Doing a review of the year makes the months flash past very quickly. But it also reminds you of how much headbanging goes on. (Not the heavy metal variety.)

Back in July, the Sainsbury Centre for Mental Health published a report that highlighted severe failure to treat dual diagnosis prisoners – the many inmates with both mental health and substance misuse problems – and pointed to under-resourcing of inreach teams. And what’s this in the news this issue..? Another report from the same source highlighting the same problems and pointing out that they are being ignored. Do we really wonder why prison overcrowding has been getting worse all year?

We always want treatment to be evidence based. But there’s an awful lot of evidence we choose to ignore. This year saw in-depth reports released from newly set-up groups as well as familiar organisations and treatment bodies who care deeply about influencing a new drug strategy. A wider public health approach has been underlined many times and must surely be taken on board – and that needn’t conflict with existing strategy. As our letters page underlines, there are many conflicting views on preferred modes of treatment – but the common theme that unites is the need to give each individual the best chance of recovery, ie a healthy life integrated with society.

Nick Barton takes the lid off quality in our lead feature, as well as giving us an excuse for a Christmassy cover. (And a further excuse to eat a box of chocolates while taking the photo.) Is your service providing the standard of treatment you would give your own relative? A self-audit can be tough, but Nick’s five assessment parameters can help.

It’s time for our Christmas break! We publish DDN again on 14 January, but in the meantime we’re here for all your letters, articles, adverts (which can still go online) publishing jobs and service user conference enquiries, so stay in touch! Season’s greetings to all our loyal readers and advertisers – see you in 2008.

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‘Before all I had was an existence, but now I have a life that’s worth living,’ says Matt, who was six months into recovery when he wrote the article on page 11.

Matt would not be writing the same story if he had decided not to pursue the goal of becoming drug free. His detox was hard work and painful, but for him the process of rehab was about stripping everything in his life down and getting to the root of why he was using in the first place. Maintenance would have seemed like a sticking-plaster option: he needed to prove to himself that he could achieve the seemingly unachievable, to give himself the same chances as anybody else.

Our cover story makes the case strongly for the goal of abstinence in treatment, but equally it highlights the necessity of having that choice. A service user is quoted as saying he was maintained on a methadone script for years without being encouraged to go drug free. Another expresses his regret that he did not explore 22 years ago the opportunities of getting off drugs and learning the life skills he was discovering in rehab. That’s a long time not to have explored other options; what could he have done sooner with the right support?

Of course prescription drugs including methadone have a hugely important role in making stabilisation possible – but they must never become an excuse for not offering anything more.

Jim McCartney’s academy (page 10) opens up possibilities beyond being able to function OK. He is ambitious about making ex-drug users contenders in the workplace, with a full armoury of social skills and the motivation to do well. It emphasises the argument reiterated in our letters page and in FDAP conference presentations – that It’s not about reducing the options to ‘either harm reduction or abstinence’, but about making sure we have both, at the time the individual is ready – and this can not be emphasised enough in a climate of fear over budgets.

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It’s strange being on the other side of the media. This week I took part in Radio Five Live’s breakfast show, alongside Richard Phillips from Phoenix Futures, who was also in the London studio; and clients in treatment in Phoenix’s centre in Hampshire, who were being interviewed throughout the morning by the programme’s co-presenter.

I witnessed the very detailed research that went on before the programme, when the researcher contacted me to follow up different lines of enquiry and information sources. The reporter down in Hampshire heard stories of recovery first hand, and took account of the complexities of drug treatment in her reports.

What a shock then, when I had a look at the Five Live website later on in the day. Apart from a few valiant souls giving a perspective from the drugs field, the many comments represented a poisonous diatribe from members of the public. It was a stark reminder of why headline figures can be so dangerous – ready fodder for distortion. And of course headlines are impossible to retract and repackage to a public that is determined to make every drug user the reason for all society’s ills.

The volume of responses from the field to the drug strategy consultation is a reminder of inspiration within the field as well as problems that need to be addressed. We shouldn’t forget that, during the current media feeding frenzy.

In the centre of this issue we’ve featured the Prisons and Beyond conference, which looked at many different aspects of prison drug treatment. We hope you’ll find it an interesting insight. It seemed appropriate to finish this issue with RAPt’s reunion (page 18) – an enjoyable occasion that brings home the invaluable work of prison drug workers.

And finally… we’re three years old this week! A massive thank-you for all your support – and to our advertisers for enabling us to keep a free circulation and vital editorial independence.

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Interviews pulling apart drug strategy are two a penny at the moment – inevitable as the consultation closes for the new strategy. But the interview on Radio 4’s Today programme was particularly disturbing – not just for the the points it raised, but for the way it raised them (page 4).

Yes, it is always legitimate to question how vast amounts of public money are being spent. But to accuse mainstream treatment services of handing out illegal drugs as a reward system to ‘junkies’ was a potential body blow at a time when the field needs all the political support it can muster. Drug workers are used to fighting prejudice and stigma from the public day in and day out, but it doesn’t help to have misleading information aired on the BBC’s flagship breakfast programme, and it’s concerning to reflect on the nature of this attack at such a politically sensitive time.

The shame was that the argument boiled down to such pitiful logic: that drug patients need to be motivated towards treatment with vouchers and incentives – effectively bribed to do anything positive for themselves.

The following morning, Dr Michael Ross featured on the programme to make essential balancing points: that the main reward for patients is that they are entering treatment for themselves. ‘Most patients hate being addicts,’ he said. ‘What’s needed is to reinforce their self-esteem… giving up drugs has to be the patient’s own idea, and very frequently it is’. By his brief statements he rehumanised the argument, taking it back from the plethora of contested statistics and refocusing it on improving people’s quality of life. Of course our drug services always need to be accountable on whether they are effective. But we should not let the assumption raised in the programme – that a minute proportion of drug treatment works and that public money goes towards helping treatment centres to indulge in bad practice – be the inaccurate picture that sticks.

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This morning one of our readers phoned up and discussed his experience of treatment. As he talked, he became increasingly frustrated when he considered the limited options that had been offered to him and to friends in the past. ‘Why is it that aftercare is so poor?’, he wanted to know. ‘Why isn’t treatment geared to long-term recovery? People just go round the system for years, without any hope of reintegrating into society and getting themselves a job. Clients don’t know they have choices: it all depends on where their DAT decides they’re going.’

