How do you make recovery visible and relevant to a diverse community? Ashley Gibson of the Unity Drug and Alcohol Recovery Service shares Cumbria’s experience.
In early 2012 Cumbria DAAT decided to go out to tender for a recovery-oriented, asset-based service with one lead provider. Those of us involved in Cumbria service provision felt it to be a forward thinking step – we really wanted more people to get well and we liked how the focus on recovery had impacted on other areas of the country, and the North West in particular. It was also clear from consultations with people accessing services that they wanted change too, and the tender specification accurately reflected the needs of those surveyed.
Back then Cumbria, like many other parts of the country, was struggling with the numbers in treatment. Having learned to bring people into treatment and minimise harm, we were finding it difficult to move people through the system, despite service provision that encouraged uptake of support programmes. We weren’t wholly unsuccessful – the Straight Ahead programme and Bridging the Gap were proving themselves as recovery building assets – but there were question marks over the necessary visibility of recovery in Cumbria.
Bridging the gaps
Obstacles to change included the geographical distances between local communities, Cumbria being pretty much the same size as the rest of the North West. It has a mixture of affluence and rural poverty, with pockets of high unemployment in areas like Barrow and the west of the county, and some significant housing challenges. Centralised approaches to working in the diverse communities of Cumbria were just not demonstrating enough relevance to local needs.
As a treatment system made up of different providers, we struggled to pay enough attention to what happened to people who were leaving treatment and we were not proactive enough regarding feedback that there was no aftercare available. We supported the set-up of Smart Recovery but at that time we didn’t have enough people at that level of recovery to sustain it. We had a lot to learn – and still do. Our contact with, and knowledge of, 12-step recovery was sporadic at best.
Cumbria had three main providers, covering prescribing and clinical, criminal justice, and structured day care services. This created some really positive joint working and some not so positive competition. Everyone recognised the importance of keeping people who access services at the heart of the process – but I am not sure that this always happened, however hard most of us tried.
Recovery focused
Greater Manchester West Mental Health NHS Foundation Trust were successful in their bid to provide a recovery-focused asset-based service in Cumbria, with a contract beginning on 1 July last year. For those like myself, whose previous experience had always been with third sector organisations, it was an interesting prospect. GMW senior management were very clear with us all that recovery would be at the heart of the way forward and that we would be working with an asset-based approach. It sounded exciting; in my role as a third sector service manager in Cumbria I had already been involved with asset-sharing ideas, particularly in Barrow, and had previously attended a John McKnight asset-based community development seminar in Kendal. I am also in recovery and the prospect of what felt like going back to my own roots in my work was a really inviting one.
As the result of a consultation exercise, Unity, with a strapline of ‘recovery in your community’, became the new name for the ‘one provider’ service. The name reflected the need of people from the previously separate services to unify with people already in recovery and those accessing services. It also felt like a message to ourselves as we built the foundations of our co-productive approach within Cumbrian communities.
Flexible approach
Taking an innovative approach, and recognising that recovery networks are key to people getting and staying well, Unity set up an asset building fund. This takes bids during each year of the contract from groups and organisations that wish to contribute to recovery and its further development in Cumbria. As well as this, a new role of community development lead (my role) was introduced into the Unity management structure. Its purpose was to support recovery development by letting us share assets through joined-up work between people and services in the community. We recognised – and it was also commented on in Cumbria DAAT’s modernisation consultation with service users – that both drug and alcohol services and recovery support needed to be relevant to local communities. One size definitely does not fit all in Cumbria.
Different recovery groups and organisations with local connections were already set up or were starting to develop their ideas. These groups were encouraged to apply for support from the Unity asset-building fund – a great opportunity for them and for Unity to start to build a co-productive approach. Those successfully shortlisted would be invited to participate in a ‘friendly Dragon’s Den’ – a nod to the popular TV programme.
Key to the accessibility of the asset-building fund was Unity’s recognition that the process needed to be very straightforward. Although bid-related goals were agreed, these would be flexible according to the specific local requirements of the group needing funding. Unity, through my role, and also the commitment of the local recovery service teams, support all groups, whether they are funded yet or not, to play their part in the local community.
Local involvement
What we try to do is listen and support as opposed to tell and regulate, in the belief that recovery is not owned but shared. We also try to help those who wish to design and develop recovery support networks to realise their aspirations. The growing mutual respect was highlighted by the contribution that different recovery groups from around the county made to our recent workforce development training. They played a major part in helping Unity staff teams develop their understanding of recovery and this co-working continues to bear fruit.
In practical terms, Unity work closely with local groups – Vulture Club in Whitehaven, New Beginning in Workington, Cumbria Gateway and Jigsaws in Carlisle, ReFocus in Penrith, and New Roots in Barrow – to develop their ideas further and make the groups more visible. These organisations are all inspired to support recovery in Cumbria and choose to work closely with Unity to develop strong and meaningful links with other organisations in their local communities.
