve had to implement, it’s also been a fantastic time for volunteering. It’s enabled us to move forward and demonstrate our ability to respond rapidly and adapt.

It’s My Script

Features

DDN

June 7, 2021

There’s no automatic reason to revert to stigmatising daily pick-ups, as DDN reports.

‘COVID has changed all our lives massively, as we know – but it’s affected drug users in one rather good way.’ At a EuroNPUD virtual event, Dr Christopher Hallam looked at the widespread use of take-home doses for people on methadone and buprenorphine. With restrictions in place and many drug services turning ‘virtual’, daily pick-ups and supervised consumption were changed to weekly or fortnightly scripts.

This ‘light touch’ model of treatment had been a game-changer for many people whose lives had revolved around the pharmacy. ‘A lot of people have found this a liberating experience,’ said Hallam. A survey by With You in Scotland showed that 70 per cent of the clients interviewed said they did not want to return to overly frequent pick-ups, while the University of Bristol concluded that the new routine was important in reducing embarrassment and stigma. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) observed ‘good behaviour’ throughout the pandemic, with very little diversion.

‘Methadone and buprenorphine are the only drugs where patients are required to take their drugs in front of pharmacy staff and it can be a terrible experience,’ said Hallam. ‘Drug dependence is a very stigmatised condition and frequent visits to the pharmacy can enhance stigma – surely not what we want, any of us.’ Medical confidentiality – ‘a basic human right’ – was also very difficult to achieve in the neighbourhood pharmacy.

For some people, daily pick-up would still be essential if they were vulnerable in some way – maybe feeling suicidal, being threatened, or having their medications stolen. But if not, then we shouldn’t go back to the default position of expecting people to attend the pharmacy on a daily basis, said Hallam – ‘particularly the case if you are not using on top, your life is not chaotic, and you may have a job’. Daily visits could be counterproductive in many ways, including increasing contact with other drug users which could be a ‘continuous trigger’, and it could ‘put people off engaging in drug treatment altogether’.

While many services were being supportive, some were slow to initiate change for the long term, leaving restrictive or punitive routines in place. The first thing to do in this instance, ‘is to speak to your drug service, at managerial level if possible, and ask for the reason you’re being asked to go back to daily pick-up,’ said Hallam. He had written the EuroNPUD take home OST advocacy brief to assist with this, and it included a letter to the drug service to request this and an advocacy letter to take things further if they didn’t respond satisfactorily.

Martin (Cuca) McCusker shared experience of using the advocacy brief with Lambeth Service User Council (LSUC), which was part of a consortium model with various treatment agencies. ‘For years we’ve been badgering users if they’re not happy to challenge a decision, but time and again people wouldn’t do it – they don’t want to rock the boat,’ he said.

Before handing out the brief to peers he showed it to staff so they were aware of it and had ‘nothing but positive feedback’. The document made clear to keyworkers that in most cases there was no need to go back to supervised consumption. ‘It makes clear what the drug user thinks of this degrading process – it will never be a therapeutic intervention,’ he said.

Of four cases in which LSUC trialled the brief, three had the successful result they wanted. The fourth person had various health risks that meant the longer intervals weren’t suitable at the present time, but enabling them to challenge their prescribing regime in this constructive way was still positive – ‘they came away feeling that they were heard by the worker, and the worker knows how they feel about supervised consumption.’

Head of legal services at Release, Kirstie Douse

The initiative was being taken further in partnership with Release, explained their head of legal services, Kirstie Douse. As ‘honest brokers’ for people in drug treatment, Release was creating and distributing an advocacy toolkit for people who use drugs and service user representatives, to be used in situations where OST was being refused, reduced or withdrawn. With funding from the Baring Foundation, they would be delivering training to service users and peers, and providing additional advocacy and legal support around it.

‘The creation of the toolkit needs to be informed and influenced by people using advocacy,’ said Douse – hence the partnership with EuroNPUD. It was designed to capture good as well as bad experiences and had benefited from diverse opinions. Drafting, review and launch of the toolkit would be followed by training events in the autumn.

The EuroNPUD take home OST advocacy brief is available at https://bit.ly/3cd5y6a

Lockdown Lifeline

Features

DDN

June 7, 2021

Kerrie Clifford and Allysa Hornbuckle describe how letters from members of AA got prisoners at HMP The Verne through lockdown.

Read it in DDN Magazine

‘I don’t get any visits. I haven’t got anyone but the letters feel like a visit from a friend.’

Never was the power of the pen more in evidence than during lockdown, when members of Alcoholics Anonymous (AA) wrote letters of encouragement and inspiration to prisoners at a Dorset prison, HMP The Verne. These letters kept inmates focused on their recovery in such a special way that the initiative received the high sheriff of Dorset’s award.

The award is given to members of the community who make a difference to other people’s lives without the expectation of anything in return, so who better to receive it than the selfless men and women of AA and the staff at HMP The Verne? They facilitated the programme and made it their business to ensure the letters continued to be delivered during lockdown.

Award winners — Pictured, from left to right: Hatti Amos (ISMS support worker), Richard Homer (ISMS recovery lead), high sheriff of Dorset George Streatfeild, deputy governor Andy Tanner, Lucy Bradley (ISMS recovery worker).

The reality of lockdown meant that men in custody often stayed locked away for longer than usual and many of their support systems like focused group work and one-to-one counselling were unable to operate. However, a glimmer of hope lay in the link that prisoners already had with members of AA via the letter-writing scheme. If staff could ensure that these letters continued to be written and delivered, then clients who were trying to remain focused on sobriety had a ray of hope.

‘When we got shut down ages ago for COVID-19, all the support networks I had significantly decreased as there were no visits, phone time was really limited, and the amount of people you could socialise with went from 600 to 20 people,’ said one inmate. Such a drastic change was likely to cause significant challenges but with a little imagination and drawing on the support of EDP Drug & Alcohol Service’s integrated substance misuse team (ISMS) who work on the wings of the Verne, the men in custody were thrown a lifeline. As one inmate said, the letters ‘provided me with a support bubble despite my normal support being gone’.

AA members had developed a weekly letter-writing rota, and as the letters continued to flow more and more prisoners began to ask if they could receive one. ‘The letters kept me motivated and on track as I didn’t feel like I was in it on my own when I read them,’ said one, while another talked about how they had helped him ‘keep focused on what I’m doing now, and also prepared me for release as they reinforce the importance of an alcohol-free life’.

