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Given the continuing and passionate debate on PeaPod’s blog we felt that now would be a good time to publish the outcomes of the above workshops.
The goal of the workshop was to look at the triad of structures, service users and workforce within treatment services, and to elicit ideas for institutional transformation.
While harm minimisation has been (and will continue to be) a good and necessary intervention, our experience in the Wirral is that, in casting the nets out wide and pro-actively trawling the borough for problem drug users, we have saved many lives.
But while methadone prescribing mitigated the worst outrages of heroin dependency, it was an acute response to a chronic condition. And in addressing one problem, it created another. Albert Einstein said that no problem can be resolved at the same level of consciousness with which is created.
What is needed, then, is a transformation of the consciousness of both workforce and service users, and a corresponding renewal of the structures of treatment providers.
Using as a template the Top Tips for NHS to do Recovery from Ollie’s blog on Wired In, we invited participants to contribute their own.
We looked at each element of the triad – structures, workforce and service users in turn.
Structures
1. The service user should be at the centre of all decision making
2. Ask the service users what is missing – they, in fact, know best.
3. Let service users write their own Care Plans and Treatment Plans.
4. Place recovery at the heart of treatment initiation, assessment and at every subsequent stage of the treatment journey.
5. Create financial incentives for recovery – treatment pays too well, there needs to be a pay-off as turkeys will never vote for Christmas.
6. Promote treatment as a means to recovery and not an end in itself.
7. Extend the length of time for which recovery support and aftercare is available post-treatment.
8. Sell the benefits of recovery to partnership agencies within Joint Commissioning Groups such as Public Health, Probation and Social Services. If these are on board, systems will be transformed.
9. Create and maintain good relations between treatment and recovery services.
10. Clarify that the meaning of recovery is largely subjective – you are in recovery when you say you are.
11. Tackle psycho-social issues with vigour – make treatment-recovery holistic, facilitating access to work, housing, and therapeutic interventions.
12. Get vocal – come out of the closet, tell your doctors, your families, your friends that you are in recovery.
13. Time limited treatment.
SERVICE USERS
1. Exposing service users to recovery – through volunteers and recovery coaches present on site as much as possible. It is easier to convince people when you can show them.
2. Create a structure for recovery volunteers to mentor and befriend isolated service users, initiating a form of recovery outreach.
3. Give service users as broad a choice as possible.
4. Roll out the full menu of recovery options without prejudice.
5. Be subtle – show and don’t tell. Trust people to know what will suit them.
6. Service users themselves will be the instruments of structural change.
WORKFORCE
1. Leaders should be inspirational with a vision for recovery.
2. All professionals at every level should be trained in recovery philosophies.
3. Staff should have a strong understanding of all available routes to recovery.
4. All staff should be required to attend fellowship and / or other mutual aid meetings.
5. Accept that some staff will leave. Recovery makes some people very uncomfortable.
6. Remember that we have been here before. Things will always change.
The workshops were very successful, with lively discussion and vigorous debate, all with a fundamental unity of purpose – that of carrying the message of the hope – indeed the certainty – that recovery is possible. We would like to take this opportunity to thank all participants for their contributions.
Oliver Mates and Damien Prescott
Agree with the vast majority of this, great stuff
Hallelujah – the only disappointing thing about the above is that it does not already happen.
Please keep up the excellent work you all do in the Wirral
Brilliant!
the only disappointing thing about the above is that it does not already happen. Indeed carl, but we are our our way to making it happen!
I am so glad that there are so many out there who are so keen to make this all happen.
I’m particularly taken by the workforce suggestions. Now that would be good to see.
What worries me from the work-force point of view is that for so long as confidentiality is used as protection for the status quo rather than for the patient’s privacy, we are not going to get very far. I seem to remember Michaela touching on this issue in a post on another thread some months ago.
How can we lose the “us”/“them” difficulty – whether it is between a well-meaning bumbler such as I and fully paid professionals: or the latter and the patient?
We must strive to agree that we, albeit all too many of us I believe, share the same planet, without making the whole thing into one giant Zimbardo Experiment, no?
Hi
Could i ask for this to be explained please?:
5. Create financial incentives for recovery – treatment pays too well, there needs to be a pay-off as turkeys will never vote for Christmas
I dont understand it
Louis, I think the issue is that if we have a treatment system that encourages folk to stay in treatment (high retention), keeps them on long term methadone and doesn’t have incentives to help move people on then the folk who work in that system (the turkeys in this case) won’t vote for change (Christmas).
GPs often get paid an enhanced service fee for looking after those on long term methadone. Abstinent recovery would mean losing those fees. Pharmacists get dispensing fees for methadone and these are higher if the dispensing is daily.
Workers may feel threatened and feel their jobs are threatened if “their” clients are empowered to manage their own recoveries. The argument is that new financial incentives may have to be created to incentivise prescribers, pharmacists and workers to move towards recovery.