His comments struck several chords with this issue. In his exploration of what helps people towards recovery, Prof David Clark (page 15) makes the point that the drug and alcohol field focuses on addiction rather than recovery: we look to treatment for a cure, rather than concentrating on making long-term life changes. Relapse rates demonstrate how unrealistic this can be – highlighted in research and by considering how residential rehabs (and criminal justice services) see the same faces time and time again. This issue’s cover story suggests that the focus can be very different if drug users are given the blocks of self-sufficiency to rebuild their lives (page 6). The San Patrignano community is an active and industrious society that turns dependency into a desire to thrive. No-one is turned away, and in turn residents are expected to earn their keep by being productive members of the community. Could it work in the UK? Prof Neil McKeganey thinks so.

On the subject of service user empowerment, we’ve teamed up with the Alliance to put together the ‘Nothing about us without us’ conference on 31 January (see opposite). It’ll be an exciting opportunity to shape future strategy and make sure service user involvement is not just three empty words. If you’re a service user or co-ordinator, please get involved!

Finally, I would like to thank Robert Skilleter, our youngest ever contributor for his article on page 10. Feedback is important in every area of this field!

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Nobody pretends that tackling gang culture is easy. Each new gang-related attack is reported as a sign that Britain’s young people are turning ghoulish overnight. Politicians flounder in rushing to proclaim the best way to tackle it: lock ’em up, deport all those you can, or hug a hoodie?

There are clues in this fortnight’s issue that the best way to take the weight out of the mob is to take the lost potential of its individuals to heart.

Professor David Clark comes across evidence relating to the most successful way of helping people towards recovery, citing ‘the ability to build up respectful relationships with service users, in which the worker has a genuine interest in the person, sees them as an individual, and takes them and their experiences seriously’ (Background Briefing, page 17). Prof Clark goes on to say: ‘only in this relationship could trust be established’.

If the reactions of the young people at Brinsford to being given the chance to express themselves through creative performance (cover story) is anything to go by, the evidence Prof Clark mentions can surely apply to young people caught up within the criminal justice system. Show an interest in their happiness, and give them a chance to explore their creativity and communicate in a familiar language, and things start happening: they tune in, start listening, start realising that there might be things in that previously uncontemplated territory – mainstream society – that might have something to offer them. Maybe they might just realise that people can gang together for all sorts of positive reasons, apart from drugs and violence.

Peter Martin reminds us that most people will develop their potential in direct correlation to whether their basic needs are met (page 10). It’s obvious where that leaves children with a poor start in life, where drugs and alcohol have always been part of their scenery. The efforts of innovative Brinsford staff (and also at Weatherby, page 8) are a commendable example of introducing a life away from the gang.

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 ‘We have moved on from a polarised debate and single approaches to a balanced strategy focused on outcomes, based on evidence and delivered through partnership’, says home Secretary Jacqui Smith, in her foreword to the new drugs consultation paper, launched this week.

Have we? That’s surely where we need to be, but there are many signs we’re not there yet. The need for evidence is constantly emphasised, underlined by the work of the UKDPC and others. Polarisation is rife, sometimes surfacing in robust debate, but all too often lurking in local treatment services with the risk of excluding those who don’t conform to an expected mould. Partnerships, when they work well can work very well (as in the screening initiative on page 14), but there are too many examples of agencies in the same area whose idea of joined-up working means cutting out the client. Things don’t often move as straightforwardly as they should within one drug service, let alone between different agencies, as Dr Chris Ford’s post-it demonstrates (page 13).

The home secretary also calls for ‘greater integration across employment, housing and resettlement’, a need emphasised by our cover story. We know only too well what happens when people come out of treatment and back into a hostel of drug users. The numbers of drug users in treatment might well have doubled, but we have to make sure service users are having the best chance of permanent integration.

Drugs minister Vernon Coaker urges DDN readers to participate fully in the consultation (page 8) and I hope you will seize this opportunity with both hands. We’re taking a break from publication in August, so I would like to thank you wholeheartedly for all your support, contributions, and advertising – which enables us to keep DDN independent and free of charge to everyone in the field. We’ll be back on 10 September, raring to go with your thoughts on new drug strategy. Keep writing in over the summer!

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The heavy burden on carers hits home in our cover story, but the terrible edge to this grandmother’s story is that through all the hardship and worry of looking after her grandchildren, she has not even had chance to grieve for her own daughter. At a stage in her life when she should be spoiling the kids with treats, she has been shocked back into the role of enforcer, counsellor and provider and left to cope entirely on her own. The Mind the Gap project is campaigning for raised awareness and a commitment to financial support in line with foster payments, and there can be fewer more deserving causes.

The results of a much-needed helping hand were very visible at The Quay Project in Plymouth (page 10) where Broadreach House have pulled off an amazing refurbishment, with help from Futurebuilders, to totally revamp their aftercare. The building was amazingly well equipped, but what really impressed me was the positive and industrious vibe that hit me as soon as I went through the front door. Service users told me they were making the experience work for them, and were anchoring themselves in training and work experience. Their addiction was not their sole preoccupation anymore and their achievements stood alongside their ambition in justifying the staff’s faith in them. Alongside, Chrissy Richman’s enterprise scheme is helping entrepreneurial service users get started in business – an enormous stride towards rediscovering skills and talents that had become submerged for years by an ‘addict’ identity.

Equally impressive was the commitment to those who are not yet as far along their journey. ‘If anybody has the temerity to relapse and stop coming we actually go and find them!’ Chrissy Richman told me. It seems to be working: she added that 94 per cent of those who tried to drop out have re-engaged. Even if they only start by coming for lunch, they are beginning to tune into a culture of acceptance and support that lets them take one day at a time.

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Release’s 40th anniversary conference last week gave a fascinating – and deeply disturbing – look back to the beginning of the ‘war on drugs’.

The artist Caroline Coon told how she had set up and run Release with fellow art students, because she couldn’t believe the government’s ‘stop and search’ regime that suddenly pervaded sixties’ hippie culture – ordinary kids doing their thing, harming nobody else.

At the time she threw herself into the cause of bring cases to the authorities’ attention – cases like 19-year-old Barry, who ended up in Wormwood Scrubs for being at a party where a small amount of cannabis was found. She thought there must be some some mistake: that our government and justice system didn’t realise what was happening to ordinary young people. She thought that if Release shouted loud enough, the prohibition ‘drug law scandal’ would stop. Of course it didn’t.

Forty years on, Caroline Coon says she is ‘sorry that all of us who have campaigned to end prohibition have not yet succeeded’ – a sentiment that was backed by others who spoke out (and wrote out), then and now.

Has the climate changed at all? Or have we moved further into victimising those in society who can least handle it? John Furniss thinks so, as he question’s Ipswich’s strategy on sex workers (page 6). The pervasive influence of the media in influencing drug policy comes in for a battering in this article, as well as at the Release conference – even Sunday Times and Guardian journalist Simon Jenkins blamed politicians for ‘cowering behind the press’.