Lockdown highlighted what was really important in life for a lot of people, and at HMP The Verne men learned about the simple need for friendship, a sense of belonging, and a network of people to help stay true to the path they’d chosen. Staff noticed the differences with the inmates and witnessed how the letters kept the men focused on their recovery and ‘created the idea of “I’m not in this on my own.”’

‘From the limited face-to-face contact and receiving their written correspondence, it’s evident that the clients who do receive the letters look forward to them enormously as they’ve acted as a constant reminder of what they’re doing now and what they’ve achieved,’ said EDP Drug & Alcohol Service’s ISMS support worker Hatti Amos. ‘I think without the letters some of the clients would have increasingly felt the impact of their circumstances. However, the letters have highlighted that even through adversity, they have that inner strength to effectively maintain their recovery journey and take the positives, regardless of how small, from any situation.’

Kerrie Clifford is marketing and communication manager at EDP Drug & Alcohol Services; Alyssa Hornbuckle is Humankind intern — Kerrie Clifford is marketing and communication manager at EDP Drug & Alcohol Services; Allysa Hornbuckle is Humankind intern

Words of encouragement, empathy and wisdom have provided these men the strength to stay focused. The high sheriff of Dorset heard about the letters and wanted to thank and reward the people of AA, as well as the substance misuse team and staff at HMP The Verne. Now, with the lockdown restrictions easing, the AA programme will slowly resume in face-to-face form, with real contact between the men in custody and the people in AA who support them. It’s safe to say that the men are truly excited to have the meetings start again, while the high sheriff’s award is now proudly displayed in the visits hall.

Stronger Together

Features

DDN

June 7, 2021

The legal niceties on the merger between Forward Trust and Action on Addiction were completed on 1 May, on which date over 100 staff became employees of the Forward Trust, and the merged organisation took responsibility for all contracts and delivery for Clouds House, the SHARP day programmes in Essex and Liverpool, the M-PACT Family programme, and the CATS training service.

All mergers cause some disruption, and the legal and HR procedures are complicated, but this has felt like a smooth process – with a clear shared mission and culture between the two organisations, and an excitement around what the future can bring. We aim, as an expanded Forward Trust (we are also mobilising around £6m of new probation contracts at the same time), to be a strong and consistent voice in the sector – providing high quality services, but also campaigning to raise public and policy understanding of the causes of addiction and social exclusion, to tackle the stigma our clients face, and to improve the design of our responses.

This latest step change in the scale and reach of our services underlines our core mission – learnt through decades of managing recovery programmes for people struggling with drug or alcohol dependence, but now applied to a wider range of client groups and situations (offenders, homeless, long-term unemployed, those struggling with mental health problems). We believe that anyone is capable of making transformational changes to the direction of their lives. With determination and support, our clients can break the cycle of addiction, offending and social marginalisation to build a positive and fulfilling life.

We are clear on the shared beliefs that lie behind this mission:

• That the root causes of most people’s slide into addiction or criminal lifestyles are adverse experiences (neglect, abuse, trauma) in childhood or adolescence. Most of our clients have been dealt a poor hand in life. They may not always have made the right choices, but they deserve our support to change the script.

• That most people want to change – they don’t choose a life of desperation, conflict and marginalisation. But they have lost, or never had in the first place, the tools to get out of the negative cycles they find themselves in.

• Consequently, instilling belief in our clients that a different path is possible, and that they are capable of following it, is a crucial component of recovery. The visible presence of role models with lived experience is therefore central to our service design.

• Services funded by the taxpayer – as most of ours are – should be designed to maximise, and be measured by, their impact on bringing about these changes.

It is important for organisations in the social care sector to have a clear set of beliefs, shared by everyone involved, that give us clarity on what we come in to work every day to achieve. I am proud that Forward Trust has this ‘mission drive’ and I would guess that similar motivations are driving most of the people working in this sector. But I am not sure that commissioners and providers spend enough time on ensuring that services are designed to represent these principles, and that we maximise the opportunities for personal development and recovery that exist in our clients.

Forward Trust jobs — Join the team at Forward Trust. See their latest vacancies here.

Whether people come to us for help with drugs, alcohol or other addictions – or practical help with employment, housing or prison releases – our approach is the same: how can the individual be helped to find their own strength, and the support of those around them, to become more than their past.

We structure our services according to four stages

Of course, it’s rare for an individual to pass through these stages in a simple and linear process, but they are useful in giving staff and clients a framework for the progress we hope our clients can make:

PAUSE – this refers to efforts to help clients rise above the pressures of often chaotic lives to stay safe, and find some stability to consider their options.

ENGAGE – where clients are ready, we work hard to build their motivation to believe in change.

DEVELOP – For those who have committed to turning their lives around, we offer a range of intensive programmes and pathways that focus on an individual’s personal development.

PROSPER – Where clients take the reward for their hard work, and pursue their interests with work, family and community – we try to continue helping them by creating peer-led recovery communities through our Forward Connect network.

Obituary – Kazim Khan, 1936-2021

Features

DDN

June 7, 2021

Last month saw the peaceful passing at age 85 of Muhammad Amir Kazim Khan, or ‘Kaz’ as he was affectionately known, a gentle giant of aristocratic Indian Raj origins.

Kazim was not just active in the race and drugs sector in Britain, but largely created it during his work at the Standing Conference on Drug Abuse in the 1980s and ’90s and then in the EU-funded and UK versions of T3E (‘Toxicomanie Europe Échanges Études’) and the Race and Drugs Project.

His scholarly but also activist and very practical brand of anti-racism realised that accusations of overt racism were rarely justified or the way forward in the substance misuse treatment sector, where people often chose to sacrifice what could have been more lucrative or status-enhancing careers to work with and champion the most stigmatised, unconventional and despised in our society.

Instead, not-so-benign neglect leading to effectively discriminatory practices characterised a sector which saw itself as already facing up to the stigma and discrimination inherent in the position of illegal drugs and their users in society – at an organisational level, racism is not a unitary thing or an intention, but an outcome of practices such as an agency’s human resources policy, its service development programme, or its communications strategy, which combine to adversely ‘impact on a category of the population that has already been classified in a racialist manner’ (Drugs : Policy and Politics). The way forward was to bring these practices to light through a guided and forensic examination of the organisation’s procedures and priorities (operationalised in Action Points for Change) underpinned by an awareness of how systemic racism arises, and then to challenge and change them.

Driven by personal experience, compassion and a sense of justice, it is hard to believe that those who worked in the sector during Kazim’s time (and in some cases still do) will ever be matched, but that may be to misread the genesis of this remarkable generation.

