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Time to ban all gambling ads, say MPs

The All Party Parliamentary Group (APPG) for Gambling Related Harm has called for a ban on all gambling advertising as well as a complete overhaul of the UK’s system of gambling regulation. ‘The Gambling Commission is not fit for purpose,’ it states. 

APPG chair Carolyn Harris
APPG chair Carolyn Harris

The recommendations are among more than 30 set out in the APPG’s final report into online gambling-related harms, following a year-long enquiry. The group, which comprises more than 50 MPs, is also calling for a ban on all ‘VIP’ schemes and inducements – a ‘cynical tool to incentivise problem gamblers’ – and for the stake limits for online slot machine style games to be capped at £2, ‘given the potential to cause harm’. The APPG has previously called for a £2 stake limit in its interim report (DDN, November 2019, page 5). 

The group’s final report is based more than ten evidence sessions, as well as submissions from a wide range of stakeholders. Other recommendations include a new Gambling Act to reflect the realities of the digital age, as well as affordability limits to be set and imposed by the Gambling Commission. According to the commission, there almost 400,000 problem gamblers in the UK, with at least 1.8m more considered ‘at risk’. A recent report from GambleAware found that just under half of people with a gambling disorder had never accessed support (DDN, June, page 5). 

The COVID-19 pandemic has underlined the need for greater protection for people who can ‘gamble with ease from home, at any time of day and at any level, via a mobile phone’, says the APPG, which also refutes claims that it is prohibitionist or anti-gambling. ‘This is to debase what is an important discussion to protect vulnerable people and children and prevent online gambling harm,’ it says. 

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

This multi-million pound industry has destroyed people’s lives,’ said APPG chair Carolyn Harris.They resist change at every turn and claim to be reforming themselves but put forward limited changes. Their primary motive is profit. During the COVID pandemic they said they would end TV and radio advertising (DDN, May, page 4) but just ended up replacing ads with ads – that none of us want to see. They have shown time and again that they will not effectively self-regulate. We cannot ignore this any longer. Urgent change is needed to stop this industry riding roughshod over people’s lives.’ 

Report from the Gambling Related Harm All Party Parliamentary Group: online gambling harm inquiry, final report at www.grh-appg.com

Bill Nelles – Doctor Wars (part one)

In the first part of his two part series ‘Doctor Wars’ Bill Nelles describes how the running battles between substance misuse clinicians in the ’70s and ’80s helped to shape today’s treatment landscape.

Bill Nelles
Bill Nelles is an advocate and activist, now in Canada. He founded The (Methadone) Alliance in the UK

What to do about opiate use and users has been discussed, argued, and shouted about for more than a century now to relatively little positive change. It’s like the opening song in The Sound of Music – ‘how do you solve a problem like Maria?’ Only no one ever does solve the problem of Maria (although I think it has something to do with finding love and, of course, climbing every mountain – a familiar metaphor for any users).

The same seems true for opiate users. We dutifully sing the songs asking for help, but too often leave disappointed. There are still hundreds and even thousands of opiate-dependent users in the UK and around the world who want and deserve a safe supply of that medicine under medical oversight, and finally some are getting it. And I use the word oversight for a reason. It should mean ensuring services are providing empathic access to a safe supply with all the social support, trauma therapies and help with housing that we know are essential to settling down to a life of quality without the poisons on our streets. Having all these is what saved me for nearly 40 years. All were necessary for me and there should be widespread shame at the lack of this joined-up care today.

It wasn’t until the late ’60s that serious prohibition started in the UK – largely because young people, not elderly users and dependent doctors, were now using heroin and getting it from doctors famous for their unusual prescribing locales like coffee bars and street corners. Some changes were understandable as the system was anarchic and largely unregulated.

But the ‘classic’ NHS clinics born around 1969 all had differing attitudes with little agreement on what to do within the teams formed to run them. Thus the era of the ‘doctor wars’ broke out – psychiatry came to dominate treatment in the UK, leading to psychotherapy becoming the approach, and in London high quality Chinese heroin replaced the state gear. So people voted with their veins.

This was in direct contrast to Dr Vincent Dole and Marie Nyswander’s approach in New York that saw opiate use as a physically mediated condition that was treatable but not curable, and not always responsive to psychotherapy. Opiate receptors were identified soon afterwards, and real research started uncovering just what was going on.

But the UK’s NHS drug dependency units were taken over by psychiatrists, not medical doctors. With some notable exceptions, their goals were abstinence through withdrawal and therapy. All these psychiatrists who held the new licences needed to prescribe heroin hardly used them, with a few notable exceptions. People were moved onto oral methadone or nothing if your particular clinician wouldn’t prescribe, or you only had access to a non-medical community drug team – tea and sympathy (of little use) if you were ‘lucky’, but confrontation if you weren’t.

The fights at the monthly meetings held at the Home Office Drugs Branch during the ’70s to mid ’80s brought together psychiatrists who hated prescribing, some of the private doctors who could still prescribe some opiates and opioids (but not heroin or cocaine), and the very few doctors who did still prescribe injectables to the few. They were often vicious and sometimes very personal – some moderating influence came from the presence and later letters and testimony of dear Bing Spear, head of the Home Office Drugs Branch the until the early ’70s. He was replaced by a warrior who did his best to shut down even oral methadone.

By 1983 even getting methadone for more than a short period became very rare in the NHS clinics and unheard of in Scotland. One of the heads of the Royal College of Psychiatrists held that ‘no one needs more than 40mg of methadone a day’ – which was a big reason so many people had such poor outcomes and used on top. Most were expected to and that’s why their methadone was kept so low. There were no objective medical tests or practices used in the UK to ensure patients had adequate doses to minimise fluctuation of methadone levels.

Prescribing anything opiate-like through the NHS to those dependent had almost completely stopped by 1983. But events were about to take an unprecedented shift, and that changed how everything would be done. I’ll explore this further in the next edition.

Read Part two here

Scottish off-sales down 5 per cent in year after MUP

Sales of alcohol from supermarkets and off-licences in Scotland fell between 4 and 5 per cent in the year after minimum unit pricing (MUP) was introduced, compared to England and Wales.  

The analysis, from Public Health Scotland in partnership with the University of Glasgow, was controlled for seasonal fluctuations, underlying trends such as household income and other factors, the researchers say, meaning it is ‘reasonable to conclude that the reductions in volume of alcohol sold were due to the introduction of MUP’. 

The biggest relative net reductions were seen in the products whose price increased  most after the introduction of MUP, such as high-strength cider, with smaller reductions recorded for beer and spirits. MUP was introduced in Scotland in May 2018, following a lengthy legal battle with the drinks industry. Public Health Scotland says it will publish a three-year analysis of post-MUP sales in 2022. 

‘The methods used in this study allow us to be much more confident that the reduction we have seen in per adult off-trade sales is as a result of the introduction of MUP, rather than some other factor,’ said professor of medical statistics at the University of Glasgow’s Institute of Health and Wellbeing, Jim Lewsey. ‘Incorporating data from England and Wales into our analysis controls for any changes in sales in a neighbouring region where the legislation was not introduced. We’ve also been able to adjust for other factors, such as household income, sales of alcohol through pubs and clubs and of other drink types.’

However the reductions were partly offset by off-trade sales of wine, fortified wine and ready-to-drink beverages, which the analysis ‘found to have increased in the year post-MUP’, said public health intelligence principal at Public Health Scotland, Lucie Giles. 

Alison Douglas, chief executive of Alcohol Focus Scotland.
Alison Douglas, chief executive of Alcohol Focus Scotland.

‘It’s very encouraging to see further evidence that minimum unit pricing for alcohol seems to be changing our drinking habits for the better,’ added chief executive of Alcohol Focus Scotland, Alison Douglas. ‘A reduction of between 4 and 5 per cent in off-sales in the 12 months following the introduction of MUP is really significant. It is also clear that it is the high-strength, low-cost drinks, favoured by heavier drinkers, which we are drinking less of. This gives real cause for optimism that MUP is having the intended effect and that it will improve – and save – many people’s lives.’

It was important not to become complacent, however, as Scotland was still drinking enough for every adult to exceed the CMO guidelines by a third every week, she said. ‘For some of us the pressure of lockdown and social distancing may mean we are drinking more.’

Addiction Treatment Directory 2024

Delphi Medical are a leading provider of drug and alcohol addiction treatment in the UK

Delphi Medical have an outstanding reputation as one of the leading providers of recovery-focused drug and alcohol treatment in the UK. The team offers excellent care on a pathway that supports and facilitates patients engaging in genuine recovery.

 

Delphi Medical’s services include:

Rethink detox – a private community-based alcohol detox service based in Lancaster. 

Pavilion – a residential drug and alcohol detox treatment centre on the outskirts of Lancaster.

Horizon Alcohol, Drugs and Sexual Health Support – a service offering free, confidential and non-judgemental support for all Blackpool residents.

Drug & Alcohol Services in Prisons – providing confidential help and support, and a range of life-saving clinical and psychosocial programmes.

 

Delphi Medical provide flexible solutions to recovery by working with individuals to better understand the traumas linked to their addiction.

As part of their service delivery, Delphi Medical recognise that they have a wider role in changing cultures and social support. The service works with multiple partners and communities to make real improvements. As part of The Calico Group and Syncora, Delphi Medical are in a unique position to provide bespoke services that fit the most complex needs.

With passion and excellence, Delphi Medical make a difference to people’s lives by providing innovative and specialist addiction services that lead the way from dependence to freedom.

Find out more at www.delphimedical.co.uk

Telephone – 01524 39375 Email – contact@delphimedical.co.uk

Delphi Services

A residential Detox Nurse
The Nursing Team are on duty 24 hours a day to support patients and monitor any changes in physical health during detox.

Delphi Pavilion Detox

The Pavilion is a residential drug and alcohol detox treatment centre on the outskirts of Lancaster, run by Delphi Medical. As part of a not-for-profit organisation, we endeavour to make detox and addiction treatment as affordable as possible.

The Pavilion team – made up of doctors, independent prescribers, therapist, nurses, support workers and volunteers – prides itself on delivering care to the highest standard with a focus on supporting patients into recovery.

The Pavilion is accessible to patients aged 18 years and over, delivering personalised and structured detoxification programmes, personally tailored to each individual.

Health, wellbeing, and personal empowerment are at the forefront of every programme, delivered in individual and group settings by trained medical and therapeutic professionals, with all services reflecting best practice, meeting CQC standards.

A combination of clinical and therapeutic services are delivered to safely support patients’ detox, whilst also addressing the contributing factors that have led to their dependence.

Detox is the first step into abstinence from drugs or alcohol, and can be a daunting decision for patients. The Pavilion provides a safe and effective in-patient detox from both drugs and alcohol, through medically assisted withdrawal.

Single and multiple detoxification services are available for the following substances:

  • Illicit drugs (opiate and non-opiate based)
  • Alcohol
  • Psychoactive substances
  • Over the counter medication
  • Prescription medication

Find out more at www.delphipavilion.co.uk

Telephone – 01524 39375 Email – enquiries@delphipavilion.co.uk

Kenward Trust rises to the challenge 

Kenward Trust rises to the challenge 

COVID-19 has proven to be an incredibly challenging time for the addiction rehabilitation sector, with community services having to limit face-to-face meetings where possible and lockdown forcing residential units to rethink their admissions process or close altogether. However, Kenward Trust, a residential alcohol and drug rehabilitation centre based in Yalding, Kent, are proud to say they are still open and taking admissions.

Kenward TrustThe Trust, situated in 15 acres of stunning Kent countryside has a variety of services to provide support to those affected by addiction, homelessness and crime. The core service of Kenward Trust is their residential rehabilitation programme which provides support to those affected by alcohol and drug addiction from for to 24 weeks. They also have Kenward Lodge based on their site in Yalding, which provides supported accommodation to those who are struggling to access drug and alcohol treatment due to not having accommodation, whether this be because they are street homeless or living in unsuitable housing. 

Increased demand

‘We are currently facing a significant increase in demand for our residential services during lockdown, so have managed to repurpose some of our accommodation to allow two isolation areas for new arrivals to the project,’ said Penny Williams, CEO of Kenward Trust. ‘We have ensured that during isolation, any residents can still partake of the programme through remote connection, so they are benefitting from all the time they have with us. I am incredibly proud of our team for keeping COVID-19 off our site and for ensuring that we can safely help those who really need it and that this is being recognised by our referrers.’

Kenward Trust Logo
Kenward Trust are currently recruiting for a Residential Resettlement Manager (closing date 19.6.20) Click here to find out more

The Trust has Move On accommodation across Kent and East Sussex, which are quickly filling up due to the increase in demand. Residents live independently in the Move On accommodation but have support from a dedicated Kenward staff team member to help them reintegrate back into the community whilst sustaining their recovery. The typical length of stay is up to two years while they find longer term accommodation and employment or volunteering opportunities.

Penny Williams, CEO of Kenward Trust
Kenward Trust CEO, Penny Williams

‘Due to this increase in demand we are looking at finding more Move On accommodation within the Maidstone area, so it is closer to our Yalding base,’ explained Penny Williams. ‘We are currently getting in contact with the council and surrounding housing associations to see how we can start this process, however if anyone could provide support with this please do get in touch. We are passionate about helping as many vulnerable members of society that we can, so any support would be greatly appreciated.’

 

Statutory funding

While demand for the Trust’s services is increasing, the statutory funding for residential rehabilitation is continuing to decline. Additionally, as a charity which relies on donations and grants to help fund the services, we are in a challenging time with lockdown. Therefore, to help provide support to those who either cannot afford the residential treatment privately or cannot take the four to 24 weeks needed off work, the Trust is launching a Day Treatment Service. This service can be run remotely during lockdown with confidential counselling via Zoom, but will also feature Evening and Weekend groups when lockdown is over.

To find out more about the services Kenward Trust provides, or to find out how you can support their life changing work visit kenwardtrust.org.uk or give them a ring on 01622 814187.

Would you like to learn how to save a life?

 

Peer distribution of naloxone is the best way to get the opioid overdose reversal drug where it’s needed.

Naloxone distribution

by Nye Jones, We Are With You

Andy struts through Redcar town centre, his bright blue naloxone hoody protecting him from the fierce north sea breeze. He bellows hello to a woman across the street and fist bumps a guy he knows from his childhood. Then he sees a man he recognises from picking up his methadone script and it’s all systems go. Andy asks if he’s heard of naloxone. He hasn’t. He asks if he’d like to learn how to save a life. He would. The two sit together on a bench outside Sports Direct. In just eight minutes Andy expertly takes him through how to respond if someone has taken an opiate overdose. With a slap on the back, he hands the man a naloxone pack to keep and waves him on his way.

Hands with a naloxone kit
Read more DDN articles on naloxone.

It seems like he’s been doing this for years, but just three months before the programme started Andy knew very little about naloxone — “I’d never seen a pack before, I never had a clue.” Drug related deaths are at record levels in the UK, with the north east recording the highest rate of deaths in England. Now, Andy is part of a team of peers proactively taking naloxone out into the community in the coastal area of Redcar and Cleveland.

Read the full article on the We Are With You Blog.


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 We Are With You, and first appeared on

https://medium.com/we-are-with-you

‘Resilient’ organised crime groups adapting to pandemic conditions

EMCDDA Report on covid impact on drug markets
Report available at www.emcdda.europa.eu

‘Active and resilient’ organised crime groups have been successfully adapting their drug trafficking routes, transportation models and concealment methods during the COVID-19 pandemic, according to a report from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and Europol. While the pandemic has led to local shortages, higher prices and reduced purity of some drugs, crime groups are continuing to thrive and make ‘huge profits’, it says.

Disruption of the drug supply chain has been seen ‘mostly at the distribution level’, the document states, as lockdown and social distancing measures have made street deals more difficult. While dealers and customers are increasingly turning to encrypted communication apps, social media platforms and the dark web to buy and sell substances, the ‘continued commercial transportation of goods across Europe’ has enabled the ongoing movement of bulk quantities of drugs between countries.

Trafficking via maritime shipping remains at pre-pandemic levels, say the agencies, although there has been ‘marked disruption’ in smuggling via passenger planes, echoing the findings of a recent UNODC report (DDN, June, page 4). Violent incidents related to drug trafficking have also continued during the pandemic, the document says.

Alexis Goosdeel: We are likely to see ‘greater volatility’ in the drug trade.

‘The economic effect of the crisis is likely to make some in our communities more vulnerable to both drug problems and drug market involvement,’ said EMCDDA Director Alexis Goosdeel. ‘Furthermore, the growth of online dealing and encrypted communication will place greater strains on law enforcement. In the post-pandemic period we are likely to see greater volatility, competition and violence associated with the drug trade. By anticipating these developments now, we will be better prepared to respond quickly and effectively to the new challenges we are likely to face.’

EU drug markets: impact of COVID-19 at www.emcdda.europa.euread it here

The Benzo Trap

Improving our understanding of benzodiazepines would save many lives, says Kevin Flemen.

Non-medical use of benzodiazepines creates big challenges for treatment services. There need to be significant changes in how we respond if we are to reduce dependency and fatalities related to this family of drugs.

The extent of non-prescribed benzo use is poorly understood. The Crime Survey for England and Wales (CSEW) reports a drop in use, but anecdotal information from drug services, including young people’s services, suggests the opposite is true.

The CSEW data is highly suspect in relation to benzos, and this may be because it misses key using populations. Questions to identify benzo use need to be carefully framed too – would young people taking ‘Xans’ automatically know that this is alprazolam, a benzodiazepine? If not, standard screening questions such as ‘have you used benzodiazepines in the past six months?’ are liable to under-count actual use.

Further, not all our benzo-type drugs will show up on urine screens, possibly because the stronger ones produce effect at very low doses – producing lower levels of metabolites below the detection threshold. And some of the drugs, such as etizolam, are thienodiazepines not benzodiazepines, so won’t produce metabolites that show up on a standard screen.

Mousetrap with pills on it
Click to download a printable PDF of this article
Young people

Young people’s benzo use appears to have increased. Some of this is recreational, influenced by popular culture, including a new generation of rappers whose image and lyrics have popularised Xanax. For others, use may be self-medicating for trauma, anxiety or other negative mental health conditions.

The trap here is the slow access that too many young people encounter when seeking help from child and adolescent mental health services (CAMHS). Long waiting lists or failure to meet the threshold to access services mean young people may be waiting months for access to CAMHS, if they can access the service at all.

In the meantime, some will find benzos and start to self-medicate. When and if the young person does access mental health services there is a good chance – in classic ‘dual diagnosis ping pong’ – that they will be told they have a primary presenting drug problem and therefore should be referred to a drug service. In turn, when they present to the drug service they may well find a paucity of treatment options to assist with their benzo dependency.

The benzo backlash

The increase in the use of Xanax may have started among young people, but the wider pattern of non-prescribed benzo use has been an ongoing issue and has morphed over time. Initial benzo dependency was largely driven by massive over-prescribing and long-term prescribing, something that has been addressed but remains an issue.

The path to hell is, however, paved with good intentions. The ongoing guidance to GPs to carefully consider the need for benzo prescribing and review existing patients has certainly reduced the extent of benzos being prescribed in the UK. But without measures to address the underlying reasons why people feel they need tranquillisers, people ended up seeking these drugs first from online pharmacies, then via the NPS market off the dark web and, ultimately, off the streets. This has allowed people to build up tolerance to novel benzos at far higher doses than they would have obtained on the NHS. These same patients, when presenting to GPs for treatment, may encounter the same reluctance to prescribe benzos that pushed them to the street market in the first place.

Prescribing trap

The NICE BNF guidance on benzos for the treatment of anxiety allows for doses up to 30mg a day. For someone who has a significant street-acquired strong benzo habit, the BNF upper limit may be well below that person’s current dose. The dose equivalence for someone using four 2mg alprazolam a day (8mg x 20) would be 160mg diazepam – more than five times the BNF upper limit for treating anxiety.

Where services do have a benzo-prescribing pathway it typically requires a person to reduce themselves off their own illicit benzos to a level where drug services or GPs could take over prescribing. This approach effectively directs a person to continue purchasing off the illicit market, with all the risks that this entails. It is the equivalent of having an arbitrary maximum dose of 30ml methadone and saying to heroin users they should reduce themselves off street heroin until they get to this level.

This situation also assumes that the person has continued access to illicit benzos that they can taper off. If a person has been purchasing off a dark web site which is then shut down, they could be left without any access to drugs, withdrawing off a high dose with no access to legal substitutes. This brings with it huge risks, including psychosis and life-threatening convulsions.

Ashton Manual

Many professionals and people seeking help online will find the Ashton Manual, a guide to benzo reduction and withdrawal by Professor C Heather Ashton. A helpful resource for many, the manual and related resources create two key challenges. First, for some people, reading the manual could reinforce fear and anxiety of withdrawal symptoms. There is a risk that people will anticipate and expect symptoms and could therefore experience a wider range of symptoms and with greater severity.

Second, the withdrawal schedules suggested by Ashton typically reflect people reducing off NHS-prescribed dose ranges. Where people have built up dependency on stronger novel benzos, and built up high tolerance on street drugs, following the sort of slow tapers proposed by Ashton could take one to two years or longer to complete. While on the one hand very slow tapers as described by Ashton minimise risks of unpleasant or dangerous symptoms, they can prove prohibitively and unnecessarily slow for people who have been using at high doses. Minute dose reductions can lead to people fixating on each reduction, and losing motivation over a protracted reduction programme.