This week we’ve had a change of Prime Minister; will the new cabinet make a difference? Gordon Brown has promised ‘a radical review of the anti-drugs strategy’ that includes helping those with substance problems into treatment earlier. Whether this will be proactive as opposed to reactive remains to be seen.

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It’s going to be difficult to get through to the drinker who doesn’t feel they’ve got a problem. The reasons why it’s bad to drink too much for our health are plain enough (page 6), but until the body shouts ‘no’, who’s going to take any notice? Our drinking habits are usually inextricably bound up with seeing friends, relaxing at home, forgetting work, having a good time. How does suddenly monitoring your alcohol units fit in with that, if you like a drink?

I have no answers, but it seems to me that clear and consistent information would be a start. For instance, a story in this week’s Independent, referring to the updated alcohol strategy, says: ‘It will be aimed at people who regularly drink two bottles of wine a day at home. Caroline Flint, the Health minister, said there were adults who were drinking twice the recommended safe level…’ Might the reader assume that it’s OK to drink one bottle of wine a day then?

I’m not suggesting for one minute that we have any control over information in the national media, but it strikes me that information campaigns need to be consistent. Why, for instance, base calculations on 9 per cent alcohol by volume (ABV) when most bottles you buy are around 12 per cent? One of the most helpful calculators I’ve found in this regard is the Drinkaware Trust site, at www.drinkaware.co.uk, which lets you tot up units in main brands without any aggravation. OK, the Trust is funded by the alcohol industry, but it has active backing from respected alcohol experts and is a practical example of arming the drinker with information.

It will be interesting to see how the public information campaigns roll out. I’ve yet to see anyone checking their units on a laptop in the pub, and I’m wondering how the unit labelling system will work on drinks served without bottles… flags on cocktail sticks in our pints perhaps?

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It’s easy to think that the diamorphine crisis has gone away. Stocks have been building with the introduction of new suppliers, and there is optimism that supervised injecting trials could yield positive results.

But talking to Plymouth User Forum (PUF) gives an insight to how the disruption to regular scripts threw stable lives into turmoil (page 6). From just talking to them it’s difficult to grasp what the impact on them must have been. But that’s the point. With diamorphine scripts restored, they just get on with life. No trips to the chemist several times a day to take methadone – their life no longer revolves around their dependency.

Carrying out a survey among local service users who had been affected was not an easy job, say PUF. Many would-be participants did not want to risk upsetting the services that could control their care, despite assurances of anonymity. Of those who did complete their questionnaire, it would be easy to ignore the number – 12 service users – as too small to make an impact on local consciousness. But take a closer look at those results: apart from the fact that 11 out of 12 had suffered side-effects to their health, most had topped up their methadone with illicit drugs, 11 had increased contact with dealers; many had become involved in other crime. Families were falling apart, and there had been a violent death following destabilisation. And all of this when their prescribers thought they were doing OK on methadone?

The members of PUF had to cross geographical boundaries to find a sympathetic consultant, and they had the good luck of having a ‘fantastically supportive’ DAAT. They were also willing to shout about what was happening to them, and insist on better treatment. What happens if you’re the person in the survey who said ‘methadone makes me too drowsy for normal living?’

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 Whatever you feel about existing data collection systems – and we know that many of you feel very strongly that they have taken over your job and burrowed into client time – there is no doubt that the NTA has consulted carefully before introducing the new Treatment Outcomes Profile system (page 10). Its designers, addiction researchers Dr John Marsden and Dr Michael Farrell, have taken on board the need to combine time-saving on bureaucracy with the goal of improving careplanning.

With recent DDN letters pages in mind, it seemed worth including feedback from the system’s testers – in case it helps you at the teething stage. Many of the stakeholders at the launch conference were optimistic that it would give greater efficiency alongside the much called for monitoring of progress – as well as a barometer of the effectiveness of individual services, that would strengthen and steer commissioning. The real test will be seeing how easily teams adapt, particularly keyworkers, to using it to its much-needed potential.

In a week when the charity Mind warns of unnecessary prescribing, we shine our torch into the doctor’s surgery to find Tony Birt (page 6). Five years ago he was dying from lack of holistic care. These days he is a passionate advocate for better treatment, and particularly understanding for drug users within primary care.

We know there are doctors out there who care about drug users. As well as those who spoke at the RCGP conference recently (page 7), there are inspiring examples around the country, such as the Cornwall group who carried out an audit to improve their referral process (page 13).

There’s plenty of inspiration in this issue: for young women through the Young Women Now movement (page 12), and for prison workers looking for an excuse to innovate, on page 14.

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The newly formed Drugs and Health Alliance are not the only ones to be calling for a complete rethink on drug strategy. This week they called for policy to be removed from the Home Office and planted where a public health focus could take root (page 4). It’s easy to be blinded by new documents and deafened by calls for this and that at the moment, but it’s crucial that we feed into new drug strategy as actively and constructively as we can.

The new alliance has drawn together diverse partners, some who temporarily abandoned their traditional lobbying posts to be at the launch. They wanted to make the point that, political differences aside, they share the goal of robust debate on any new drug strategy. There was plenty of dissent from the 2005 Drugs Act when it appeared, coupled with accusations that the field had not been properly consulted. With plenty of warning that the ten-year drug strategy expires next year, it seems entirely logical to try to influence policymakers with the weight of experience. We’ve seen the aftermath of enforced change on our letters page, since the magazine began. Please take the chance to contribute ideas, or respond to some of the articles we’ll be running over forthcoming issues, examining ideas for new strategy. Active debate will surely be healthy for the quality of our services.

With changes to ring-fenced drug funding threatened, active service user involvement will be more important than ever. Talking to the National User Network, better known as NUN, revealed that they are shaping up to a force to be reckoned with (page 8). Catching up with Kevan Martin of the alcohol service users’ network NERAF (page 9), gave useful tips on how to use a ‘softly softly’ approach to get impressive results in representing service users – and it’s extremely encouraging to see how far Kevan’s efforts have taken him over the past year.

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This week the new UK Drug Policy Commission launched – an event covered widely in the media. As newspapers used the opportunity to explore different aspects of the UK’s failing drugs policy, the UKDPC emphasised that it would bring evidence and analysis in front of policymakers.

Current drug strategy is underpinned by Public Service Agreement targets that have spawned hits and misses within the drug treatment workforce. For the ticks that are placed against channelling more drug users into treatment, there are as many crosses against letting criminal justice focused policy override public health.

