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Are our shared care clients the in-treatment addicts who are missing a slice of the recovery cake?
I ask this because it has been a number of years since I have worked in shared care and I seem to be engaging with the same service users that I sat in clinics with over 12 years ago. I have also been pondering the reasons for shared care in the first place. So I am going to attempt to open the debate here.
With having worked in the field for over two decades, I can remember some of those poor doctors that were shattered at the very thought of a drug user requesting to register with the practice. And the service user being totally defeated by the attitude of some of those fierce receptionists and doctors, that greeted them like rottweilers. As each snarled at one another – the client for a script and the doctor for some peace.
We all know many of the reasons for shared care and if I was to list them all this blog would be very long indeed.
The main reasons were to improve doctor/patient relationsh ip, encourage better health care for our clients, promote harm reduction and reduce crime. Also to support our often worn out GPs who were, by their own admission, often quite helpless when it came to dealing with the addict in general practice. And, of course, to reduce waiting times for our treatment service and not clog up the system with people that may not have needed to be there.
That was many years ago and some of our GPs have done a fantastic job in dealing with service users with the support of key workers/shared care workers. In general practice we have all done that very well. Our GPs are more informed and our service users get a better service. And what a pleasant bunch of receptionists (the war is over)!
One of the key areas was making sure that GPs got the right clients, those who were deemed by the experts as stable enough not to cause any problems in the surgery.
So by all accounts we should have a bunch of stable service users out with there. Doctors getting on with their lives and by all accounts recovering from the often hapless situation they were in many years ago. For some that is the case but for many its clearly not. So, are they the forgotten bunch of in-treatment addicts?
As I am sure people will agree, we are obsessed with getting people into treatment. We continue to get people into treatment, we continue to spend millions on methadone treatment alone and we have a great deal of people in shared care. But is the recovery message getting to them?
We now have, in some parts of the country, GPs who get paid to see their own patients, key workers with massive case loads and clients who have become so stable and dependent on king alcohol that they are getting lost in the system.
Some clinics have from five to ten clients per clinic. Some people have developed good healthy relationships with the doctor and key worker. But some are slipping through the net because like the ‘script and go’ we have a ‘wheel in-wheel out’ situation.
So as the continuing culture of binge drinking emerges, and with many of our clients becoming dependent on alcohol, is it time we revisited the recovery agenda within shared care? I say that because the standards within the treatment services (depending on where you are and how serious they are about recovery) are addressing many of the issues needed to help people sustain long term recovery. Like housing, employment, and service user led support groups. Ad are expanding treatment for their families and young people in the community
.
So the question here is, are those service users in shared care getting less than those in the main treatment services?
As I close, we should look back and compliment our doctors and shared care workers and all involved in delivering training to GPs – and be grateful as to how far we have come.
But let us not forget those service users out there. The ones where king alcohol has become a part of their daily life – on top of their script. And lets us not forget our shared care workers, that are now in some areas beginning to feel the same helplessness with some of their clients that GPs felt all those years back.
Over and out to our GPs and shared care teams. And all you good people out there with the answers.
.
Thanks for raising such an important issue Ollie.
I share your view that alcohol has become a major problem for those on scripts – and has been worsening for some time now. From my experience though, this is not limited to shared care and is an issue for those in services and in the criminal justice system.
But that is leading us to another debate and that is very un-editorial of me so I shall stop!
Thank you for raising this interesting debate Ollie – I have just been reading similar articles in the paper – it seems the ‘in thing’ at the moment.
You are absolutely right about shared care and with the right organisation and practitioners involved it can be such a support for the continuing or recovering user. I have seen through my own son’s care different attitudes to addicts and more importantly how that can have a direct impact on their recovery.
It did make me laugh when you described the receptionists as rotweillers – do they undertake a course on how to become this kind of receptionist?
A very interesting point you raised which I came across a lot when I worked as a social worker and shows it is across the board in the caring professions is the clients you meet year after year and seem to be stuck in the same place or as is often the case a worse case.
Individuals who have been in the system for most of their lifetime and as you rightly say one of the key steps to recovery is the relationship. Michaela is quite right when she said the problems do not lie with shared care alone!
I supervise a group of workers who are working flat out supporting ‘difficult to house clients’ and they are exhausted and doing a brillian job but I can see the helplessness that you so clearly describe
I remember about 10 years ago when Michael came out of his spell of being sectioned and it was suggested quite strongly that he needed to be individually house and a package of shared care put into place that went into his home and was tailored to meet his needs. Did anyone listen to this very forward thinking professinal, did they heck. Too expensive, we are not housing an ‘addict’ (they destroy property -unspoken coment), too many person hours involved, it will not work, and so many objections. Interestingly enough treatment/detox was never mentioned – maybe that was even more expensive?
So he was housed in a halfway house and you know the final outcome!
Interestingly enough Ollie imagine my frustration being a professional working in the caring field, perhaps the best care co-ordinatior Michael could have and a mother of an addict and no one listening to you (oh I forgot patient confidentially/human rights act and all that!) – anyway that’s another story and I remeber writing that blame is a wasted emotion.
Great debate
Sue x
This is a great topic. It’s gone through my mind many times about the challenge of helping those who are in treatment from their GP move towards recovery.
The truth is we know little about this group. Two studies suggest a very significant alcohol problem in maintained clients. We don’t know how many are in education, training or employment.
We don’t know how many are on benefits, how many are enmeshed in communites of addiction, how many know that recovery is a reality.
Maybe something for the Recovery Academy to look at?
The shared care team at your service was combined with the detox. team at least twelve months ago to become the SCART (Shared Care and Recovery Team).It is puzzling that you choose not to mention this.
As you co-manage that team surely the ‘Recovery Message’ is getting through by now?
Therfore is it correct to assume that as a result a significant number of clients are now embracing recovery, and moving out of the methadone treatment that the subtext of your article would suggest you do not fully support?
Or is this not the case? Please let us know.
Thanks for your comment do not be puzzled I never mentioned the(SCART) team because I choose not to thats quite simple to me.
But giving that you have yes the message is getting through and the fact that I co mannage the team dos not have any relevence to the blog which is not an artical.
If you read it again it asks whether some people in shared care depending on where you are is getting a fair slice of the recovery cake.
A significant number are and are embracing recovery which is great. My question is whether we are missing a number of people who have also devloped peoblems with alcohol which is becoming a national problem.
I think the subtext of the blog is very clear and I can assure you I fully support and embrace the recovery agenda but my experience is we learn more and more as we go along MGS and become students of recovery where we listen to clients and learn as we go along hence the blog and the comments above yours, many thanks again I hope that answers your question.
ollie.
Well explained Ollie well explained.
Vince
