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This week saw the welcome publication of the NTA’s ‘Commissioning for Recovery’ guidance. It’s on the NTA website. It is further evidence of the NTA’s impressive turnaround (in language at least). So, based on the document, can we sign up to the new direction?
Actually, I’ve been quite cynical to date of this Damascene conversion, wondering if it has more to do with the imminent election and potential change in government. The Conservative party has not pulled its punches on how they see the ‘failures’ of the current approach. However there is much in this document to recommend it.
The guide puts the 2008 strategy at its threshold. The goal is abstinence (in the past that would have had some NTA officials reaching for the mouthwash). The jaw dropper is that here at last is the language of recovery. There is talk of vision; ambition; aspiration; recovery steps; reintegration; mutual aid and recovery champions. Now we’re talking!
There is still the hype of course. For instance, we don’t all agree that the treatment system in England is the ‘best in the world’ in terms of successful discharges. Really? Successful at helping people begin a recovery journey perhaps, but we’ve seen methadone prescribing (with not much else attached) as an adequate end in itself, locking many into a small life to which they’ve never been shown an alternative.
Careful attention is required, the document says, to ensure the system is balanced. We can save a bit of time here by simply pointing out that the system is not balanced. Abstinent recovery is so lofty an aspiration for many professionals working with clients that it currently lies beyond the orbit of Pluto.
To be fair, I think that changing this what the authors of the document are trying to achieve. It would have been better in my opinion to accept that it is starting out with a long way to go, rather than implying that we just need a few tweaks to the system.
The document points commissioners to a series of steps. Firstly, understand the problem by gathering information. Leadership should be provided and there should be partnership working. Engaging with service users and their families is highlighted. Engaging with clinicians; arguably the hardest bunch to engage, is mooted.
The value of mutual aid and aftercare is signposted here and I welcome that, but it does not go far enough. For those of us who believe in the fundamental value of recovery communities and networks like Wired In, commissioning links and supports to these needs to be foremost.
The treatment experience on the recovery journey can be an important one. But it is a tiny part. The post treatment environment is crucial if we want to see sustained recovery and it is this that needs encouragement, attention and resources.
If there is a ‘magic bullet’ to recovery (and there ain’t) it would be communities of recovery. Here the guidance says commissioners ‘may want to” consider building links to mutual aid like Narcotics Anonymous or SMART Recovery. If you could hear my heart sink it would have the sound of a lead brick dropping into the deepest ocean trench.
NTA, this is critical to sustaining recovery for many and it is so undervalued. “May” is not good enough. A recovery service ought to be judged as ‘good’ or ‘bad’ on this criterion. Mutual aid groups number thousands in the UK and have the potential to transform recovery outcomes if treatment agencies practised assertive linkage to them (essentially taking people along to meetings rather than just handing out an information list).
In all the guidance is rich, well referenced, with robust checklists and it has clearly been informed by those who know something of the elements of recovery. It’s evidence of moving in the right direction and I can sign up, though I’d argue for a bit more emphasis on building communities of recovery and working out how to support mutual aid.
Will it have an effect? I think so. I’ll be more convinced that the quantum shift is not just words when the NTA start supporting Wired In, which of course does not get a mention.
Hi peapod,
From my conversations with people in Scotland (who don’t have a NTA),
I am led to believe that they recognise that access mutual aid and support within the community are crucial. You are right about this, and the vast majority of research backs you up.
I agree that this language “sounds” good, but am also a little sceptical at this point. A complete change in culture doesn’t just happen overnight. From my days on the script (as little as 2 years ago) I remember being discouraged from making reductions, and I remember NA being referred to in disparaging tones.
We are making progress, but there is a lot of work that still lies ahead.
Viva la revolution!
Matt
I keep coming back to the feeling that I am no longer sure who the NTA is. I know that within any organisation there are differences in philosophy and approach but there is at least a sense of coherence.
I am all for the ‘new’ NTA focus on recovery but it feels this in spite of, rather than because of, the NTA as a body.
What it feels like is there are really committed and able advocates or recovery within the NTA (mentioning no names but I suspect many of us know them) and then those on the other side.
So any report or change of direction feels it has been thrashed out as a result of horse-trading. You can put that in if you leave that other bit out.
But now is not the time for compromise documents, is it? It’s time to put money (among other things) where mouths purport to be.
Good summary and you all raise important points for consideration, discussion and action. Communities of recovery are so so important.
Hi peapod,I dont know much about anything yet,But im all for change to help people on thier journey,Thank god we have people like you and many more on this site to help.I took mark and yourselfs advice and went out to get some information to help in my early stages,To cut a long story short im seeing a counciler once a week.Although there isnt any SMART meetings here i managed to get the recovery guide book/members handbook homework task book and recovery tools book,Hoping to come across the water too in the near future,Thanks again pal.Take care.C.x
Thanks for the comments.
Matt: I agree that culture change doesn’t occur overnight. There is evidence of movement. There’s still prejudice and ignorance around mutual aid and I’m afraid I see evidence of that all around. We have much work to to.
Michaela: you are right, there’s friction within the organisation. I’ve heard some appalling attitudes expressed (publically) in the past. Perhaps its an organisation in transition and better times lie ahead. I certainly intend to watch and blog this space.
Sarah, thanks for the affirmation. Communities of recovery are critical for many to sustain recovery. They haven’t really “got” that yet.
Claire; great to hear you are moving forward with your recovery. The next Serenity Cafe night is on February 26th at Old St Paul’s (just at the back entrance to Waverly Station). Take a look at the website:
http://www.serenitycafe.org.uk/