There have also been notable successes, such as lower rates of HIV among drug users than in other comparable European countries. The Commission’s job will be to highlight what works – obviously harm reduction measures in this case – as well as what doesn’t.

The new charity has already involved a diverse body of expertise – including some that normally comment on policy, rather than help to form it. It will be interesting to see whether informing drug policy will mean influencing it in the near future, to the point of salvaging us from the bottom of the European league table of drug problems.

Being informed is equally important at community level, as highlighted in our cover story. Yaser Mir is a natural communicator, but his story illustrates how easy it is to get it wrong when offering drug and alcohol services to diverse cultures and communities.

Yaser warns against ‘parachuting in academics and professionals to stir things up’ and his experiences illustrate just how easily this approach could push the problems of young Asians and their families underground. Hearteningly, a diversity policy does not have to be a prohibitively expensive overhaul, which hopefully should inspire managers to make sure the team’s up to speed.

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There’s been an unwelcome chasm reopening between abstinence and maintenance in the last two years, Daren Garratt told the National Drug Treatment Conference last week – a statement frequently reflected in our letters pages.

It was interesting then to read Sara Moralioglu’s investigation of harm reduction in North America (page 8) – a story made all the more remarkable by the scale of progress – particularly in the United States, where the climate of incarceration for drug users has made campaigning for harm reduction initiatives a dangerous game.

Back home we seem stuck on how to classify harm. Following on from the RSA Drugs Commission report earlier this month, calling for a rethink on drug strategy, an article in the latest Lancet demonstrates how an expert panel would reclassify 20 drugs according to their actual level of harm – relating to physical harm, dependence risk and wider impact on society (news, page 4). The project involved experts working in all areas of addiction, medicine, psychiatry and law and was an attempt to offer ‘a systematic framework… that could be used by national and international regulatory bodies to assess the harm of current and future drugs of abuse’, instead of a system that is considered by many to be arbitrary, without much scientific basis.

But the BBC has already reported Home Office Minister Vernon Coaker’s reaction as: ‘We have no intention of reviewing the drug classification system.’ Classified by the trial system, alcohol and tobacco would be recognised as (together) accounting for about 90 per cent of all drug related deaths in the UK.

Alcohol Concern has already criticised the chancellor for ignoring the chance to increase alcohol excise duty in this week’s budget. Can policy in this country ever shift to a public health approach?

We’re taking a break for Easter, so our next issue is out on 23 April. See you then!

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There’s a lot to read in the RSA Drugs Commission’s new report – probably what you would expect from a two-year study involving representatives whose different jobs touch the drugs field, from public health to criminal justice.

 The recommendations mirror much cross-sector lobbying – for a strategy that addresses all areas of life, home and work, instead of pointing straight to jail – and asks government to acknowledge that current drugs strategy is failing.

 It’s a big ask. As far as the Home Office is concerned, a criminal justice led strategy is filling treatment places and helping citizens sleep more soundly at night. There’s a big tick against DIP, and testing on arrest is being credited with bringing more people into contact with drug workers.

The Commission is asking government not only to lead the way in stopping the ‘demonisation’ of drug users; it’s asking them to pass the lead for drug strategy from the Home Office to the Department for Communities and Local Government, so local areas, led by their drug action teams, can work out what’s best for their own communities.

Stepping back from the detail, the Commission is suggesting a massive fundamental shift in attitude. It asks government and society to stop chasing the impossible dream of a drugless society, and to look at where support is most needed. Taking the hysteria out of the drugs debate is our only chance of basing strategy on actual harms, it suggests. We could start looking at alcohol, tobacco, solvents and prescription drugs, alongside drugs that are currently illegal.

Turning the tables, we could consider consumption rooms and prescribed heroin as a regular option. The report, boldly entitled ‘Facing facts’, has been released in time for the government’s much anticipated drug strategy review next year. We look forward to seeing which ideas hit home.

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With an estimated 400,000 people with hepatitis C in the UK, it might seem the most logical move to introduce compulsory testing for anyone entering treatment services. Many people don’t know they have the virus, which can manifest itself years later in debilitating symptoms that need expert medical care.

Talking to Siobhan Fahey, a viral hepatitis clinical nurse specialist (page 6), brings some important considerations to light. Compulsory testing can be counterproductive, she points out, driving clients away from services. There is a lot of ignorance surrounding hep C, and much ground to be made up – from raising awareness about the virus to helping people tune into their symptoms.

The Scottish Executive has bitten the bullet by committing an initial two years’ worth of funding to a detailed action plan, with a promise of further resources in the future. With one per cent of Scotland’s population – that’s 50,000 people – thought to be infected with hep C, the chief medical officer has acknowledged an urgent situation and is backing a target-driven approach that involves agencies throughout the country. The hope attached to the plan is in its accountability: a coordinating group has been set up, and regional leads have been designated to make sure the promised action is not forgotten about in their area.

If the plan falters, there are enough stakeholders involved to ask why, and to push progress along to the next gateway for funding in two years’ time.

For the drug users and former drug users who make up most of the hep C caseload, there has to be a breakthrough in the rates of supportive testing, care and treatment – not just in Scotland, but all over the UK – and plenty of scope for a strong multi-agency approach. Recovery is hard enough, without having to contend with the frightening burden of a mystery illness.

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The most persistent strand running through our readers’ survey responses was alcohol, alcohol services, lack of money for alcohol.

Putting all the pieces together, you get a very disjointed picture of treatment and funding. Detailed documents such as the NTA’s 205-page long effectiveness review of alcohol treatment (see page 7) give interesting and valuable research – but are the key themes finding their way into better treatment?

At the very practical end of the scale, the user-led North East Regional Alcohol Forum (NERAF) is feeding into policy with the very real evidence from its members on what works. Their recent initiatives have included responding to the government’s ‘Know your limits’ campaign on binge drinking, and launching a community detox and peer-led aftercare service for alcohol clients.

Somewhere in between, there are some tremendous initiatives going on regionally to involve clients with alcohol services before they come to the stage of desperate need. Our cover story writer, Alan Alker, explains how his area has introduced brief interventions – judged by several research studies to be the most effective action in tackling dangerous drinking – into primary care services. As with so many alcohol-related initiatives, it makes economic sense to incentivise GPs to take screening onboard. A statement in the NTA report leaps out:

‘Commissioning brief interventions in primary care settings would have a major impact on public health’. On that note, I am very pleased to welcome Alcohol Concern to our panel of DDN partners. I hope we can help to strengthen the ever-growing alcohol policy lobby, through publicising its successes and struggles, in return for the very welcome expertise they will offer our editorial.

