Residential Rehab 01 - setting the scene

Access to residential (or even the cheaper quasi residential) rehab is at an all time low.  The stark facts are that for a variety of reasons, very few people get into rehab anymore, and yet it remains one of the most effective treatments for recovery from drug and alcohol addiction out there

Now by asserting that rehab is effective, please don't read into that that I am saying other forms of treatment are not effective, I am advocating a mixed economy of treatment options.  Please DO read into the above that at present we do not have a proper mix of treatment options.

In 2010 the coalition government published its new drug strategy, which now promotes Recovery rather than being predominantly about Harm Reduction.  The new strategy focuses on "supporting people to live a drug free life".  

Already less than a year old and we see some unhelpful semantics attempting to hijack the new strategy by re-defining the simple term "drug free life" to mean, "free of drugs of dependency", or "free of illicit drugs" etc – anything except what it says on the tin

We are in danger of rebranding harm reduction and calling it recovery - not good. There seems to be a disconnect between policy and practice as very few substance misuse partnerships seem to be "re-balancing" their treatment systems to adopt a recovery focus.

There are a number of reasons for this but one of the reasons seems to be a lack of leadership from the very top of government.  To change the focus of an almost £1billion pound treatment economy needs more than the publication of a new strategy.  It needs more than a few PbR Pilots and it needs more than the current, confusing and stalled / paused NHS Reforms

My experience is that there are substance misuse partnerships out there (whether as DAATs or as part of Community Safety Partnerships) that are in limbo.  Some are taking the initiative and moving forward as best they can, and others are standing still, effectively 'holding the fort' until news of next steps arrives or is clarified.

The last government were characterized by an over use of targets, micro-management and medaling and this government is characterized by not wanting to be like the last government.  Therefore, rather than showing real leadership and getting behind their published strategy they are adopting a, we'll let the market decide what works approach, predominantly through PbR.  Unfortunately there are 8 PbR pilots, some of which are already floundering (but putting on a brave face) and 140+ other DAATs wondering, “ok, we’ve had the new strategy, what next”

There is no real practical guidance, drive, or workforce development to help coax HMS Drug Strategy along.  There is no target date to achieve re-balancing by; there is no requirement to commit any % of resources to recovery.  Many partnerships are even confused about what Recovery actually is.  The coalition are hiding behind the localism and big society agenda, which is itself unclear at this stage

You may not believe me but I take no pleasure in writing in such harsh terms about a field which I love, which I am totally committed to and which has not only helped me by offering me rehabilitation when I needed it but continues to sustain me in employment.  I advised the conservatives, directly and indirectly when they were in opposition.  I gave evidence, as a civil servant, to the centre for social justice policy review (the addictions report) and I praised the breakdown and breakthrough Britain reports as some of the best evidence I had ever read. 

I guess, given the coalition that the 2010 election produced all bets were off .  Maybe this is coalition government, paralysis.

It’s a long way from the potential of the Breakthrough Britain Report, (Volume 4 Addictions, Towards Recovery) where the opening statement was…..

“If we concentrate on restoring people’s lives, most of the public health and crime issues will take care of themselves. ”

Looking at the current treatment landscape, in the light of these excellent reports and best intentions, shows us just how far we have regressed.  These reports were based on a solid evidence base and were the result of a lot of hard work and good consultation and being so far out of step and is an indicator that at present the tail must be wagging the dog i.e. civil servants, not ministers are again driving policy

In trying not to become like the previous government the current coalition will have the same regrets as Tony Blair said he had in that he never went far enough, fast enough.  Well, the current coalition are going fast but it seems they have left the roadmap (the reports referred to above) behind

I’d urge them, to re-read the addictions reports they authored in opposition, to pick them up and drive them forward.  Any strategy is dependant upon implementation.  Implementation doesn’t arrive on its own, it needs visible and dynamic leadership, something the wait and see approach is not delivering

Huseyin Djemil

ps - later in the week I will start proper the series on how to access residential rehab, what your (and your commissioners) rights and responsibilities are; using a variety of case studies and other examples to hopefully illustrate this

A week in life of the good consultant....

I originally started this blog, several years ago, to track my progress as a new consultant.