No matter how conventional the entry route, open minds will be affected by encounters with the built-in unconventionality and survivor capabilities of committed users of stigmatised and banned drugs. Like them, they will find that really doing the job properly involves a preparedness to bend some rules and extend beyond comfort zones in favour of an overarching rule – to do the best you can for your patient, client and community.

Kazim did not just exemplify that generation of giants, but challenged it and took it by the hand to make it aware of the race-related dimensions of its work, leaving a legacy in the form of many who would otherwise never have considered race and racism were issues for them or their services.

He taught them that if they are truly to do the best for all their actual and potential service users, these issues can no longer be sidelined – and that the examination of systemic racism will improve a service not just for visible minority populations, but also for the ‘white’ majority.

As well as his vocational legacy, Kazim leaves behind someone for whom he always expressed a tender love – his wife Anita, a pocket dynamo with a monumental personality, and also a much-loved figure in the substance use sector, and his daughter Yumna and grandson Jamie.

Born in a leap year on 29 February, Kaz would joke that he was really only 21. He will be remembered as forever youthful in his charm and openness to new experiences and learning, even though he had so much to teach the rest of us.

Obituary by Mike Ashton, Editor of Drug and Alcohol Findings.

Forward Momentum

Features

DDN

June 7, 2021

April 2021 was a huge month for the College of Lived Experience Recovery Organisations (CLERO). After more than a year of building relationships, trust and a sense of shared purpose in the group of 12 members, we have finally reached a position where we have invited both LEROs and other interested parties to join us.

We now have more than 50 members and we are continuing to grow and expand, in spite of our cautious approach. This culminated in a Recovery College event on 23 April, where we were delighted to welcome Dame Carol Black to address more than 100 delegates. She spoke of the central role that she sees lived experience playing in the treatment and recovery system of the future, and her optimism of achieving genuine and meaningful change.

We also used the event to start consultation and LERO engagement in our work to develop quality standards for lived experience recovery organisations. Our framework for this is inclusive and strengths-based and so our initial plan is to have standards – two for each of the letters in the acronym CHIME:

Connectedness
Hope
Identity
Meaning
Empowerment

Participants at the Recovery College were asked to provide examples and principles from their own lives and work to inform the initial iteration of the standards, and we will continue to engage with those who volunteered to be part of our working groups as we develop and test these models. This way of working allows us to have a bottom-up approach that means everything we do is informed and developed by the people we serve.

This links to our second key work theme for which we are delighted to have received funding support from the Big Lottery. This project has four aims for the CLERO:

To recruit and train people of lived experience across the UK to be the first cohort of peer researchers
To undertake an audit of innovation and good practice in LEROs across the UK
To undertake fieldwork that will inform the development of our quality standards
To set up a CLERO website to engage with LEROs and with other key stakeholders

To support this, on 27 and 28 April we ran the first two of four days’ training over Zoom and in the offices of the Well in Barrow in Furness. Thirty-one people with lived experience participated from across the UK, and will become a cohort of lived experience researchers who will design, carry out, analyse and write up the audit and the standards fieldwork. We will look to run another round of this training in 2022, drawing from the membership of the CLERO (our tier 2 partners).

The event was hugely successful and we will use the follow-up two days late in May to finalise our research work and to start the process of measuring what it is LEROs do and achieve – please join us and contribute to our journey. For further information about joining please contact LERO.connectors@gmail.com

David Best is professor of criminology at the University of Derby. Dave Higham is founder of The Well Communities

Dual Diagnosis Worker – Croydon

Featured Jobs

DDN

June 4, 2021

Therapeutic Manager – Kent

Featured Jobs

DDN

June 4, 2021

Scotland publishes new treatment standards

News

DDN

June 1, 2021

Ten new standards for drug treatment have been published by the Scottish Government’s Drug Deaths Taskforce, with the aim of reinforcing ‘a rights-based approach for people who use drugs and the treatment they should expect, regardless of where they live’.

Scottish drug policy minister Angela Constance

The standards apply to both substitute medication and psychological and social support, and stress the importance of people being able to make informed choices about the kinds of medication and help available. People must also ‘be able to start receiving treatment on the day that they ask for it’, the Scottish Government states. Funding from the annual £50m for treatment services announced earlier this year (DDN, February, page 4) will ensure that alcohol and drugs partnerships are able to embed the new standards by next April, it adds.

Four separate funds worth a total of £18m are also open for applications from not-for-profit organisations in the drugs sector, the Scottish Government has announced. They are a £5m recovery fund to improve residential capacity, a £5m improvement fund for outreach services, a £5m local support fund and a £3m children and families fund. The schemes will run for five years and are intended to improve access to treatment and support consistent standards.

‘We now have a set of standards which are safe, accessible and person-centred,’ said drug policy minister Angela Constance. ‘These will help ensure consistency of treatment across the country. Making help available and giving people an informed choice is an essential part of respecting a person’s rights and dignity. It is also an approach which is more likely to be effective and provide people with the support and treatment they need.’

‘Scotland’s MAT [medication-assisted treatment] standards are the most significant landmark in improving Scotland’s response to problem drug use in over a decade,’ added Scottish Drugs Forum CEO David Liddell. ‘Implementing the standards will be the most significant development in addressing the ongoing public health emergency of drug-related deaths.

People who enter treatment are amongst the most vulnerable people in our society and often find engaging with services difficult. Services need to be more attractive, more approachable and more accessible, and reach out to people who have been in treatment but no longer are. These standards are the basis for making services truly person-centred. Implementing them will help services develop empowering relationships with people in treatment. Full implementation of the standards will save lives, reduce harm and transform people’s quality of life.’

Medication assisted treatment (MAT) standards for Scotland: Access, choice, support are here

Fund details at www.gov.scot/news/funds-open-for-drugs-services/

MUP has had ‘lasting impact’ on drinking levels

News

DDN

May 28, 2021

Minimum unit pricing (MUP) is having a lasting impact in reducing alcohol consumption in ‘some of the heaviest drinking households’, according to new research by the University of Newcastle published in Lancet Public Health.

The team looked at the alcohol purchases of more than 35,000 households across the UK, and found they had fallen by almost 8 per cent in Scotland following the introduction of MUP in 2018.

The households that tended to buy the most alcohol were the likeliest to reduce their purchases in both Scotland and Wales – where MUP was introduced last year – researchers found. MUP’s impact was measured by using northern England as a control for Scotland and western England as a control for Wales. However, some high-purchasing households in the lowest income bracket had not reduced their purchasing levels, meaning they were now spending more on alcohol than before. A full evaluation of the impact of MUP will be published by NHS Health Scotland in 2023.