Finally, a note of sincere thanks to all of you who returned such interesting and detailed readers’ surveys.

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‘As a GP in Reading 20 years ago, I only came across one or two sex workers,’ Dr Stephen Pick told me. The picture now is very different – whether we want to see it or not. With an established sex trade, the challenge is to make a connection between women and the services they desperately need but are reluctant to seek out (cover story, page 6).

Dr Pick seems to be one of those prize specimens, a GP determined to improve his patients’ overall wellbeing, as well as fixing ailments while fighting with the surgery clock. At what must be a particularly difficult time for sex workers to feel comfortable about approaching services, he suggests straightforward ways through which GPs can make it easier – recommendations that echo documents from the Home Office and NTA, produced last year.

Has this research hit home? In the NTA study, 92 per cent of women said they were wasting their lives by being on drugs. Almost as many said they wanted to be able to cope with life without using drugs. Surely this points to the fact that if realistic help is offered, there’s a good chance they’ll take it?

Communication is a strong theme throughout this fortnight’s issue. What’s the best way of getting parents to discuss drug issues, and how do you equip them to tackle difficult subjects with their children? Drug, alcohol and parenting charities debated issues at a recent seminar and learnt from innovative schemes (page 12).

Gary Rees shows determination to improve communication between prisons and makes progress in healthcare and harm reduction through the innovative ‘Sparcle!’ network, on page 10.

Finally, amid reports of how crystal meth is devastating America, the Home Office reclassified the drug this week. How worried should we be about its impact on the UK? Two different viewpoints contribute to the national debate, on page 13.

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Welcome to our first issue of 2007! I hope you’ve found it easier to get back into routine than we have… After all that Christmas excess it seems appropriate to carry articles with titles like like ‘alternative high’ and ‘New Year challenge’.

To tie in with our latest treatment directory (centre pullout) we’ve looked at different ways of doing things. The Windmill team make the most of team skills to give a valuable variety of options on page 11; could you share good practice with other inpatient teams?

Paul Goodman shares experience from the Ley Community on page 12. Their recent research on client outcomes leads him to caution against looking just at completion rates as a gauge of success in rehab. He urges those involved in weighing up the suitability of a placement to look at the longer term picture, and whether clients make it back to being part of society.

Jim McCartney takes us back to basics on page 10, reminding us that people, and not just systems, should be the beating heart of services. In place of the usual exhortation to go to the gym at New Year, he recommends a ‘mind gym’ as part of rehab, where clients ‘stretch the mind muscles into new realms of thinking’, with the aim of ‘tapping into new resources at the core of their being’.

Our cover story describes a strong opportunity for lifelong change. I wonder what inmates of Hindley Young Offender Institution thought, when they learned they would be taught how to scale walls. But the outcome of their outdoor skills and initiative course certainly seems to have woken inspiration in many of its participants. The story is in itself a challenge to perceptions: some of those on the course were nervous about trying the activities, but confident when given the skills to achieve a ‘legitimate’ high. It’s an interesting illustration of how instilling a little positive self-belief can take someone a long way.

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In this month’s issue: DDN reports on health, criminal justice and industry sectors debate alcohol, while Service Users take feedback one step further.

Click on the links below to read more, and don’t forget to join the discussion by commenting, tweeting and liking our Facebook page. 

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In this month’s issue: Transitional services bring young people back into treatment.

Click on the links below to read more, and don’t forget to join the discussion by commenting, tweeting and liking our Facebook page. 

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Harnessing energy

Why old tricks often work best in the internet age

There’s a different energy at local events compared to national ones. Maybe it’s because more people know each other, or maybe it’s because people are swapping information that they can make use of immediately – information that can affect what you do tomorrow.

This certainly seemed the case at Greater Manchester Service User conference this week (page 10-11), which must have involved a tremendous effort of co-ordination between local agencies and service users. We know the amount of effort that goes into organising an event, but if they’ve helped a fraction of their delegates to take the next step forward into getting support, housing, work or just advice and friendship, then it’s got to be worthwhile. Even the steering group, made up of service users and representatives from all the local DATs and the NTA, must be worth the (no-doubt headache-inducing) effort involved in coordinating meetings, just for the relationships it encourages between participants who might not otherwise meet. Aside from the general good vibe, the practical sessions certainly demonstrated the possibilities of practical local co-ordination on aftercare.

Several of the Greater Manchester services talked about their initiatives involving leisure activities and exercise, and emphasised that creating a sense of wellbeing in recovery is as important as having financial stability. Our cover story (page 6-7) demonstrates how East London service users have harnessed their group’s energy, quite literally, through creating a cycling project. Successfully securing grant money to set it up, they’ve become not only fitter and more energetic, but also more mobile, more visible, and proud to raise awareness that people recovering from the soul-destroying state of addiction can be at least as high achieving as any other person that’s motivated to do well.

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Wars of words

How can you fight a war with nonsense?

There’s some tough talk on the ‘drug war’ in this issue, and we make no apology for that. Danny Kushlick’s piece (page 12) highlights how drug policy is governed by forces other those at the heart of drug work, ignoring many respected names who speak out against prohibition. Who controls received wisdom? Whatever our views, shouldn’t drug workers be at the heart of policymaking, bringing much needed experience of clients’ public health needs to the debate?

The national press often have a lot to answer for in making our jobs (or experiences of drug treatment) more difficult – but interestingly, we always land the blame on the tabloids. Chris Huhne, speaking at the Release conference (page 10) says ‘we need to get the debate back to what works, rather than what titillates the tabloid newspapers’. But the broadsheets are equally capable of pulling us backwards. Only today, as we go to press, a Times columnist headlined her piece with ‘Say no, no, no to the rehab industry’ and proceeded to tell readers why the 150,000 people working in drug action teams are helping to rip off taxpayers by contributing to a ‘pharmaceutical holding pen in which the UK’s addicts can be corralled’. Furthermore, ‘the industry doesn’t care,’ she says. Do their readers believe this? Unfortunately, judging by the remarks on the online version, many do. ‘Two months is usually sufficient to get most people off drugs,’ the columnist proclaims confidently, with no consideration of factors that might contribute to a drug-using background or exacerbate relapse. I know you’ve read many of these pieces before, but their frequency is a stark reminder of how difficult it is to engage in informed dialogue outside of this field.

Talking of changing culture, our cover story presents a huge challenge: are you prepared to treat smoking seriously in your drug service? It’s an issue that you might not want to tackle – but will you be taking it on board?

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Talking Frankly

Shock, horror… humans behind the Home Office helpline!