In Barrow and Workington we have recently taken our next step in recovery asset building. Following an inspirational visit to friends at the Scottish Recovery Consortium and some practice at our workforce development days, we have joined the brave new world of ‘recovery conversation cafés’, inviting people who access local services, carers and people from the community to talk about what recovery means locally. This is a great way to have everyone who supports recovery get together, make use of the links we have, forge new ones and decide on actions that relate to recovery in the local communities of Cumbria.
The informal café atmosphere is designed to help everyone feel at ease and talk openly about real ideas that will support recovery networks and their development. It is ideally suited to the asset-based approach as it brings focus to the sharing of strengths and assets in a positive environment. So far the Barrow and Workington conversation cafés have been vibrant and full of ideas that have included such things as social media development, ways to challenge stigma and sharing of workspace.
Community connections
We have also begun work to build relationships with 12-step and other mutual aid organisations. North West representatives from Narcotics Anonymous came out to Barrow-in-Furness to put on a ‘myth-busting’ event to support positive, reality-based links that ensure people accessing treatment services get a full range of recovery choices, and Unity are now working to support the set up of new NA meetings in Cumbria. In Carlisle the Unity team and partners linked with an Alcoholics Anonymous public meeting, building important relationships to facilitate more informed choice for people accessing services. This linkage has been further developed after Mark Gilman’s visit to the city to promote mutual aid facilitation, as AA will be hosting an open meeting to introduce the 12 steps at Unity’s Botchergate centre from September. In HMP Haverigg we will soon have Smart Recovery meetings taking place, with staff members currently in training.
To mix metaphors for us, recovery is not a bull at a gate but a rising tide, as it becomes more visible in Cumbria. What I love about it is its diversity – each locality doing its own thing, demonstrating, I think, that we were right not to centralise our ideas. The beauty of it is how, as the varied organisations and their members develop in their own local communities, there is increasing talk of wanting more contact with each other, and we hope to help everyone get together this month for our very own Cumbria recovery walk.
The next recovery conversation café is planned for 24 September in Carlisle.
Ashley Gibson is community development lead at Unity Drug and Alcohol Recovery Service, Cumbria.
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Get them young
It’s time to overcome our paralysis on tackling young people’s drug use, says Kate Iorpenda of the International HIV/AIDS Alliance.
Article 3 of the UN Convention on the Rights of the Child declares that in all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration. With this in mind, the issue of drug use among children – and in particular injecting drug use – is one that raises a number of ethical dilemmas and consequent heated debate among practitioners.
Perhaps it’s because we find the reality of children and adolescents using drugs too difficult to face. Or perhaps it’s because supporting young people to use drugs more safely seems irresponsible and contrary to the values of protecting children. Whatever the reason, the comprehensive services that are available to young people in some countries are not currently translating into service provision in poorer countries. In such contexts we need to be asking ourselves: have we consulted with young people to find out what they want and are we well enough informed about the types of drugs they take and their patterns of use? Otherwise we run the risk of being paralysed by the ethical dilemmas and conflicting values about what it might mean to be providing teenagers with clean needles.
Injecting drug use is a key driver of HIV epidemics in regions like Eastern Europe and Central and South East Asia, and the little available data we have indicates that in some countries children start injecting at a very young age. The lack of funding and attention to the needs of young people who use drugs has resulted in a situation where we lack concrete data on the extent of their drug use. However we do know that children with histories of abuse, mental health problems, and drug dependence in the family are among those at higher risk.
Adults have rights and choices about services and can be helped to seek other support – counselling, debt advice, housing – but with children there is a duty of care, and so service providers need to think both about safeguarding that duty of care and about how far it extends, given the complex and multiple needs of many young people who inject drugs.
Children and young people are often hidden within harm reduction services due to age restrictions and fears around asking and documenting age. In some countries, legal systems criminalise children as young as eight for drug use but deny them access to harm reduction services until they are 18. Additionally, service providers are often poorly prepared to work with young people, running programmes that don’t meet their needs and which have been designed without their input.
What kind of system punishes a child for drug use by incarcerating them in an adult prison? So many rights are being denied while we make up our minds on such issues. We need to know so much more about young people and their drug use and to recognise the diversity involved: different ages, different contexts, different genders, different drugs. We have to find ways within existing legal frameworks, good or bad, to ensure that we listen and respond. We need to collectively challenge the systems that continue to deny young people access to evidence-based interventions because of their age, but we also need to go beyond global policies.
Instead we must face the problems head on and listen to young people, find the missing data, face the unpalatable truth about the extent of their drug use and the systems that violate their rights. We need to confront uncomfortable choices to ensure that young people have access to information and services that they need and respect, and to support and protect their ability to make decisions. Easy to say and so much harder to do, but we are going nowhere unless we get over our paralysis.
Kate Iorpenda is senior advisor on children and impact mitigation at the International HIV/AIDS Alliance, www.aidsalliance.org
The International HIV/AIDS Alliance is supporting the Support. Don’t Punish campaign (supportdontpunish.org) which calls on governments to bring an end to the criminalisation and punishment of people who use drugs.