‘We can now see that the introduction of MUP in Wales at the beginning of March 2020 has had a similar impact to the one we saw in Scotland in 2018, and we hope to see a continued benefit,’ said study lead Professor Peter Anderson of Newcastle University. It was, however, ‘a concern’ that high-purchasing, lowest income households ‘did not adjust their buying habits, and their spending simply increased as a result of the MUP policy’, added co-author Professor Eileen Kaner. ‘This is something that we want to explore further so we can better understand the reasons behind this, as well as its impact.’

Alcohol Health Alliance chair Professor Sir Ian Gilmore.

‘This is powerful real-world evidence of the success of minimum unit pricing as a harm reduction policy,’ said chair of the Alcohol Health Alliance, Professor Sir Ian Gilmore.

‘Westminster has said time and time again that it is waiting for evidence from Scotland and Wales on minimum unit pricing. The evidence is here – it’s time for the government to introduce minimum unit pricing in England in order to save lives, cut crime and reduce pressure on our NHS and emergency services.’

Meanwhile, smoking killed around 8m people worldwide in 2019, according to another Lancet study, with the number of smokers now at a record high of 1.1bn people. The increase is being driven by population growth, it says, with almost 90 per cent of smokers becoming dependent before the age of 25.

Researchers estimated the prevalence of smoking and its attributable disease burden in more than 200 countries from 1990 to 2019. Over the past three decades, more than 200m deaths have been caused by smoking, with the annual economic impact exceeding US$1tn, it says. While smoking prevalence had reduced worldwide, ten countries now accounted for two thirds of all global smokers, including China, India, Russia, Japan and Indonesia, with 341m smokers in China alone.

Alcohol study here

Smoking study here

COVID-19 and learning disability – change must come

Partner Updates

DDN

May 28, 2021

Turning Point’s national director of operations, Clare Taylor, discusses the impact of the COVID-19 pandemic on people with learning disabilities.

Inequalities in health outcomes for those with a learning disability has long been an issue. On average, the life expectancy of a man with a learning disability is 14 years shorter than the general population; this rises to 18 years for women^[1]. NIHR research released in March 2020 also found that people with a learning disability are more likely to be admitted to hospital with conditions that could be prevented by better community and primary health care^[2].

Regretfully, the COVID-19 pandemic has exacerbated these pre-existing health inequalities. The range of measures put in place to stop the spread of COVID-19 has led to increased isolation, hardship and put a toll on some of the most vulnerable in society. As a provider of residential care and supported living services for people with a learning disability, we have seen these issues first-hand and worked where we could to mitigate them.

Professor Tom Shakespeare at the London School of Hygiene and Tropical Medicine has been primary investigator on research looking into of the impact of the pandemic on people with a disability. Through the use of qualitative interviews with a range of stakeholders, they painted a picture of the struggles that people have faced over the last year.^[3]

Professor Shakespeare’s research found that many people with a disability have really struggled with isolation through the pandemic.

At Turning Point, we have witnessed the impact of national guidance restricting visits from friends and family in residential social care settings first hand. It has been particularly challenging for people with limited capacity to understand the reasons for successive lockdowns and despite sterling efforts from support staff to maintain contact with friends and family, the lockdowns have placed huge pressure on mental wellbeing of people we support, particularly those with limited verbal communication.

On the plus side, we have been able to continue to provide support in our residential and accommodation based services throughout the pandemic.

Professor Shakespeare also highlights the closure, or suspension, of day centres, day services and large sections of the social care system and the fact large numbers of social care contracts were cancelled, put on hold, or severely limited as key issues which heightened this isolation and put pressure on informal carers.

The pandemic has also impacted access to health services. A recent study into the experiences of people with autism found significant barriers when accessing COVID-19 services. They found that interruptions to standard health and social care left over 70% of autistic people without everyday support.

In addition they found that in spite of people with autism being at elevated risk of severe illness due to co-occurring health conditions, there was a lack of accessibility of COVID-19 testing and that many COVID-19 outpatient and inpatient treatment services were reported to be inaccessible, predominantly resulting from individual differences in communication needs.

Professor Shakespeare’s research also found examples of difficulty accessing services when they were moved online during the pandemic. Many of the changes presumed that people have access to the internet, however for those who didn’t there was a “double exclusion”.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Turning Point

Kayleigh’s SUG

Uncategorized

DDN Help User

May 28, 2021

We are a service user-led group that focusses on wellbeing and taking a holistic approach to members’ journey of recovery.

Website: http://www.kayleigh.com
Telephone: 00000 000 000
Email: 123@emailprovider.com

Experts call for drug law reform

News

DDN

May 27, 2021

‘One of the most important areas of social policy is still bound by legislation passed 50 years ago,’ Transform chief executive James Nicholls told an All-Party Parliamentary Group for Drug Policy Reform event to mark the 50^th anniversary of the Misuse of Drugs Act.

‘That’s a long time for any legislation to stay in place without amendment or reform. It’s not fit for purpose, and most obviously it’s failed dramatically to achieve its own aims.’

More than 50 MPs and peers have now signed a statement calling for urgent reform of the act, alongside health specialists, charities, bereaved family members and former police officers. For half a century the act has ‘failed to reduce drug consumption’, it says. ‘Instead it has increased harm, damaged public health and exacerbated social inequalities. Change cannot be delayed any longer. We need reform and new legislation to ensure that future drug policy protects human rights, promotes public health and ensures social justice.’ An early day motion has been tabled calling on the government to recognise that the system is not working and to adopt a science-led approach.

James Nicholls: We need to break the deadlock

The UK’s drug-related death rate remains one of the highest in Europe, despite the annual £1.4bn cost of drug enforcement in England alone. According to data analysis by Transform, drug deaths in England and Wales have risen by more than 7,000 per cent since the act came into force, from 38 to 2,883, while heroin use has increased from less than 10,000 people to a quarter of a million.

‘The Misuse of Drugs Act has been a disaster,’ said Nicholls. ‘In the 50 years since it was introduced, we have seen both use and deaths rise dramatically. The UK now has the highest drug deaths in Europe, and the situation continues to get worse. The government’s recent review of drug markets sets out this failure in detail, and confirms that it cannot be resolved simply through more policing. We need to start a debate now to finally break the deadlock.’

Statement at transformdrugs.org/mda-at-50/parliamentary-support

See feature in the June issue of DDN

How Forward’s enterprise support is creating new opportunities for economic growth

Partner Updates

DDN

May 26, 2021

Photo by Glenn Carstens-Peters on Unsplash

Forward’s social enterprise development manager, Tev Souleiman, reflects on Forward’s enterprise support over the past year and shares the organisation’s plans for the future.

