DrugScope's conference 2009
Presentations from our annual conference - Drug Treatment at the Crossroads: where next for the recovery agenda? October 2009
Plenary powerpoints | Workshop powerpoints | Photo gallery | Presentation summaries
Service user panel
Sue Baker, director of Time to Change, discussed “Combating Stigma and Discrimination”.
- Time to Change is a £20 million programme being delivered by Mind, Rethink and the Institute of Psychiatry aiming to end discrimination faced by people who experience mental health problems.
- The Time to Change programme includes 28 local community projects, a national high-profile campaign, mass-participation physical activity week, legal test cases, training for student doctors and teachers, and a network of grassroots activists combating discrimination.
- The overall aims of the programme are to create a 5% positive shift in public attitudes towards mental health problems, a 5% reduction in discrimination by 2012, to increase the ability of 100,000 people with mental health problems to address discrimination, to engage over 250,000 people in physical activity, and to produce a powerful evidence base of what works.
- Evidence suggests the best approach is to combine the enforcement of legal rights with work to engage the public, alongside grassroots projects that bring people with and without mental health problems together. Public attitudes can be changed, as can the behaviour around mental health by involving people with direct experience of mental health problems in work carried out on the programme.
- Attitudes can also be changed by combining national programmes with local, community activities, sending out clear consistent messages to specific audiences and monitoring and evaluating all programme work.
Martin Barnes, Chief Executive of DrugScope, welcomed delegates to the conference and thanked the speakers for their presentations.
- The National Drug Strategy’s commitment to re-integration is welcomed, but there is still much to be done to break down the barriers and stigmas attached to being or having been a drug user. There is concern that in the future many former drug users will be excluded from working and volunteering in services due to needing to register with the new Independent Safeguarding Authority.
- While record investment to treatment services has been fuelled by the link between drugs and crime, continuing to make this case for funding may reinforce damaging stereotypes that underline stigma and discrimination, and promote the ‘politics of fear’. We should try to engage in a debate that promotes compassion and increases awareness of context, causes and consequences.
- The commitment to improve problem drug users’ opportunity for training and employment through the welfare system while identifying those who would benefit from treatment is positive, but the concern remains that in seeking new powers in the Welfare Reform Bill, the balance is too much towards compulsion and sanctions.
- Changing drug trends have seen fewer young people presenting with heroin and crack addiction but more with cocaine problems. Three legal highs – BZP, GBL and Spice – are to be made illegal. The response to changing drug trends raises questions about our legal framework and whether the Misuse of Drugs Act is fit for purpose to minimise harms.
- Progressive drug policy is possible under a potential Conservative government, but we must communicate with the public, media and politicians to champion a positive vision of recovery and challenge stigmatising caricatures.
Dr David Best, Reader in Criminal Justice at the University of the West of Scotland discussed, “The Politics of Recovery”.
- In a review of Birmingham treatment services most clients were seen once a fortnight for an average of 46.6 minutes. This equates to under 19 hours a year, only 4 of which were ‘therapeutic activity’. Evidence suggests nationwide statistics may be even worse.
- While approximately a third of clients had discussed harm reduction and relapse prevention in their last session, only a fifth had discussed care planning and 1% discussed motivational enhancement. Addiction can be framed in terms of behavioural aspects and life choices that can’t be treated through medication – acute opiate withdrawal may last 2-3 weeks, but psychosocial recovery can take years.
- Key predictors of sustained abstinence include supportive relationships, employment, moving away from drug using friends and having reasonable accommodation. Treatment should reflect these social and environmental needs and act as an opportunity to build this kind of stability. This can be done through increasing an individuals ‘recovery capital’ – personal and life skills, beliefs and desires around recovery, and engagement with family and community.
- Why do we still need a debate around recovery? There is a lack of understanding of the relevant literature and evidence base, and there are opposing and entrenched interests unwilling to give up their ‘slice of the pie’.
Rowena Daw, director of policy at the Royal College of Psychiatrists, discussed “Recovery and Mental Health – A View from the Royal of College of Psychiatrists”.
- When a mental illness is diagnosed, it may only occur once in a lifetime contrary to popular belief of it being a lifelong illness. It is also noted how those diagnosed with mental illness can suffer discrimination from professional services, and how these professional attitudes are key to the success of the individual’s recovery.
- Ways of assisting recovery through day-to-day working include enhancing effective person-centered services through working in multi-disciplinary and multi-agency contexts, adoption in policies of trusts, incorporated into training of professionals (for example in mental health nurses’ and psychiatrists’ undergraduate training), and new types of workers including recovery coaches, WRAP trainers and peer supports.
