Stand up and be counted

Women in the sector are using their power to collaborate and demand change, says Karen Tyrell.

women's drug servicesOver the last decade, the number of women dying drug-related deaths has increased by almost 80 per cent, yet the number accessing treatment has remained stubbornly static. This means that there are likely to be many women out there who are facing substance use alone and this needs to change.

Despite this gender disparity in terms of the people who access services, from a staffing perspective approximately 70 per cent of people employed in the substance use treatment sector are women and many of them work in services. I was one of those front-line workers when I began my career more than 20 years ago but as I’ve progressed my career the number of female colleagues around me has dropped.

This lack of women in senior roles has meant that the opinions and experiences of women have often not been heard during decision-making discussions and this, combined with very little gender-specific research, has led to the needs of women not being considered in the design of services. For example, it’s a lot more difficult to pick up a script every day or attend a group session if the pharmacy is on the other side of town, you don’t have access to a car and you have two children in tow.

Women are also a lot more likely to fall into the category of ‘hidden homeless’ – sleeping on friends’ sofas or staying in bedsits and who therefore won’t be connected to services through street outreach staff or hostel workers. Not to mention the fact that women who use drugs or alcohol often face additional stigma which can make accessing services more daunting. A lack of recognition of the inherent challenges that women face has led to:

  • There being no female-only inpatient detox facilities
  • Vastly fewer choices for women who want female-only residential treatment
  • No consistent access to specialist midwifery for women in substance misuse
  • No specialist services for women struggling with both addiction and the menopause
  • No national minimum standards for women’s treatment

‘I’m not sure, with the exception of a few specialist organisations, if we ever had the specialism needed in the sector to fully support women,’ says national head of service, public health and substance misuse at Turning Point, Nat Travis. ‘Traditionally, providers have always seen a greater proportion of males in treatment, often in the region of two thirds to one third and we need to change this and ensure that we provide the right opportunities for women to engage with treatment, and that our treatment offers them what they need.’

I’m pleased to say that the sector is now working together to address this issue. Last year, I saw Hannah Shead, CEO of Trevi, present about the female-only residential treatment service her organisation runs. She was really compelling and I reached out for a chat. This got us to thinking about why there isn’t a place for women to come together and use our collective power and voices to improve things at the front line for the women our services are here to support. So we decided to set up a women-only space, under the banner of Collective Voice, but with a broader membership (DDN, April, page 5).

From the start, we’ve tried to come at the problem from a different angle than other cross-organisational meetings (which in themselves are a fairly rare occurrence). We are a time-limited group – we’ve collaborated to build a shared understanding of the problem, and we recognise that focussing on women’s issues are a small fragment of our day jobs. We are forgiving, kind and unafraid. We’ve tried hard to come together with a different perspective. We don’t come to the meetings as representatives of our organisations, or to tell each other how brilliant our organisation is. We come together as women. We share jokes and have developed a space for psychological safety. It’s given us an opportunity to be bolder and to focus more on the needs of women – something we’ve all wondered if we could have done more of in our day jobs, or, as in my case, across my career.

Our aim is to improve the treatment offer for women who access drug and alcohol services, by bringing together senior women with a passion to improve things. We want to ensure specialist women’s drug and alcohol provision is available to all women, irrespective of treatment delivery type or geography, as a right. This means access to gender-specific (and women only) services and spaces; inpatient detoxification, residential treatment and community service delivery.

We know our sector is in flux, with the publication of the new drug strategy, changes in the commissioning landscape and a slew of new standards, processes and systems in development. Our group aims to influence commissioning and outcome monitoring to consider needs through the lens of sex and gender. We also aim to influence performance outcomes which OHID may be considering, to ensure they reflect women’s health and social care needs. We want to influence workforce development activities as well as advocating for the development of minimum standards for women’s services in substance misuse.

There is a risk, in a world of flux, that we end up simply rebuilding the treatment system of the past. That system did not effectively meet the needs of women. We need to create a new system of harm reduction, treatment and recovery for the future, which puts the needs of women at its heart. Women are central to local communities and families and are hugely influential across every domain of life. If we build a women-first or women-centric system, it will benefit everyone within it – not just women.

Basically, we are coming together to stand up for the needs of women, as distinct and separate from men. If you get the chance, please do the same.

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Case Study

LORNA: ‘The women’s group I attend is quite mixed in terms of age, ethnicity and life experience. We talked early on about what being a woman means to us as individuals and I think that allowed us to be open with each other. Each woman’s story is different but we all share the experience of being a woman and having a woman’s body. I believe that those shared experiences allow us to connect better than in a mixed group.

I feel it is a more relaxed atmosphere and that conversations flow more easily without men being present. I know I feel safer, more open and less guarded than in a mixed group. I believe that such safety has been the catalyst for me being able to be more reflective, to listen to other women and to support them. It has made an enormous difference to my mental wellbeing. The group has also helped me to feel a greater sense of personal worth and self-esteem. I feel like I’m getting myself back and that I’m becoming a more whole person.’


Lorna attends HAGA Alcohol Service in Haringey

Karen Tyrell is executive director of culture, strategy and external affairs at Humankind, on behalf of the Women’s Treatment Group which includes representatives from Bristol Drugs Project, Change Grow Live, Changing Lives, Cranstoun, Humankind, Phoenix Futures, Trevi House, Turning Point, WDP, With You and Working With Everyone

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