Social enterprises are a powerful means of creating employment and economic opportunities for the people we support and their communities. Entrepreneurial and responsive to their audiences’ needs, they are also empowering, giving people with lived experience the chance to unleash their talents and shape their own futures.

That is why Forward launched our first Enterprise Strategy in 2018. Part of our wider work to support people from disadvantaged backgrounds into meaningful and rewarding employment, away from past offending or addiction, it focused on providing intensive enterprise coaching for our clients who wanted to become self-employed or set up their own businesses.

Until March 2021, our strategy was supported by the Forward Enterprise Fund, which invested £400k in eight social enterprises to help with their growth ambitions. Delivered in partnership with the Social Investment Business, it also included financial pledges through a crowd funder scheme.

And our client group is truly diverse. To date: 35% of our clients have been from BAME backgrounds; 22% have been female; and 40% presented with mental or physical disabilities.

Responding to the pandemic

When I joined Forward in March 2020, the enterprise service was really beginning to flourish. Our enterprise coach, Stephen Anderson, was supporting a varied and exciting caseload, and when Covid-19 made face to face support impossible, our team quickly embraced digital platforms such as Microsoft Teams and Zoom to support our clients throughout the many challenges of the pandemic. As Tinyan Okungbowa, founder of Chasing Prospects CIC, explains:

“Covid-19 and the lockdowns presented various challenges, but Stephen maintained contact with me throughout. The constant encouragement via emails and calls increased my confidence and helped turn Chasing Prospects into fully-fledged organisation.”

Our online support also included a series of seven enterprise masterclasses. Delivered in partnership with Deloitte and a range of fantastic organisations and speakers, these reached over 200 participants from pre-start-ups, new enterprises and other professionals in the sector.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by The Forward Trust

Ian’s training

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DDN Help User

May 26, 2021

With experience in many diverse areas, CJ Wellings can be your ideal publishing partner. Let us help you communicate in print, online and in person.

Website: http://www.cjwellings.com/
Telephone: 123
Email: ian@cjwellings.com

Cross-party MPs demand reform of UK drug laws

Partner Updates

DDN

May 26, 2021

27th May 2021 marks 50 years since the UK’s Misuse of Drugs Act 1971 received Royal Assent. This pivotal anniversary has spurred charities, senior scientists, ex-police, public health specialists, bereaved family members, and over 50 MPs and Peers from all parties to sign a statement calling for the Government to urgently review the Misuse of Drugs Act.

The joint statement says, “The Misuse of Drugs Act (1971) is not fit for purpose. For 50 years, it has failed to reduce drug consumption. Instead it has increased harm, damaged public health and exacerbated social inequalities. Change cannot be delayed any longer. We need reform and new legislation to ensure that future drug policy protects human rights, promotes public health and ensures social justice.”

According to the latest Home Office review, the annual cost of drug enforcement in England alone is £1.4 billion, yet the UK currently has one of the highest drug-related deaths rates in Europe.

New data analysis by drug reform charity Transform Drug Policy Foundation shows that since 1971, the Misuse of Drugs Act, or the ‘War on Drugs’ has failed to reduce harms or protect people (full data analysis and sources available on request).

In England and Wales alone:

• Annual drug-related deaths have risen from 38 to 2883 – an increase of over 7,000%
• Heroin use has increased from under 10,000 people to over 250,000 – an increase of 2,500%
• Cannabis use has increased from around half a million people to over 2.5 million – an increase of 400%
• Cocaine seizures have increased from around 6kg a year to over 4,000kg a year, a 666 fold increase, but the UK still has the highest rate of cocaine use in Europe (with 5.3% of young adults using cocaine in the last year).

MPs from across the political spectrum are making the case for reform, and highlighting the failure of the Misuse of Drugs Act to fulfil its primary purpose of protecting UK citizens against the harms of drugs:

“The Misuse of Drugs Act is hopelessly outdated and in need of urgent reform and change. Drugs policy should no longer be seen through the narrow prism of the criminal justice system but as a health issue, so that we can ensure those with drug dependence can get better access to the help and support they need.” – Dr Dan Poulter MP (Conservative)

“The Misuse of Drugs Act was supposed to eradicate drug use, reduce harm, and keep people safe. But since 1971, drug use has risen dramatically in the UK, decent people have been needlessly criminalised and had their lives destroyed, those struggling with addictions have been stigmatised and punished, thousands of children have fallen victim to trafficking and exploitation at the hands of criminal gangs, and we are in the midst of a devastating drug-related deaths crisis.” – Jeff Smith MP (Labour)

The All-Party Parliamentary Group on Drug Policy and the Cross Party Group on Alcohol, Drugs and Justice will meet on 26th May to mark the 50 year anniversary and discuss options for reform. An Early Day Motion has been tabled to coincide with the meeting calling on Government to be led by the science, and recognise the overwhelming evidence that the current system is not working.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Release

New maps identify areas of need for gambling treatment

News

DDN

May 25, 2021

A new series of interactive maps to identify local levels of demand for gambling treatment has been released by GambleAware.

The maps show usage of – and reported demand for – support for gambling harms according to local authority areas and wards.

The maps detail the areas of higher take-up for gambling treatment as well as localities where there are increased levels of awareness of the services available. In areas of higher demand, the charity urges local authorities to ‘do more to promote the existing help available through the National Gambling Treatment Service’. The data is based GambleAware’s annual GB treatment and support survey, which is an overview of treatment demand and usage as well as prevalence of gambling-related harms. Just under 1% of adults are estimated to be problem gamblers, with a further 1 % considered to be at moderate risk.

‘We want to assist local authorities and services in delivering the best possible treatment and support for gambling harms in their area,’ said GambleAware’s research, information and knowledge director, Alison Clare. ‘These new interactive maps can be used to identify shortfalls between treatment and support services and prevalence of gambling participation and harms, which can be used to inform local responses. The existing support available through the National Gambling Treatment Service can be used to help address these shortfalls.’

Maps available at www.begambleaware.org/gambleaware-gb-maps

Placing quality of life at the heart of transformation

Partner Updates

DDN

May 24, 2021

Davinder Jhuty, national head of service – learning disability at Turning Point, discusses the importance of multidimensional support strategies in treatment outcomes.

By putting the lives and choices of people at the centre of transition and transformation thinking, it has brought about radical change in the way we can enlarge people’s opportunities for empowerment and self-determination. The process starts by looking beyond a referral document and supporting the person to reimagine their ambitions and priorities in a life recontextualised by the opportunities afforded by a supported safe independent home.