Unknown tablets

Efforts to accurately substitute prescribe for illicitly acquired benzo habits are further confounded by our uncertainty as to the specific drug and specific dose that the person is actually taking.

A significant amount of the tablets sold as Xanax could contain one or more other compounds. Alprazolam may or may not be present – weaker or stronger benzos could be present, and these could be shorter or longer acting than alprazolam. Dose may be higher or lower than the claimed strength, and there may be other psychoactive compounds present such as quetiapine.

While drug testing websites such as WEDINOS are invaluable in highlighting trends in pill composition they are less helpful when considering tapers and withdrawal protocols – even if pills held by the client are submitted for analysis. The analysis doesn’t show the amount of each psychoactive compound in a pill, and without testing several pills from a batch, no certainty can be derived from testing a single pill.

This uncertainty about drug, dose and strength makes it impossible to accurately assess:

  • what level of substitute prescribing is required
  • how fast or slow a taper should be applied – some novel benzos have a very long duration of effect (100-200 hours) and so slower tapers may be required.

In lieu of accurate and rapid pill testing, the only practical way of substitute prescribing and tapering is to prescribe symptomatically, increasing dose and slowing withdrawal where there are clinical indicators of unmanageable withdrawal symptoms combined with careful assessment of the patient’s self-reported symptoms.

Escaping the trap

Services need to urgently develop new pathways and treatment protocols for people using benzodiazepines outside of clinical and prescribed settings. These need to include:

  • screening tools to assess for patterns and nature of
    benzo use
  • research into the extent of non-prescribed benzo use
    in the UK
  • protocols to test clients’ pills for content and potency
  • appropriate levels of substitute prescribing with tapers
  • rapid access for children experiencing anxiety to CAMHS to reduce self-medicating with benzos
  • staff training and training for GPs about addressing the use of prescribed benzos without driving people towards illicit markets.

www.kfx.org.uk workshops have moved online during the current lockdown.

Email kevin@kfx.org.uk for joining instructions.

Commissioning Quality

The new national substance misuse commissioner forum will play a vital role in responding to future challenges, say Chris Lee and Prof Jim McManus.

Even through these unprecedented times, councils are absolutely committed to ensuring that people seeking help with substance misuse get the right treatment and support, as part of their public health and other wider responsibilities. This includes helping vulnerable people being given another chance to find work, rebuild relationships, improve their physical and mental health and find safe and secure accommodation.

Chris Lee is, public health specialist at Lancashire County Council
Chris Lee is a public health specialist at Lancashire County Council

But more must be done. Only a fifth of dependent drinkers are currently accessing treatment, while the success rates of drug services vary five-fold from place to place. What’s more, new threats are emerging all the time – one only needs to look at the drug-related death statistics to see that. We must not be complacent. Councils know more needs to be done in close collaboration with local partners to ensure everyone gets the support they need wherever possible.

Covid-19

The COVID-19 emergency comes after a lengthy period of financial and policy upheaval for the drug and alcohol sector. For example, those of us in local government have long argued that reductions to councils’ public health grant – used to fund drug and alcohol prevention and treatment services – is a false economy that will only compound acute pressures for criminal justice, NHS and social care services further down the line.

The Local Government Association (LGA) and the Association of Directors of Public Health (ADPH) have jointly agreed to support the establishment of a national forum for substance misuse commissioners in England. While there are strong regional support networks across England, coordinated by Public Health England regional teams, the purpose of this new forum is to provide a strategic national space in which to bring together those with commissioning responsibility in local government, and enable a representative commissioner voice.

Prof Jim McManus, director of public health at Hertfordshire County Council
Prof Jim McManus is director of public health at Hertfordshire County Council

With many people currently finding new ways to work, this development will be a timely opportunity adding structure and support around the alcohol and drug agenda in England. It will provide a dedicated space to address the issues and concerns of those commissioning substance misuse related services and the opportunity to share ideas and experience or even just support colleagues.

‘The new national network comes at an important time,’ said director of public health at Hertfordshire County Council, Prof Jim McManus. ‘Bringing commissioners together to learn and share good practice is core to the improvement ethos of local government known as sector-led improvement, and will seek to bring some structured support to an area which has been neglected in recent years. Part of this will be ensuring we develop the best possible services and best commissioning practices. This is just one plank of ensuring we have a response to drug and alcohol issues and the need of our populations. But it is an important plank.’

With physical meetings unlikely to happen for the foreseeable future, the intention is to initially develop an online forum to bring people together and use Knowledge Hub as a central platform – it’s hoped we can physically bring people together at a future date!

Key objectives

  • To support the development of good practice and effective commissioning approaches
  • To enable commissioners to share information, intelligence, challenges, ideas, and to support problem-solving
  • To represent commissioner views on relevant current and emerging policy and strategy
  • To influence legislation and policy at a local, regional and national level
  • To enable national representation of substance misuse commissioners in relation to other sector organisations.

While planning is at an early stage, we would welcome expressions of interest to join this emerging forum. If you have any ideas to support this development or wish to register interest in joining, please contact: enyal.lani@adph.org.uk

 

 

DDN June 2020

‘We need to be proactive and responsive’

INNOVATIVE DEVELOPMENTS and impressive collaboration have characterised our sector’s response to the crisis (page 8).

But what we also need to keep up with are the changes in the drugs market and regional trends that could tip the drug-related deaths crisis into further catastrophe. One of the trends identified by Release’s new drug monitoring network is increased use of benzodiazepines, so our cover story looks at how we can respond to this by developing urgent new pathways and treatment protocols. It’s essential that we remain proactive and responsive at the same time as making so many other adjustments to routine.

Commissioners have been thinking along the same lines and there’s an invitation to join a new national forum on page 11. As we’re all particularly concerned about diminishing resources and the threat of services being decommissioned, it’s the right time to create a space for clear strategy and a representative commissioner voice.

Collective Voice are working hard for the treatment sector and invite your involvement in rising to important challenges (p14). When we emerge from this crisis let’s not forget the many gains we’ve discovered from working more closely together.

Claire Brown Editor of DDN magazine
Claire Brown, editor

Keep in touch claire@cjwellings.com and @DDNmagazine

Read the issue as an online magazine or download the PDF

Gender imbalance

The lockdown may be having a disproportionate effect on female service users, warns Gordon Hay.

Gordon Hay is a reader at the Public Health Institute, Liverpool John Moores University
Gordon Hay is a reader at the Public Health Institute, Liverpool John Moores University

The coronavirus pandemic and the subsequent lockdown impacts on all society, and is likely to be impacting more on groups such as those in contact with drug or alcohol services. Research studies are being launched to explore how COVID-19 and lockdown impact on people who use drugs, and there is a wider discussion about how levels of alcohol use within the general population have changed over the last few months (DDN, May, page 5) and issues such as the relationship between domestic abuse and alcohol use during the current crisis. While new research studies are being set up, existing monitoring and surveillance systems can quickly be augmented to highlight emerging issues facing those in contact with drug or alcohol services.

The Public Health Institute at Liverpool John Moores University has, since 2013, hosted the Integrated Monitoring System (IMS) which records activity at a range of primarily low-threshold drug and alcohol services across Merseyside and Cheshire. Just as the UK entered lockdown, six additional questions were added to the monitoring system to enable services and commissioners to identify additional issues facing their clients.

As services were not mandated to ask the additional questions, the numbers are relatively small but large enough to highlight the impact of gender. Two months from lockdown, emerging findings from 1,435 contacts with services involving 468 clients suggest that female clients are impacted more than males. Overall, very few clients (about 1 per cent) report concerns about having symptoms of coronavirus. Interestingly, only a similarly small amount reported problems accessing medicines, healthcare or harm-reduction supplies – however this finding is unlikely to be representative of all people who use drugs or have problems with alcohol, as the monitoring is being undertaken in healthcare, particularly harm-reduction, settings.

Woman looking through window
Click here to download a printable PDF version

 

More clients report difficulties in social distancing and accessing basic needs such as food. While social distancing was reported as an issue for 22 per cent of female clients, only about 10 per cent of male clients reported difficulties. For accessing basic needs, 6 per cent of female clients as opposed to 2 per cent of male clients reported issues.

Behavioural change

Changes in the clients’ alcohol, drug or tobacco use were explored. Although it cannot be assumed that any changes are increases or decreases, 15 per cent of female clients reported a change compared to 6 per cent of male clients. While all of these differences are seen to be statistically significant, the starkest gender difference occurred when considering mental health, with 23 per cent of female clients reporting that their mental health had been affected by the current environment, compared to 10 per cent of male clients.

Research typically shows that women who use drugs face additional challenges, for example the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) suggests that women are particularly likely to experience stigma and social disadvantage and to have less social support. They may be likely to come from families with substance use problems and have a substance-using partner, have faced Adverse Childhood Experiences (ACEs) and may have co-occurring mental disorders.

Information monitoring

The emerging information from this monitoring system is not a replacement for more detailed research, as we can only highlight that there are differences and would only be able to speculate on why these differences are occurring, and research is needed to examine why females are experiencing lockdown differently to males. Those working in drug and alcohol services, and commissioners of these and similar services, should be alert to any additional difficulties faced by female clients and seek to explore them in more detail during contacts with female clients.

 

In the Picture

The parliamentary group discussion moved to Zoom for its first meeting since the crisis hit services, as DDN reports.

UK Houses of parliament
Click here to download a printable PDF of the article

The issue around deprivation and inequality is going to come out really strongly.’ Speaking at the Drugs, Alcohol and Justice Cross-Party Parliamentary Group’s first Zoom meeting, Karen Tyrell, executive director of Humankind, was the first of the treatment providers to give an update on the situation since COVID-19 had turned ways of working upside down.

Karen Tyrell, executive director of Humankind
Karen Tyrell, executive director of Humankind

With two-thirds of clients falling into the ‘vulnerable’ category, the organisation was pleased with the way many had switched readily to online support. Staff and commissioning teams had risen to the challenge, but one of the main worries was the drop-off in people coming into treatment – Humankind had seen a third fewer people entering services, and exits were also down as the organisation was trying to keep people in treatment during this unpredictable time.

Laura Bunt, deputy chief executive at We Are With you echoed that the move to remote working overnight had been ‘astonishing’, but that many people who weren’t accessing support were deterred by fear of putting pressure on the NHS as well as contracting COVID. There had been impressive collaboration within the sector, and some innovative developments including trialling a ‘click and collect’ model for needles and other essential harm reduction equipment. But there was also an increase in mental health issues from the boredom, loneliness and a situation that ‘has been really tough for everybody’.

‘We’ve had to put our thinking caps on,’ said WDP’s chair Yasmin Batliwala. Collaboration and communication – between staff, service users, commissioners and other services – had been key to carrying on, including more training through webinars. ‘We’re speaking more to each other than we ever did,’ she said. The crisis had shown that there were opportunities to do more online in the longer term.

Beyond the immediate crisis all the organisations were deeply worried about funding, redirection of resources and the threat of services being decommissioned.

The vital need for sector funding was underlined by Niamh Eastwood, executive director of Release, which had set up a monitoring network to hear about changes in the drugs market.

Niamh Eastwood, executive director of Release
Niamh Eastwood, executive director of Release

‘We’ve already had a public health crisis with drug-related deaths,’ she said. ‘If fentanyl arrives it will be a catastrophe.’ The network had been identifying regional issues, such as fluctuations in heroin purity in the north and north east of England and reports of ‘really poor’ quality ketamine.

There was increased use of Xanax, especially among young people, increased use of psychedelics, and a reduction in MDMA use (‘not a drug for physical distancing’).

Diversion was not happening, as ‘people are holding onto their meds’ (mainly methadone) during the crisis. The move to longer-term prescribing had been helpful in making people ‘feel more in control of their treatment’.

A reduction in opportunities for shoplifting and begging had led to increased use of benzodiazepines to replace other drugs. Meanwhile patterns of policing ‘were not proportionate in lockdown’, she said, with an increase in stop and search for low level offences.

Dr Richard Piper, chief executive of Alcohol Change UK, gave a snapshot of the effect on drinking culture. A national survey on lockdown drinking had tested the hypothesis that people would be drinking more, but findings contradicted this. While 21 per cent of people were drinking a greater volume of alcohol (‘binge drinkers’ continuing to binge), many (35 per cent) were found to be drinking less (DDN, May, page 5).

‘Some have decided to protect their immunity, take care of themselves and only drink when out,’ he said, adding that the disruption had enabled people to break drinking routines. There were five times as many people coming to Alcohol Change UK’s website looking for information and five times as many searches around alcohol and health on Google, suggesting that people were receptive to the opportunity to make healthier choices.

UK Recovery Champion, Dr Ed Day
UK Recovery Champion, Dr Ed Day

Participating in the group discussion, most felt that there were lessons for working smarter after the crisis, particularly around more intelligent prescribing options, tech solutions and web-based support.

But there was also a note of caution about moving to a world of teleconferences and losing face to face contact.

‘The recovery community has responded very strongly with some great web-based support,’ commented Dr Ed Day. ‘But it is no replacement for real face-to-face contact and some people must be falling through the cracks.’

Staying Alert

The sector has risen admirably to the challenges of COVID-19. But it needs to remain vigilant when it comes to what happens next, says Peter Keeling.

If the current emergency has demonstrated anything, it’s the importance of having a robust healthcare system. Drug and alcohol treatment and recovery services form an absolutely essential part of this, but like so many others our sector is facing incredible challenges because of COVID-19.

Hand blocking Covid-19
Click to read the full article in DDN magazine and download a printable PDF.

The fact that services from community treatment to residential rehab have been able to find solutions is testament to both the sector’s innovative strength and the dedication of its key workers. And it’s these qualities that are keeping people safe. But now we need to ask ourselves about the next steps for drug and alcohol treatment, and what lies ahead for the people who rely on our support.

Over the past few months, Collective Voice has been working hard to bring together people and organisations from across the sector, so we can identify key challenges and find solutions that work for everybody. We’ve seen unprecedented levels of collaboration across third sector providers, NHS trusts and commissioners, who have all brought their expertise to bear on what is possible when it comes to provision of OST, face-to-face interventions, supported housing, and many other areas of our work.

It’s far too early to assess the longer-term impacts of changes to these core aspects of treatment and recovery. But even at this early stage it’s clear that many in our field are asking themselves the hard questions of ‘what do we keep?’ and ‘what do we lose?’ The sector has always been a champion of innovation and flexibility when it comes to designing services around people’s needs, and this flexibility has been crucial in recent months. It has allowed us to keep people supplied with life-saving OST medication and food, helped us create safe spaces for women and children fleeing abuse and violence and, almost overnight, allowed the sector to shift to digital ways of working so frontline staff can maintain crucial relationships with their clients and support them in their recovery.

The crisis has also highlighted our sector’s ability to collaborate; not just at national policy level, but also at local levels. Because it’s at these levels that drug and alcohol services have established themselves as key partners in cross-sector initiatives that support some of the most vulnerable people in society. The London Homeless Hotels Drug and Alcohol Support Service (HDAS), brought together to provide treatment for people living in hotels under the government’s rough sleeping initiative, is a perfect example of the kind of innovative, collaborative response the sector is capable of. Similarly in Dorset, Avon and Wiltshire Mental Health Partnership NHS Trust is working with drug and alcohol partners and the local public health team so that council delivery drivers can provide vulnerable service users with OST medications. Across the country, there are many other examples of such collaboration.

These local and national relationships have helped the sector support itself during an extremely turbulent period where quick decisions have had to be made to keep people safe. Areas that already had strong relationships across sectors tell us they’ve been well placed to respond quickly, and councils which already had good relationships with the voluntary sector have stated how critical these relationships have been when mobilising the local response.

The sector has proven itself entirely capable of meeting the immediate challenges of COVID-19, but what comes next? Because as we look to how services will operate in the ‘new normal’, there are a number of issues that are already causing concern.

1. Increased alcohol consumption

The effects of social isolation during the COVID-19 lockdown appear to be having a noticeable effect on the country’s alcohol consumption. Recent research from Alcohol Change UK, while highlighting some positive indications of a segment of the population who are actually drinking less during lockdown, nonetheless showed that around one in five drinkers are drinking more frequently (DDN, May, page 5). The longer-terms effect of such a substantial portion of the population negatively changing their relationship with alcohol could create a potential new cohort of people seeking treatment as they begin to recognise their consumption has changed for the worse. If there is an increase how will it be paid for? None of us have a crystal ball but it seems fair to say there may well be questions over the level of public spending the country can afford and we know that people with drug or alcohol problems are a frequently discriminated-against group.

2. Rough sleeping exit strategy

The move to swiftly house people in hotels and other temporary accommodation during the COVID-19 emergency has, in many ways, been a success story. It has taken enormous energy across different systems from local authority workers to homelessness, mental health and drug and alcohol workers, but as the COVID-19 emergency enters its second phase, the contracts with hotels to accommodate people previously sleeping rough will end. This leaves our sector, and the many other connected parts of the system, with a significant challenge to continue providing support. But it is also an important (possibly never-before-seen) opportunity for services to create pathways into long-term meaningful support for people who have historically sometimes been difficult to engage (see news, page 4). Ensuring continued accommodation obviously needs to be at the heart of the planning for this group, but it will be a wasted effort for many people if the building blocks of wider support are not also put in place – especially access to drug and alcohol treatment.

3. Local government funding

We welcome the £3.2bn commitment by the Ministry of Housing, Communities and Local Government to support people in the most vulnerable of circumstances during this unprecedented crisis. Local authorities have already distributed some of this funding to fortify services that support people experiencing multiple disadvantage, particularly around rough sleeping, and it is testament to the strength of collaboration between local government and treatment providers that our service users have been kept as safe as possible. But since the funding lacks protection, we are concerned that some public health services – including drug and alcohol treatment – will not benefit from its distribution. This funding is needed by a sector that has been forced to take on unexpected emergency costs around PPE procurement, and payment of locum and bank staff to cover staff sickness.

4. Unforeseen consequences of service adaptation

Services have mobilised quickly and effectively to adapt, while both managing risk and maintaining effective support. But there will soon be a need for the sector to properly assess the consequences of these changes and their effects on service users’ treatment and recovery. The remote (and particularly digital) delivery of assessment, key working and more structured interventions has undoubtedly made services more accessible for some people, and the forced changes to OST provision are likely to provide benefits going forward. But there will still be people in desperate need of treatment for whom online services will not be appropriate, and it is vital that these changes are seen as a welcome addition to the range of available services, not as a replacement. At a time when investment in drug and alcohol services may become challenging, and where digital services could be seen to be a cost-saving exercise, the sector must be vigilant as to the effects of service adaptation and ensure an appropriate balance is found.

Peter Keeling, campaigns officer at Collective Voice
Peter Keeling is campaigns officer at Collective Voice

Finally… We want to pay tribute to the thousands of workers across the country providing essential treatment and support to people with drug and alcohol problems. COVID-19 has shone a light on the extreme vulnerability of many of our citizens, from rough sleeping to domestic violence, and we will continue to push for our sector, and its many unsung heroes, to receive the same level of recognition. But we can only do this with your help and expertise, which is why we’ve launched some new ways to communicate with the field, including a weekly bulletin and an open source Slack community (all details at www.collectivevoice.org.uk). We want to hear from you about how we can best support the sector, so please do get in touch: Peter@collectivevoice.org.uk

 

June Letters and Comment

DDN welcomes your letters Please email the editor, claire@cjwellings.com, or post them to DDN, CJ Wellings Ltd, Romney House, School Road, Ashford, Kent TN27 0LT.

Letters may be edited for space or clarity.

Serious stress

I was pleased to read Victoria Hancock’s article about secondary traumatic stress (DDN, May, page 14), especially her call for this to be taken more seriously by senior management. I must confess that although it’s an issue that’s concerned me for a long time, I wasn’t even aware that it had an official name.

I’ve worked in this sector and associated fields like homelessness and mental health Ð for close to two decades, and some of the stories I’ve heard from clients have been truly horrific. Hearing about this kind of trauma and abuse, and witnessing its often still-raw effects on clients, is something that can be extremely difficult to switch off from or forget Ð and I’m not sure what it would say about me if I was easily able to do that.

In my experience it’s not something that necessarily gets any easier, either. I remember asking a colleague how they coped with it early on in my career and being light-heartedly assured that I’d soon ‘toughen up’ Ð the implication being that if I didn’t then I’d probably be better off in some other line of work. Obviously things have moved on since then, but this is still an under-discussed issue and it’s good to see it getting some attention.

Name and address supplied

Best buddies

I read with interest the article about Lancashire’s Recovery communities working together during COVID-19 (DDN, May, page 8) and thought you may be interested in our ‘sobriety buddy’ initiative.

For members of any detox community meetings are a cornerstone of recovery, but this is just not an option for anyone leaving a detox facility right now. So at our Birchwood residential detox centre community in Birkenhead we’ve created a new initiative – each member can have their own personal ‘sobriety buddy’ (see news, page 5). The idea is to provide support for people while they undertake a detox programme, so that support can continue when they return home too.

We realised extra support is needed under current conditions, and so we set about finding volunteers to help service users in this difficult time and be that person on the other end of the telephone with some good sobriety time under their belt.

Research shows that coping with stress and isolation can make a relapse more likely, especially in the early stages of sobriety. When our coping skills are tried, we often revert back to behaviours that are not necessarily serving us.