To recap I had worked in the field of addictions / substance misuse for many years and was presented with a unique opportunity (crisis) to do something new.  Stumbling blocks really can become stepping stones to new opportunities, as I know from my own journey of recovery from addiction, so I started freelance consulting in July 2007.

Several years on, and now as the Director of my very own company (Green Apple Consulting Ltd), I have not forgotten those early days and want to capture and communicate some of what being a consultant is all about in this and future blogs.

I could look at any week since July 2007 as most weeks have been busy, interesting, manic, diverse etc etc.  Even though I've been busy all the time I've also been worried about all sorts of things, mainly, delivering my current contract(s) and where the next contract is coming from, and nothings really changed in that regard, except I can maybe pick and choose the roles a bit more now than I could then

I'm not complacent though as the cliche really is true, you're only as good as your last project

This week has been an interesting week:

• Monday and Tuesday I worked from home on two separate contracts, for two county partnerships on developing and changing prison based substance misuse services within those counties
• Wednesday I was invited to HMP Bronzefield (a privately run prison) to be part of a delegation to meet with HRH Princess Anne in her role as Patron of The Butler Trust.  Later that evening I was invited to speak at an upcoming recovery conference 
• Thursday I was at the South East DAAT Commissioners Meeting, representing one of my clients as an 'honorary commissioner'
• Friday I was working from home again, taking calls, answering emails etc

And next week looks just as busy and diverse

• Monday, prison meeting at 11am, working lunch at 1.30pm, 3pm meeting with Care, before going on to meet with Care and David Burrowes MP at Portcullis House
• Tuesday, Surrey DAAT (meet with the Manager in the morning and with the executive group in the afternoon)
• Wednesday, work from home in the morning and from 4pm House of Commons for the launch of the Concordat
• Thursday and Friday are again, admin and working from home days and on Sunday I am invited to attend (and very much looking forward to) The Ley Community, to celebrate with them 40th Anniversary for delivering transforming, rehabilitative care to men and women with drug and alcohol addictions

The above is not about name dropping or showing off about how interesting my job is.  Its about demonstrating that people in recovery can aim high, that we can have a good life beyond treatment.  Its about having and keeping a hopeful outlook on life, despite our usual worries about money or relapse or what we think others think about us, or what we think about ourselves or (to get properly into some rehab speak - what we think others think of us!!!

I got into consulting because I felt I had to leave the civil service because I landed a great job but it made me miserable.  I also went into to treatment many years ago because I wanted to give up drugs and start my life again as a criminal without the major impediment of a drug habit around my neck

Along the way, in life as in work, my motivation changed and I learnt a lot, made new friends, redefined my goals and suddenly was living again.  Relating my personal story back to the treatment field of today we have to do so much more than we are doing.

Treatment and recovery services (as they are beginning to be defined) need to provide hope and opportunity for those that access them.  In my experience, those accessing drug and alcohol treatment services (like me) predominantly want to give up drugs, move away from dependancy and live again

In the coming weeks and months I want to chart what I do as a consultant but will also try and give my recovery insight as well as bring insight from friends, colleagues and clients in recovery

Hope you enjoy it

All the best

Huseyin

Is PbR the next Credit Default Swap?

I'm luckier than most, in that I managed a whole 8-days on leave in Cornwall this year and never had to come home once to deal with a crisis!!  Mind you, I did need to take work with me and had a major report deadline to hit while I was away, which thankfully due to good wifi, laptops etc was possible, if a bit inconvenient

On returning home I've had a brief bug (not a pleasant 24hrs) and have struggled to get up to speed with all thats going on around me, namely oldest son back to college, youngest back to school, finishing off the garden, work, house-hunting (maybe), some interesting business opportunities and Newsnight on BBC2 last night predicting the meltdown of European economies and a double dip recession - I'm in a constant state of anxiety

Tonight's Newsnight was discussing the riots / re-offending and Ken Clarkes comments, about a 'so called' feral underclass

Suddenly, after years of a drug policy that used drug treatment as a crime reduction tool we have the coalition deciding that prisons and the criminal justice system should focus on reducing re-offending and the prime initiative for achieving this will be to Pay by Results

For the uninitiated this means that the government will pay various "providers" (whether charities or private sector providers) a sum of money if they get an offender to stop committing crime (and go straight - according to Nick Herbert MP on Newsnight).