The essential quality of human life is the core measure of success in transformative support services; yet the concept of quality is highly individual and someone’s choices may be abstract and seemingly subjective to others. How do we start the conversation about quality of life with someone for whom emotional and physical harm, substance use, traumatic experience and instability in housing, work and education have been the fragile building blocks of their early lives?

This came to mind when I was looking at a post-transition review of support for two women with whom we worked recently to achieve move-on from secure custodial environments into their independent supported homes in the community. Fundamentally the achievement of improved quality of life has been rooted in a collective understanding of what is required to resolve past experiences so we can support each woman to start visualising a better future.

As professionals, we are too well aware of the challenges of prioritising and coordinating support requirements with people experiencing complex needs; especially when historical behaviour is often used by many in the referral pathway to determine assessments of current risk and need. Considering these two women, their individual and collective complex needs span traumatic experiences, mental health conditions, substance use, physical conditions, autism, unsafe living environments, destructive co-dependencies and resultant criminal behaviour. Both had detailed referral information which told us much about their past lives and less about their present priorities and future aspirations; yet it was clear both women had so much potential to achieve that previously elusive better quality of life.

So how did we start to understand what ‘better’ looked like? Core to the success now achieved by both women was the deployment of a multidimensional support strategy led by an experienced skilled manager who acted as a key worker. The manager created a small highly knowledgeable internal Turning Point team from learning disabilities, substance misuse, mental health and forensic colleagues.

This team worked as one – a bespoke complex support panel – with a defined lead. This minimised the number of assessments and conversations had with both women whilst optimising the richness of those conversations. The key worker manager became a central coordination point for a multitude of external stakeholders across mental health, physical health, housing, social care, the justice system and now for natural support networks.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Turning Point

Change Grow Live is working with Norfolk Police to prevent overdoses

Partner Updates

DDN

May 21, 2021

Change Grow Live is working in partnership with Norfolk Constabulary to prevent overdoses and save lives.

Naloxone is an emergency drug that temporarily reverses the effects of opioids like heroin, methadone, opium, codeine, morphine and buprenorphine.

We’ll be training 310 police officers in the Norwich and Greater Norwich area on how to use naloxone. They’ll be carrying Nyxoid kits, which administer naloxone via a nasal spray. If someone overdoses on an opioid, naloxone will reverse the effects for 20-60 minutes, giving you time to phone an ambulance. This collaboration with Norfolk Constabulary shows the difference we can make when we work together.

You can find out more about naloxone here.

If you want to find out about getting a free kit and training, give us a call on 01603 514096.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Change Grow Live

A quarter of adults worried about their post-lockdown drinking

News

DDN

May 20, 2021

One in four adults in the UK are concerned about the potential impact of lockdown easing on their alcohol consumption, according to new research by With You.

With You's new short film. — Watch and share ‘finding the right moment’ With You’s new short film.

A poll of 2,000 people commissioned by the charity found ‘widespread concern’ about falling back into old drinking habits or shaking off drinking patterns developed during lockdown.

The same proportion also said they’d be reluctant or embarrassed to seek support for problematic alcohol use, while two thirds wouldn’t feel comfortable starting a conversation with a partner, friend or family member if they were worried about their drinking. This is despite one in ten respondents saying that they did have concerns about someone else’s drinking.

The charity has also launched a new public awareness campaign to help people have ‘more open, positive’ conversations about alcohol. ‘Find the Right Moment’ includes a video about how to raise the issue of someone’s drinking and encourage them to seek appropriate help, as well as a campaign page with links to alcohol support locally or online. The keys to talking to someone about their drinking include properly preparing yourself, looking for ‘green light’ moments and being patient, says the charity.

With You’s executive director of services for England, Jon Murray

‘For many, the long-awaited easing of lockdown restrictions is an exciting time, allowing people to socialise and reconnect with friends and family,’ said With You’s executive director of services for England, Jon Murray. ‘But this research shows that for some it’s also a time of heightened concern, with many feeling pressure to drink more when socialising, worrying they’ll be unable to reverse drinking habits developed during lockdown or fearing they may fall back into old habits.

‘Alcohol is everywhere in our society, but often people feel ashamed and embarrassed to talk about it, compounding feelings of shame and isolation,’ he continued. ‘Behind most recovery stories is the support of family and friends. People are understandably worried about how and when to bring up the issue of a loved one’s drinking, fearing they could make things worse or be met with anger, but a non-judgemental conversation can make a big difference and be the first step in someone making positive changes.’

Find the Right Moment campaign at:

www.wearewithyou.org.uk/support-our-work/find-right-moment

‘Appreciating nature soothes my soul’

Partner Updates

DDN

May 19, 2021

For Mental Health Awareness Week, staff and clients of The Forward Trust shared examples of how connecting with nature supports their wellbeing.

JP, client, Forward at The Bridges residential rehab

Over the past few years, I have lived a chaotic lifestyle and as a result, my mind tends to drift off quite a lot. Nature helps me to meditate, bring my mind to the present moment and focus on the here and now. Nature is beautiful and it is important for me to admire God’s creation.

Going out into a natural environment keeps me grounded; appreciating nature soothes my soul and relieves me of stress. Listening to the sound of birds chirping calms me and keeps my mind present.

At The Bridges, to connect with nature, we have done some horticultural activities like planting and nurturing different types of plants, and we have recently started to go out into nature together. We have all been stuck indoors a lot because of the lockdown, which can get a bit depressing, so I suggested that we should have more days out. As soon as we started going out for walks and bike rides, breathing in the fresh air and appreciating the outdoors, there was a shift in the mood of the whole house – everyone starting to feel uplifted.

Our next activity is a fishing trip, and I’m looking forward to it – I’ve never fished before! After that, we’ll be visiting the Humber Bridges – all these thing are going to have a positive impact on our mental health.

Valérie Ferretti, recovery support team leader

During the pandemic it has been a struggle to manage the lack of social interaction, not seeing family abroad and coping with juggling home schooling. The sudden loss of my 16-mile-a-day ride to and from work removed me from nature and I started appreciating how important it was to me to connect to nature. We are so lucky, even in London, to have so many parks, commons and woods around us, so there are many opportunities to escape from our built environment.

I started replacing my morning ride with a brief walk around one of the local woods. When it snowed, it was lovely to get out early and go sledging before starting work. If you walk to your local park or wood you can sit down, close your eyes, listen to the birds and forget where you are for a while. It is amazing how only 15 or 20 minutes outdoors can ground you and prepare you for the day ahead!

