Why gender matters in drug and alcohol treatment

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The Government closed its call for evidence to inform its forthcoming Women’s Health Strategy this week, amidst recognition that a system designed for men by default leads to health inequalities for women. Vicki Ball, head of housing and homelessness services at Phoenix Futures, explores what this means for drug and alcohol treatment.

Here at Phoenix Futures, we believe that the strategy must take wider determinants of women’s health into account, including access to universal and specialist services, and experiences of services, which will be different among different groups. Gendered inequalities fostered by service design are compounded when women have multiple health and social care related needs.

For example, it is widely acknowledged that access to statutory mental health services is severely curtailed if an individual is experiencing drug or alcohol dependency. Likewise, people with mental health conditions can struggle to jump through the hoops required to access drug or alcohol treatment.[1] Women are particularly disadvantaged by these strictures because women are more likely to experience mental ill health than men.[2] They are also more likely to have caring responsibilities, to live in poverty, or to experience interpersonal violence in the home, all issues that can cause health problems as well as impact on ability to access services that provide treatment.

Phoenix Futures worked with nearly 4,000 women across our community, housing, and rehab services last year. All were using substances problematically. 66% additionally were experiencing mental health problems, a proportion that rises to 90% amongst women who accessed our residential rehabs.

Rehab operates as a particularly good treatment setting for people who are experiencing multiple needs, taking away some of the challenges inherent in delivering treatment in the community to those who may lack a stable base or support network, struggle to attend structured appointments, or who require additional treatment.

For those women facing the most complex needs, time in residential rehab affords the opportunity to receive intensive support across a range of areas in addition to drugs and alcohol, including mental health, housing, offending, and family support. Treatment is delivered within a supportive community. Time away from stressful lives gives participants the opportunity to reflect, contemplate, and affect change. It is an evidence-based treatment and it is effective.

In 2015, following consultation with women we worked with in HMP Holloway, we opened a gender-specific residential rehab in London, developing a trauma-informed psychosocial programme alongside highly personalised access to mental health treatment, including specialist eating disorder support and one-to-one clinical psychology input. The women we worked with had multiple, and often complex, needs. 71% had a mental health need for example. Almost half were homeless at admission. 39% had a history of offending.

A significant number of them were also mothers, and this was central to their identity. They had found it impossible to access and coordinate the range of support they needed in the community – residential treatment was a must for these women. The service was inspected by CQC, who rated it Outstanding. It was among the very best in the very small sector of rehabs for women.

Read the full blog post here.


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