We offer people this service before they arrive for their detox. During their first telephone consultation with our office we ask if they would like a sobriety buddy to support them. Their buddy will then text first to introduce themselves, and they can move onto talking daily if that support is wanted. There is no better way to learn than from someone who has been there and is happy to share their experience; we are able to guide people on how to deal with difficult life events without resorting to past behaviours and it’s been getting great results.

It’s already been such a success we are going to continue running this after lockdown as the support people have received has made all the difference.

Jo Moore, manager at Birchwood (a Kaleidoscope Project facility), Birkenhead

In solidarity

When I was at school I always thought that I’d make something of my life, do something exciting and follow my dream of helping others. However, it turned out I’d end up on a different path.

I joined the ambulance service the day after my 18th birthday and worked for them for over ten years as a paramedic. Six years ago I developed a brain problem and ended up needing multiple surgeries over the following two years and during this time I was prescribed Oramorph. It turned out that I’d become addicted to it and I never thought I’d end up becoming one of the people I previously cared for. I then began injecting the Oramorph when taking it orally wasn’t working quickly enough. When my prescription was abruptly cut off I went into withdrawals and ended up swapping to injecting heroin and crack cocaine.

After getting myself clean I decided to start a blog to help those who are in my previous shoes and the family and friends of those with an addiction. The blog can be found here at: www.drink-n-drugs.com or on Facebook and Twitter ‘Drink ‘n’ Drugs’. I hope it helps others as writing it helps me!

Dave Richens, by email

In memory of Kevin Knott

It is with great sadness that Bradford Drug Services report the passing of our colleague Kevin Knott after a short illness. Kevin was a drug worker in the Bradford and Airedale district. Kevin was a big supporter of service user influence and involvement and he frequently attended the DDN service user conferences.

Kevin was a great guy who was very popular and loved by all – such an inspirational, funny, caring and genuine individual, fantastic at his job and able to instil confidence in anyone he met. He was a proper character who loved a laugh and was a true legend. It was such a pleasure to have known him over the years and his legacy and treasured memories will last forever.

Gerard Smyth and all his colleagues in Bradford

Zooming in

Technology is helping to make sure that recovery workers and clients stay connected. While it can never take the place of face-to-face working we should retain the best parts of the ‘Zoom boom’, says Charlotte Hadaway

The lockdown has changed my working day. As an outreach worker in Devon I can travel up to 60 miles a day to see my clients. We’re a very rural county, so I work from a number of Together/EDP hubs as well as GP surgeries and community locations.

Before lockdown, technology enabled me to do simple things like keep an online diary so everyone knew where I was and who I was seeing, or write up my notes on the hoof using Wi-Fi and phone tethering. When lockdown hit, all this changed. We had to adapt quickly to be able to offer a safe and secure service, and I have to say Together/EDP have been brilliant at supporting us during the changes. We have daily virtual meetings with managers and team members, we’re kept really well informed of developments and what we need to do to keep everyone safe, and we’ve been encouraged to use virtual groups utilising Microsoft Teams, WhatsApp, Zoom and other technologies. I think it’s fair to say that we’ve adapted well and changed the way we work – we continuously share the experience, reflect on what’s working, and keep each other going.

When we started setting up Zoom meetings we didn’t know how tech savvy people were, but I was really surprised that clients jumped at the chance of joining an online group. They really wanted to see each other and know how they were getting on in their recovery. It’s never quite the same as being in the same room, but it’s a great alternative. I don’t think you can beat human contact because you see people’s expressions, you see their movements, you can look into people’s eyes and you can see behaviours better up close. You can still see that on Zoom, but it’s not as powerful as face-to-face.

We are very clear about our meeting rules with Zoom, especially around respecting each other and confidentiality. I find that when people do share their feelings, others still connect well with them – they are very respectful, they are listening to that person and that person feels held by everybody in the virtual group. The online meetings have kept clients in contact with each other. It’s often just talking about the little things that makes people feel they’re part of something. Just knowing they’re being heard is really important.

Charlotte Hadaway EDP
Charlotte Hadaway is an outreach recovery worker at Together, part of EDP Drug & Alcohol Services (EDP is a subsidiary of the Humankind charity).

What will happen beyond lockdown is hard to tell, but I would like to offer an evening virtual meeting going forward. It will be easier for some clients who experience high anxiety or who are trying to work full-time and manage their recovery. I know that just getting to an appointment can be quite stressful for some people, so these digital solutions are a great way for people to have more choice in treatment. I’ve also learnt that it is important to be patient while clients are setting up Zoom accounts, as tech can be daunting for those not used to it.

It’s fair to say that most agree there is a new place for virtual groups post lockdown. Of course, nothing beats face-to-face group work. The interaction between clients can mean everything, especially in early recovery. A hug, a conversation over a cup of tea, a chat in the break – it’s bonding, friendship and fellowship all rolled into one. But to meet online is the next best thing, and I’m looking forward to keeping the best bits as we move forward and offer more choice and variety to our clients.

 

Grow a little kindness

Samantha Smith shares the Roots project’s successful campaign for Mental Health Awareness Week.SIG Penrose Roots is a garden-based community recovery project that provides a therapeutic growing space for service users, members, volunteers and the wider community. Through work in the garden, we equip people with new skills, help reduce social isolation, and promote positive mental, emotional and physical wellbeing.

After weeks working from home in lockdown, while the Roots staff are busy supporting the community, my mind started to turn to what we would have been doing if life was still ‘normal’. For the past four years we have put on our annual Walk and Talk (adding cycling in 2019) to mark Mental Health Awareness Week. We would go for a leisurely walk around the Luton area, with service users and local partners, to discuss the important topic of mental health in a more relaxed and open way.

This year the pandemic meant this could not happen and we had to come up with another plan. The 2020 theme is kindness, which is very close to the heart of all who attend our various projects. So I thought about how we could make a campaign with the theme of kindness to tie in with what we currently do at our community garden – and the ‘Lettuce be kind’ campaign was born.

The team of staff and volunteers got to work planting 50 lettuce seeds to grow and nurture into something that we could give out to the community. By 18 May, the team had grown the lettuces, made care labels and were ready to start randomly placing the lettuces across Luton. They went to bus stops, parks and green spaces, doorsteps and various residential streets. All carried the message: #lettucebekind – perhaps the roots to kindness can start with yourself. Be kind to this lettuce and it will repay your kindness.

The campaign was a huge success and had many tweets and messages from excited community members who had found one of the lettuces. The campaign also got a mention on the BBC East Twitter live update and the team was invited to talk about the campaign on BBC Three Counties Radio.

We will be following up with other campaigns over the coming months. It was a huge effort by the whole team and helped to get the message of kindness out there as a gentle reminder that in these days of supposed disconnection we have never been more connected.

Follow the campaign on twitter

 

SIG launches newly designed website

User-friendly site gives clear signposts to all the services on offer.

New Social interest group websiteThe Social Interest Group (SIG) is excited to announce the launch of their newly designed, consolidated website, www.socialinterestgroup.org.uk. After six months of development, the launch of the new site was officially announced today, Tuesday 26 May 2020. The new site is faster, easier to navigate, and more user-friendly.

Previously, the main SIG website consisted of details about the charity and overall strategic information. Alongside this, there were individual websites for the subsidiaries, Penrose Options and Equinox Care, where visitors could find information on the individual charities and the services they offer. 

There is now one single SIG website incorporating the Equinox Care, Penrose Options and SIG investments information. This provides a seamless integration of the group brand as a whole and includes information on the services offered. 

Breakdown of Social interest group activities‘I am pleased that we have achieved this in the time that we have,’ said group chief executive Gill Arukpe. The site was built in-house and was a collaboration between our IT and communications teams. It is particularly exciting that instead of three disparate websites of differing quality, look and feel, there is now one single site where visitors can find out about the wonderful work we do to support our service users.’

The new site provides visitors with an easier way to learn about SIG’s services, including who they are, how they work, service user stories, staff blogs and careers pages. It also features integrated social media buttons for Facebook, Twitter, Instagram and LinkedIn to foster improved communication with stakeholders and visitors.

www.socialinterestgroup.org.uk

  


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 also appeared on The Social Interest Group’s site.

 

 

 

 

 

Don’t squander chance to end rough sleeping, urge parliamentarians

The government needs to establish a £100m housing support fund to avoid losing a ‘golden opportunity’ to put an end to rough sleeping, says a report from the Housing, Communities and Local Government Committee. 

Around 90 per cent of rough sleepers have been housed in temporary accommodation in response to COVID-19, providing a ‘unique opportunity to eradicate rough sleeping in England for once and for all’, says the committee. It wants to see at least £100m a year dedicated to long-term housing support to avoid the thousands of people in temporary accommodation ending up back on the streets, and warns of a ‘looming homelessness crisis’ as more tenants struggle to pay their rent and the three-month ban on evictions expires. 

The government needs to work quickly to put in place a housing-based exit strategy and the funding to support it, the committee urges. This should be in the form of a dedicated funding stream to allow local authorities to make sure people are securely housed, as well as provide for additional support services for rough sleepers. The government recently denied press reports that it was about to stop funding the scheme to provide emergency accommodation for rough sleepers in hotels.

‘We must praise the efforts of all those who have done so much to help take people of the streets during the current health emergency, but what happens next is crucial,’ said committee chair Clive Betts. ‘It is simply not good enough for anyone to leave temporary accommodation and end up back on the streets. This isn’t just about protecting vulnerable people from COVID-19. It is not safe to live on the streets in any circumstances, and it is not acceptable to allow it to return once the health crisis abates.
 
‘In our report we have called on the government to grasp the golden opportunity that has presented itself,’ he continued. ‘For the first time in over a decade rough sleepers have been comprehensively taken off the streets and given accommodation. This must become the new norm.’

 

Protecting rough sleepers and renters: interim report available here.

Early Day Motion salutes vital role of treatment services

An Early Day Motion has been tabled to recognise the essential role of treatment services and thank the ‘unsung heroes’ on the frontline of drug and alcohol service provision.

It also calls for MPs to ensure treatment providers are involved in post-pandemic public health plans.

The statement reads:

That this House acknowledges the vital role being performed by drug and alcohol treatment services throughout the country during the COVID-19 outbreak; recognises that key workers on the frontline of critical service provision are among the unsung heroes who rarely receive the recognition they deserve; commends the dedication with which they have maintained crucial support for a most vulnerable section of our society; expresses its gratitude for the flexibility shown in adapting to meet the needs of service users in these most difficult current circumstances; recognises that the work has been achieved after a decade of depleted resources as a result of austerity and funding cuts; notes that a surge in mental health issues can be anticipated in the wake of such crises; recommends that to help people stay safe, protect the NHS and save lives, future funding for this often-overlooked sector should be safeguarded; and calls on the Government to ensure drug and alcohol treatment providers are involved in shaping plans for post-pandemic public health provision.

Statement, with signatories, here: https://edm.parliament.uk/early-day-motion/56995/treatment-services-during-the-covid19-outbreak

Half of people with gambling disorders have not accessed support

Just under half of people with a gambling disorder have not accessed treatment or support, according to a study by GambleAware. Of those scoring above eight on the Problem Gambling Severity Index (PGSI) – considered ‘high risk’ – 46 per cent had not accessed support. 

DDN Gambling and Health guide
DDN’s guide on gambling addiction will help identify problems and guide you through the available treatment options.

The research, which included a YouGov survey, found that up to 61 per cent of the population had gambled in the last 12 months. Overall, 17 per cent of gamblers experiencing harm at any level had accessed support over the last year, with barriers to seeking treatment including stigma, reluctance to admit having a problem and lack of awareness of available services. Perceived stigma or shame was cited as a reason for not accessing support by 27 per cent of problem gamblers. 

In particular, women and people from BAME communities and lower socio-economic backgrounds may ‘not be having their treatment and support needs adequately met’, says GambleAware. Just under a fifth of gamblers from lower socio-economic backgrounds were ‘likely to report that nothing would motivate them to seek support’, researchers said, while women were three times more likely than men to cite practical barriers like time, cost or location as reasons for not accessing treatment. Around 7 per cent of respondents said other people had also been affected by their gambling. 

GambleAware is calling for services tailored to the needs of groups less likely to access services, as well as campaigns to increase awareness and reduce stigma.  

‘This research has shown that there is a clear need to further strengthen and improve the existing treatment and support on offer, to develop routes into treatment and to reduce barriers to accessing help,’ said GambleAware chief executive Marc Etches. 

GambleAware chief executive Marc Etches
GambleAware chief executive Marc Etches

‘Services have to be flexible to meet the needs of individuals and easy to access. Meeting the needs highlighted in this report will require partnerships between the statutory and voluntary sectors, both those services specific to gambling treatment and other health and support provisions. Working with those with lived experiences is essential in designing and promoting access to services, as well as helping to prevent relapse. It is important to engage community institutions including faith groups, to help make more people aware of the options available to them and ensure no one feels excluded from services.’

Treatment needs and gap analysis in Great Britain: synthesis of findings from a programme of studies available here.

Be kind to yourself

Kindness is all around us lately. But how do we be kind to ourselves?

As a cognitive behavioural therapist I see kindness in the people I work with and support every day

by Beth Marr, cognitive behavioural therapist

Kindness is everywhere at present. We hear stories about acts of kindness on the news, be it frontline staff putting their lives on the line to protect sufferers, or people delivering food and goods to neighbours in need. We see it in the pictures of rainbows on windows, a warm and comforting image depicting hope through the scrawl of a child’s crayon. We can even wear it courtesy of the numerous t-shirts available bearing slogans such as ‘Be kind’ and ‘Keep talking’.

As a cognitive behavioural therapist, much of my working day is spent in the company of people’s hopes and fears. I get to know who they feel they are, who they would like to be, but something that is very often missing is kindness.

I hear of loved ones, I hear of the people who have become their second heartbeat in a way, helping them to breathe through life’s darkest moments, but when we come to look at their own self-image, the words on my notepad take a decidedly harsher tone. ‘Useless’, ‘embarrassment’, ‘ugly’, ‘inadequate’. These words pepper the pages with a sense of resignation – as much a part of the individual’s identity as the blood that flows through their veins.

Read the full article on the We Are With You Blog.


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 We Are With You, and first appeared on

https://medium.com/we-are-with-you

DDN Conference 2022 Information

Thank you for booking the DDN National Conference on 23 June in Birmingham. We can’t wait to see you!

Please see below for information for delegates and exhibitors 

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The venue

The New Bingley Hall, Hockley Circus, B18 5PP –  is a large space approximately 10 minutes in a taxi from Birmingham stations and has ample free parking. We have held events there in the past and it is a large flexible space that allows plenty of room for both presentations and the exhibition area. The venue is all on the ground floor with disabled access.

From 7pm on the night of the 22 June some of the speakers, delegates, exhibitors, and the DDN team are meeting for an informal catch up and ‘harm reduction cafe’ in the Shakespeare Inn, B3 1JJ If you are in town the night before the conference we hope you will join us.

The DDN Team are staying in the IBIS Styles on Lionel Street. Unfortunately we have been unable to secure a reduced rate or block booking. Please book your hotel independently on booking.com or similar sites. 

Travel Updates

The venue is on the outskirts of Birmingham with ample free parking and well connected to the main road network meaning most delegates travel by road. If the proposed rail disruption means you are looking to make alternative arrangements please check out the DDN social channels and the hashtag #ddnconf to arrange carsharing.

Delegate Names

If you have booked as part of the CLERO or made an individual credit card booking we already have your details. If you have made a booking directly with DDN as part of an exhibition package or group booking please use this form to add the names of people attending. 

Conference Timings

Delegate registration will be from 9am and the main conference sessions will run from 10-3pm with additional breakout meetings and sessions running until 5pm. There will be tea coffee and refreshments on arrival with further refreshments throughout the day including a full cooked lunch!

The programme

We are running presentations from the main stage throughout the day (with breaks for lunch and refreshments). We are committed to focussing on projects that are led by people with lived experience and support people to engage with wider services. A full programme will be available shortly.


Exhibitor information

Exhibitors will have access to set up stands from 8am on the morning of the conference. There will be limited availability to drop stands and materials off at the venue between 2-4pm the afternoon before (22 June) but you will not be able to set your stand up until the morning of the event. If you would like access to drop stuff off on 22 June please email ian@cjwellings.com to be added to the list.

Exhibition stands can be dismantled after the lunch break (approximately 3pm) although you are welcome to leave your stand up until the end of the day.

Exhibition Stand details

You have an exhibition stand which will be a tabletop and chairs. If you need power for your stand, require more space or have specific requirements please email ian@cjwellings.com to request them. 

As those of you who have attended before will know this is a vibrant area at the heart of the event and interactive stands and giveaways are incredibly popular. 

Delegate bag inserts and information for couriers

If you are sending inserts for delegate bags or would like to courier stands etc in advance this is being coordinated by our partners at Changes UK. The deadline for bag inserts is Friday 17 June at 5pm (please send 500) and deliveries for stands must be received by 5pm Tuesday 21 June at the latest. If you are couriering materials in advance please email ian@cjwellings.com to be added to the list. 

Please mark all deliveries clearly as DDN Conference 2022 and send them to:

Attention Stacey Smith, Changes UK, Recovery Central, 9 Allcock St, Birmingham B9 4DY. Contact number for couriers is 0121 796 1000.

If you are arranging couriers to pick up stands etc after the event please let ian@cjwellings.com know in advance. Stands must be picked up from the venue on the day of the conference unless you make prior arrangement.

Delegate names

If you have not already done so please add names of people attending as part of your group using THIS FORM

I hope this helps you prepare for what should be a fantastic, interactive, energetic and inspiring event.

If you have any questions or would just like to discuss the event or DDN magazine please don’t hesitate to contact ian@cjwellings.com 07711 950 300

 

DDN Conference 2022 Delegate Names

DDN Conference 2022 Delegate Names

Main Contact(Required)
Please add the details of the person who will be the main contact for your party. We will use these details to send any changes or updates.
If you have any questions relating to the event or your booking please contact ian@cjwellings.com 07711 950 300

 

Government denies imminent end to rough sleeper funding

The Ministry of Housing, Communities and Local Government (MHCLG) has denied claims that it will no longer be funding the scheme to provide emergency accommodation for rough sleepers in hotels (DDN, May, page 5). A story in the Manchester Evening News on 14 May stated that civil servants had told Greater Manchester Combined Authority officials that the scheme was ‘no longer being funded by central government’, that March’s original COVID guidance to local authorities had ‘been scrapped’, and that a leaked report said that MHCLG had now ‘drawn a line’ under the programme.

MHCLG has since responded via Twitter stating that ‘any suggestion that the government is reneging on the commitment set out at the start of this national emergency is entirely wrong’, and that the department had been clear that councils ‘must continue to provide safe accommodation for those that need it’. Suggestions that funding is being withdrawn or that people are being asked to leave hotels are ‘unfounded’, it says.  

More than 90 per cent of rough sleepers known to councils at the beginning of the COVID-19 crisis – around 5,400 people – had now been ‘made offers of safe accommodation’, the ministry added, stating that it would ‘work with partners to ensure rough sleepers can move into long-term, safe accommodation once the immediate crisis is over’.

The government came in for significant criticism from homelessness organisations at the start of the outbreak for failing to provide them with adequate guidance or explain how people sleeping rough or in hostels were expected to self isolate. It later instructed all local authorities to find emergency accommodation for rough sleepers by the end of March.

St Mungo’s has launched a campaign, No going back, which is calling for funding to be put in place for local authorities to ensure that no one is made to leave emergency accommodation without being offered suitable alternative housing. It also wants to see more housing and support for people with complex needs, and more safe and secure housing for women and survivors of sexual abuse. ‘The government now needs to ensure that everyone isolating in a hotel can move into specialist hostels or permanent housing – depending on their needs,’ it says. ‘And that no one is forced out without the right support to stay off the streets for good. If the government takes action now thousands of people can be helped off the streets permanently.’ 

 Details of No going back campaign at www.mungos.org read it here

Tsunami of Need

Phoenix Chief Exec Karen Biggs blogs about the impact of COVID-19 on the people who rely on drug and alcohol treatment services.

Man staring at a Fjord
Isolation is the enemy of recovery

The COVID-19 pandemic has brought many people in society to a crisis point. People who were already struggling to access the health and social care they desperately need. When society opens its doors again it will reveal a tsunami of need which we should be ready to meet.

Many people use drugs and alcohol to try to numb pain and smother deeply traumatic experiences. Many more of us would too, if faced with similar circumstances. People who use drugs have always been invisible; labelled as ‘hard to reach’ or ‘too complex’.

They are not; the reality is that decision-makers and funders haven’t spent the time and money required to reach out, understand and help. There are many reasons for that – poverty, entrenched stigma across society and the sense of some people are more deserving than others. What is clear now that is that we don’t need to argue anymore about whether or not that is true. It is fact, proven, accepted and understood – no matter how hard it is to stomach.

‘Funding reductions are exacerbating gaps in treatment provision. As funding pressures have increased some services have disappeared altogether (such as outreach service targeting newer users), whilst others have been rationed (such as inpatient detoxification for people with complex and multiple problems heroin assisted treatment and residential rehabilitation.)’
Professor Dame Carol Black

So, what happens when people who are already struggling to stay alive lose the fragile links to the support they have? Lose the opportunity to be with others with the same shared experiences of life? When people lose their sense of belonging? The answer: negative thoughts, relapse, self-harm, overdose, suicide and death.

