Basic HTML Version
18 |
drinkanddrugsnews
| October 2012
Profile |
Roland Lamb
www.drinkanddrugsnews.com
R
oland Lamb, who was one of the speakers at the second national
Recovery in the Community
conference in Sheffield last month
(
DDN
, September, page 5), has used his five years as director of
the Office of Addiction Services at the Philadelphia Department
of Behavioural Health to help to oversee the introduction of
‘recovery-orientated systems of care’ across the board.
The City of Philadelphia’s drug and alcohol treatment and mental health
services are integrated into one comprehensive system, working via a network of
agencies and collaborating closely with criminal justice, education and child
welfare departments. The city’s philosophy is that the ‘central role of individuals
and families in responding to, managing, and overcoming’ substance and mental
health problems should be ‘an organising point for the entire system’. Its vision is
one of ‘recovery, resilience, and self-determination’ with professional treatment
viewed as one aspect among many to support people in managing their own
conditions while ‘building their own recovery resources’.
Although it had always been proficient at dealing with immediate crises,
transformation was needed to shift the department’s focus to the long-term,
says Lamb. ‘We had a very good acute care system, a very good crisis-oriented
system. We did a very good job of taking people in, treating them and sending
them home, but then you have a person who finds themselves coming out of a
treatment programme and going back into the very community in which they
struggled and survived their initial addiction.’
As a result, that acute care level had become characterised by the ‘recycling’ of
people, he states, and it was this – coupled with wider issues – that convinced the
department that something needed to change. ‘They’d go into our detoxes and
our residential treatment programmes and in less than six months they’d be back.
And then there were the collateral issues, like increases in the prison population
because of our preoccupation with the drug war. One out of every 100 Americans
is incarcerated – we’re filling up our prisons, we have broken families and we have
the disconnect between professional help and community support, families and
therapists. A lot of fragmentation all over the place.’
It’s this disconnect that the city aims to address, and his vision is one of
aligning and integrating departments throughout the local government
structure to ensure that professionals ‘coordinate our dollars’ to provide
ongoing support. Everyone wins as a result, he maintains. ‘It’s to the prisons’
Liberty to
CHA
Philadelphia is aiming to live up to its ‘city of brotherly love’ motto
by fully integrating its substance and mental health services to
provide seamless support for vulnerable people.
David Gilliver
talks to its director of addiction services, Roland Lamb
benefit to keep folks in the community and functioning well and it’s to the
child welfare department’s benefit to keep families intact and functioning well.’
*****
On a wider level, the aim is for far more ‘functional involvement’ with the clinical
healthcare system, something that’s being partly facilitated by the Affordable
Healthcare Act, which is pushing both sides to work more closely, he explains. ‘So
ideally we’d have a systemwhere no matter where I presented, if I had these other
issues on board those services could be brought to me in one place. We’re talking
about the creation of managed care hubs and healthcare navigators – people who
can help others navigate the system, an excellent role for how we use peers.’
Fully achieving this vision won’t be easy, he acknowledges, not least because
of the economic situation. ‘These last few years of really having a recovery focus
have positioned us well, but we’ve received a number of cuts in our drug and
alcohol area – we just got hit this July with a $1m cut.’ And while greater
integration does allow the city to manage its money better, some of the biggest
obstacles to change have come from within both the departmental structure and
the recovery community itself.
‘The resistance comes from all directions. It comes from people in recovery
who’ve been used to a systemwhere people tell themwhat to do and what they are
and what they’re not. We’re a stigma-driven society, so you have people who don’t
have a high opinion of their worthiness for care and, for that reason, in many cases
don’t even access it. Then you have the treatment providers, who are used to one
particular way of doing things, and then you have the administrators and the
recovery advocates. When you propose a system transformation you propose that all
those folks are going to have to change their position and be something different.’
He compares the system’s previous incarnation to ‘rich parents’, throwing
resources at a problem unaware of how little long-term effect it has, and says the
department is ‘still not over the hump’ in getting everyone on board. ‘Like any
other transformational model you have your early adopters, your late adopters,
and you spend a lot of energy trying to convince everybody in the middle. People
want to be in control, and I often tell people that the most insidious of all
addictions is the addiction to power, and it’s also the greatest illusion. People
think that they’re going to lose something that they never really had – “I’m not
going to have the power do decide how these dollars get spent”.’