- There must be recruitment of people with lived experience of mental illness at all levels, peer professionals to be supported and trained, reciprocity, a willingness to go the extra mile, a focus on the individual’s inner resources, and also further research.
- Various challenges face the mental health profession such as increasing personalisation and choice, changing the nature of day-to-day interactions, redefining service user involvement, increasing opportunities to build a life beyond illness, financial pressures in Trusts, and the resistance to change of staff and service users. These all present obstacles in smoothing the way for a more seamless approach to recovery. Implications arising in this area include the role of medication in chronic illness, evaluating current research practices, and increasing the public’s knowledge and awareness of psychiatric practice.
- Recommendations for recovery include asking yourself (as the professional) questions after each client interaction such as whether you engaged in active listening, clarifying what other options are available such as psychological treatments, making sure you are aware of the client’s needs, being aware of external resources such as friends and family, and encouraging self-management of mental health problems.
Dr Geraldine Strathdee, Consultant Psychiatrist Bromley ACT; Co-clinical lead, London Mental Healthcare Pathway Programme, discussed “Recover and complex need – the experience of an Assertive Outreach team.
- A ‘typical’ pathway into complex needs may include:
A family history of mental health
Chaotic lifestyles and sexual, physical or emotional abuse
Difficulties at school with unrecognised/undiagnosed learning difficulties
Truanting and petty crime
The beginning of mental illness
Institutions, youth offending teams, psychiatric wards
Assertive community treatment with multi agency care
- Clients with complex needs may have problems with substance misuse, psychosis illness, neuro-cognitive impairment, personality difficulties, physical ill health and social exclusion.
- A multi-agency Assertive Outreach team is made up of community psychiatric nurses, psychiatrists, social workers, psychologists and occupational therapists. Local partnerships include working with housing teams, benefit advisors, police and probation, carers and a range of skills training and therapy sessions.
- Recovery is a complex and individual process and needs to go far beyond clinical needs – driving and parenting support, volunteering, contacting lost family, financial appointeeships have all proved useful as part of personalised care packages.
- All care packages should address housing, self belief and meaningful activity, financial and social stability, and personal health.
Ian Wardle, CEO of Lifeline discussed “Three key discourses and our field’s future”.
- Over the past two years, debates and discussions about Recovery have had a major impact upon how we, in the drug treatment sector, understand our role and define our impact.
- The Recovery movement isn't confined to drug treatment, it has also had a profound impact on the mental health field. In both fields it has impacted upon and to some degree infiltrated Mainstream Discourse.
- In the drugs field, a Recovery perspective has governed the approach taken in the Scottish Drug Strategy and has also recently begun to influence mainstream discourse in England and Wales.
- There are thus two principal discourses: a challenging recovery discourse, on the one hand, and a mainstream harm reduction discourse on the other.
- To these two we must now add a third major discourse that is shaping our field: the Systems Discourse.
- The systems discourse is closely linked to debates on Localism and is the subject of various pilots: the Total Place initiative from DCLG and the Systems Change Pilots from the Home Office. The latter affects our field directly and aims to devise new forms of more efficient partnership working at local level.
- The impact these three discourses have on each other will determine our field's future over the next 5 years.
Dominic Williamson of Revolving Doors, a charity that works to improve the lives of those who are involved in the cycle of crisis, crime and mental illness, discussed, “Homelessness, Criminal Justice and Recovery”.
- Recovery is a personal journey underpinned by hope. Key components of the recovery process can be finding and maintaining hope, believing in oneself, re-establishing a positive identity, building a meaningful life, and taking responsibility and control.
- The dynamics that exist in the recovery process with the self (including emotions, memories, and childhood patterns) are the focal point. Overlapping areas with self include basic needs (such as money and housing), social aspects (including family, friends, and love), health (mental, physical, and treatment), and contribution (such as learning, and work). It is the interaction of each of these overlapping spheres that ultimately impacts the overall recovery process.
- Further contributors to the recovery process include the individual’s behaviour and how this behaviour both influences and is influenced by personal factors (such as mood and health), and the social environment. This is known as triadic reciprocity – a model developed by the psychologist Albert Bandura.
- Determinants of self-efficacy include mastery experience, vicarious experience (“if they can do it, so can I”), and social and emotional states.
- The responsibility to build hope is at all levels: frontline staff (to listen and link-up), management (to support and join-up), organisations (to work across boundaries), commissioners (to understand journeys and to navigate pathways) and politicians (to lead and develop a policy framework).
- The dynamics of the challenges must be understood, we must value and listen to the individual, support them to build their own pathways, and professionals at all levels must take responsibility for their role in the client’s recovery.