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Something funny has been happening recently. Unfortunately, I am not talking funny ha-ha or even funny weird – more funny scary really, in that events have revealed some quite disturbing evidence of how services view ‘those who engage with their services’. I know it’s quicker to write service user, but that term is sticking in my throat at the minute for reasons that I hope this blog will reveal.
I am not trying to sell uchooseit on these pages, but for those of you who are not aware of us we are a peer led organisation focused on supporting the more practical side of recovery. Our ethos is not to duplicate any existing services, but to create a recovering community that in effect utilises the experiences of those in recovery to support others on the same journey.
All pretty straightforward right? I feel the need to stress again that we do not seek to duplicate any existing services, aiming to be entirely complementary. In effect this means that needs are identified by people with drug and alcohol issues and then met by people in recovery, where possible, and in partnership with statutory services where appropriate.
Our service is delivered by volunteers – not as a cheap alternative to paid staff, or as some sort of gap filling exercise for service users that are out of treatment that nobody knows what to do with – but as integral to what we do.
We offer training, qualifications and real tasks for people to do (myself included) as a means of enabling people to use their skills (yup – we do have skills beyond drinking and using drugs) and make some steps towards the kind of lives we want to have.
Anyway what has been funny scary recently – knew I’d get there in the end constant reader – is standing accused of stealing people from other services. Now, not only are our grafting days well and truly over, it is not that easy to pop a passing service user in your handbag (or man-bag in the interests of gender equality).
But joking aside the fact that this accusation has been levelled – both up-front and sneakily – reveals what I think is a shocking view of how many, not all, but many services view their clients.
Since when did admitting to a drug and alcohol problem – and taking steps to do something about it – equate to individuals belonging to a service?
At what point did we become infantilised, unable to make our own decisions without the say-so of someone we may see for half an hour every two weeks if we are lucky?
When did it become acceptable to tell a 40 year old what they can and can’t do? I fail to see how attending or coming along to a peer-led women’s group once a week compromises treatment in any way.
But the reality is we are not talking about treatment being compromised here. Funnily enough, those who have a clearly defined role – the prescribers, those with a criminal justice remit – work very closely with uchooseit, all of us recognising that we provide something as a whole that we can’t provide as individuals.
The issue lies with those in the middle, all those who still focus far to much on outdated psycho-social interventions that are long past their sell by date – motivation to change courses anyone? Whoops – a bit controversial? Sorry.
The fact is that painting by numbers and pins in ears do not meet the needs of everyone in recovery. If it works for you, fantastic, but there should also be the freedom for those of us in recovery to explore other options should we so wish.
And as for accusations of purloining service users – well I’m afraid it’s not a fair cop guv.
This goes on all too often. I’m so glad you flagged it – and look at Peapod’s blog!
While this is alarming (not to mention incredibly frustrating) it’s not surprising. It’s really important that it is highlighted though; thanks for doing that Michaela.
I remember an addiction specialist condemning a small charitable treatment centre locally on the grounds that it had no doctors, nurses or “specialist” staff. However, it was getting clients into recovery at thousands of times the rate of the statutory treatment services and it deeply saddened me at the lack of insight.
The issue for me is what do we do to help make things healthier in addiction services? As I was reading the recent paper on how they tackled a widespread systems and services malaisein Philadelphia, I came to believe that we need the same sort of gargantuan approach here.
I rather suspect grassroots recovering people are going to have to do the driving work to make change happen.
This is one of the challenges ahead. It is all well and good talking about recovery, having some excellent services doing it right, but we need to change overall systems. It will take time aqnd needs careful planning. The Philadelphia transformations needs looking at very carefully and we must learn from them.
Michaela as usual your humour and writing skills hit the nail on the head, visions of stealing a “service user” and popping them in my ahndbag, its big enough as it goes, then craftily swining them over my shoulder, tip toeing away from the scene, stripey black and white t shirt and mask firmly in place. This is the sort of crap that is no longer acceptable, if “service users are lucky enough to have a range of services to choose from they will be attracted to which ones serve their needs, Simples!
Great blog and spot on as per!
Hi Michaela, great post. Firstly let me lay my cards on the table – I am a counselling psychologist working in a statutory treatment service in a small, parochial island community. The approach here is top-down all the way as no ‘service user’ wants to stick their head above the parapet on an island of less than 100,000 people (where treatment options boil down to either our service or 12-step). No massage, art therapy or auricular acupuncture here. No maintenance scripts. Just substitute prescribing on a reduction programme with daily supervised consumption.
I find your comment about outdated psychosocial interventions interesting and it has made me wonder if I am now behind the times as I deliver a six week relapse prevention course based around the stages of change model. My clients (all drinkers BTW) appear to find the course an invaluable source of information and support during the early stages of recovery. Am I missing something, and is there something you feel I could be doing differently? I am genuinely curious about your antipathy towards such approaches and would appreciate a reply.
Hi Michaela
firstly – lovely crafted blog , beautiful to read -thank you
I have often thought some of this stuff is encapsulated in the expression “my client”, when in reality all a service or worker can own is thier intervention in someonelses journey.
I sense it is important we do not convey the world as a range of competing services owning clients, even where a few will, but rather a range of diverse choices that individuals can make about what may or may not suit or work for them.
Comissioning has created an unhealthy competiviteness, alongside the implied threat of power realingment with empowerment movements. Challenge is about improvement for all.
Best wishes
Michaela…………what you are describing I think is the compulsive caretakers “protecting the supply”. We know that the supply of sick people to try and fix isn’t actually going to run out……….but as you say it’s about power and control, a desire to hang on to people which can be extremely powerful and totally unconscious. Oh, the delicious joy of knowing what’s best for someone else……………it is weird but they’re just frightened. And of course it is also about money and jobs so to a certain extent there is a need to keep people in the system because if everyone got better the funding would disappear!……………..
First of all thanks to all of you for your responses. I am pretty new to this field and sometimes worry that I am imagining ghosts in the machine. So it is dead reassuring that I am not alone. For me, knowing that this is a widespread experience, in some ways gives me a sense of hope i.e. that by naming the problem we somehow take a step towards tackling it.
Secondly a reply to Shoddy. I really don’t have an antipathy towards psycho-social interventions per se – in fact I see them as a valuable tool. But as with all tools unless they are used in the right way, for the right job, by the right person – need I go on?
In many services people are literally bunged on courses as part of rehabilitation orders. Friends and colleagues I work with have literally been round the cycle of change that many times that they are meeting themselves coming back.
I’m all for the kind of intervention you describe but very anti what is often a bums on seats exercise for people who do not want to be there in the first place. So I suppose my blog should have read ’focus too much on the outdated use of psychosocial interventions’ – meaning as a one size fits all, what else shall we do with them? kind of approach.
“Cycle of change” thats a contradiction in terms I believe and your absolutely right totally useless in drug and alcohol field. Precontemplation, contemplation, lapse and relapse (and back again) it should have been called the cycle of no change…hhmmm the dark old days when I used to actually believe that. It was about as useful as being told the average age of a heroin user is 37.5 and uses for ten years…does anyone really fit into that stereotype…next thing they’ll be telling us where we’re most likely to shop and what size shoes we wear…coming to think of it who’s we.