Read the article at

www.phoenix-futures.org.uk

———–

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, and first appeared on their site. Read this and more article like it on

www.phoenix-futures.org.uk

Why COVID-19 will change social care for good

From claps for our carers to government recognition that funding for adult social care is a top priority, something is finally changing.

It would have seemed unimaginable a year ago that neighbours would come together at 8pm every Thursday night to join a chorus of thanks and appreciation for everyone working hard throughout the NHS and in social care. The cheering and saucepan banging is wonderful recognition for those going out on the frontline every day to treat those in great need and to support the rest of us to keep safe.

Giving credit to hard working doctors, nurses and all NHS staff in the direct path of this virus is, of course, extremely important. Alongside this, valuing the role of care staff and other public sector key workers marks a significant change.

Read the full article at www.turning-point.co.uk

——–

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 first appeared in the Turning Point blog

 

WDP and Hermes deliver essential items to Capital Card users during COVID-19 pandemic

Leading drug and alcohol charity WDP has partnered with Hermes, one of the UK’s largest parcel delivery companies, to provide its most vulnerable Capital Card users access to essential items during the coronavirus pandemic through a home delivery service.

Hermes electric vanUsers of the WDP Capital Card earn points by engaging in drug and alcohol treatment and can then spend their points on positive activities and products in their local community at Spend Partners, such as cinemas, gyms or eateries. However, many Capital Card Spend Partners are closed due to the current lockdown.

This innovative partnership means that service users who are currently unable to leave their place of residence, whether because of self-isolating or mobility issues, can place orders for essential items that they would usually ‘buy’ in their local WDP service’s pop-up shops, such as toiletries and non-perishable items. Hermes will then deliver these orders to the service user’s door within one week, as part of the Capital Card ‘Shop on Wheels’ initiative. While WDP services remain fully operational, social distancing guidelines dictate that the pop-up shops cannot currently open on-site.

Hermes is generously providing delivery options in 11 different WDP service locations across Greater London and Cheshire West and Chester, meaning ten packages per week per location can be delivered to service user homes.

WDP chair Yasmin Batliwala
WDP chair Yasmin Batliwala

Yasmin Batliwala, Chair of WDP, said: ‘We are excited to be partnering with Hermes to support our service users during these difficult times. Our Capital Card team are doing everything they can to find new and innovative ways to support our service users, and this news is yet another example of their hard work and dedication and exemplifies everything that WDP is about. We welcome Hermes into the Spend Partner family and thank them wholeheartedly for enabling us to provide safe and secure access to essential everyday items for our most vulnerable service users without them needing to leave their homes.’

Sasha Law, head of internal comms and engagement at Hermes, said: ‘We’re proud to be able to support the Shop on Wheels initiative, which is a great cause, and we’re pleased to be able to use our network to support some of the most vulnerable in society. Hopefully this support will help make a positive impact and enable WDP to continue their valuable work.’

Read the full article and find out more about the Capital Card on www.wdp.org.uk/news


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, and first appeared on www.wdp.org.uk

 

New helpline for prisoners released during pandemic

A new free-phone helpline has opened for men and women in the North East who are being released from prison during the coronavirus crisis.

The helpline is provided by the Humankind charity from 10am to 4pm, Monday to Friday, on 0800 731 2072. It can also be accessed through the website.

‘Changes community based services have had to make alongside the Ministry of Justice initiative to release some people from prison early have prompted us to launch this additional support for drug and alcohol recovery clients leaving North East prisons,’ said Amy Levy, of Humankind, which is based in Bowburn, Co. Durham. ‘We hope to provide information and guided signposting to services and support which is already available across each local authority area in the North East.

She added, ‘There’s considerable evidence that confirms the first few weeks following release as being a critical period during which men and women face a range of increased risks.’

The helpline will point callers to community drug and alcohol service provision, local pharmacy information, local authority housing support and support hubs for vulnerable people, Job Centre Plus and a wide range of community support projects. Links to Probation will also be key for those men and women released on any form of licence, including those released under the early release scheme.

Humankind provides the non-clinical drug and alcohol recovery service element of the new Reconnected to Health service led by Spectrum Community Health CIC.

The Reconnected to Health partnership, which also includes Tees, Esk & Wear Valleys NHS Foundation Trust (TEWV) provides integrated healthcare to men and women resident across the region’s seven prison establishments – Durham, Frankland, Holme House, Low Newton, Northumberland, Kirklevington Grange and Deerbolt. The service is commissioned by NHS England. 

All drug and alcohol recovery clients leaving prison in the North East will get details of the helpline in their release packs. Information about local services, including links and telephone numbers, will be held on a dedicated page on the Humankind website.

 

 

Weathering the storm

While COVID-19 is wreaking havoc on the vulnerable, the economy and society as a whole, it is also generating – by necessity – some new and innovative ways of working. DDN reports.

With the UK’s lockdown now in its second month, everyone has had to adjust to the ‘new normal’. However, in much the same way that COVID-19 can be far more damaging to people with weakened immune systems or pre-existing conditions, so it has the potential to cause disproportionate damage to sectors already depleted by year after year of shrinking budgets. Whether the inevitable recession that comes in its wake will lead to greater austerity, or whether renewed respect for health services and – perhaps – a different attitude to society’s most vulnerable might see the drug and alcohol sector get off relatively lightly (DDN, April, page 7) is yet to be seen.

In the meantime treatment services, like everyone else, are having to get by as best they can. Substance misuse staff have been designated as key workers eligible for COVID-19 testing if they display symptoms and for school-based care for their children, which means the sector is able to function better than most. Arrangements have also been made to try to ensure people can get their substitute medication, and organisations have also been able to move elements of their support online.

Guidance

director of health, care and wellbeing at the Calico Group, Nicola Crompton-Hill.
Director of health, care and wellbeing at the Calico Group, Nicola Crompton-Hill.

The government published its guidance for treatment services and commissioners on 15 April (see news, page 4) which – alongside instructions to minimise face-to-face contact, scale back hep C testing and defer detoxes – recommends increasing provision of harm reduction measures including naloxone, and encourages services to increase stock held by NSPs and allow people to take more equipment. The guidance also advocates new ways of working, such as by phone or video call, something most organisations were already doing.

‘I do think that the drug and alcohol sector were getting on with it ourselves because of the very nature of what we do,’ director of health, care and wellbeing at the Calico Group, Nicola Crompton-Hill, tells DDN. ‘But I think what the guidance did was offer reassurance. One example was that staff were recognised as key workers. That alone really helped me and the management teams realise we’d be able to manage staffing levels and safeguarding better.’

WDP chair Yasmin Batliwala
WDP chair Yasmin Batliwala

‘We were heartened to read the guidance, especially as WDP had already implemented the overwhelming majority of it,’ agrees WDP chair Yasmin Batliwala. ‘The guidance is sensible and comprehensive but will of course need to be updated to suit the ever-changing situation, particularly as lockdown restrictions are eased and we begin the return towards normal service operation – albeit with stringent protection measures in place.’

WDP has moved support to online resources, videoconferencing facilities and phone appointments where it’s considered safe for the service user, although it also continues to safely operate in-person appointments. ‘Our IT department has also rolled out a large amount of equipment and support in a short space of time, for example a desktop phone system used on tablets to allow staff to make and receive calls using the usual service number,’ she says.

Bath: A volunteer PPE manufacturing initiative set up in a school sports hall during the coronavirus pandemic. Credit: Andrew Lloyd/Alamy
Bath: A volunteer PPE manufacturing initiative set up in a school sports hall during the coronavirus pandemic. Credit: Andrew Lloyd/Alamy

It’s possible that one of the long-term impacts of all of this might be a shift towards more online support and counselling generally, although clearly there are areas where this will be far from ideal. ‘We’ve been adapting the model and the programme where we can to offer virtual support and virtual counselling,’ says Crompton-Hill. ‘Some staff in our residentials aren’t used to working digitally so I’m really proud of how quickly that culture’s been adapted, and we’re starting to think about how we can enhance services going forward. Given that when we come out of the actual crisis we may be left with a reduction in funding, can we do more in the style that we’ve had to adapt to? But there are lots of mutual aid groups operating virtually at the moment and what’s key to mutual aid is actually going out there and socialising with people in similar situations – having that connectedness and those one-to-one chats. So although people have done their very, very best, those sort of things will be really impacted, so it’s just trying to get the balance right. I think we’ve just got to hope as a sector – and fight a bit – to try to get back to where we were in terms of our offer and delivery.’

Unprecedented

The unprecedented operating environment has meant that organisations have needed to come up with other alternative ways of working. While the lockdown has inevitably forced the partners who provide the rewards for WDP’s Capital Card scheme (DDN, February 2019, page 6) to close, the organisation is securing a free-of-charge arrangement with a national delivery company to deliver essentials like clothing and hygiene products from Capital Card shops – normally located in services – direct to service users’ doors. While keen to return to normal operating models, WDP will ‘certainly be able to boost our offer with a lot more home participation for service users in the future,’ says Batliwala. ‘This should really help the momentum of recovery journeys between in-service appointments.

Support

Although it’s been a period of rapid change, the local authorities commissioning WDP’s services have been ‘extremely supportive, which has been a big help’, she adds. ‘It’s been a real two-way process – there’s been a real sense of really wanting to help us with PPE, for example, which has been really welcome,’ agrees Crompton-Hill.

‘We’re proud of the way all WDP staff have risen to the challenge with both dedication and innovation,’ says Batliwala. ‘To say thank you to them doesn’t seem nearly enough. The fact that we’ve managed to still provide both an in-person and remote service in all areas has been a huge success. We’ve maintained very regular communication, guidance and encouragement to staff throughout, and have done whatever we can to boost morale in small ways such as pizza lunch deliveries and ‘fresh fruit Mondays’. We have also vastly expanded our online support for staff, including workouts, weekly wellbeing webinars and tips for effective home-working and coping with lockdown in general.’

Long-term impact

What no one knows, of course, is what the long-term financial impact of all this is going to be on the sector. ‘A lot of the work we’re doing at the moment is looking at the “what if?” and factoring in the financial implications of that as a business,’ says Crompton-Hill. ‘I think what we need to try to do as a sector is use what we’ve learnt over the last month to see if we can step up to what those financial challenges might be, for example can we do more digitally so we can see more people? We don’t want to have to do that because a lot of our services run on being able to come together, but we may have to.

London: A space underneath Tottenham Hotspur Stadium is used as a food hub for delivery of pre- packaged meals to the homeless and vulnerable. Credit: Simon King/Alamy
London: A space underneath Tottenham Hotspur Stadium is used as a food hub for delivery of pre- packaged meals to the homeless and vulnerable. Credit: Simon King/Alamy

‘One of the things I’m proud of is the staff and their resilience, and their ability within a very short time frame to adapt their everyday practice,’ she continues. ‘We’ve been specifically helping with homelessness. We looked at all the beds we had available and with every service that had a bed it was, “can we help?” Everyone mucking in together has been a real theme over the last month.’

Another thing that the crisis has reinforced is the vital importance of effective communication. ‘Really open and transparent communication has been key,’ she states. ‘I’ve had that from the local authorities we work with, and we’ve done that with all of our clients in treatment, all of our staff, partners – it’s really helped us through this. I’ve never had as much communication coming through, and I’ve never sent as much out. But I think that helps people feel fully informed, and it’s been a real key thing for me. You’ve not felt alone in the process.’

Scots widen availability of naloxone

The Scottish Government has widened the availability of naloxone as part of a package of support for people affected by drug use during the COVID-19 pandemic.

Other measures include £1.9m to support people on OST while in prison to switch to a prolonged release injection of buprenorphine (Buvidal), and an ‘enhanced offer of residential rehab’ for people leaving prison during the outbreak in order to reduce pressure on local services. 

Under current UK regulations, only drug treatment services are allowed to supply take-home naloxone kits. However, Scotland’s lord advocate has confirmed that it would ‘not be in the public interest’ to prosecute anyone working for a service registered with the Scottish Government – for example, a homelessness organisation – who supplies naloxone for use in an emergency during the crisis. Non drug treatment services will need to register with the Scottish Government to become a naloxone provider.  

‘While this public health crisis is ongoing, we must not lose sight of the fact there continues to be a significant number of highly vulnerable individuals who are at great risk of harm as a result of alcohol and drug use, who continue to need a wide range of help and support,’ said public health minister Joe FitzPatrick.

public health minister Joe FitzPatrick.
Scottish public health minister Joe FitzPatrick.

‘Buvidal is an alternative to methadone or buprenorphine tablets which is administered by a seven or 28-day injectable dose, rather than daily administration. By making this available to people in prisons, we will support continuity of care, while reducing the need for daily contact and reducing pressure on our frontline prison officers and NHS staff.

‘I welcome the lord advocate’s statement of prosecution policy in respect of the distribution of naloxone during the period of disruption caused by COVID-19,’ he added. ‘This will help to ensure that we can continue to support those affected by drug use and keep them safe.’

A new normal

Within days of lockdown being announced, Lancashire’s recovery communities had transformed their way of life on a grand scale, as Chris Lee explains.

LUF Lounge
Read the full feature in DDN Magazine

We are all living with significant changes as a result of the threat posed by COVID-19. For some this is just another factor in busy lives, for others it’s a real threat to a safe and functioning lifestyle. The pressures of isolation, worries about money, housing, food, keeping children occupied and all of us safe will be creating untold pressures and risks for some.

The UK recovery movement might have drifted from the popular narrative, however in parts of the country, thriving, diverse recovery communities are adapting to the ‘new normal’. We wanted to highlight how two organisations, Red Rose Recovery/Lancashire User Forum (LUF) and The Well Communities are adapting to support those in recovery and beyond.

Lancashire has had a sustainable and thriving recovery scene for well over a decade. This had led to well-developed peer support structures, training, employment, group work, activities, volunteering and more. All of this is delivered very much as an asset-based community development approach – local people with lived experience supporting other local people with lived experience.

LUF Live LoungeThe Old Normal

In the current circumstances, some ‘normal’ work is still ongoing, albeit under the guidance of physical distancing, use of appropriate protective equipment and essential journeys:

  • In the early days of lockdown donations of food and toiletries from high street retailers were delivered to the elderly, homeless and vulnerable, along with packs from Lancashire Fire and Rescue Service.
  • Volunteers have been supporting the delivery of more than 600 meals a day to feed individuals who are vulnerable, isolated, quarantined or shielded in local communities; information about digital support is distributed through the food parcels.
  • Local treatment providers have been supported to deliver naloxone and safe storage boxes
  • Support has been given to individuals in recovery housing.

However, with no face-to-face mutual aid running and normal peer support ‘suspended’, a dramatic shift to digital provision has been implemented locally to do all we can to ensure no one is left behind. Both Red Rose Recovery and The Well Communities have rapidly embraced digital tools and shifted support online within days of the UK lockdown coming into force. This emphasises the flexibility of community organisations and the principle of building delivery around those who use them.

This isn’t perfect, but sharing the learning has been key to the success of recovery communities locally. One simple issue has been to try to buy mobile phones and credit for those with no resource and therefore at risk of isolation, or to actively support people to download software and give tutorials to support access.

The New Normal

Employed workers and volunteers in the recovery communities are desperate to help those in need in any way they can. It took a while to get them to recognise the severity of the situation, the risks involved and to adapt to new ways of working. However, now as always, they have proved how they adapt quickly and develop new skills to enable work to continue safely.

The ‘new normal’ is being supported with daily team Zoom meetings (other platforms are available), and regular outreach is now via telephone and social media platforms and tools – WhatsApp and Facebook. This aims to replicate as far as possible the principles of pre-COVID delivery but with the added bonus that group work is now open to all without geographical restrictions.

Since the lockdown began:

  • more than 15 online support groups are running each week with regular participation
  • live exercise classes (weekly) achieve around 100 views per session and active participation
  • recovery shares (weekly) are viewed by up to 500 people
  • live topic broadcast (with field experts) are viewed by up to 700 people

Both organisations have also inadvertently created ‘flagship’ broadcasts. Red Rose Recovery and the Lancashire User Forum developed the ‘LUF Lounge’ on Saturday evenings at 5pm – hosted on Zoom and broadcast to Facebook as a live stream. The Well have been using Facebook to live stream for broadcasts on Monday and Friday each week at 12 noon. Both events have drawn in both local and national figures to update, educate, support and entertain our recovery communities.

Both organisations have been collaborating to share experience of the technology, to support each other’s approaches in reaching out and provide meaningful content for the local recovery communities – and beyond. Digital delivery has meant reaching recovery communities in Wales, Australia and New York!

New partnerships are appearing as a result of the new digital world, for example working with local housing providers to support delivery of food parcels in the physical world and support them to access the online offer.

LUF Live LoungeThe Lessons

What are we learning as a result of all this?

  • Isolation and mental health have been key issues raised, especially from those in supported housing as they are almost confined to their bedrooms (although we know that not all are keeping to lockdown rules and meeting up with friends etc).
  • People are struggling when they are unable to see their children and other family members; this is also undermining some people’s mental health.
  • There is a perceived increase in relapse; local treatment provision has seen an increase in referrals.
  • Another key concern is that those who have experienced crime, assault or dispute are desperate for personal contact, something no digital transformation can ever overcome.
  • Facebook and Twitter followers are rapidly increasing alongside significant increases in requests for support.
  • The beauty of digital is that the analytics are available to help inform reach. We can see an unprecedented surge in views with a global reach from the broadcast events so far.

The future

This has yet again highlighted the inherent value of community organisations and community participation. It has shone a light on the need to address digital inclusion and ensure people have access to the right tools to enable participation, alongside other existing social, economic and health inequalities.

Plans are currently being developed to build on these early developments and to bring along other groups who wish to join in, to build digital inclusion, develop the new digital skills and embrace what technology has to offer. This will include technical, social and policy development needs.

The future is clearly unknown. When will lockdown measures begin to ease, how will that happen and what restrictions will remain? All are questions that society as a whole will be grappling with. What is certain is that the digital shift in delivery for recovery communities locally is here to stay. Yes, the physical world is important and digital cannot replace much of ‘normal’ recovery activity. However the ability to reach out beyond borders (of whatever sort), to share stories, experiences, music and thought in times of crisis is aided by digital platforms. The increased connectivity is making a difference, for example people who suffer with anxiety or those living in rural communities. We can’t just go back to ‘normal’.


FIND OUT MORE

Chris Lee is public health specialist at Lancashire County Council

chris.lee@lancashire.gov.uk

Peter Yarwood, strategic engagement lead, Red Rose Recovery, peter@RedRoseRecovery.org.uk

David Higham, CEO, The Well Communities, dave@thewell2.co.uk

LUF Lounge: www.facebook.com/groups/279396408828996

The Well Communities: www.facebook.com/groups/thewellcommunities/

DDN May 2020

‘We’re learning about new versions of outreach’

WE’VE HAD TO CHANGE OUR PLAN for this issue several times this month as your news and survival tips have been coming in.

DDN May 2020The good thing is, it’s not just about business as usual – it’s become about being better than usual. Not only are we hearing about swift action to keep essential services maintained – we’re also learning about new, enhanced versions of outreach, where service users are an essential part of developing and maintaining the model.

Tweeting their invitation to the LUF Lounge on a Saturday night, Red Rose Recovery offer ‘community and connection with a whole heap of compassion’ and this spirit is playing out through the Lancashire recovery communities, with their ‘dramatic shift to digital provision’ (page 8). Particularly exciting are the partnerships that are forming from this ‘new digital world’.

Last month we raised the issue of delayed scripts through a ‘plea from the pharmacy queue’ and there’s been a lot of hard work going on to improve the situation. The clinical and prescribing team at Humankind are among those working round the clock to ensure no one is ever without medication (page 13).

Carry on the great work and new ideas – and share them with us! Community means more than ever right now.

Claire Brown Editor of DDN magazine
Claire Brown, editor

Keep in touch claire@cjwellings.com and @DDNmagazine

Read the issue as an online magazine or download the PDF

Staying on track

What does COVID-19 mean for hepatitis C elimination plans in London? Dee Cunniffe gives an update.

Dee Cunniffe, LJWG project lead
Dee Cunniffe is LJWG project lead

Two months ago, on 2 March, senior leaders from across the NHS, addictions sector and public health in London came together at City Hall to kick start work on a new routemap to eliminate hepatitis C in the capital. The World Hepatitis Alliance hailed the partnership as ‘an example of best practice that could be replicated in cities across the world’ and support for this initiative from every connected sector in London has been impressive.

However, just days after our ‘kick start’ event, the enormity of the impact of COVID-19 started to unfold. That seems like a lifetime ago now, and since then the NHS has completely reconfigured to create capacity for coronavirus patients, and all outreach and addictions support services have had to adapt to supporting people remotely.

So, where does that leave our plans for eliminating hepatitis C? While people who had started treatment are being supported to complete it and become hepatitis C free, outreach testing and treatment initiations have paused in most places, and some hepatologists have been redeployed to COVID wards.

We know this is not forever and Matt Hancock has already started talking about the restoration of other NHS services. This will require substantial service reconfiguration in many places and will take several weeks, maybe months for some areas.

Reception for Routemap to Eliminate Hepatitis C in London
Reception for Routemap to Eliminate Hepatitis C in London

Creativity and fresh thinking will be required to ensure that healthcare challenges, such as finding the undiagnosed people who are living with hepatitis C, are not worsened in the long term due to this crisis. For example, we will need to think more creatively about how we raise awareness and provide information and support online, and whether self-testing could be used, as it has for HIV.

