It’s time to properly address the huge unmet treatment needs of BAME communities, says Sohan Sahota. BAC-IN is a Nottingham based, specialist drug and alcohol recovery support service for individuals, families and young adults from diverse ethnic communities – an award winning, grassroots community service inspired and founded by people in recovery and built on a foundation of knowledge gained by those with first-hand experience of addiction and multiple disadvantage. Our approach is holistic and culturally sensitive, enabling individuals to access support with addiction recovery, mental health and additional wellbeing services. We offer a range of activities, including one-to-one and group support, counselling, aftercare, leadership mentoring, personal development workshops and specialist training to help people achieve sustainable recovery, make responsible life changes and build healthy relationships. The essence of lived experience, addiction recovery and cultural expertise is at the heart of BAC-IN’s guiding philosophy, organisational principles and service delivery. We are passionate and motivated to improve outcomes for BAME communities – we’ve witnessed and understand the inequity that this community of people experience with addiction, complex trauma and the cultural repercussions for their families. This reality drove the development of BAC-IN in early 2000 as a response to a gap in mainstream drug treatment services for BAME communities. Under-representation Our partner organisation New Hope Rehabilitation (NHR) provides abstinence-based supported living accommodation in the Nottingham and Derby area. NHR are a small local BAME-led service founded by professionals with extensive experience of working in substance misuse, criminal justice and adult and children’s services, most of whom also have lived experience of recovery from substance misuse. The philosophy of NHR is rooted in the desire to make a lasting difference in the lives of the people who come for help and support. As a multicultural society, we must address the growing under-representation, unmet need and increasing health inequalities in treatment for BAME communities, including women, families, young people and veterans. Despite mainstream services being available for those in addiction, uptake is low amongst BAME people due to their perceptions of such services as clinical and uncaring, as well as a perceived cultural distance between worker and client. BAME communities are not resistant to treatment, nor are they naïve about treatment services. The realities are closely linked to cultural barriers to access, lack of choice and poor experiences of engagement in available treatment. The impact of cultural shame, discrimination and past experience of racism, exacerbated by mistrust of services and language barriers, prevent many from coming forward for help. Disconnection Mainstream and addiction charity services are doing excellent work providing generic support, advice and clinical treatment that benefit many from all backgrounds. There is however a disconnect between the experience of BAME communities accessing help and the perceptions of how well service providers are catering for all communities – these misperceptions have left many who are seeking help unsupported, resulting in further complex issues leading to severe health consequences and fatalities. Local and national commissioning arrangements often underestimate the level of need among BAME communities, which often results in stark under-representation in treatment as highlighted in the annual NDTMS reports and elsewhere. A greater investment is required to improve access and develop culturally appropriate treatment and recovery services. Knowledge of lived realties, intersectionality and cultural issues is vital in supporting BAME people effectively – cultural context is critical in understanding who people are in terms of their world view, attitudes, beliefs, cultural backgrounds, ethnicity, faith, family dynamics, religious practices and their history. The role of cultural empathy, lived experience and ability to connect are at the heart of building trust and developing equality within the therapeutic relationship. Core elements The purpose of appreciating the culture of an individual in recovery is to better understand who people are intrinsically and how to help them. In order to do this, it’s not enough just to understand their dietary needs, religious holidays or what faith they belong to. The most important element of a person’s culture is their psychology – what are their core beliefs? What is their faith? What is their attitude to family? What is their experience of stigma, racism, oppression and prejudice? What are their communication styles? What are their concepts of disease, health, addiction and recovery? How do all of these things impact their relationships, their identity and their reasons for developing substance problems and their need for recovery and wellbeing? Without these core elements of deep cultural understanding and the ability to foster a genuine sense of connection and belonging, approaches to addiction and recovery for BAME communities will remain stuck under a low ceiling of effectiveness and continued poor psycho-cultural engagement by treatment providers. Cultural competence training can help to some degree to improve interpersonal communication but cannot replace culturally appropriate community-led support. Integration We need services that are fit for purpose and that have the capacity to reach and engage people who need help. The value of integrated services running alongside BAME specialist community services must now be a priority – they can both draw on each other’s assets and produce an overall stronger integrated system to benefit the community as a whole. They can share knowledge and expertise wherever one is lacking – the right support from the right people and organisations is key in establishing a stable and lasting recovery. Equal access to treatment and recovery is the way forward, but to make this happen there must be significant investment in specialist community and lived experience led service providers to address gaps, inequalities and unmet need for under-represented groups. Give people a choice of service providers, treatment options and embrace approaches that work, be it psychosocial, culturally specific, faith-based or spiritually informed models to transformative recovery and wellbeing.