Drug treatment in the UK is regarded as world class – effective, evidence-based and supported by a wealth of data, with figures from the National Drug Treatment Monitoring System (NDTMS) showing how far the sector has come.
However, it’s now acknowledged that treatment itself is only one of the things that contribute to a successful outcome. Making a long-term transformation relies on a range of factors – referred to as recovery capital – that can be boiled down to straightforward ideas like improved health, a job, somewhere to live and friends. Building these resources is an important part of starting to make a change, and often an essential part of sustaining it.
The advantages to building recovery capital are clear but the environment is, if not hostile, then certainly challenging. The treatment sector is in a state of flux and the external environment is also changing, with jobs and homes hard to come by and public services undergoing significant changes.
The Recovery Partnership was keen to learn more about how the sector is adapting to the changing environment, and how it is managing to provide the type of support needed to build lasting recovery. While NDTMS and the other hard data the sector collects tell an important story, to learn more about non-treatment related activity and the reality at a local level, talking to services and the people who work in them was crucial.
The State of the sector 2013 research (see news story, page 4) aimed to do this by a number of means – an online survey, telephone interviews with chief executives and local managers and four regional ‘Building Recovery in Communities’ summits last autumn in which more than 200 people participated. The survey itself was completed by around 170 services, while around a dozen interviews were conducted, primarily with services in local authority areas where there was an especially low or especially high public health allocation.
Given the breadth of what the Recovery Partnership wanted to learn about, it’s hardly surprising that the findings are best described as mixed. Some key points include:
• There is no evidence so far of systemic disinvestment. Roughly twice as many services reported a decrease compared to those reporting an increase, but the average increase was larger than the average decrease. This may be evidence of a trend towards larger contracts and fewer providers in a given area and this is consistent with in-year figures from the Department for Communities and Local Government, which suggest that, broadly speaking, funding has been maintained in 2013-14.
• There is some engagement with health and wellbeing boards and police and crime commissioners, but variable levels of awareness of the contents of joint strategic needs assessments (JSNAs) and police and crime plans – particularly the latter. Where people were aware of the contents of local plans and assessments, several expressed concern that the focus was more on crime and anti-social behaviour than treatment. In the case of JSNAs, there were concerns that drugs and alcohol were insufficiently reflected, which may not be problematic if the boards are working on the principle that if it’s not broken, don’t fix it, but it’s something to watch out for.
Generally, services appear to be facing challenges around supporting people to accumulate recovery capital, with housing, jobs and support for complex or multiple needs all highlighted as areas of concern:
• Housing was the most commonly encountered support need after support to overcome dependency – unsurprising, as NDTMS data indicates many people accessing treatment have some sort of housing problem. However, housing and housing support was the most commonly identified local gap, including the ability to access particular types of accommodation, such as drug and/or alcohol-free supported housing.
• Management of overall health was the second most encountered support need. While availability of physical or general health services does not seem problematic, more respondents felt that access to mental health services had worsened than improved over the last 12 months. Several expressed concern about the threshold for mental health support and that raising it meant that many people were going without. The problem of support for people with complex needs or dual diagnosis remains unresolved.
• Employment, training and education (ETE) came fourth on the list of support needs and was the third most mentioned local gap. What’s interesting is that, in response to another question, very few respondents said ETE support wasn’t available locally, and many services reported a partnership with Jobcentre Plus and/or Work Programme providers. It may be that while the support is available, it isn’t achieving the sort of results services would like to see and be part of.
In short, while the findings aren’t calamitous – and in some respects are pretty positive – there are some areas of work that look as though they’re struggling, and many of the areas where services and partnerships appear to be facing difficulty are related directly to recovery capital.
Later this year, we’ll be repeating the exercise to see how the sector is faring now that the new commissioners and funders are bedded in, and we’ll be looking in more detail at the findings from 2013. As State of the sector 2013 focused primarily on community and residential drug and alcohol treatment, we’re also aiming to do some work looking at prison treatment and young people’s services. Please keep your eyes open for them – the more people who take part, the more reliable the findings will be.
Full report at www.drugscope.org.uk
Paul Anders is senior policy officer at DrugScope