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June 2014 |
drinkanddrugsnews
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Events |
GPs conference
EARLY INTERVENTION WAS THE THEME
at
SMMGP and RCGP’s 19th national conference on
managing drug and alcohol problems in primary
care, promoting an idea of ‘working with the
system’ to engage vulnerable people and stop
problems before they had a chance to develop. With
the backdrop of a changing sector and funding cuts,
delegates heard examples of what was happening
up and down the country to meet the needs of
those affected by drug and alcohol problems, as well
as bringing into sharp focus several barriers – both
political and social – to taking early action.
The DrugAware model, introduced by
programme lead Anna Power, showed education as
a means of reaching young people in schools and
academies across Nottingham. Power pointed out
that young people were seven times more likely to
become a drug user if one of their parents were, and
so the scheme was aimed at identifying those
vulnerable children and engaging with them before
problems could take root. It included young people
in the development of the in-school programmes,
taking the emphasis away from punishment and
focusing on engagement. The programme had
proved successful, she said, with 80 per cent of
schools across Nottingham now DrugAware schools.
‘Change the late intervention culture’ urged
Graham Allen, MP for Nottingham North. It was of
utmost importance to break the cycle of
intergenerational use – and the most effective way
of doing this, he said, was by making sure that
services and programmes ‘meshed together’,
ensuring commissioners and practitioners shared a
common goal. Giving children social and emotional
support would set them up to have a better
standard of life – and early intervention would
create an ‘emotional bedrock’ for them.
Allen also pointed out the importance of having a
strong evidence base in order to ‘monetise outcomes
to get funding’. The best way to appeal to the
government and policymakers, he said, was to
emphasise the ‘massive cost of failure’, which would
inevitably cause more money to be dedicated to drug
and alcohol misuse programmes and social welfare.
Duncan Selbie told delegates that preparing
children for life was a target for PHE – as it should
be for the nation as a whole – not only by dealing
with drug and alcohol problems, but also issues like
obesity, domestic violence and tobacco. There were
‘three people in the early intervention relationship’
he said – government, local services and the public –
and there needed to be a conversation as a nation
on how best to tackle these issues.
When answering questions from the floor, Selbie
denied being ‘too cosy’ with the drinks industry,
reiterating that PHE was clear in wanting minimum
unit pricing and plain tobacco packaging, and saying
that ‘being independent isn’t about being loud, it’s
about winning.’
Concerns were raised about the state of commis-
sioning, and the effect it was having on delivering a
good service. Selbie said that local government
‘understandably wanted the most they could get
out of their spending’. He urged services to ‘have the
courage and patience to work with that process’ by
showing local government that their way of doing
things would be the best and give the most value
for money.
The effect of the commissioning process on early
intervention was touched upon again in a workshop
held by Turning Point’s Selina Douglas. She highlighted
the challenge that substance misuse services had,
more than any other, to make sure they
met performance expectations, while
under the pressure of ‘having to do more
for less’ and keeping service users ‘at the
heart of any change’.
Discussion among the workshop
participants revealed that the process
of tendering and retendering was
putting stress on frontline workers,
who questioned whether those who
were making the changes really
understood what it was like, both for
them and their service users. The
performance focus changed too
frequently, said an attendee – where it
was once ‘get [service users] in and
keep them in’, the focus was now ‘get
them out and keep them out’.
Another delegate questioned how
the targets that had been set for
treatment services were being
monitored for long-term effects, and
what impact they would have on early intervention
and on society ten years down the line. Douglas said
that early intervention had been difficult in the past
because of a lack of evidence, but that the evidence
base was now stronger, which would make it easier
in the future.
Di Wright, of the commissioned services for Kent
County Council, said that commissioners were
looking at commissioning different services together
‘so that it enhances both sides and gets a better
service for clients,’ to which Douglas added ‘a
substance misuse service cannot exist in isolation –
it has to exist in a network of services.’
Stigma and mental health issues also posed
obstacles to identifying problems early. Alcohol
misuse was an issue that was often overlooked, said
consultant liaison psychiatrist Dr Peter Byrne, and
many people were reluctant to admit that they were
struggling with alcohol for a variety of reasons. Not
only was there social stigma, but people with alcohol
problems were often seen as ‘the patients that
doctors dislike’, said Byrne, and fear that their doctor
would treat them differently often prevented people
from seeking help. This ‘failure to disclose’ meant
problems were not being identified early enough, and
community-specific services – such as LGBT and
Muslim alcohol services – were needed to help
engage with those who were reticent to seek help.
‘Interventions are critical,’ said health
improvement lead Lee Knifton, ‘but without
relieving social stigma, they won’t be as effective as
they can be.’ He told delegates that in Scotland, and
in particular Glasgow, overall public health was ‘as
bad as it gets’, and had been declining
systematically since the ’50s, with health
inequalities having accelerated since the ’80s.
Almost all of the inequalities, he said, had to do
with ‘addiction, mental health, violence and suicide’
and working with these interlinked areas of public
health should be a priority.
Stigma was a complex social phenomenon that
‘dehumanised and separated’, he said, compounded
by things like religion, personal experience and the
media, and it would take more than just giving
people ‘the right information in the right ways’ to
tackle it. Ten years ago, Knifton and colleagues in
Glasgow mental health services made a ‘city
alliance’ with the government and regeneration
agencies, which undertook participatory research
studies with marginalised communities who had
experienced stigma and discrimination. It aimed to
generate practical solutions and brought together a
community of organisations alongside service users
to understand the nature of stigma and mental
health, identifying issues such as a high degree of
‘recovery pessimism’ among practitioners.
As a result of this research, the Scottish Mental
Health Arts Festival – now in its eighth year with
200 partner organisations – was created as a means
of ‘challenging stigma and perceptions of people
experiencing mental health problems’ and engaging
harder to reach members of the community, such as
the poor and ethnic minorities, through music, art
and comedy. The events aimed to start the right sort
of discussion about mental health and addiction,
with a view to relieving stigma and helping identify
problems early.
Changing opinions about early intervention was
crucial, added Dr Peter Byrne during a Q&A session,
and as a lot of media coverage of mental health and
addiction was negative, it was important to publicise
stories that would ‘capture the media’s attention’.
Among frustrations with the changing
commissioning landscape, minimum unit pricing and
plain tobacco packaging, it was incredibly difficult to
get health into the political debate, but ‘as physicians
we need to get the right stories out there,’ he said.
For conference reports and presentations, visit
www.smmgp.org.uk/html/reports.php
‘Giving children social
and emotional support
would set them up to
have a better standard
of life – and early
intervention would
create an “emotional
bedrock” for them.‘