Before talking to John, who works as an advisor on the FRANK helpline, I associated the government campaign with pushing red sofas around shopping centres. The chat enlightened me considerably about the very real and in-touch service behind the scenes, where experienced drug workers give non-judgemental advice and reassurance – whether it’s information about the effects of taking drugs, or calming down someone suffering withdrawal symptoms at 2am. It was interesting to hear about the interface with mainstream services. Having worked with addiction teams in Inverclyde and Glasgow, John is all too familiar with the pressures on local services and valued the chance to be part of a team that helps deal with the straightforward information that many callers seek. FRANK advisers do not get involved in treatment, but they do ‘signpost’ young people and their parents – a significant role in encouraging those who might not turn up at face-to-face services of their own volition, but who are fully versed in using mobile phones and websites.

We talk a lot about linking up and bridging gaps in this field, but our cover story takes the concept beyond a blueprint on the desk. Social workers are obvious partners for drug and alcohol workers, but it doesn’t always happen naturally. Just last issue we reported that social workers were asking their trade body for joint training with drug and alcohol agencies, because ‘social work has not had a good reputation in terms of working with people with substance problems’. On page 6, Edinburgh demonstrate how close partnerships with social workers are giving clients continuity of care and helping to peg in firmer long-term support – ‘doing wonders’ in the words of one of their service users.

Also looking beyond treatment, Jim McCartney gives clues to working towards self-sufficiency on page 14 – and for a snapshot of personal achievement, read ex-drug user now business woman Nancy’s story on page 12. 

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Drink up, stay real

Can public health really come from the other side of the bar?

Effects of harmful drinking are all too plain in this issue, from the children suffering their parents’ excesses to the man still reeling from the blow of his brother’s painful death. We know too much too often is no good for us, yet we drink because if feels good and is part of life and socialising for many of us.

It’s debatable whether we’d take note of unit counts on bottles from our seat at the bar, but consistent labelling would be a start. Alcohol Concern’s chief executive Don Shenker demands much more on page 8: he highlights July’s independent report on the drinks industry, which revealed widespread ignorance among licensees of their own code of practice. Far from being on top of self-regulation, as they have insisted they are, the industry was shown to be guilty of persistently targeting the most vulnerable; selling more drink to the drunk and serving underage teenagers. Don Shenker wants an end to this pretence through introducing a mandatory code – a public health objective in the Licensing Act; add your views through the consultation.

There’s much evidence documenting our drinking culture – we don’t expect to be surprised by it. Just yesterday I listened to a radio interview with Professor Norma Daykin from the University of the West of England, presenting findings of a government-funded study. It showed that many radio presenters mentioned alcohol and made light of it, wanting to connect with an audience that drank regularly to socialise – the booze banter was as natural a part of dialogue as any other subject. It demonstrated the size of the mountain – health risks happen to other people, a culture change is not just around the corner. What we can do is demand honesty and fair trading in an industry that thinks writing ‘Please enjoy [brand name] responsibly’, while peddling ‘drink all you can’ promotions is doing their bit for public health.

On a lighter note, welcome to our first issue after our summer publishing break – it’s good to be back!

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Disingenuous? Moi?

DDN is what it is… a receptacle for other people’s ideas

A question about editorial control was put to me this week: should DDN be publishing articles that hadn’t been vetted by a panel of experts? What were my criteria for including articles and letters? Was I actually qualified to make a judgement on what went in the magazine without the backing of an academic or charitable body to take forward a set of agreed objectives or further academic progress? Was DDN’s claim to be an ‘independent publication’ (because we are not funded by any organisations) rendering us guilty of ‘disingenuous neutrality’ because we have to take enough advertising revenue to pay for the free circulation of each issue?

It’s fair enough to ask what we’re trying to do with DDN, and I’ve been thinking this over a lot during the week, while working on the issue. My obvious answer is that we’re about communication, and from day one we’ve never tried to replicate or replace in-depth research or evidence-based material. We’re the ‘quick round-up’, the taster to a subject, and hopefully the signpost to sources where our readers can find out more – particularly if the subject matter isn’t directly on their ‘patch’.

To take this issue… there’s insight from Sussex on tackling the growing segregation of a minority community. There’s progress from Bristol offered from experience with their service users on how to provide more effective advice on ketamine. There’s an article on liver transplants by a clinician who asked me to highlight the desperate need for more involvement from the drug and alcohol field. And there’s our experience of sharing International Remembrance Day with drug users, families, supporters and drug workers in Kennington Park last week. I’m not sure which of these pieces would have benefitted from expert review; they are what they are – a reflection of the diverse contributions to DDN, which at the end of the day is a melting pot of readers’ experiences. We’ve a publishing break during August, so I’m off for a lie down. Keep your letters coming… see you on 8 September!

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Harness the energy

User groups are rightly passionate about what they do

By the time I got in touch with Dave Stork to interview him about the progress Gloucester’s Service User’s Support Team (SUST) had been making, he was quite wound up. Why hadn’t I got in touch sooner, while they were doing their outdoor challenge course? Why hadn’t I been down there for their service user conference last month? To me, in a busier than usual fog of activity here, the reasons were obvious. To Dave down in Gloucester, it was a sign that we weren’t interested and that initiatives that had taken so much time, energy, planning and effort were insignificant to us. I hadn’t communicated what what was going on to delay me from arranging the story earlier; Dave naturally thought I wasn’t bothered.

I mention this only to demonstrate how easily different perspectives play their part in influencing the dynamic of user involvement. Dave’s first experience of trying to contact me convinced him that DDN isn’t interested in service user involvement; I hope I managed to convince him that quite the opposite is true. But it made me think how easily the relationship between a hard working service user group rep and those who hold the local purse strings for service user involvement could fail to gel through simple misunderstanding. Service user groups have to be passionate about what they do – after all they’re in the business of campaigning for better treatment and standards while trying to support their members, whatever stage they’re at. With different pressures on those who are answerable to budgets it would be easy to disconnect because of differing priorities – but it could be a wasted opportunity not to appreciate hard work in different guises on each side, and harness the positive energy.

 I’m glad Dave persisted with his suggestion for an article. Not only was it enjoyable talking to him, but it gave me a fresh burst of energy in thinking about the second service user conference we’re organising with the Alliance for next January. I hope energetic groups like SUST will want to take part.

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Come on, out with it!

Why open debate can only be healthy for this field

Reading about Jane’s experience as she walked into a family support service is a powerful reminder of what support services are about (page 6) – whether they are drug treatment services, carers’ support networks, or the wider services that help put life’s building blocks back into place. Her overwhelming relief that there were people there who not only understood what she was going through, but could put a practical action plan together for her to cope with the trauma of facing up to her son’s behaviour, put her back on track in a way that struggling on her own could never have done.