The steering group for the routemap brings together senior representatives from Public Health England, local government, NHS England, addictions service providers, homeless services, CCGs and The Hepatitis C Trust. While many of these people and their organisations are completely focused on combatting COVID-19 at the moment, they are all also deeply committed to the goal of eliminating hepatitis C. No one wants progress made in addressing hepatitis C to be another victim of COVID-19.

There is one thing that has been constant in my experience of working in the hepatitis C field for the last ten years: progress has always been built on the passion and dedication of an army of incredible people, from people with experience of living with hepatitis C to nurses, consultants, addictions support workers, and many more. I know that we will all rise to the new challenges and, as a ‘new normal’ develops, ensure we continue to make progress to our goal of eliminating hepatitis C.

Key Areas for Action

Five Key Areas for Action

The routemap to eliminating hepatitis C in London has five key areas for action – raising awareness, engaging with people who are under-served by traditional health systems, working with GPs to find the undiagnosed, making pathways as quick and easy as possible, and aligning hepatitis C and HIV Fast Track Cities Initiatives.

Read more at www.ljwg.org.uk/news

More reports and updates from DDN on the work of the LJWG

Remembering Simon

Tributes have been paid to Simon Morgan; Change Grow Live recovery worker, DDN volunteer, and a much-loved member of the Stratford-upon-Avon music scene, who was an inspiration to family, friends and colleagues.

Simon Morgan, 57, from Norton Lindsey, Warwickshire, died after a road accident on Friday 3 April. He was out cycling when the accident involving a tractor happened, near Balsall Common. He was taken to hospital but died later that evening.

Simon was much loved by his friends and colleagues. His closest friend and his colleague Chris Jennings gave us an insight into the ‘real’ Simon.

They became friends in teenage years and stayed close ever since. Chris was a member of The Fragiles at the time Simon was in Domestic Bliss and the pair properly joined forces in The Suspects, a band that featured in the Easter 1982 edition of The Herald’s Focus magazine.

Simon and Chris formed The Hop in 1983 and early work features Chris on vocals. Chris would then move to London, but the pair kept in frequent touch. Chris recalls: ‘He would visit, call me and send letters with home-made mix tapes on cassette. Over the years we’ve been through everything together, holidays, good times, bad times and played at some of the most dubious venues in London.

Domestic Bliss - Simon Morgan
Hear Domestic Bliss on Youtube

‘He was a prolific songwriter, still putting down ideas shortly before the accident. He was one of the most intelligent and articulate people I’ve ever met. He was a prolific journalist with exceptional literary skills, widely recognised as an expert in his field with the ability to produce thousands of words effortlessly. He was also interested in and highly knowledgeable about art, politics, ancient history, megalithic remains and their surroundings – indeed, there wasn’t much he didn’t know about, and his energy and output was unreal.

‘He was a musical expert and was still listening to everything from avant-garde jazz, pan pipes and punk to reggae, French hip hop and more recently, the sounds of Bristol’s Ossia and Young Echo.’

Alongside the shared love of music, they had been working together in recent years for Change Grow Live, with people recovering from drug and alcohol issues. Simon’s previous roles had included being part of his father’s firm working on exhibition electrics but he then went late to university and graduated as a social worker, quickly moving into recovery work.

‘He was a key player in treatment services and he was a pioneer,’ says Chris. ‘He was a champion of the underdog and was never afraid to challenge authority.’ But at the same time other enduring qualities shone through to all who knew him. ‘He was also one of the most loyal, sensitive and caring human beings I have ever known,’ he said.

‘As Simon’s manager, I only knew him for six months, but I was enormously impressed by his contagious passion,’ added Change Grow Live team leader, Paul Woods. ‘What a wonderful guy, who had a profound impact on me in the short time I knew him.’

DDN adds…

For years we have been indebted to our team of volunteers for helping us stage the DDN Conference. Whenever we think about this role we will always remember with gratitude and affection the star that was Simon Morgan, who cheerily, competently and without fuss coordinated a superb effort on our behalf, meeting and greeting delegates, then helping them find their way around throughout the day. Simon’s cheery band of colleagues was a credit to his ‘can-do’ style and charisma. The picture was taken in March, on a visit to The Glee Club, when Simon brought some of his group to look around the venue and go through logistics for the conference. We larked about not knowing that the event would be postponed – Simon was going to compere the entertainment programme and sing with his guitar.

Simon felt like one of our team members and we will miss him very much. We know how hard it will be for those who called him ‘the heart of the recovery community in Coventry’. Our sympathies to his family and many friends. DDN

Home from home

Keeping the home ties strong is one important way that Phoenix Futures keeps their residents’ motivation high, says Liam Ward

Aligned with government guidance – and as with other registered care homes – our residents are currently unable to receive visits from their loved ones. We know that these connections are really important; in a recent study, more than 60 per cent of our residents told us that repairing relationships with loved ones is one of the most important and motivating factors behind their recovery. 

Evidence confirms that visits are conducive to improved outcomes throughout treatment and emphasises how a regular structure of contact with loved ones can provide a welcome balance to the hard work required throughout residential treatment. 

COVID-19

COVID-19 has meant that elements within our programme have had to be adapted to ensure the continued safety of everyone in our care. Without visits we wanted to ensure we supported our residents to keep connected with their loved ones, and our services have certainly done that! 

Access to WhatsApp, FaceTime and Skype video calling software has been increased as well as the availability of the service telephone and, where appropriate, residents’ own personal devices too. Additional time is given for those wishing to contact families and children. 

family look at tablet
Mobile apps help to keep residents in touch with their families.

Further to this, services are being innovative and finding ways to keep families updated, connected and reassured that their loved ones are being cared for. 

Our Wirral Residential’s choir has been singing and sharing videos on social media, including their closed community group on Facebook. This has allowed family members to watch their loved ones looking well and enjoying activities. Family members commented that it was amazing, and that they were proud. They also said how good it was to see them doing so well. 

The residential community responded by creating video messages that were shared, and in turn received heart-warming and motivating messages such as ‘you’re doing great’, ‘love and miss you’ and ‘keep up the good work’, which were passed onto them by staff. 

Sense of achievement

Lee B has been with us in our Wirral Residential since January and told me how he FaceTimes his son twice a week but misses having visits. ‘I can’t wait for the restrictions to be lifted so he, my mum and my nan can come,’ he said. ‘They’ve been going on the Facebook site and writing comments. It makes me feel really proud of myself. It gives a sense of achievement and reminds me why I’m here.’

Phoenix Wirral Choir
Wirral Residential’s choir has been singing and sharing videos on social media

 

I asked how Lee felt after hearing from his family. ‘I feel sad for a short time because I’m missing them,’ he said. ‘But after I reflect on it, reflect on the reasons I’m here, it makes me feel good seeing them smile and feeling like I’m achieving something with my life. 

‘If I was still out there, I’d be dead,’ he added. ‘I used to be isolated, I suffered from anxiety, I was paranoid. I would have spiralled. I was out of control. Now I’m healthier. I’ve got colour back in my skin and colour back in my life.’

Lee A was admitted in late March after the lockdown had been announced by the government. He spoke about his initial feelings upon entering rehab during this time, and spending his first few days separate from the community as part of our screening process for new admissions. 

‘It was the way it had to be,’ he said. ‘I had company with the other new admissions, and we all kept a social distance. Staff were fantastic. They kept us engaged, kept us entertained. When that was over I was excited to go into my first meeting, but I hadn’t mentally prepared myself. The community were so welcoming and understanding though, I warmed to everybody.’

Lee A went on to discuss his relationship with his family, and his feelings around being away from them. ‘I hear from my mother, my grandparents and my sister about two or three times a week. It’s strange for me to hear them say things about me like “I’m proud” or “well done”. I pushed these people to the ends of their tethers. It’s been hard to explain to people what I’m feeling, but here (in rehab) we can all relate to each other.

‘Yes, I want to see them, but we all respect the rules, it’s for our safety and for others. [When we were addicted] we were selfish, we didn’t care, but now we feel empathy, we worry about other people,’ he said. ‘Now more than ever we understand these rules, we don’t want to hurt anybody. It’s beautiful to have that part of us back, something missing all those years.’

Lee A continued ‘My family notice a difference in me. They hear it over the phone. I didn’t make sense in the past when I spoke. I’d go too fast and lose my point but now I’m concise and well mannered, I have confidence in my voice. My family have told me it’s lovely.’

‘We’re in the best place’

Dave C arrived with us in December. He spoke about those he misses most and gave his thoughts on the impact of COVID-19 on his and their lives. ‘It’s been tough because my mother has no immune system. She visited me before the lockdown. I can’t help worrying it was the last time I’m going to see her. It’s always in the back of my mind.’

Dave speaks on the phone to his mother several times a week, as well as other members of his family, who keep him abreast of their activity – or lack of it, in some cases. ‘People outside are bored. We’re in the best place because we’ve got the community. The boredom can’t set in,’ he said. ‘I love being here. It’s one big happy family.’

Dave went on to speak about the impact of the staff team on his experience whilst being in rehab, particularly at this difficult time. ‘The staff are fantastic. What they’ve done for us is above and beyond. Loads of services are closed down and can’t take admissions. They’re a fantastic bunch of people. After I leave, I want to get my health and social care education. I want to be part of this team.’

His feelings were echoed by his peers. ‘I’m so grateful to the staff here. They’re doing everything they can – putting on activities for us, making plans for families to visit once restrictions are lifted. I respect them for putting their lives at risk,’ said Lee B.

‘I speak to my family every night’

David F, a resident at our Scottish Residential service in Glasgow, added, ‘Staff have been brilliant. They’re worse off than us out there. They’re out there on their days off, some of them alone, then they come in and they’re positive, encouraging and determined.’

David is the most senior member of the community in Glasgow, having been with us since September 2019. As a result, he is looked to as a role model for other residents and is allowed certain privileges to reflect his progress. One is more regular access to his phone, which he uses to call his family.

‘Before treatment, communication with family was terrible. They’ve always been supportive, but we never really talked. Now I speak to different members of my family every night. I speak to my mum, my aunt, my daughter, and even my brother who lives in Australia,’ he said.

‘They tell me it’s hard, but they don’t tell me how they’re feeling. They might have a sense of making me feel like I need to go. They tell me a bit but just encourage me mostly.’

David went on to reflect on his feelings towards the current situation around coronavirus, and the effect it has had on him and his programme. ‘We get updates on how it’s going on, but because we aren’t out there and experiencing it I think we’re a little sheltered, so maybe we don’t realise the gravity of the effect on the rest of the world. We see it on the news but we’re not living it.

I was going on home visits before all of this and having face-to-face contact. My mum was coming to family support groups. Even though that’s been taken away, I’m trying to take a positive out of it. It’s time to build up more strength and have more chance of recovery.’ 

Liam Ward residential marketing manager for Phoenix futures
Liam Ward is residential marketing manager for Phoenix

Across the country, the feelings in our services follow a consistent thread. Times are hard, but those with us are in a safe place and are supported by others in their residential communities. There is a tremendous sense of cohesion and unity between those in treatment and the dedicated staff teams supporting them. 

Dave C likened the feeling to the mantra of his beloved football team, Liverpool – ‘This means more’. ‘It runs through this house,’ he said. ‘You can see it in the faces of all these amazing people around you.

 

Gambling firms suspend TV ads during lockdown

British betting firms will voluntarily remove their TV and radio advertising during the COVID-19 lockdown, the Betting and Gaming Council (BGC) has announced.

Existing advertising slots will be replaced by ‘safer gambling messages’, donated to charity or removed, says the council – the industry body representing betting shops, casinos and online gambling companies. 

Ray Winstone
Actor Ray Winstone is the face of Bet365’s TV advertising campaign

The changes will come into force no later than 7 May and stay in place until at least 5 June, and will only be reviewed when lockdown restrictions are relaxed. BGC members account for around half of all gambling advertising on TV and radio, and the council says it hopes other operators will follow suit. Direct marketing via social media, text or email by its members has also dropped, the council says, with members committing to ‘further increases in safer gambling messages online’.

Overall gambling levels have fallen since the lockdown began as a result of betting shops and casinos closing and the suspension of live sporting events, says BGC.  

‘This major announcement by our members will result in the removal of half of all product advertising on TV and radio,’ said BGC chief executive Michael Dugher. ‘I hope now that other major gambling operators like the National Lottery follow our lead. We have been working closely with our member companies since this crisis began to monitor the impact of betting and gaming. There hasn’t been an explosion in people betting online as some had predicted – in fact, the opposite is true with total revenue down by up to 60 per cent.’

DDN Gambling and Health
DDN’s guide on gambling addiction helps identify problems and guides you through the available treatment options.

 

RSPH Survey

Meanwhile, the Gambling Commission has issued advice on how gambling companies should keep consumers safe during the COVID-19 outbreak, and the Royal Society for Public Health has designed a confidential survey on behalf of the Gambling Health Alliance to help understand what impact the lockdown is having on those vulnerable to gambling related harm. 

 

 

Gambling Commission guidance at http://www.gamblingcommission.gov.uk/home.aspx

Survey at

https://www.surveymonkey.co.uk/r/L9HBYBT

Online COVID-19 support tool launched in Scotland

A new online tool to help people stay up to date with changes to treatment and pharmacy services during the COVID-19 outbreak has been launched by the Scottish Drugs Forum (SDF), We Are With You and Scottish Families Affected by Alcohol and Drugs.

Pharmacies and treatment services can submit weekly updates, which are then shared through the lead organisations’ websites and social media channels. The database can also be accessed in the form of a user-friendly map, to allow people to see what is available close to them.

‘It has been a real team effort to create a map of all Scotland’s drug and alcohol services’ revised arrangements during the COVID-19 lockdown,’ said We Are With You Executive Director Andrew Horne. ‘People can now see, at the click of a button, which services are being delivered across the country. Whether it’s new arrangements for emergency one-to-one support, or injecting equipment delivery services, people can get accurate information from a central source. We can all get through these times if we work together and look out for each other.’

The tool would complement the Scottish Drug Service and Needle Exchange Directory websites, added SDF CEO David Liddell. ‘It has been a cause of great concern to hear that some of the most vulnerable people in our society have not been able to access basic support with their drug problems during a particularly challenging time for all of us. This tool will ensure that services and people with drug problems have access to real-time information on current service provision.’

Tool available at www.sdf.org.ukview it here

Substance misuse staff eligible for testing

People working in drug and alcohol treatment are among those now eligible for coronavirus testing if they develop symptoms, the government has announced.

While testing patients remains the government’s priority, the Department of Health and Social Care (DHSC) has expanded the list of professionals who can be tested to include all NHS, social care and community pharmacy staff, as well as people working in voluntary sector organisations providing substance misuse support, prison and probation staff, and people working with the homeless, rough sleepers, vulnerable children or vulnerable adults.

Testing will allow people unable to return to work because either they or a member of their household have symptoms ‘to know whether they do have the virus’, says DHSC, and advises any worker on the list who would like to be tested to speak to their employer. ‘The list is not exhaustive and local and regional areas can refer other frontline workers in their area for testing as determined by need and available capacity,’ it adds. The categories only apply to England, and the lists for devolved administrations may vary.

Matt Hancock: Allowing vital workers to return to the front line

The scale of testing in the UK has been a controversial issue throughout the COVID-19 crisis, with the government’s target of carrying out 100,000 tests a day by the end of the month deemed ‘impossible to reach’ by some scientists.

‘I am determined to ensure that everyone who needs a coronavirus test should be able to have access to one,’ said health secretary Matt Hancock. ‘Today’s expansion of testing will allow even more vital workers to return to the front line. We have built up capacity in the system with new testing and diagnostic facilities backed by Britain’s world-class scientists and industry partners. This means we are now able to give even more workers who support and protect us the ability to know if they have coronavirus if they have been demonstrating symptoms.’

 More information at www.gov.uk/guidance/coronavirus-covid-19-getting-tested

Coronavirus guidance issued for providers and commissioners

New guidance for commissioners and treatment providers during the COVID-19 outbreak has been issued by Public Health England (PHE) and the Department for Health and Social Care (DHDC).

While services don’t need to close they should be taking steps to ‘keep face-to-face contacts between staff and service users to a minimum’ and minimising use of biological drug testing, it says. 

naloxone kit
Provision of harm reduction measures and take-home naloxone, should be increased where possible

Given the pressure the on NHS and other services it will ‘mostly be necessary to defer drug detoxes, especially inpatient’, the guidance states, as well as scaling back testing for hep C. Provision of harm reduction measures such as NSP and take-home naloxone, however, should be increased where possible, while arrangements for prescribing and dispensing will need to change to take account of social distancing, pharmacy closures and staff unavailability. 

Providers, commissioners and pharmacies should be as ‘flexible as possible, within the legal framework, to support the safe delivery of OST’, it states. Services should be transferring ‘most, if not all’ patients from supervised consumption to take-home doses, and providing them with up to two weeks’ worth of take-home supply where possible. Anyone advised to self-isolate asked to nominate someone to collect medicines on their behalf. 

Services should also be increasing the amount of stock held by NSPs, allowing people to take more equipment or ‘providing packs with more equipment in them’, it says, as well as increasing outreach and peer-to-peer supply ‘with appropriate social distancing’. The ‘usual expectations’ on services for monitoring, reporting, performance management and contract re-tendering, meanwhile, should be scaled back to focus on delivery.

Service users should be told not to turn up without an appointment, and staff should contact them before their appointments to check if they’ve developed symptoms. Providers should also liaise with local hospitals to ‘ensure they are aware the symptoms of COVID-19 may be confused with withdrawal symptoms in a dependent drug or alcohol user’, the guidance adds. ‘It is important that anyone taken to hospital and showing symptoms that could be either alcohol or drug withdrawal or COVID-19 is managed as if they have COVID-19, unless and until the results of testing show otherwise.’

New ways of working during the outbreak, such as contacting service users by phone or video call, may also ‘bring to light new information about a service user’s home life’, it says. ‘If staff discover a service user is living with children, or see that a service user with children is now struggling to cope, they should consider whether the family would benefit from further support from their local Early Help service, community food banks and other resources.’ Staff should also be monitoring safeguarding issues, and note that referrals to children’s social care services may be appropriate in cases where children are having to take on ‘inappropriate caring roles’. 

Providers should also be monitoring reports of adulterated or unusually strong drugs or any unexpected effects, the document stresses. ‘If usual drug supply routes are affected, there is a risk that alternative substances will be sourced and sold. Cases should be reported to drug.alerts@phe.gov.uk.’

COVID-19: guidance for commissioners and providers of services for people who use drugs or alcohol at www.gov.uk 

 

Regular drinkers consuming more during lockdown

Almost 20 per cent of daily drinkers are consuming more alcohol during the coronavirus lockdown, according to research commissioned by Alcohol Change UK.

However, while more than a fifth of drinkers overall are now drinking more often, one in three are either drinking less frequently or have stopped completely, with the lockdown changing the way people drink ‘at both ends of the scale’. 

pic by www.quotecatalog.com

The survey, of more than 2,000 people, suggests that 14m UK adults are either drinking less often or not at all, while just under 9m are drinking more frequently. Almost 40 per cent of current or past drinkers said they were taking steps to manage their drinking, suggesting ‘an awareness that lockdown might lead us to drink more frequently or heavily and that many are keen to keep their drinking healthy’, the charity says. 

Reduced consumption

People who were already drinking the least are more likely to have reduced their consumption, the survey found – almost half who drank once a week or less have cut down or stopped, compared to 27 per cent of those who drank between two and six times a week and 17 per cent of daily drinkers. ‘Worryingly’, 18 per cent of daily drinkers are now drinking more, it states. 

DDN alcohol and Health
DDN Alcohol and Health provides a clear and detailed overview of the risks of excessive drinking.

Around 7 per cent of respondents also said they were living in a household where drinking – either their own or someone else’s – had worsened tensions, rising to 14 per cent of those living with children. The figures supported what Adfam had ‘been hearing from families,’ said its chief executive Vivienne Evans. ‘Family and household members are largely unrecognised victims of the harm alcohol can cause; at the best of times they suffer emotional and physical distress, and feel isolated because it’s not easy to own up to having a heavy drinker in the household.’

Just under 10 per cent of the survey’s respondents said they were being ‘careful’ with the amounts of alcohol they bought, 14 per cent were making sure they had drink-free days and 6 per cent were not drinking at all. People were also turning to online support, with 4 per cent seeking advice, 3 per cent accessing remote support groups or receiving one-to-one counselling and 2 per cent using apps to monitor their consumption. 

Extensive research

‘This is the most extensive research yet into drinking during lockdown and it shows that this unprecedented period is having a significant impact on the way the UK drinks,’ said Alcohol Change UK chief executive Dr Richard Piper. ‘More than one in five of us are finding ourselves drinking more frequently in lockdown; many of us use alcohol as our go-to stress reliever, and in this very stressful time it’s not surprising that we might find ourselves reaching for a drink more often. But at the same time people across the UK are rising to the challenge by taking steps to manage our drinking. More than a third of us are putting in place ways to keep our drinking in hand, ranging from taking drink-free days to using online support groups. We want to come out of lockdown as mentally and physically healthy as we possibly can, and managing our drinking is an important part of that.’