In doing so are we writing off all the money we currently pay the legion of public sector staff charged with running the system to date - why doesn't the Government pay them by results?.  Are we saying that a sort of socio-serco-tesco or a large charity can really succeed where all the institutions of the state have failed?

Does that make the Payment by Results model the equivalent of a Credit Default Swap in sub-prime mortgage terms - I wonder how things will turn out!!

You dont need to be a rocket scientist to work this one out.  What amazes me is that the civil servants seem to be able to sell this type of mutton dressed as lamb to successive governments and successive governments, it seems, adopt this ludicrous stuff as policy.  Its suggesting that the same ends (crime reduction) via a different means (PbR) and less process and target measures will be a good policy - in reality it is the old policy rebranded, repackaged and after a bit of running about, business as usual

If you talk to ex-offenders, ex-drug users, to people that have turned their lives around and ask them what helped them, they will tell you, from the vantage point of their new lives, it wasn't the gimmicks, or the policies, the systems and the companies, or the charities for that matter - invariably what they tell me is that it was people, (the prison officer, the teacher, the probation officer etc etc) relationships, someone that believed in them, went the extra mile with them.  They will tell you that somehow this caused hope to rise up in them.

A hope that helped them to dare to believe that if they embarked on this journey of change that they had a reasonable chance of success.  Hope is a powerful thing and I dont hear us talking about hope much.  Payment by Results, we want the result and we will pay someone to go and get it for us because we want the good stuff, the changed person and the good behaviour and by offering a financial incentive to a company or a charity to go and get it for us what we are offering is in effect a credit default swap that defines a persons worth like a sub-prime credit or debt and sells it on for a profit - or we call it a social bond if we are a bit left of centre and don't like the idea of a profit - no thanks

When the dust settles we will have an invoice for the public sector (that didn't shrink that much), an invoice for all the "results" (that will turn out to be mainly short term) and a load of charities will be left holding the toxic debt for the bogus results and we will have to watch them fail or bail them out, either way we'll end up paying at least 3 times for a situation that is far worse that it is now

What we need to do is employ strategies that work, not credit default swap PbR gimmicks.  If we want to change behaviour we need to send a greater proportion of people in the system, to a rehabilitation setting, somewhere they can address their addictions, their relationships, their behaviour, including their offending and their attitudes to themselves, to others and to society

Currently very few people get intensive help in prison and hardly anyone gets to go to rehab after prison and there is enough money in the system for this to happen, right now - I know, I work in the system, I work with rehabs, with prisons and I am regularly in touch with people in the criminal justice system, workers and offenders.

Rushing PbR into a criminal justice and treatment system in flux and expecting it to help everyone do more with less is like re-arranging the deck chairs on the Titanic and expecting it to float as a result.  The system does need change, it does need rebalancing but it needs to use the tools currently in the box.

The Titanic, sadly, never used all its lifeboats, the lifeboats it did use were not full up and so people died needlessly.  We know the current system is damaged, leaking badly and we have to 'save' as many as we can which doesn't mean rushing off and building a new boat (at least not yet).  It means shifting resources away from the over bloated prescribing budgets that maintain people in addiction, erodes their will and cognitive ability to change and causes inter-generational problems (for addicts as carers and for the children in their care)

We need to identify the most in need and divert them to the best and most appropriate help, in many cases this will mean rehab, whether in a residential setting (after or instead of prison) or an intensive programme in prison e.g. a 12-step or a TC option

It will mean using the money we have much more effectively, there are millions of pounds being spent on things that dont work, and treatments that work are dying on the vine because very few are investing in them - please believe me when I say we are NOT short of money.

In 2008 I authored a pamphlet for the Centre for Policy Studies called inside out: how to get drugs out of prison and some people were genuinely shocked to hear that we had illicit drug markets operating in all of our prisons.  Today this is not a disputed statement.

Rather than using common sense and a degree of foresight that comes from experience, we may have to accept that we had the resources to make a difference, in our prisons and with the most prolific of offenders, but that we used our time and our resources badly.  Designing a system of payments instead of a system of care and support!!

Viva the next market bubble - money never sleeps

All the best

Huseyin