As a sector we need to do more to widen access to drug support

Not enough people are able to get the help they need. This is the moment to be bold and ambitious in changing that.

The first part of the Dame Carol Black Independent Review of Drugs was published in February last year. It was a very candid review, painting a stark picture of the significant problems and lack of effective solutions in how we currently treat drugs and drug-related harms in Britain.

The report concluded that we need radical and transformative change in order to reduce the estimated £19bn costs of drug-related harms to society and deliver better outcomes to people with drug issues.

A key question the report asks is: as a sector are we doing enough to ensure that people can get the help they need?

From our perspective as an organisation providing frontline drug and alcohol services across England and Scotland the answer is clearly no.

But there are several things the sector can do to widen access to support, including several solutions we are already exploring as an organisation.

The key problem: not enough people are able to access support

The way drug and alcohol services are designed and delivered largely hasn’t changed in decades. Though there have been pockets of innovation, there’s a perception that services are slow to evolve in reaction to changes in society including changing drug trends and changes to how people access healthcare. On the whole this perception is true.

The Black Review highlighted how long-term disinvestment has resulted in providers prioritising the severe needs of one core population of drug users: long-term male heroin users. This has come at the significant expense of other groups of drug users with little development of expertise and services to meet the needs of these groups. Some services have evolved to become homogenous and exclusionary to such groups as women, non-opiate users, people from minority groups and younger people.

This is important because many national indicators show the sector is going in the wrong direction.

We continue to see women underrepresented in drug treatment and research (75% of people in treatment are male). NDTMS data consistently shows people from black and minority ethnic groups are underrepresented in treatment. Drug-deaths are rising across age groups, including a large rise in cocaine deaths and female drug misuse deaths. Drug use is increasing in young people, but 40% fewer are accessing treatment than a decade ago. And 80% of dependent drinkers are not accessing any kind of support. Meanwhile, despite increasing levels of use of novel psychoactive substances (NPS), steroids, crack cocaine, and prescription and over-the-counter drugs, few specific services and interventions cater for these substances.

Working together to widen access to treatment

We believe making our services more accessible and engaging is key to improving outcomes and we’ve made this one of our key priorities over the last few years.

Everyone’s experience is unique to them. Every support plan should be tailored to the individual and based on what they want to achieve. If two people are using the same drug, it doesn’t mean the support they receive should follow the same model. The people we work with are complex, diverse with their own unique experiences. They will have their own needs and demands, and will do best when they experience things based on their own priorities and goals.

The experience of providers adapting delivery models during the COVID-19 pandemic has shown that providing flexibility and different options through which to communicate improves both attendance and engagement. Through a mix of phone and online appointments, attendance rates in our drug and alcohol services averaged 90% during previous lockdowns, with 80% of people saying that their needs had been met in their last appointment. The response to COVID-19 from across our sector has shown that we can evolve how we deliver services at a rapid pace.

However, diversifying the services we offer means more than just offering a mix of digital and in-person treatment. It requires designing and delivering services that are inclusive and designed around the needs of specific groups, and not the organisation. It also means including the groups in the design and delivery of services, and having services that are more flexible and able to meet people where they are at, not just in the rigid confines of a fixed building. At With You, we are doing this by providing veterans with veteran-specific services, women only drop-in times and female key-workers, web-chat services for LGBTQ+, or a helpline specifically for older drinkers. Though these cohort specific services are improving access and engagement in treatment, they also show how much more we can do. We need to constantly ask ourselves: what else can we be doing to access these hard to access communities? What else can we do to ensure people with lived experience are at the heart of our services?

Lastly, the way services are designed and delivered in many places hasn’t changed in decades. For many people, entering treatment for the first time remains daunting and long assessment forms and lengthy admin tasks still act as a barrier between key-worker and service user. We need to ask ourselves what can we do differently? We’ve tried to improve people’s experience and engagement during this initial stage of their recovery journey.

Reducing the admin burden on workers via new digital tools and reducing the need for people to physically come into services to answer probing questions about their background, has meant more contact with service users, stronger connections with key-workers, and higher retention of people during this critical part of their recovery journey. However, perhaps we need to be looking further afield, outside our own sector to learn what works for others?

Collectively, we need to do more

Over the coming years, we need to continue to push ourselves, the Government, and the sector to be more ambitious in improving the quality of service provision, and how people access and engage with services.

This doesn’t just require more targeted investment, but means that resources already available need to be used more effectively. Being bolder in order to transform how we deliver services, also means not being fearful of getting things wrong, but using it as an opportunity to learn from it to build better.

There are many reasons to be hopeful about the long-term impact of the Black Review. However if it is to have the impact it could, it must be matched, not only by ambitious Government investment, but by our own ambitions, as an organisation and as a sector. We need to demonstrate that we’re able to do things differently and come up with new solutions in an ever challenging environment.

These are tough times for everyone. Our services are open and we’re here to work alongside you during this difficult time. Visit our website for information and advice, to chat to a trained advisor or to find your local service.

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