Cover story |
Community initiatives
Th
8 |
drinkanddrugsnews
| December 2011
www.drinkanddrugsnews.com
W
hile Adfam’s concentration has always been on supporting
families affected by substance use, more often than not a
family member’s first reaction on learning that their relative
uses drugs is to look for help on the user’s behalf. For the
families of people with multiple needs – defined by the
Making Every Adult Matter coalition as people who
experience a combination of problems, are routinely excluded from services and
lead chaotic lives – finding this support can be particularly difficult. They can
experience the frustration of not knowing if there is anyone at all in the local area
who can – or will – help, which can be compounded by the message ‘you should
try somewhere else’ coming from several services at the same time.
The common theory when discussing dual diagnosis (combined substance
misuse and mental health problems) and complex needs is that each service
concentrates too much on its own traditional sphere. For example mental health
workers lack focus – or at least confidence – around substance misuse issues, while
drug and alcohol workers see their remit as limited to drug or alcohol use alone.
But if professionals struggle to deal with multiple needs and dual diagnosis,
how do families cope? They routinely have to handle both mental health and
substance use issues in tandem, and feel they don’t have a choice in the
matter. Though they may not have accredited training, their experience is
undeniable – but they cannot tell their family member to try a different family at
the other side of town who might be more suitable to work with their particular
needs, and they cannot look to job descriptions, role profiles, managerial
support or training history to point them in the right direction.
Where the list of problems being experienced by an individual service user
grows, the stigma felt by families is multiplied. It is difficult enough admitting
that a family member (especially a child) has a drug or alcohol problem, but
when this is twinned with mental health problems and other difficulties such as
domestic violence, the situation can be made even worse.
There can be an assumption that people with severe and longstanding multiple
needs have little or no chance of being in loving or productive family relationships,
and that nobody raised in a properly caring environment could possibly experience
such a multitude of problems. This is particularly perceived of the homeless, for
whom relationship breakdown is accepted as a primary cause of their difficulties.
But it is extremely important not to make these assumptions, especially
when dealing with multiple needs. In these cases, lives are often so complex
that family members are the only ones with a true, full picture of the service
user’s history, and even when family relationships are broken, rebuilding them
could be a key ambition of a service user.
Families are aware of problems going otherwise unnoticed in a way that many
services are not, and are better placed to identify markers of true progress and
sources of hidden concern. As well as often being frustrated by confidentiality
barriers – being unable to find out whether their relative has made appointments
recently, or has even been seen, for example – families also struggle to give
information to services that they think could make a positive contribution to care
planning. Just as families can provide a huge amount of recovery capital for people
in drug or alcohol treatment, they can also play a key facilitative role for relatives
with multiple needs, being fully in tune with their wishes and helping to coordinate
their care across a complex mix of local services.
Adfam has always argued that, notwithstanding the recovery capital that
families can provide and the importance of involving them in treatment where
safe and appropriate, families deserve support for their own, independent
needs. We believe that the ‘treatment status’ of a substance user should not
determine the family’s need for support; and since people with multiple needs
often struggle to access services effectively, there is a real risk that their
families will be left out of the picture.
Though Adfam has seen and supported a growth in services for families
affected by someone else’s drug or alcohol use (with some support also available
for the families of offenders), individual support services for the families of people
with a variety of complex problems are unknown territory. So while there may be a
homeless service, a mental health worker and a drug treatment agency in a local
area, there will not be distinct services working with the families of homeless
people, the families of people with mental health problems, and the families of
substance users. Therefore the families of people with multiple needs will often fall
into the remit of ‘family drug support’, as long as drugs account for one of the
multiple problems being experienced – which is extremely common.