Services now ‘on their knees’, says Carol Black

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

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

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

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

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

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

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

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

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

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