We’re engaged in debate about recovery at the moment (following last issue’s article on the UKDPC recovery statement, debated at the NTA’s annual conference) and part of that process is experiencing the painful railing against polarisation that manifests itself on bulletin boards and blogs, as well as directly to us here at DDN. But I make no apology for carrying debate, because that’s exactly what DDN is here for. If you’re part of a harm reduction network, you know why you’re there; if you’re contributing to a blog that supports abstinence you know you’re among like-minded friends. But addiction doesn’t microchip its subjects with the ‘right’ treatment mode; that’s for us to work out, by debate, by knowledge-sharing, and by convincing others through the benefit of research and experience. If we don’t get it right, Jane’s son continues to terrorise his family and presses the self-destruct button harder; if we do get it right… well read the cover feature (page 6) and tell me if it’s worth it.

Direct experience speaks volumes, particularly Christopher Hallam’s article – a personal account of how methadone maintenance has helped him create a new and productive life, in which he spells out what the threat of being without it means to him. The article speaks volumes about the individuality of drug treatment and should surely stop in their tracks anyone who believes that treatment is about herding everyone down the same road.

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Redefining recovery

Can the drug and alcohol field agree on a definition?

We’ve got an interesting question for you this issue: can you redefine what recovery means? Can you sign up to a definition that’s been put forward by a group representing different disciplines, interests, viewpoints and backgrounds? Do semantics matter – ie is this statement helpful in refocusing the drug and alcohol treatment field in the same direction? Or could it be counter-productive in giving us more definitions to argue about?

The logic behind the exercise is that we need to move beyond polarised views and agree where ‘recovery’ should take the client. In the view of the working group, this meant focusing on life beyond treatment, so that treatment itself could be more aspirational. I don’t think many drug and alcohol workers would contest that positivity, wellbeing and inclusion in society are all vital in taking their clients through the difficult here and now of drug treatment – but there has already been crossfire between those who are concerned about the statement, some to the point of strong opposition, and those who cannot see why it is not a straightforward mission to move beyond the old ‘abstinence versus methadone’ debate and work with the client’s choice of treatment. Will the usual entrenched ideologies get in the way of consensus? Is the statement on the right track? As I am in danger of simplifying the entire exercise, you must read the article on page 10 and let us know what you think.

It’s a right old game sometimes, getting your service noticed in the face of a different local culture. But Jacquie Johnston-Lynch describes in our cover story how her 12-step service in Liverpool not only played the game of attracting clients, but played it alongside the harm reduction teams, to become part of the same strong league of services. This is surely what it’s about – getting out there and playing with enthusiasm, so that clients can make their treatment choice safe in the knowledge that it will spare them penalties and bring them goals. Read the article and you will be talking like this too.

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Taking a global snapshot

Why harm reduction must focus on the public health challenge.

BECOMING IMMERSED in an international harm reduction conference is quite an intense experience, but

that’s what we did last month at IHRA’s event in Barcelona. It was the first time DDN had been to this annual

event, and the first time we had been invited to produce daily magazines covering it. We decided to make the

most of the opportunity by sharing some of the insights to harm reduction revealed by delegates from different

countries, in this issue of the magazine.

If you are born into an addicted family and spend your childhood in and out of dealers’ houses, how likely are you to escape a life that’s entangled with drugs? Mark Ashby’s article (page ten) really hammers home the lack of choice some kids have – and their random chance of getting relevant support before they are beyond reach. It’s not so much ‘hidden harm’ as really obvious harm, and when the lack of dedicated support services for the young client group are highlighted, there is no justification for not catching them earlier.

If adults who enter drug treatment environments and the criminal justice system are vulnerable to learning from those with more extreme habits, how much more at risk is a young person? Mark surely has a point when he points to the woeful gap in bespoke treatment units for adolescents. The Kidsco charity is about more than just steering children away from drugs. It does its best to fill fundamental holes in their lives, which could be a daunting remit when the issues they arrive with are way more adult than they are.

For as long as DDN has been going, we’ve printed raging arguments over maintenance treatment versus abstinence. Our cover story (page 6) has a different – and in my view important – purpose. It explains why we are often failing clients by giving them insufficient information about the likely outcomes of each treatment to inform their choice properly.

Methadone maintenance suits many people and can be a very useful route to stability and reintegration. But are we making it plain to clients that it is not a logical route to abstinence, that they can’t veer easily from one mode of treatment to the other – and if that is what they are hoping for then they need to look at a different set of options for support? The four respected authors present the evidence for an argument that could shake up the current default options for offering treatment. Let us know your views.

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Talking to Tony in the warmth of the Brighton Conference Centre I asked him how he coped with homelessness, during his eight years on the streets. ‘I just did’, he said, ‘you get used to it after a while. You hardly notice how cold you are – you get by.’

You could ask the same of some drug services and general practices: how do you deal with the homeless people that come to you? ‘You just do – you get used to them after a while.’ Does that mean they’re being treated as people who need help like anyone else – or as someone to be hurried out of the waiting room before they cause offence?

Sharyn Smiles, addressing an audience of mainly GPs at the latest conference on managing drug users in primary care, was an exceptionally engaging speaker, and I found it very difficult to imaging her in the situation she described herself living with a few years ago, navigating the city by people’s shoes (see page 12). How do people like Sharyn become so invisible? Some of the stories aired at the conference’s Q and A sessions shed some light on the situation: some GPs were having to stop their receptionists from turning homeless people away – staff who were using bogus rules for why they couldn’t join the practice, or making the conditions difficult by demanding proof of identity through a recent utility bill. ‘We need to get tough on these practices and remind them what the law is,’ GPs at the conference agreed.

The challenge is taking this action beyond this specialist group of sympathetic and highly committed GPs, who have a special interest in making it easier for those in most need to find them and get treatment.

Closed lists are a disgrace: GPs can register anyone at their practice, so there is no excuse for turning anyone away because they can’t produce evidence of an address. No one should be at the mercy of chancing upon a good outreach worker.

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Are residential treatment centres up to scratch? In explaining the new star rating system, David Finney mentions that the drug and alcohol sector performs better than most (page 6). Clearer signposts to good (and not so good) treatment should give clients and commissioners better choice, and prompt the poorer performers to shape up for survival. 

The lottery of service standards becomes even more urgent when applied to support for children of drug-using parents. This frequently hidden clientele can not step forward to choose for themselves, as our researchers highlight on page 14. It’s an unequivocal argument for replacing the postcode lottery with centralised control.