Professor Ian Gilmore


The lockdown period would be difficult for many dependent drinkers and those in recovery, added chair of Alcohol Health Alliance UK, Professor Sir Ian Gilmore. ‘If you are concerned about your drinking or the alcohol consumption of someone you know, make sure you reach out for help.’

 

London rough sleepers housed in hotels

More than 1,000 homeless people in London are now self-isolating in hotels and other locations during the COVID-19 outbreak, according to the mayor’s office.

Homeless person.

City Hall has been working with the government and charities to block-book rooms across hotel chains including Best Western, Travelodge, InterContinental and Accor. Specialist rough sleeper support is being overseen by St Mungo’s, while Change Grow Live is providing substance misuse support for those who need it. Anyone developing symptoms of COVID-19 will be referred to a specialist facility in a hotel in east London. 

The operation is being funded by a £10.5m grant from the mayor and the Ministry for Housing, Communities and Local Government. The government had previously written to all local authorities instructing them to find emergency accommodation for rough sleepers by the end of March (DDN, April, page 4).  

Official figures from three years ago put the number of rough sleepers in London at just under 1,000, although the Combined Homelessness and Information Network (CHAIN) – which is managed by St Mungo’s – said the total number of people seen sleeping rough in the capital by outreach workers was closer to 8,000 (DDN, February 2017, page 4). 

Sadiq Khan

Sadiq Khan
London mayor Sadiq Khan

‘As we approach the peak of the coronavirus pandemic it is more important than ever to ensure the most vulnerable Londoners are supported in clean, secure accommodation,’ said mayor Sadiq Khan. ‘I’m proud that this outstanding coalition of compassionate organisations, charities and individuals have stepped up to the challenge. The speed with which we have acted, and the willingness of multinational companies to work with us at this critical time, is testament to what can be achieved when we work together.’ There was however, more to do, he stated. ‘More money, volunteers and hotel rooms will be required.’

Round the clock support

‘Our teams are working round the clock to support over 1,000 people who were living on the streets or in emergency hubs into hotel accommodation in London,’ added St Mungo’s chief executive Howard Sinclair. ‘Thanks to the GLA and other partners, these vulnerable people are now in a place where they can self-isolate in safety, and are out of harm’s way. We begin to look beyond the crisis and work out next options for people when they have to leave their crisis accommodation. This will enable us to ensure that support and housing is available to anyone at risk of sleeping rough so people have a home for good.’ 

SIG Joins the Fight Against Coronavirus

In partnership with Guys and St Thomas’s Hospital, the Social Interest Group through SIG Equinox joins the direct fight to help people recover from COVID-19.

Until the Pandemic is over, we will be welcoming people who are being discharged from Guys and St Thomas hospital and are recovering from COVID-19 into our Brook Drive service. These patients, who are deemed medically fit for discharge but are either homeless or vulnerable, will be supported to get well, and have the necessary arrangements put in place for them to safely return home or into stable accommodation. 

This is a temporary change to our normal service at Brook Drive and we will still provide limited residential detox where it is critical to life.

Speaking about this change, Gill Arukpe, CEO of the Social Interest group said, ‘The Board and I made one of the toughest ethical decisions we have had to make together.’

Gill Arukpe, CEO of the Social Interest group
Gill Arukpe, CEO of the Social Interest group

‘We decided it was ethically right to ask the staff team at Brook Drive to temporarily change who they worked with in response to the biggest public health issue we, as a country, have faced in our lifetime. The staff in Brook Drive, working together with our partner, Villa Street GP practice, are amongst the most professional and dedicated team of nurses, recovery workers, cleaners, admin workers and cooks any CEO could wish for.

They save lives daily and I know they will continue to do so in the coming weeks and months. It is an extraordinary day for the SIG Equinox staff team and I am so proud of everyone within the Social Interest Group for stepping up and proactively fighting back against this devastating virus. We are stronger together and I hope anyone reading this will join me in celebrating our teams of dedicated staff during this crisis.’

socialinterestgroup.org.uk


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 also appeared on The Social Interest Group’s site.

 

 

 

 

 

Pharmacists allowed to dispense methadone without prescription

Pharmacists are to be allowed to give out methadone, buprenorphine and other medicines containing controlled substances such as opioids or barbiturates without a prescription during the COVID-19 pandemic. The home secretary wrote to the Advisory Council on the Misuse of Drugs (ACMD) earlier this month asking them to urgently review emergency measures that would ‘ensure patients continue to have access to medicines, build resilience and help relieve pressure elsewhere in the health system caused by COVID-19’, the government states.

Priti Patel: Asked the ACMD for an urgent review

The proposed measures, which were developed by the Department of Health and Social Care (DHSC) and the Home Office, are to enable registered pharmacies to supply controlled drugs without a prescription where patients have been receiving the medicines as part of ongoing treatment, allow them to vary the frequency of dispensing for an instalment prescription, and extend the Serious Shortage Protocols (SSPs) to include controlled drugs in Schedules 2, 3 and 4 (Part I) of the Misuse of Drugs Regulations 2001.

The government has assured the ACMD that the measures will only relate to NHS services and that controlled drugs would only be supplied by registered pharmacies regulated by the General Pharmaceutical Council and at the pharmacists’ ‘professional discretion’. Cases where there is ‘insufficient information available to dispense safely’ would be referred back to the original prescribing service. The National Crime Agency (NCA), National Police Chiefs Council (NPCC) and HM Prison and Probation Service have been consulted and view the risks of diversion as ‘outweighed by the need to continue to supply medicines to those in need’.

The ACMD is ‘generally supportive’ of the measures, says the reply from its chair Dr Owen Bowden-Jones, given the exceptional circumstances and the potential risk of discontinuity of supply. ‘However, pharmacists will require additional support and guidance, as they will be working outside of the scope of their usual practice,’ the letter states. The ACMD has recommended that national-level guidance be issued in consultation with the relevant royal colleges and professional bodies, and notes that the measure ‘would be associated with a greater risk of misuse and diversion’ for patient groups requiring OST or opioid pain medicines.

Owen Bowden-Jones: Pharmacists will need support to work outside normal scope

‘Patients with substance misuse issues might attempt to place pressure on a pharmacist to dispense in accordance with this measure, or might visit a range of pharmacists in an attempt to locate and exploit weaknesses in any of their practices in order to be supplied with medicines against best practice,’ the letter states. Risk assessments by pharmacists will need to be documented and recorded, the prescribing service notified and ‘rigorous’ ID checks carried out, it stresses.

People will need to be able to safely store medicines in locked boxes and have access to take-home naloxone, the document adds, as well as be able to maintain regular contact with the professionals responsible for their prescriptions. ‘Pharmacists will also need to be supported by the original prescribing service to minimise the risks associated with this measure, which include the possible increase in risk of drug-related death,’ it states, and stresses the importance of ensuring that the measures ‘do not extend any longer than is necessary’.

Shared perspectives

Having had to postpone his trip to the DDN conference, Bill Nelles reflects on the differences in drug policy between the UK and his Canadian home.

Bill Nelles harm reduction activist
Bill Nelles is an advocate and activist, now in Canada. He founded The (Methadone) Alliance in the UK

Sometimes things happen in life that force us to change our plans, but it’s especially hard to miss a planned journey. I’m writing, of course, about the COVID-19 virus that forced the postponement of the DDN conference, which I was planning to attend in order to talk about the ‘overdose crisis’ in Western Canada where I now live. I was particularly annoyed because I was looking forward to being back home in the UK and seeing dear friends and colleagues.

I’m never sure how many UK users and drug workers remember me when I lived and worked in London, but there’s a good chance that if you were working or using from the mid ‘80s to 2004, you heard me training about AIDS, drug treatments, overdoses and user involvement.

Here in Canada we don’t have any national publication like DDN that gets to users and professionals alike. DDN’s February editorial, and its article about Vancouver, reminded me how good it is to read sound and unambiguous editorials and articles that say what they mean and don’t pull their punches. The issue had excellent content on the increasing level of danger to users from contaminated supplies. Jussi Grut’s article described the five-fold rise there has been in fatal overdoses in British Columbia (BC) since the street supply has become contaminated by cheap and often poorly made synthetic opioids like fentanyl and carfentanyl. The already high number of overdose deaths here suddenly climbed steeply from just over 400 in 2014 to 1,600 in 2018, in a province with only 3m people.

2016: Vancouver’s Downtown Eastside neighbourhood, a mural highlighting fentanyl-related drug deaths Credit: Gerry Rousseau/Alamy
2016: Vancouver’s Downtown Eastside neighbourhood, a mural highlighting fentanyl-related drug deaths Credit: Gerry Rousseau/Alamy

I also wanted to express the same fears that I felt in 1985 that something bad was on the horizon. Something that could, and should, change the balancing trick we cling to when keeping a safe drug supply just out of reach of the people who need it, and who may live or die depending on reaching such services. Nowhere is this more evident than in the cohort of around 500 people in Vancouver who have access to clean pharmaceutical heroin, or hydromorphone. Hydromorphone isn’t used a lot in the UK but it’s kind of like North America’s legal heroin. It’s also much cheaper than importing heroin from Holland.

This group has had no direct overdose deaths, because of course they don’t need to use the poison on our streets. Massive publicity and easy availability of naloxone kits have also helped hundreds to reverse their overdose and stay alive. I planned to outline the differences between UK and Canadian services. I remembered DATs and DAATs, which we have never had here, but which are often envied. Then I heard they have gone the way of the dodo, with no ring-fenced drug funds any longer. My reaction was like Charlton Heston’s at the end of Planet of the Apes: ‘You fools, you went ahead and did it!’

One thing that is very evident here is the absence of any arguing about whose treatment is better. Users are much more united here. BC has had comprehensive availability of opioid treatments to rival any European programme for five years now, and peer educators are employed by health providers to educate, encourage trust and provide advocacy. The challenge is to scale these services down for people using in rural settings – including many First Nations people, who were living here when Europeans settled in their lands.

There are certainly some shafts of light to mark our progress. Last year saw the first reduction in overdose deaths since 2012, dropping from 1,600 to 1,000. While they remain far above the 400 a year before the crisis, we are getting much better at responding to them.

 

Uncharted territory

The coronavirus outbreak has transformed almost every aspect of our society at dizzying speed. DDN looks at the impact so far on treatment services and their vulnerable client groups.

Public health experts had been saying for years that a pandemic on the scale of ‘Spanish flu’ in 1918 was long overdue, and there were fears that it had arrived with avian flu and later with the SARS coronavirus in the early 2000s. When COVID-19 hit, however, it was the real deal. The final impact may prove to be far less deadly than 1918, but only time will tell. In the meantime the situation is changing at breakneck speed, with society’s most vulnerable – as always – at particular risk.

The long-term impact on the drug and alcohol treatment sector also remains unknown. The fallout from the financial crash of 2008 led to the prolonged austerity policies that decimated the treatment field, and there is no doubt that COVID-19 will cause a recession – it’s just a matter of how deep and how long. And no one in the field needs reminding that when decisions are made about which groups to spend scarce resources on, their clients tend not to be near the top of the list.face mask and hand wash

But for now there’s an urgent health crisis to deal with. Services know that their older clients are an extremely vulnerable population, and many will have long-term respiratory issues as well as weakened immune systems and overall poor health – both physical and mental. One of the most vulnerable populations of all, of course, is people sleeping rough. Homelessness charities were issuing increasingly urgent messages about the need for clear guidance and warning they would be forced to turn people away from shelters if they presented with symptoms.

When official guidance did come it was swiftly branded inadequate, as it failed to set out how those sleeping rough would be able to self-isolate. The government subsequently instructed local authorities to provide accommodation for all rough sleepers by the evening of 29 March, but days later it was still unclear how many homeless people had yet to be housed.

Treatment agencies meanwhile are acting on government and PHE advice as well as drawing up their own action plans. Peer-led charity Build on Belief (BoB) felt it had no choice but to close in order to protect the health of volunteers, staff and service users. ‘It was an extremely difficult decision,’ chief executive Tim Sampey tells DDN.

‘All our services are London-based so we’re up to our necks in this – Kensington and Chelsea was a hotspot from the start. We’ve always recruited from our volunteer teams, so of course people have underlying health issues across the board. We figured out that two thirds of everybody either volunteering or working for this organisation has an underlying health problem that would put them at risk, and at that point we had no choice but to shut. In many cases we beat our providers to the punch by a day or so – a lot of the messages I got back were, “We were just about to ask you to do that anyway.” I don’t know what it’s like outside London but here it’s just prescribing, basically.’

Covid-19 share
Click for updates from services and the latest news and information on Covid-19

Executive operations director for Humankind, Anna Headley, tells DDN that while staff will self-isolate if they – or family members – have symptoms her biggest worry is the service users. ‘How are they accessing their treatment, whether that be prescribed treatment or an adjunct to that?’ she says. ‘We run a lot of hep C clinics, so their hep C medication for example. And then services are closing down. Everybody’s trying to reduce the footfall into their premises, which is absolutely the right thing to do, but of course you have to manage the risk of that if you’ve had service users on daily supervised consumption. Some pharmacies are no longer offering that service, so what’s the alternative to that?’

BoB intends to offer as much support to people as it can via phone or social media, and is working out how best to make that work. ‘We’re looking at what the rules will be around that,’ says Tim Sampey. ‘I don’t want to put staff in the position where they’re being rung 12 hours a day, seven days a week. But we’re going to try to do what we can remotely.’

‘A lot of our guys who are in recovery rely on our groups and social gatherings that we do to keep sober,’ says Anna Headley. ‘Some group workers who can’t run groups any more have made little videos, anything to try to keep that interaction with service users. We’ve got an amazing team and we’ve set up webinars to train staff in doing remote one-to-one consultations. We also have online counselling with DrinkCoach and we’ve been able to adapt that into regular psychosocial interventions, so that’s working really well, and obviously phone contact. We’re mobilising staff who’ve traditionally worked in big offices and are suddenly home workers.’bus driver wearing a facemask

One significant concern, however, is that many of the people who need support the most – and may already have significant mental health issues that will be compounded by further isolation – will not be able to access it. ‘Lots of people don’t have internet access at home, don’t have a computer or in some cases even a smartphone,’ says Tim Sampey. ‘A lot of our client group are going to be incredibly isolated.’

There are also concerns that over-stretched emergency services may be slow to respond to overdose situations, while anyone who has the infection could be more at risk of respiratory failure during an overdose, and some people have expressed fears that reduced supplies of street drugs as a result of restrictions on movement could lead to potentially harmful substances such as synthetic opioids being added to supplies.

Overall, people who use drugs are being advised to adopt common-sense precautions such as not to share pipes, joints or snorting equipment and make sure they prepare any drugs they take themselves. ‘We’ve tried getting information out to vulnerable groups in a number of ways, including social media, but it’s often the people who are most in need of that information who aren’t accessing it,’ says Anna Headley. ‘That’s the worry.’

There are also the simple day-to-day practicalities of how to get by in a situation like this. For most people, their lives are facing huge disruption and they may be frequently confronted with empty supermarket shelves, but they will be able to cope. That’s not going to be the case for many service users, however. ‘Some people are really vulnerable and don’t have the option of driving around to different shops,’ says Anna Headley.

‘We can buy our way out of this problem, they can’t. If they have a disability and impaired mobility they may find it difficult to access alternatives for their food. It is also a sad reality for some within our client group that, with fewer people out and about, clients begging will have less opportunity for charity in the form of cash donations or food brought to them. This is at a time when local support groups have also closed due to the virus.’

One huge issue for treatment services – as with other organisations up to and including the government – is simply trying to keep ahead of all this. ‘It’s the speed things are changing that caught everybody out,’ says Anna Headley. ‘We had a full business continuity plan set up on the afternoon the prime minister did his first big announcement, and it was out of date within an hour.’

When it comes to the long-term financial impact on a sector that’s already been cut to the bone, however, it’s impossible to predict. ‘We’ve just had the public health grant announcement, which does give me a bit of hope,’ she says. ‘With governments it’s always cyclical, and I hope that they do realise people are at a very low ebb and that they do have to invest. I do try to have a glass-half-full attitude.’

‘I think the wider sector might not be too bad per se, because they’re working with a vulnerable client group,’ says Tim Sampey. ‘I think politically there’s going to be a real pushback on looking after the homeless and people with addiction problems, so I think the wider sector may be a little better protected than we might think. From a BoB perspective it’s going to be tricky for us if we’re not able to open for three or four months. At the moment we’re asking our staff to go and help out at our providers to see what we can do together collectively, but ultimately what can you do? It’s all so far out of your control that I’m trying not to think about it too much.’ 

 

‘Aspirational’ treatment standards published by WHO and UNODC

A revised edition of the International standards for the treatment of drug use disorders has been published by the World Health Organization (WHO) and United Nations Office on Drugs and Crime (UNODC). All UN member states have signed up to the document, which incorporates the results of extensive field testing.

Originally published in 2016, the aim of the document is to ‘develop and expand effective, evidence-based and ethical treatment for drug use disorders’, with the updated version containing input from service user and advocacy groups. The publication stresses the importance of joint working with health, social care, criminal justice and housing bodies, as well provision across community, in-patient and residential rehab settings. It also promotes the use of evidence-based interventions, provision of trauma-informed women-only services and the importance of using non-stigmatising language.

While the standards are ‘aspirational’ and national or local treatment systems need not attempt to meet the recommendations ‘all at once’, over time ‘progressive quality improvement with evidence-based and ethical practice as an objective, can and should be expected to achieve better organised, more effective and ethical systems and services’, it says.

‘A remarkable achievement’, says Annette Dale-Perera, who was ‘honoured’ to work on the 2020 version.

‘UNODC and WHO invite those responsible for local or national policy development, planning, funding, delivery and monitoring, and for the evaluation of treatment for drug use disorders, to measure up local systems and services for the treatment of such disorders against the standards,’ the document states. ‘The aim is to identify gaps and areas that fall short of the standards and work with the appropriate stakeholders’ to improve them.

‘All 192 UN member states have signed up to this document,’ said Annette Dale-Perera, who was ‘honoured’ to work on the 2020 version. ‘This is a remarkable achievement, given their different views.’

Available to download here

Dame Carol Black Review – Next Steps

Dame Black has spoken loud and clear. How policy makers respond will be crucial, says Oliver Standing.

Report from DDN magazine on the Carol Black review
Read it in DDN Magazine

At the recent Glasgow drugs summit Dame Carol Black shared a number of truths many readers will be sadly all too familiar with. Drug problems spring up in areas of poverty and social exclusion; successful treatment and recovery is contingent on effective, coordinated support around housing, mental health and criminal justice; and when people leave prison they often miss out on the vital support they need. She also reminded delegates that our world-class treatment and recovery has been eroded and fragmented by austerity and localism.

Some commentators may look at the Glasgow summits and conclude that no concrete political outputs were agreed. At a time when drug-related deaths and other visible manifestations of extreme inequality such as rough sleeping are on the rise this is understandable, as is the perception that ongoing increases in drug-related deaths constitute a serious failure of public policy and/or political leadership. We must harness the sense of outrage and urgency that many of us feel to bring about change.

Positive developments

So, in that spirit, I want to point to some more positive policy developments that may help build the necessary momentum to make that change happen. Though the last Conservative manifesto was light on detail around drug and alcohol treatment, a subsequent addendum was published laying out plans to tackle addiction. This included two crucial pledges – to introduce a combined addictions strategy and a ‘dedicated monitoring unit at the heart of government’. Collective Voice welcomes both commitments.

The addictions strategy should address the public health emergency of drug-related deaths by outlining a clear plan to enable local authorities to fund and deliver effective, evidence-based and person-centred support. The 2017 strategy was not gripped firmly enough by government to bring about transformational change. This strategy should be driven by an effective inter-departmental approach, united behind a shared vision.

Dame Carol Black
Dame Carol Black: ‘The illegal drug market has long existed but has never caused greater harm than now.’

The monitoring unit could bring some welcome political attention to a field that has been fundamentally shaped in the past decade by the twin challenges of austerity and localism. Austerity has seen more than a quarter of our funding lost and localism has meant that loss has not been evenly distributed.

Challenges

It would be wrong to directly link all our challenges with the move of drugs and alcohol to local authority control. But there is an unquestionable issue over priority. Funding evidence-based and life-saving drug and alcohol services will never be the first thing on the list for local politicians dealing with substantial funding pressures.

However, a successful central unit will require a careful balancing between the local and the national. The unit should have sufficient powers to encourage local areas into action where appropriate, reducing the local variation in support and working effectively with Public Health England with clearly delineated roles and responsibilities. Most importantly, the development of the unit must be supported by sufficient new funding and political investment to ensure its long-term potency.

While more money is not the answer to all of our questions it is a good response to a great many, as the unprecedented scale of the cuts has forced local authorities to make very difficult decisions. Increases in public spending could enable the support of a greater number of people. There are over 314,000 people in England who use heroin or crack problematically, and 586,000 with an alcohol problem. Many aren’t currently receiving help. More support means an increase in family stability, fewer children taken into care, fewer blue light call outs, fewer emergency admissions to hospital and fewer people caught up in the criminal justice system.

The prime minister has spoken extensively about his commitment to the areas represented by new Conservative MPs. These areas – many of which are ex-industrial – have experienced high levels of drug-related deaths and multiple disadvantage. If the government is serious about this commitment then an investment in the health and happiness of our most vulnerable citizens, as well as technological or transport infrastructure spending, is surely necessary.