The winter lockdown was harder, so I made a commitment to meet a friend for an hour’s walk each week. It has now become our self-care routine and we are still doing it and feeling the benefits, lockdown or not!

I was also lucky to be granted an allotment last summer and I would definitely recommend getting yourself on the waiting list for a plot. This is not just about the exercise, fresh air and nurturing and seeing your plants grow, but the amazing sense of community. We all call each other neighbours, support each other and share plants.

It also helps me and my little boy feel more connected to our second home, France, that we have been unable to visit and closer to our family there, all of whom grow their own veg. And by sharing tips on how to look after our plots, it gives my parents a way of getting involved too, even though they’re in France. They’re looking forward to being able to come and help us!

It is still hard to not know when we will finally see family again and strange to think that this summer, it will two years since I last saw them. When it feels overwhelming, I force myself to do something outdoors. It always has me feeling better and more appreciative of what I have, rather than what I miss and cannot have.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by The Forward Trust

Nurture from nature

Partner Updates

DDN

May 18, 2021

Jon Hall, Phoenix’s environment and sustainability manager, reflects on the value of nature to aid recovery from addiction and poor mental health.

Phoenix Futures’ Recovery through Nature (RtN) programme model has three key elements that act as catalysts for self-efficacy and self-actualisation during someone’s recovery:

Producing/doing something positive and tangible
Engaging with nature
Working as a team.

I set up the programme 20 years ago and it now stretches from Fife through to Essex in community, prison, and residential settings. It’s at the forefront of our work.

Our data supports RtN as being a powerful therapeutic recovery tool, and for many people I speak to, they tell me it is where they can find purpose, peer support and community. As well as being my focus for the last 20 years, it’s great to see it become an essential part of so many recovery journeys and central and to their wellbeing.

The isolation and uncertainty of Covid-19 disproportionately affected the people that we support, so my team were determined to keep RtN functioning as much as was feasible and offer our people something to engage with during this difficult period. In our residential settings, this was simpler as the programmes remained fully open, but proved more challenging and required some innovative thinking in our community-based projects.

As soon as the first lockdown was hinted at, we launched our ‘Dig For Victory!’ – a project I created with the intention of growing as much veg and salad as possible. It would give our people something positive to focus on and provide healthy, nutritious food for people who needed it.

In our community projects, we purchased and distributed as many seeds (with compost, pots, and instructions) as we are able to access, along with distributing plants to nurture. My RtN team leaders kept in regular contact with people on the RtN programme who were living in isolation and gave them nature-orientated ideas to engage with during their daily exercise. Linking people to an objective gave them something, however small, to focus on in the darkest and most challenging of times – all in line with my vision of RtN being an inclusive family.

I’ve been amazed how lockdown has acted as an accelerant for many RtN orientated objectives. For example, we started to share suggestions and advice on conservation and horticulture and develop ideas for competitions and activities that people could realistically engage with.

For example, our next project was ‘The Great Purple Potato Challenge!’ with the objective being to see who could grow the most potatoes in a bucket from a single seed potato. This saw staff, people who use our services and their families all learning how easy it is to grow and nurture healthy food that can later be eaten.

We also ran ‘The Phoenix Futures’ Mission to Mars’ where we asked people to grow plants to donate to our ‘Busy Beeing Recovery!’ projects, through which we are creating beautiful pollinator-rich habitats from February through to November for our endangered wild bee populations (and many other species).

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Phoenix Futures

SIG takes part in Mental Health Awareness Week

Partner Updates

DDN

May 17, 2021

SIG participated in the just concluded Mental Health Awareness Week – here is a snapshot of the week’s activities.

Biscot House

Biscot House decided on an afternoon away from the project with a kickabout in the park and picnic. Unfortunately, due to very wet weather, getting out to the park was not possible so they decided to have the picnic indoors and have a chat over lunch.

Two residents participated in the picnic and lots of discussions over a wide spectrum were had, often discussing mental health without realising it.

The kickabout will be rescheduled and could become a regular activity in the future

Bridge House

Staff at Bridge House held a pamper afternoon with residents, to give the mums a relaxing afternoon where they could de-stress and have some time doing something nice for themselves.

Staff and residents made homemade face masks with natural products; one with honey, oats, yogurt, and lemon for exfoliating and reviving dull skin and one with avocado, yogurt, and kiwi for combination skin. Not only was this about learning how to make masks on a budget from everyday items in the house, but also learning and understanding the benefits of some foods, such as honey, which has antiseptic healing properties.

One resident said: “Looking good and feeling good helps with mental health and self-esteem.”

After the pamper session, everyone sat together for a lunch of tuna pasta.

All residents were gifted a hair mask treatment to use in the evening once the children were in bed.

The morale in the house was very positive and shows that a little self-care can go a long way to support mental health and wellbeing.

Enfield

The Enfield service got together with the Enfield Community Rehab Team (ECRT), who they work in partnership with, and organised a party for residents at Enfield. It was a good opportunity for staff and service users to sit and socialise as a team.

Four service users helped staff from the ECRT put together a gazebo, just in case there was rain. The psychologists commented on how well they worked as a team and how proud they were with the effort put in to working collectively to get the job done. Amongst the participants was a service user who struggles on a day-to-day basis to get out of their flat and interact/socialise.

It was a very happy and proud moment to see these service users come together and go that extra mile and push themselves for a positive cause. A garden party where food, drinks and music were provided, was a great opportunity in an informal setting for staff to speak with and understand how each service user feels and what goals they would like to achieve for the future.

This party also provided the opportunity for new members of the ECRT to introduce themselves to the service users they will be working with closely and learn how best staff can support them during their time with Enfield.

There were seven service users in attendance and the party provided an opportunity to socialise in a fun and safe environment.

All in all, it was a great outcome for all.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Social Interest Group

More support is needed for people with complex needs and their end of life care

Partner Updates

DDN

May 14, 2021

Close up of holding hands — Photo by Joey Yu on Unsplash

Writing for Dying Matters Awareness Week 2021, Gill Campbell, head of nursing at Turning Point, talks about the importance of palliative care for those with complex needs.

A conversation many of us don’t like to think about, it can be difficult to discuss end of life care with our loved ones. In the last year, coronavirus has put death into the mainstream like never before, beaming onto our television screens every night.

For Dying Matters Awareness Week, the theme this year is ‘In a good place to die’, focussing on the importance of having plans in place and being able to talk openly with close friends and family about our dying wishes.

People we support at Turning Point with a learning disability or autism, mental health or drug and alcohol problems often experience poor end of life care. This can be due to limited healthcare knowledge on the part of their primary carers and a generalised approach to palliative care that doesn’t consider complex needs.