With criminal justice led programmes forming a main joist of drug strategy, Roger Howard (page 10) highlights how much we are taking for granted about the effectiveness of these interventions. The report highlights that standards of prison drug treatment are unacceptable – so why aren’t we tackling reform head-on?, asks Kathy Gyngell (page 11).

On a different note, I was very interested to learn about Lapidus, a membership organisation for people who believe in the power of writing as a tool for healing and personal development. Fiona Friend looks at what this can mean for the addiction field, on page 12. Diary writing can be extremely cathartic; DDN contributors who have shared their personal stories often say that it helps them to take stock of how far they’ve come. A member of Fiona’s creative writing group adds: ‘I explore my feelings in a way no other format can do’.

There’s another side to it that emerges from those who have experienced addiction: People who have experienced extreme highs and lows in their life are are often passionate about helping others get beyond that situation – which could explain why user forums can work so well as a support network. Empathy in written format can be a very powerful tool indeed.

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The new ten-year drug strategy’s out – and yes, it’s a serious business. There’s some essential paperwork to prove it: not just the detailed strategy itself, but also the report on the consultation which gives vital clues on whose comments and suggestions made it to the strategy document. The accompanying action plan gives the timescale for key actions (some on the horizon, and some way off in the no-man’s land of beyond the next election) and says who – for the moment at least – is responsible for delivery.

It’s a lot to take in, and initial reactions have tended to land squarely on the headline grabbing. Most people I’ve spoken to haven’t had chance to read the strategy in detail yet, and have only had time to read press coverage of the bits that concern them – which is what gave us the idea of presenting key points from the strategy as a game, on page 6-7. The issues are serious, but this will give you an at-a-glance round-up until you have time to read the full document. Everyone affected by the drug strategy needs to know what’s in it sooner rather than later – how else will we keep abreast of the many timings in the action plan? ‘Getting tough’ seems to have won the headlines again, obscuring some gems of progress, particularly on family support.

The commitment to helping drug users get into treatment and reintegrate into society are among the strategy’s most important elements, but they have been swept into the coercion bag. Everyone understands the need to get vulnerable people into treatment, but why – when launching a strategy with input from right across government, including the Department of Health – focus on the threat of removing financial support?

Of course public health does not grab headlines like removing ‘bling’ from drug dealers. But we have to make sure that the daily headlines for those working in the drug and alcohol field – the increase of blood-borne viruses; rocketing rates of liver disease – do not get lost in the noise of the crowd pleasers.

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Reactions to our first DDN/Alliance service user conference have been illuminating, interesting and inspiring for the next attempt. Most of the responses to our office and to our colleagues at the Alliance have been overwhelmingly enthusiastic; it’s on the online forums that discussion gets more open. Some contributors suspected there was no point to the event, as nothing would change. Others found it a less than polished experience compared to a standard conference format. Some didn’t go – but were sure it couldn’t have been worth it. That’s the most frustrating comment to hear!

Was it worth it? Well we hope and believe so – but it depends on what happens next. We got a lot of information from it, and in this special issue we’ve only been able to include a fraction of the many comments and suggestions that were left on hundreds of post-it notes. I hope it gives you a taster of the passion in the room that day: there was appetite for positive change and constructive liaison to get there – we now have to try and harness this energy to make it happen. None of the information we gathered will be wasted (except maybe the suggestion to get spent meth bottles valued as recycled glass… though who knows?!).

The comments will inform our work on DDN, and give us ideas on improving communication with service users all over the country. Documenting problems and issues is surely the start of improving them. This event was just the beginning: expect to hear more!

One of the very strong messages that’s come through already is how much people gained from sharing experiences with others from around the country. If you have thoughts about the conference, or any other aspect of service user involvement, please don’t stop the dialogue: get in touch so we can explore the issues that matter to you.

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Back to London, and a flurry of activity to get this issue together after our DDN/Alliance service users’ conference in Birmingham. The response to the event has been so encouraging: it was such a busy day that it was difficult to step back and see what the experience was like for those attending. But we couldn’t have hoped for a more positive reaction. As Daren Garratt says in his article on page 14, we plunged in knowing what we wanted to do at the outset, but had to adjust and improvise to keep the growing event interactive.

Whatever the lessons for next year, the main thing is that we have a wealth of enthusiasm to build on. The team of Alliance volunteers was amazing, and the network of friends and service user groups is growing, alongside the professionals who want to make positive treatment experience and active user involvement happen in their area. We’re reading each and every comment jotted down at the interactive session in the afternoon, and are teasing out key issues for our conference special issue, next DDN. Whatever the tricky issues are, pinning them down in print must surely be a constructive step towards tackling them. To all our speakers – some of whom did not have the easiest remit, but who participated excellently (a special mention, NTA chief executive Paul Hayes!) – a massive thank you.

Issues don’t get more difficult than our cover story this time. It was hard to accept the picture on the front of the magazine, and I was at first inclined to vote for a more subtle illustration that didn’t make me flinch. But that after all is the point: it’s an unpalatable issue and you will be left appalled by the state of affairs described on page 6.

Closer to home, Maggie Semmens and Claire Clarke take apart their treatment offered to women to examine if there are better ways of responding to their specific needs. The research and active response is an excellent example of changing things for the better whenever you can.

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Wolverhampton’s Service User Involvement Team are doing so much, it was difficult to cram it all into one article (cover story). Behind the tangible successes of the group are a raft of partnerships and a lot of goodwill and co-operation from neighbouring services, including treatment providers, police, probation, and businesses like the local art gallery, who are being generous with facilities and offering new opportunities to develop talent.

The group is powered by the enthusiasm and commitment of its project manager and team, including a growing band of volunteers, and is given vital support by the local commissioner, the regional alliance advocate (who was determined to see the service user group regenerated to useful purpose) and others.

It’s not all been plain sailing. But the team’s journey is an inspiring example of what determination, creativity and enthusiasm can achieve when carefully blended with a vital base mixture of structured planning. Trickier issues will test the group’s patience, but they have passed a vital milestone in getting local services to engage in a dialogue of improvement and to publicly display their responses to criticism in their waiting rooms, in a show of commitment to do better. In a short space of time, the group has become an impossible-to ignore element of local treatment planning. The comments from SUIT’s members show the difference the initiative has had on their lives and outlook – and that’s got to be encouragement to those who are wondering whether the workload is worth it.

We wanted to know how other service user groups around the country were getting on, so have extended our regular ‘fact file’ for this issue, to create space for a round-up of eight groups. We’ll keep the fact files coming in future issues, but hopefully it will give encouragement that, in the words of Wakefield’s correspondent, ‘one step at a time will amount to a giant leap’!

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