The proposed removal of the ring-fence around vital public health funds has been postponed by at least a year and will not now happen until April 2021 at the earliest. This is good news, although of course not in itself sufficient to guarantee a high-quality treatment and recovery system in England. Therefore we recommend that the ring-fence around the public health grant is maintained for good and that the lost public health funding at local government level is restored.

New policy developments can help make the case for joined-up and connected services. Previous attempts to deliver treatment and recovery services have hit a ceiling due to siloed approaches. Our policy and research discourses are catching up with what those touched by addiction have always known – that only a connected response can work for a problem that does not reside in any one department of human life but sprawls across them all. Work to support a citizen’s drug problem is almost useless if they have no home, fragile mental health or paralysing trauma.

Considering addiction with reference to other domains of multiple disadvantage will enable the strategy to catalyse change in allied areas. The 2017 strategy made welcome recognition of the fact that addiction is both cause and consequence of poverty and trauma – we were pleased to see £46m in the recent budget for a programme of coordinated work on multiple need, and we also hope that the second part of Dame Black’s review will make the case for effective partnership work, something the voluntary sector has always been good at.

The new strategy and monitoring unit should also refocus political attention on alcohol treatment. Whilst it’s welcome to see the issue of problem gambling being pulled into the political mainstream, it’s perplexing to see almost no mention of alcohol at a time of quiet crisis in alcohol treatment. There is a clear correlation between disinvestment and the diminishing numbers of people getting help – over 16,000 fewer alcohol users were supported this year compared to 2013-14, while 82 per cent of people who need specialist help are not getting it.

The government’s response to alcohol must be brought ‘up to speed’, with the strategy outlining how a greater number of alcohol users – and their children – can be reached and supported. The fact that stigma can force people to the margins and prevent them getting life-saving help should be recognised.

The linking of different forms of addictions in the new strategy must be used as a chance to combat the stigma around drug use. The second part of the Carol Black review also provides a valuable chance to acknowledge the negative role stigma can play in stopping people getting help – supporting recovery can be a powerful way of addressing wider health and social inequalities.

Oliver Standing, director of Collective Voice
Oliver Standing is director of Collective Voice

My final message to government would be: we know what works. We are equipped with a range of interventions from opioid substitute therapy to motivational interviewing, from needle exchange to residential rehab, which can be drawn upon by skilled workers to meet the needs of their clients at the exactly the right time.

If the field is provided with sufficient resource and appropriate structures we can unleash the transformative power of treatment and recovery to change lives, reunite families, support communities – and save the state money while we’re at it.

 

 

DDN April 2020

‘Listen to the messages from the frontline’

April 2020 DDN Magazine
Read April’s issue here

WHAT’S NORMAL RIGHT NOW? The last few weeks have been a white-knuckle ride for all of us, and we bring you this month’s DDN not really knowing what the next days and weeks will hold.

You will no doubt have enough to worry about at home and work but we hope that this edition will bring a sense of proportion to the task ahead. With so much beyond our control, we need to focus on essential priorities – which is where the clear protocols and sound harm-reduction practices are so useful. We have been so impressed by the swift initiatives to share action that will save lives.

In the rush to convert everything to a virtual working world, take time to listen to the messages from the frontline (page 10). You’re in this profession because you care, so please take heed of what’s not working well to iron out these bumps over the next few weeks.

We’re here to support you in any way we can, so let us know if you have good stuff to share, tricky issues to learn from, or better ways to communicate that we can let people know about and join in. We may be working from home but we’re throwing our energies into making sure we bring you the mag –and also put the DDN Conference back onto the stage as soon as we can safely do so.

Keep in touch – a hello goes a long way! 

 

Keep in touch claire@cjwellings.com and @DDNmagazine

Read the issue as an online magazine or download the PDF

Matters of Life and Death

Kevin Flemen confronts a topic we all need to talk about.

red rose illustrating griefA few years ago, on a training course we started to discuss death. Surprisingly this wasn’t on the drug-related deaths course, where such discussions could be expected to take place.

This was on an NPS course, and the conversation related to a worker struggling with a young person whose high-risk polydrug use and apparent unwillingness to take on board harm reduction measures left the worker desperately worried and stuck.

We discussed the idea of the young person writing a ‘what if…’ letter to their parents. ‘You think you are going to be OK,’ the worker said. ‘And hopefully you will be. But if something bad happened, maybe you might want to write a letter to your parents now. Just in case. You can leave it with me, so I could pass it on to them.’

Further down the line, the worker got in touch saying that after having this discussion with the young person they came in two weeks later, saying that they hadn’t used at all. The enormity of sitting down with a piece of paper saying ‘Dear Mum and Dad, if you get this then…’ was, for this young person, a catalyst for change.

While my initial interest in this may have started with discussions around risk and mortality as a part of motivation, it isn’t now my primary interest. Instead it’s the realisation that drugs workers should be discussing the risk (and ultimately the inevitability) of death far more than we do.

advert for naloxoneDrugs work is fundamentally an optimistic occupation. It seeks to reduce harm, reverse overdoses, promote and achieve recovery, help people reach their turning point, to change and grow, to rise phoenix-like.

But people can, do and will die. Some very prematurely, some less so. In our optimism what discussions can, and should, we have with our clients about mortality? How do we balance these discussions (which could be considered pessimistic) with the need to inculcate our services with positive messages of hope?

Many people who use drug services are isolated from family. They may not have close contact with ex-partners, their children, siblings or their own parents. Obviously this won’t be true for all, but it’s painfully true for some.

This isolation may be compounded by professional isolation – limited access to GP care, recurring episodes of homelessness, transience, periods of incarceration.

Given this personal and professional isolation, drugs workers can have a key role in representing a person’s wishes and intent regarding end-of-life care and their death.

For example, has the person considered their wishes in terms of advance decisions (living wills)? If they’d overdosed, been deprived of oxygen and could be maintained on a ventilator, what would they want? Has anyone asked them? Has it been recorded anywhere?

Beyond these discussions, does the person want to write and lodge letters for estranged family or friends? Have they considered writing a will if they have possessions they wish to pass on? How do they want their funeral to be conducted?

For some people these conversations will be much more ‘what if…’ They could take place with people who have significant risk of overdose, or who had recently experienced and survived an overdose.

For other people, with multiple, chronic and serious health problems the discussions may be less ‘if’ than ‘when’. We would have these conversations in elderly care settings. We would have them in cancer care and other serious illness contexts. We are starting to have the conversations with older dependent drinkers. But few agencies are having the conversations with older and at-risk drug users.

It’s probably worth restating the dual nature of these conversations, and introducing a note of caution. They could on the one hand be a catalyst for change. But they can also form part of a package of care for a planned and dignified death, where the person’s end-of-life wishes are known and can be respected. Workers engaging with such discussions should be clear in their own heads why they are having the discussion and the purpose of it.

Kevin Flemen runs the drugs education and training initiative KFx – www.kfx.org.uk
Kevin Flemen runs the drugs education and training initiative KFx – www.kfx.org.uk

 

In the relentlessly optimistic world of hope and recovery from addiction, such conversations may seem – literally – morbid. But they are long overdue and our reluctance to have them deprives drug users who die the dignity and rights we afford to other members of society.

 

KFx workshops have moved online during the current lockdown. Email kevin@kfx.org.uk for joining instructions.

Become a Playwright

Outside Edge Theatre Company invite you to enter an exciting competition with a life-changing prize.

Outside Edge Theatre Company (OETC) is the UK’s only theatre company and participatory arts charity focused on addiction. We’re inviting people in recovery to submit plays for the inaugural Phil Fox Award for Playwriting and the winner of the competition will receive a £6,000 commission and mentoring from playwright Enda Walsh.

This award, named after OETC’s founder, invites playwrights with any level of experience from across the UK to submit full-length scripts about issues related to addiction. The prize of a £6,000 commission from OETC will enable the winner to continue developing the winning script or to develop a new one about issues related to addiction. They will also receive mentoring from multi-award winning playwright Enda Walsh, who chairs the competition’s judging panel.

Phil Fox
The late Phil Fox who inspired the award

This year’s competition is open for entries until 16 June with a winner announced in early November. Submitted full-length plays from UK residents must be original, unproduced and about issues related to addiction. Writers with lived experience of addiction or affected by addiction are strongly encouraged to apply, although this is not a requirement for eligibility.

Playwrights will need to clearly articulate how their scripts relate to these issues, which are not limited to substance or alcohol misuse, but also include subject matter involving non-chemical addictions, such as social media or sex addiction. Plays may also explore the social or structural determinants that contribute to addiction, such as access to services or the supply chain of an addictive product. The characters do not themselves need to be addicted – for example, plays about people directly affected by another person’s addiction, such as family members, will also be accepted.

‘The launch of the inaugural Phil Fox Award for Playwriting is an exciting change of direction for Outside Edge Theatre Company,’ says OETC artistic director, Matt Steinberg. ‘This investment in developing new writing and finding stories not often represented on our country’s stages builds upon our reputation as an innovative theatre maker producing hard-hitting and controversial plays.

‘To be joined on this new adventure by such an extraordinary panel of judges feels like a fitting tribute to the legacy of our founding artistic director, whom the award is named after. We hope this accessible commissioning opportunity encourages established and first-time playwrights to think imaginatively about issues related to addiction. I can’t wait to read what they come up with!’

Alongside Enda Walsh, judges for this year’s award include Simon Stephens (Tony and Olivier Award-winning playwright), Barbara Broccoli OBE (James Bond films and West End and Broadway theatre producer), Indhu Rubasingham (artistic director of the Kiln Theatre), Denise Gough (Olivier Award-winning actress), Matt Applewhite (Nick Hern Books managing director and commissioning editor), Sonya Hale (OETC associate theatre facilitator and Synergy Theatre Project and Heretic Voices award-winning playwright) and Matt Steinberg (OETC artistic director).

‘We’ve assembled a fantastic judging panel who share my admiration and respect for Outside Edge Theatre Company,’ says Enda Walsh. ‘We are all very much looking forward to receiving these plays. To those writers – get writing, be brave with your submissions, and the very best of luck with the work.’

More information on the 2020 Phil Fox Award for Playwriting, including how to apply and eligibility criteria can be found on OETC’s website, www.edgetc.org/phil-fox-award

The Phil Fox Award for Playwriting is generously supported by an anonymous friend of Outside Edge Theatre Company, The Carne Trust and Unity Theatre Trust.

Outside Edge Theatre Company will be performing at the DDN Conference later this year – look out for our rescheduled date.

A safe space

The threat of COVID-19 has prompted Phoenix Futures to make their rehabs even more of a sanctuary, as Liam Ward explains.

Liam Ward residential marketing manager for Phoenix Futures
Liam Ward is residential marketing manager for Phoenix Futures

The coronavirus outbreak has drawn attention to some of the most vulnerable groups in our society. Those most at risk include the elderly and those with existing health conditions, which includes people with substance misuse issues. Here at Phoenix Futures Residential Services we are open and continuing to accept admissions. Rehabs are already safe places for people with more complex needs and we have reviewed our practices to ensure we adapt to the specific challenges of COVID-19.

Our services provide an ideal environment for those whose risk in the community has been heightened by current events. A recent survey found that 92 per cent of our service users identify as having experienced emotional or mental health issues, with 67 per cent receiving a diagnosis for their condition. Forty per cent of our treatment population are recognised as having a physical disability, and 55 per cent have experienced homelessness, with one in five presenting as no-fixed-abode upon admission to our services.

For those with housing instabilities, mental or physical health conditions and substance misuse issues we can offer a safe environment with all aspects of care accessible under one roof. The residential services offer 24-hour staffing and peer support in a safe, abstinent environment.

‘It has been a really difficult few weeks for everyone,’ says Leanne Smullen-Bethell, head of house for our National Specialist Family Service. ‘Staff have had to change the way they live their lives and in turn, so have our service users. This has all happened at such a pace it has been hard to absorb, but we have supported each other to carry on through this.’

Adapting the programme

The programme is being adapted to further enhance safety, while taking on board the daily government guidance. ‘We have had to decrease the size of groups and workshops so as to promote social distancing, and limit individuals going out of the house for everyone’s safety,’ says Leanne. ‘One of the saddest things we have had to do is to stop all visitors to the service. This is an incredibly difficult decision when parents are looking forward to seeing children, but we all understand this is about protecting one another and saving lives.’

‘The community have been exercising using online resources and DVDs and making the most of the beautiful gardens we are privileged to have here at the family service,’ she adds. ‘They have also been able to speak with family and loved ones using video calls, which has boosted spirits.’

These innovative responses are not limited to the family service, with each of our Glasgow, Wirral and Sheffield sites also adapting to provide the best possible experience for those placed with us. With the benefits of fresh air and exercise on people’s mental health widely documented, our large grounds allow us to practise social distancing with ease, while enabling residents to take their daily exercise.

Communication

Allocated timings for phone usage have been extended to ensure loved ones are accessible and we have increased access to internet messaging services, books, games and use of iPads and televisions to give a healthy balance between the demanding nature of the programme and the need for some personal time too. In Glasgow, our service has been lent a number of musical instruments by Vox Liminis, and in Sheffield we have extended our Recovery through Nature initiative (DDN, July/August 2019, page 17) to provide more regular and engaging content throughout the programme.

By providing a safe space for these vulnerable people, we are supporting the services in our communities who face an increased demand for their support. Rehab has always provided a comprehensive package of support for the most vulnerable, and continues to be a valuable resource for helping reduce the risk to individuals and their families throughout this difficult period.

‘During times like these it’s as imperative as ever to ensure individuals who need residential treatment can still access our services,’ says Dave Potts, head of operations for the residential services. ’We are, as always, very pleased to be in a position to help those who would be at risk in the community.’

www.phoenix-futures.org.uk

 

Believe in better

While having to close Build on Belief because of coronavirus was like losing a limb, says Tim Sampey, they’ll soon be back to doing what they do best.

We never shut Build on Belief (BoB) services. Never. We’re open every weekend of the year across London, the only exception being if Christmas falls over a weekend, and only then because there’s no public transport. We pride ourselves on always being there – the one constant in the lives of people for whom chaos is so often the norm. Yet here we are, closed for the first time in our history. It’s like losing a limb.

One of the staff summed it up best when she said, ‘I can’t believe it. All those years of addiction and living on the streets, our battles through recovery and getting a job with BoB, and we get taken down by a sodding virus. It’s like living in the War of the Worlds.’

BOB CEO, Tim Sampey
BOB CEO, Tim Sampey

It’s strange how you can run into the law of unintended consequences by sticking to your ethical guns. We’ve always been intensely proud of the fact that everyone employed by BoB volunteered for the charity first. That for half of our staff this is their first experience of paid employment. When it became obvious that the coronavirus was going to be more than an inconvenience, we dug in the medical histories of our staff. Sixty per cent fell into the vulnerable category, at serious risk were we to contract the coronavirus. The same weekend, we had a look at our volunteers. It was even worse. We were faced with a choice, knowing we had no choice. We were going to have to close.

Many of the staff and volunteers didn’t want to. No one raised the issue of their own health or the potential risk they would be taking. Instead they came up with a raft of sweet, if impractical, suggestions. ‘What if we only let people in for ten minutes at a time?’ ‘Couldn’t we limit the numbers so everyone stayed six feet apart?’ All unworkable, but you had to admire their spirit. They wanted to continue working.

All the staff were willing to go and help our local service providers stay open if they couldn’t run their own services, although for many either underlying health conditions or lack of transport made it impossible. They wanted to be busy, to be doing something useful.

With a third of us in self-isolation, and the rest stuck at home, what we feel most right now is guilt. What about our homeless clients? Those whose substance use means they are still living in a whirlwind of chaos and daily uncertainty? The socially awkward and isolated who leave the house just once a week to visit us? Those living in bedsits, trapped in a single room for the foreseeable future? Those without access to the internet and Netflix to alleviate the boredom of being home all day? The hungry? The lonely? We have staff who want to do outreach, staff who want to set up a new food bank, and the answer is always the same. No.

It’s heartbreaking. We are the staff and volunteers of Build on Belief. We’re not used to feeling powerless. We’re used to finding solutions and getting stuck into a problem, not staring out of a window and watching it pass us by. We’ve managed to keep our two existing food banks open, but it’s hard to know for how long.

We’ve set up WhatsApp groups for volunteer teams and the staff (the staff one is hilarious) and are trying to muddle our way through the technicalities of Microsoft Teams and Zoom so we can communicate face to face and do some online training. We update our Facebook and Instagram feeds daily and are working on recovery stories and tips to post on our website. We’re going to join the digital world as best we can and continue to look after each other.

Today we are glad it’s called Build on Belief. We believe we will get through this. We believe things will get better. We believe that before too long we will get back to doing what we do best – helping those who need it most. Build on Belief. It does what it says on the tin.

www.buildonbelief.org.uk

 

New horizons?

Will the coronavirus pandemic give us an opportunity to confront society’s problems, adopt radical policies, and emerge with steadfast solutions, asks Martin Blakebrough.

Martin Blakebrough is CEO of the Kaleidoscope Project
Martin Blakebrough is CEO of the Kaleidoscope Project

A crisis such as this forces pressing issues to the foreground, issues that governments have long avoided taking sufficient measures to solve. Our under-funded health surface, often cruel welfare system and unacceptable numbers of street homeless are now frighteningly visible to all.

But, as the country faces a shutdown unparalleled in living memory, we are reminded of our mutual dependence, our fragility and indeed our ingenuity. We are buoyed up with the rhetoric that ‘we are all in this together’, but in less turbulent times this oratory is absent. The heroes of the health and social care system, alongside the vulnerable and marginalised they protect, are left off the agenda.

I remember the shock I felt as this virus hit China. For me China is not a distant nation, but the country my son has made his home. He kept me updated as his daily life changed drastically. Now we must deal with this awful virus. Indeed many of Kaleidoscope’s staff are on the front line, whether supporting people in our residential facilities or at medical services that demand face-to-face contact. Our OST services and clinics remain operational, with pick-up regimes carefully managed and outreach coordinated by colleagues who are required, by virtue of their vocation, to put themselves and their families at increased risk.

Staff like myself are the lucky ones, able to work from home (although I’m married to a paramedic so my chances of avoiding the virus are even less assured). The frustration of frontline workers at Kaleidoscope, and across social care, has been the lack of available safety equipment, and we are doing all we can to resolve this. So as we try to keep ourselves safe, equally we must help our clients to survive amid impending lockdown, adapting our service delivery at pace, and offering increased virtual support to ensure our service users remain connected.

I am amazed by our staff and how they have risen to the challenges before us. Now is the time for creative thinking, so how do we stay solution-focused when we find ourselves in such unfamiliar territory? We rely on new ideas, so let’s share information and, where we can, pool together our resources and tools. Please, let us know of anything that is helping you, so we can share with our team and support each other.

The pressure on some staff will no doubt be heightened by having extra childcare duties in light of school closures. We of course welcome the government initiative that supports key workers without the added support of a partner, so their children can continue to attend school. But we recognise this may not apply to all staff, and for those struggling, we can only expect they work flexibly from home and do what they can.

Social media is often portrayed negatively, but we are seeing its value today. It is important we use it to our advantage, and instead of staying glued to the constant churn of headlines, we encourage our teams to stay genuinely connected with colleagues – I have never known so many different ways to communicate.

The world we walk back into will be very different, and maybe we will see how it is a better place if we have learnt to care for each other. As we settle down to the new reality of life around us we need to keep safe, find time to laugh and also time to share our worries, and I am optimistic we will come through these difficult times. In China the shops are opening and many people, my son included, can now enjoy the company of friends in a restaurant or a bar. So if you are working in the field then keep as safe as you can and follow medical guidelines. And hopefully in the heat of summer we may be like Luke, sitting out in the open with life seeming a bit more normal once more.

A big welcome to EDP and new services in Staffordshire and NE prisons

During these challenging times we are pleased to be able to bring some news of new ventures, with EDP joining us as a subsidiary and two new services starting in Staffordshire and the North East today.  

Paul Townsley, Humankind Chief Executive
Paul Townsley, Humankind Chief Executive

EDP will be a subsidiary of Humankind retaining many of its own processes, systems and brand and will continue to work within the community and inside prisons to improve people’s wellbeing, social connections and employability in the South West. 

Paul Townsley, Chief Executive of Humankind said: “Humankind and EDP have worked collaboratively for several years and recognised that we could have a greater impact for service users by bringing together our learning, development and resources.  

Joining together is a natural alignment between two organisations which have very similar values and ways of working.” 

Also, today, Humankind will begin a new drug and alcohol service, commissioned by Staffordshire County Council. Staffordshire Treatment and Recovery Service (STARS) includes harm reduction, care coordination, clinical interventions, recovery and aftercare. 

The new service, commissioned for 5 years, will have bases across the county, including Stafford, Newcastle-Under-Lyme and Burton. 

In the North East, from today, we will provide recovery support in seven prisons as part of the new Reconnected to Health service led by Spectrum Community Health CIC. The new integrated partnership, which also includes Tees, Esk & Wear Valleys NHS Foundation Trust (TEWV) will cover HMPs Durham, Frankland, Holme House, Low Newton, Northumberland, Kirklevington Grange and Deerbolt. It is commissioned by NHS England. 

Paul Townsley,Chief Executive of Humankind, continued: “We are very pleased to be able to support thousands more people across the length of breadth of England from today, from the south coast, through Staffordshire and in the North East. Although these may be difficult times to begin new services, we are committed to extending our support and welcoming new staff and service users to Humankind.”