Everyone should have fair access to care and advocacy where needed to support them to have as dignified and peaceful death as possible. As a matter of human rights, each person should be seen as an individual; there is no right or wrong way to die, it’s different for everyone. Health inequalities affect the people we support not only throughout their life, but at the end of their life.

Health and social care providers, like Turning Point, have an important role in ensuring everyone has access to care. Using knowledge accumulated over 50 years in the sector, we can offer support and advice to palliative care clinicians when they’re supporting someone with complex needs. For example, if someone has a history of opioid addiction, then they would need higher doses of morphine to manage pain.

By being registered to the correct GP, someone can ensure they are as close as possible to primary care. As a GP is the primary contact for end of life care, it can pose a problem for someone with complex needs. People with a learning disability are less likely to have access to primary care: in 2017/18, only 55.1% of patients with a learning disability received an annual learning disability health check.

A prevelant issue within the drug and alcohol community is homelessness. Without proper identification, it’s impossible to register with a GP, meaning they would go without primary care access and likely be passed between multiple services.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Turning Point

The Forward Trust and Action on Addiction join forces to reach more people

Partner Updates

DDN

May 13, 2021

The Forward Trust and Action on Addiction have joined forces to expand much-needed addiction recovery services in the UK.

The Forward Trust and Action on Addiction are uniting their efforts by merging to create a powerful force for recovery from addiction, at a time when there couldn’t be a greater need for these services.

The charities join forces to reach more people in more places to live their lives free from addiction and the stigma associated with it.

Both charities share a longstanding commitment to helping individuals achieve long term, stable, abstinence-based recovery from addiction, and supporting families affected by addiction.

The Covid-19 pandemic has had a devastating impact on individuals and families who are affected by all forms of addiction. Rates of harmful drinking and drug-related deaths are at an all-time high; gambling addiction is rising exponentially, and families and children are living with the hidden harm of addiction in greater numbers than ever. All this is happening at a time when access to treatment is diminishing.

The two charities have joined forces in response to an ever pressing post-Covid surge in demand, combining their expertise to create a powerful voice to achieve lasting change in relation to addiction and recovery.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by The Forward Trust

Connecting with nature is essential to good mental health

Partner Updates

DDN

May 12, 2021

Connecting to nature’s miracles can bring tremendous benefits, says Mark Peters.

Connection to nature is fundamental to good mental health.

However, our busy lives keep us distracted from this in lots of different ways: the ever-pinging notifications on our phones demanding our attention to a screen, the concrete, tarmac and brick environments many of us live in, the tight schedules filled with work and home-life leaving little space to stop and pause.

What would happen if we were to stop and pause, just for a moment, and engage our senses?

We’d feel the solid earth beneath our feet, an ever-present, always-reliable support to stand and face the day’s difficulties. We might hear the rustle of the newly-sprouted leaves that sway in the breeze heralding summer’s arrival.

We’d feel the touch of the sun’s May warmth on our skin, gentle and comforting. In our darkest moments, when perhaps depression has us in its grasp, or during the overwhelming agitation of a bout of anxiety, nature remains all around us: a reliable, undemanding companion.

Spending time immersing ourselves in the natural world brings tremendous benefits.

Movement, fresh air and sunlight do wonders for our physical body, improving our stamina and immune systems, as well as promoting improved sleep. Exercise releases endorphins and serotonin, the chemicals produced by our bodies that improve our mood. Time spent in nature can boost our emotions, help us to feel more motivated, and give our self-esteem a lift.

A few years ago I worked with a man who experienced depression and anxiety. His cramped, noisy home was a place he often felt unsafe and alone. It was also where he spent almost all of his time.

We explored small changes he could make to help him improve his mood day-to-day. Spending time outside was one of the possibilities we identified. For the next week, he spent time each day exploring the local park, finding different paths and places to sit, and even discovering the beauty of the local river.

He reported a marked improvement in his mood, his levels of motivation and his self-esteem directly as a result of his explorations of the natural spaces around him. He made huge progress with his mental health issues.

Carl Jung the psychologist said: “I want to be freed neither from human beings, nor from myself, nor from nature, for all these appear to me the greatest of miracles.” I think Carl Jung was right: we’re surrounded by nature’s miracles. This Mental Health Awareness Week, it’s important to reflect on the tremendous benefits reconnecting to those miracles can bring.

Read the full blog post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by With You

WDP to provide substance misuse services to rough sleepers in Camden and Islington

Partner Updates

DDN

May 12, 2021

WDP are delighted to announce that they have been successful in two bids to deliver substance misuse services to rough sleepers.

The new services will be delivered in the London Boroughs of Camden and Islington. Each service will operate an outreach model of psychosocial support and prescribing to help rough sleepers address their substance misuse issues and eventually enter structured treatment.

Several new roles are needed for the new service. Click to see these and other opportunities with WDP.

The services’ key focus is people’s safety, and staff will be out in the community, working with rough sleepers wherever they feel comfortable and safe. In both boroughs, there will be specialist roles that will work with women and also around dual diagnosis, to help those experiencing complex mental health and substance misuse problems.

WDP’s Capital Card will also play a big role in helping people get the essential items they need and find their feet in the community.

Lisa Luhman, Commissioning Manager for Camden & Islington Public Health said: ‘Camden and Islington are excited about the development of the new rough sleeper services, and believe the services will achieve great outcomes for some of our most vulnerable residents.’

Yasmin Batliwala, Chair of WDP said: ‘Winning two new contracts to provide substance misuse services for rough sleepers in Camden and in Islington is a testament to the quality of our care. We will be able to reach more people in need of our services, especially rough sleepers who are particularly vulnerable. We look forward to welcoming new staff, and new hope into the WDP family.’

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by WDP

Two years on from their merger with Blenheim, Humankind’s work in the capital is going from strength to strength, says Manish Nanda.

Read some of their stories and find out why they volunteer at WDP.

Zoe

Ray

Volunteers Week (1-7 June) is an opportunity to celebrate the wonderful work of our volunteer workforce. Phoenix Futures and Forward Trust share their thoughts – and gratitude.

Website: http://www.kayleigh.com Telephone: 00000 000 000 Email: 123@emailprovider.com

Website: http://www.cjwellings.com/ Telephone: 123 Email: ian@cjwellings.com

Website: http://www.kayleigh.com
Telephone: 00000 000 000
Email: 123@emailprovider.com

Website: http://www.cjwellings.com/
Telephone: 123
Email: ian@cjwellings.com