Read the full article on Humankind’s Blog.


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 Humankind, and first appeared on 

www.humankindcharity.org.uk

 

Tips for the home teacher

With many more weeks of home schooling to go, Becky Cranham’s tips might save your sanity…

One week down, lots more to go. As it sinks in that schools probably won’t re-open until September, parents of young children are finding it difficult to keep-up with home schooling and trying to work out the best way to cope.

If your children are at home with you and you’re concerned that they keep up with their school work, our tips from PlanBee could help you embed learning in fun and free activities. As well as our daily free lessons on YouTube, (last week these lessons had over 5000 views) there are lots more online to help kids keep busy, active and learning!

What’s cooking?

Baking provides a wealth of learning opportunities ­– and produces delicious results! Working through a simple recipe with your child will help develop measuring skills (Maths), following instructions (English) and can help them understand reversible and irreversible changes (Science).

Top tip: Ask your child questions as you work through the recipe, such as ‘What do we need to do next?’, ‘How does our mixture look different now to before we added the flour/butter/sugar?’.

Nurture nature

Planting seeds and watching them sprout and grow is always rewarding. And you don’t need a garden. Pop some multi-purpose compost in a plant pot, plastic cup or old yogurt pot, sprinkle the seeds in and cover with compost. Encourage your child to take responsibility for making sure the plant has enough water and sunlight, and challenge them to record what happens to the seed each day.

Top tip: Fast growers include mung beans (2-5 days), cress (3-7 days), lima beans (4-7), sprouting seeds (4-12), radishes (7-14), pumpkin (7-21), nasturtium (14-21). Lettuce, basil, chives, mint and parsley are also relatively easy to grow.

Make them an expert

Are they crazy about LEGO? Challenge them to find out when it was invented, by who and how it became so popular. Do they love singing and dancing? Challenge them to write and perform their own songs, or even create a music video. Crazy about science? Challenge them to put together a demonstration or presentation about their favourite scientist.

Top tip: Give your child the role of the ‘teacher’. If they feel like experts in a particular field showing off their knowledge to others, it’s more likely to keep them on track.

Keep them moving

YouTube is an endless source of great exercise and dance videos for young children, if you’re looking for something additional to Joe Wicks, there’s…

Dance ‘n Beats for fun dance routines

Just Dance: more challenging videos for older children.

Cosmic Kids Yoga: tie them in knots!

Jump Start Jonny: free high-energy workouts

Top tip: Make sure children warm up and warm down before and after each workout session.

Code with confidence

This is much easier than it may sound. One of our favourites is Scratch. Children can program their own interactive stories, games and animations while learning a bunch of key skills along the way.

Top tip: The main Scratch site is designed for children aged 8-16, but there is also an easier version called ScratchJr for 5-to-7s.

Telling a story

Ask children to pick a main character, a setting and a special object  and let their imaginations run riot! To present them to the world too, they could stick with the good old traditional pen and paper or try creating an eBook. Book Creator is a great free app.

Top tip: Encourage your child to use this handy formula for story writing: SOMEBODY (a space ranger) WANTED (to save the world from an evil alien lord) BUT (their space ship broke down) SO (they hitched a ride with a friendly alien) THEN (they made it just in time to destroy the evil alien lord).

Keep reading

Check out Epic, which has access to 35,000 children’s books, learning videos, quizzes and more. You can try it free for 30 days. Encourage your child to act out the finished story or create a puppet show.

Top tip: Ask them about what they have read. Use a free Reading Question Matrix.

Model making

Use playdough or modelling clay to make a model of the solar system or to show the animals and plants in a habitat or food chain. Or use recycled objects, such as boxes, food packaging, bubble wrap, newspaper to make a medieval castle, a space ship, a dinosaur or a Tudor galleon. 

Top tip: Get your child to test ways of joining materials before they begin. Glue or masking tape, staples or glue?

Getting creative

Here are our top fuss-free art activities that don’t require too much equipment (or mess!).

  • Rock painting: grab some small rocks or pebbles next time you go out for a walk and paint them as animals to create pet rocks!
  • Photo cut-outs: Print off any picture and cut it in half using zigzag lines. Stick one onto a plain sheet of paper and challenge your child to complete the picture.
  • Copy the old masters – or ‘modern’ ones such as Piet Mondrian or Kandinsky.
  • Still life: plop an apple, a vase, a glass or a flower in front of them and ask your child to draw what they see.
  • Squiggle art: use curvy or straight lines. Challenge your child to turn it into a drawing.

Top tip: For additional arty inspiration, Pinterest is an excellent port of call.

And finally…

  • Treasure hunts: Hide challenges or calculations around your home which have to be found and solved to get a prize.
  • Sorting objects: Gather household objects and challenge your child to sort them into groups. How many ways can you sort them? What criteria can you use?
  • Create a board game: get your child to make their own version of snakes and ladders, or a quiz game.
  • Create puzzles: can your child devise a Maths puzzle or secret code to email to a friend?
  • Turn the tables: Invite your child to be the teacher and teach you something you don’t know!

Visit PlanBee for great free resources and lesson plans to use at home.

Becky Cranham is an education expert and former primary school teacher. She is a director of PlanBee.

Looking after people on Medication Assisted Treatment during the Coronavirus pandemic

Statement from Mark Moody, CEO Change Grow Live

Mark Moody, CEO Change Grow Live
Mark Moody, CEO Change Grow Live

I’d like to take this opportunity to explain the decisions we have taken in relation to Medication Assisted Treatment (MAT).

Change Grow Live’s services look after some of the most vulnerable people in society, including more than 30,000 people who rely on us to help them manage and reduce their dependency on heroin and other street drugs.

Last week, with pharmacies under increasing pressure and more stringent social distancing measures coming into force, it became clear that we could no longer support people on Medication Assisted Treatment (MAT) using our tried and tested approach.

It was not going to be possible for most people on a daily regime to keep collecting their prescriptions or for pharmacies to keep delivering the vital supervision services that help keep people safe.

We were faced with a stark choice: have thousands of people on a daily regime to find their own solutions to an erratic and unpredictable supply of prescription drugs, or move to a new way of doing things.

After consulting widely and balancing the risks and benefits of various scenarios, we took the decision to move to a new regime offering people up to two weeks supply of medication because:

  • Without medication, people are more likely to use street opioids and this would put them at greater risk of harm
  • It’s almost always safer for someone who needs medication to have it available to take home rather than leaving them with nothing at all
  • People on Medication Assisted Treatment (MAT) are likely to be at significantly greater risk of complications from coronavirus, and have already been advised to avoid all unnecessary social contact.

Dr Prun Bijral, Executive Medical Director, explains the rationale behind this new approach in more detail:

This new approach balances the requirement to continue providing those on Medication Assisted Treatment with the drugs they need whilst contributing to the national effort to reduce the spread of Coronavirus.

The consequences of catching Coronavirus are more serious for many of our service users because of their compromised health status and the particularly high prevalence of respiratory disease within this group. Asking them to attend a pharmacy once every 2 weeks, instead of once a day, greatly reduces their exposure to the risk of infection.

Additionally, stopping daily supervised consumption also greatly reduces contact with pharmacy staff, reducing the risk of infection amongst this critical group of health professionals at a time when families and communities need them the most.

Our overarching advice is to stop daily prescribing, but it’s important to note that whilst we plan to move the majority of people on Medication Assisted Treatment to a 2 weekly pick up, there are exceptions to this based on specific risk factors, for example those living in hostels, night shelters, or rough sleepers.

We are also taking a range of actions to mitigate any risks associated with 2 weekly supplies by providing people with locked boxes, naloxone and regular telephone contact.  We are monitoring this situation on a daily basis and will adjust our approach if the data indicates there are increased overdoses, drug related deaths or other serious unintended consequences.

We fully recognise that this is not a perfect solution and that there are risks involved. We’re doing everything we can to make sure that people on Medication Assisted Treatment programmes, their families and communities are kept safe and well.  

www.changegrowlive.org


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 first appeared on Change Grow Live’s website

 

 

 

 

 

Q&A – New legal rules around children in care

Solicitor Emma Roberts offers advice around the new legal guidelines around children in care during the coronavirus pandemic.

Emma Roberts, associate solicitor specialising in family law at Stephensons Solicitors LLP
Emma Roberts, associate solicitor specialising in family law

In light of the current health crisis and government guidance about safety constantly changing, parents, family members, children in care or those involved in children’s services will feel particularly worried about what effect this will have on children. Rules have been updated and changes have been made to living arrangements, schooling and family contact.

 

The following Q&A sets out current legal regulations around children in care:

Children’s services have told me they are making an application to court – what can I do?

Despite the current health crisis, the law says that children’s services, in local authorities, must get involved and investigate if they have ‘reasonable cause to suspect that a child who lives, or is found, in their area is suffering significant harm’. They must take action if, following their investigation, they believe that a child has been or might be harmed.

If the local authority considers the situation to be serious enough, they may decide that it is necessary to apply to the court for a ‘care order’ or a ‘supervision order’. These kind of court cases are referred to as ‘care proceedings’.

These cases will continue to be dealt with by the courts. If you are a parent of a child who is the subject of care proceedings then you automatically qualify for legal aid, regardless of your financial circumstances. Other family members may also qualify.

You should contact a family law solicitor as soon as possible and they can advise on your case. A specialist family law firm will have online facilities in place to enable video conferencing in line with current government guidelines.

I am involved in care proceedings at the moment – what will happen to my case? 

The government has confirmed that the justice system must continue to operate during the current crisis. All care proceedings are extremely important. Your case will carry on and your family will not be forgotten.

However, there will need to be changes to the way that most court hearings take place and new dates will be set. The courts are still working out exactly what is going to happen. Each case is different and will be looked at individually to decide the best way forward for the case and the family. Your solicitor will be able to explain what might happen in your case.

As long as the government advice remains for people to stay at home and avoid public places, except where it is completely necessary, almost all court hearings will take place remotely. This means that they will have to take place by video link, over the internet or by telephone.

Some hearings may still have to take place at court. Your solicitor will talk you through whether this is likely to be required in your case and will discuss with you how this will work and any concerns you have. In individual cases, it may be that not everyone has to attend court and that some people can join by video or phone.

For the time being, the courts are having to prioritise the most urgent of hearings. Although all cases in care proceedings are extremely important, some hearings might have to be put back for a few weeks so that judges can focus on immediate issues of child safety. It is likely that other hearings, which discussed next steps, will not happen at all because everyone involved might be able to come to an agreement, which the judge can be asked to approve. As always, your solicitor will talk you through the options and take your instructions before agreeing to anything.

I have received a letter from children’s services saying that they want to have a pre-proceedings or PLO meeting with me about my child/ children – what should I do? 

Despite the current health crisis, the law says that children’s services must get involved and investigate if they have ‘reasonable cause to suspect that a child who lives, or is found, in their area is suffering significant harm’. They must take action if, following their investigation, they believe that a child has been or might be harmed.

If the local authority considers the situation to be serious, but still wants to avoid going to court, they may decide to start the ‘pre-proceedings process’ which is sometimes referred to as the ‘PLO process’. This is where there is a meeting with you and your solicitor to try to come to an agreement about what needs to happen to manage the concerns the local authority has about your child or children. The local authority will write to you first setting out their concerns and inviting you to a meeting.

Parents who receive these letters are automatically entitled to legal aid to cover advice from a solicitor and he or she will attend a meeting with you. Local authorities are still working out how these meetings will go ahead in light of the current health crisis and government advice. It is likely that most will take place by video or phone.

My child is in care – can I still see them?  

This is likely to be a huge worry for families where a child is in care. At a time when you want to be with your loved ones it may become more difficult to do so.

What does the law say?

When a child is the subject of an interim care order or a full or final care order, the local authority has parental responsibility for them which it can use ‘to the exclusion’ of the parental responsibility of parents and others. This means that it can make decisions about the child’s contact with their family members even if these are not agreed by the family members.

However, the law says that when a child is in care, the local authority must allow the child reasonable contact with their parents and, in certain situations, other family members. Social workers should find out, and take into account, the wishes and feelings of the child, the parents, and anyone else with parental responsibility, when making important decisions about the child including about their contact with their family.

Arrangements for contact should be set out in the child’s care plan. The care plan (including arrangements for contact) must be kept under review at regular intervals (no later than four weeks after the child becomes looked after, and then within a further three months and then every six months) and whenever a substantial change to the plan is needed.

A local authority can refuse to allow contact with a child in care if they are satisfied that it is necessary to do so in order to safeguard or promote the child’s welfare AND it is an extremely urgent situation. In these circumstances, this refusal of contact can only last for up to seven days. The local authority must immediately explain in writing why contact is suspended, for how long, and state that the decision can be challenged in court.

If the local authority considers that it needs to extend the refusal beyond seven days, then it will require a court order authorising it to do so. The local authority has to make an application to the court and this application should be sent to parents with parental responsibility and any others with parental responsibility.

Parents, children, and in some circumstances other family members, can make an application to the court for an order about contact.  When such an application is made, the court can make a judgement regarding what it considers appropriate.

Whenever the court is asked to make a decision about contact with a child in care (whether the application is made by the local authority, child, parent or other family member), the law says that its ‘paramount consideration’ must be the child’s welfare. The law says that in deciding what the child’s welfare requires, a court must consider a number of issues called a ‘welfare checklist’ –

  1. the ascertainable wishes and feelings of the child concerned (considered in the light of his age and understanding);
  2. his physical, emotional and educational needs;
  3. the likely effect on him of any change in his circumstances;
  4. his age, sex, background and any characteristics of his which the court considers relevant;
  5. any harm which he has suffered or is at risk of suffering;
  6. how capable each of his parents, and any other person in relation to whom the court considers the question to be relevant, is of meeting his needs;
  7. the range of powers available to the court under this Act in the proceedings in question.

Local authorities also have a duty to promote contact between a child and their siblings unless it is not consistent with their welfare. Arrangements should be set out in the child’s care plan.

What does all this mean for me and my child/children?

These are very difficult times and there are likely to be a lot of problems facing social workers in making arrangements for children in care to have contact with their families. On 23 March 2020 the government introduced new measures requiring people to stay at home except for very limited circumstances. It is unclear whether contact with children in care will be an exception to this general rule. Even if there is some kind of exception which would allow contact with children in care, individual contact centres may have to close, and any that remain open are likely to be very short staffed. Foster carers and other carers may have to self-isolate because they or someone in their household has become unwell or is vulnerable.

Local authorities are going to have to look at each case individually and decide what can happen in relation to contact. Parents (and other family members in some situations) should be consulted about any change in the plan for contact with their child and it is always advisable to try to discuss any concerns with your child’s social worker and Independent Reviewing Officer and to see if a way forward can be agreed.

It is worth bearing in mind that seeing your child face-to-face is not the only way to have contact. You can also spend time with them over Skype or similar video facilities, and on the phone. It might also be possible to send emails and letters or cards. Although this is far from ideal, it may be that in the individual circumstances of your case and in light of the current situation, a court would consider this to be reasonable and to meet your child’s welfare needs, at least on a temporary basis.

I’m unhappy with what is proposed, can I challenge it?  

  1. If your child is in the care of the local authority and you are still in care proceedings then arrangements for contact can be dealt with within the care proceedings and it may be possible for you to make an application for contact within the care proceedings. You should discuss this with your solicitor.
  2. If your child is the subject of a final care order (the care proceedings have finished) then you may be able to make an application to the court for contact with them.
  3. If your child is in the care of the local authority without an order, usually based on your consent (sometimes referred to as ‘section 20’) then you may have additional options and you should consider taking legal advice.

The situation regarding sibling contact, and contact with other family members, is slightly different and a solicitor will be able to discuss this with you.

Legal changes

Although there are going to be changes in the way that hearings happen, courts are still operating. Legal aid is available for applications for contact with children in care, or if you receive an application from the local authority asking the court to authorise a refusal of contact between you and your child. Legal aid is not, however, automatic like it is for care proceedings and pre-proceedings meetings. The Legal Aid Agency will require information about your finances and about the circumstances of your case before granting legal aid.

A specialist family solicitor will offer advice and assistance when responding to the local authority decide in relation to contact with your child, or if you receive an application from them asking the court to authorise them to refuse to allow contact between you and your child.

Emma Roberts is associate solicitor specialising in family law at Stephensons Solicitors LLP

 

We’ll get through this, pledge activists

Harm Reduction Information on COVID-19A comprehensive advice sheet for people who use drugs during the coronavirus outbreak has been prepared by EuroNPUD, INPUD and Respect Drug User Rights. ‘We can do it!’ states the COVID-19: Advice for people who use drugs leaflet. ‘People who use drugs have dealt with very serious viruses before.’

The document, work on which was led by EuroNPUD project manager Mat Southwell, includes essential COVID-19-related harm reduction advice, as well as wider health information around the virus. It also contains guidance on successfully managing opioid substitution therapy during the crisis, including what to say to prescribing services.

People who use drugs should also prepare for disruption to the supply chain, it warns, as restrictions on movement make it far more difficult to transport and distribute drugs. ‘If you can afford to, keep a reserve or source some opioid medications in case your supply is cut,’ it advises. People should also be planning how they would manage a rapid detox or full withdrawal should that become necessary, it states.  

Sharing via web and mobile inforrmation on COVID-19
DDN’s full list of resources, service updates and more on coronavirus

Readers are also encouraged to network with peers to look out for others and share planning and advocacy strategies, as well as reinforcing the importance of maintaining respect during the crisis period. ‘Be patient and thankful even if services are slower, limiting numbers allowed in buildings at any one time and if staff are wearing masks and gloves,’ the document says. ‘This is part of keeping essential services running.’

View and download the leaflet here

 

Categorise people dependent on drugs as high-risk population, government urged

People who are dependent on drugs – including alcohol – should be categorised as a high-risk population for COVID-19, says a submission from Release and Transform to the Treasury Committee enquiry on the government’s coronavirus financial package. Protecting people who use drugs is a vital part of the wider effort to safeguard society as a whole, it states.

Failure to protect the vulnerable will cost us far more than the investment in treatment.

The ‘vast majority’ of the 320,000 people who are drug dependent will be more vulnerable to infection with – and the worst impacts of – COVID-19, say the organisations, leading to ‘vastly increased’ pressure on the NHS. The government needs to dramatically increase funding for treatment services to address the needs of the most vulnerable and help reduce the number of infections, it says, as well as supporting implementation of prescriptions outside existing guidelines to reduce social contact.

Any national prescription delivery service for ‘shielded’ vulnerable people will need to include medication such as methadone and buprenorphine, it adds, while systems also need to be put in place to ensure an adequate supply of sterile injecting equipment and other harm reduction supplies, including naloxone. Failure to protect this population would cost ‘far more both financially and in lives lost’ than the investment in treatment and the other suggested support, the submission states. 

James Nicholson: ‘Remember those with little or no social support.’

‘At a time like this, it is easy to overlook the needs of the most marginalised in our communities,’ said Transform CEO James Nicholls. ‘As we, rightly, look to protect the most vulnerable among our families – the old, and people with underlying conditions – we also need to remember those who have little or no social support at this time. The homeless, and people with alcohol or other drug problems, almost always fall to the bottom of the list when it comes to political action: which is partly why the swingeing cuts to services in recent years has been allowed to continue. At a time like this, the risk of marginalisation is further increased.’

The Department of Health and Social Care (DHSC) and Ministry of Housing, Communities and Local Government have announced that £1.6bn of the government’s COVID-19 fund will go to local authorities, including for increased support for homeless people and other vulnerable populations.

Click for COVID-19 advice, service updates and more

People who are homeless are facing ‘severe danger’ during the COVID-19 outbreak, said Homeless Link chief executive Rick Henderson, as they are unable to self-isolate and were either relying on communal night shelters and hostels or sleeping rough. ‘Now that the country is in a lockdown period and following this investment from government, every local authority area should now move quickly to ensure that no one is sleeping on the streets, no one is sleeping in a communal setting, or using shared sanitation facilities.’

Release and Transform’s submission to Treasury Committee enquiry on government’s coronavirus financial package at release.org.uk  Read it here

Broadway Lodge have today launched their brand new podcast

Abstinence-based addiction treatment centre Broadway Lodge have today launched their brand new podcast called ‘Miracle Mansion Podcast’. 

The first episode is now available to download on Apple Podcast/iTunes and Spotify.

Markkus Trew, Head of Treatment and Counselling Broadway Lodge
Markkus Trew, Head of Treatment and Counselling.

The series will feature Markkus, Head of Treatment & Counselling, talking to current and former Broadway Lodge clients as well as loved ones who have been affected by someone else’s addiction. The podcast aims to allow listeners to learn about very personal first-hand experiences of addiction and what has helped them to cope through such an emotional and challenging time in their lives.

Charlotte Thorpe, Marketing Officer at Broadway Lodge said, “Addiction is a very isolating illness and is misunderstood by many in society. Podcasts enable us to utilise another method of communication with the wider world to give society a real insight into addiction but to also help others who are suffering with the illness to feel less alone and to give them some hope that they can recover.”

The first episode is all about Vicky’s story. Vicky suffers with dual diagnosis whereby her addiction exists alongside complex mental health conditions including Emotionally Unstable Personality Disorder. She discusses her treatment experience and how her thinking has changed as a result of the therapeutic work undertaken.

The podcast is available to download here on Spotify or iTunes