DDN December 2021 December 2021 - Page 10


Tightening purse strings mean that the sector needs to be careful to not drift back to the bad old days of the harm reduction vs recovery wars , hears DDN


m an unapologetic and passionate harm reductionist , but I also love recovery ,’ said Vicki Beere , chief executive of Project Six . ‘ Both are extraordinarily important .’ She was addressing DDN ’ s ‘ More to join us than divide us ’ session at the HRI online event Constellations . However , she continued , government policy of ‘ get them in , keep them in , get them out , keep them out ’ when it came to services – coupled with ever-reducing budgets – was a major challenge in terms of meaningfully bringing the two together . ‘ We have a really badly damaged ecosystem in drug and alcohol services . We ’ ve lost those small , community-rooted , passionate organisations – we ’ ve got a system that focuses on hitting the target but missing the
‘ Our job ... is to make sure that people have access to all the paths that will help them .’
point . There is hope , but we need to support each other to get there .’
VISIBLE RECOVERY Visible recovery needed to be a central element of harm reduction services , said Stuart Green , manager of Aspire Drug and Alcohol Service and a member of CLERO – ‘ harm reduction and recovery is a spectrum .’ LEROs could play a vital role as they were strength-based and asset-based and recognised that individuals were the experts about themselves , he said . ‘ Recovery is a very personalised experience .’
It had been difficult for many in both the harm reduction field and recovery community to separate the recovery movement from the political agenda , said FAVOR UK CEO Annemarie Ward . This ‘ political ramping up of language ’, along with shrinking budgets and their effect on commissioning , had helped start a shift back to entrenched positions over the last couple of years , with even the word ‘ recovery ’ becoming tainted in many people ’ s eyes through its association in some areas with disinvestment . ‘ It ’ s very human to become tribal or fixed to one particular philosophy . But the great thing about both harm reduction and recovery is that they have tremendous principles that everybody could align under if they can see the similarities rather than the differences .’
‘ The analogy for me is that if you break your leg you want a doctor mend it but you want someone who ’ s previously had a broken leg to help you with recovery ,’ said Green . ‘ There ’ s a role to play for both ,’ and the best intervention was always people with lived experience . ‘ With person-centred services and LEROS there ’ s a different passion there
– it ’ s 24 / 7 , they don ’ t stop at the weekend . Meaningful change isn ’ t going to happen once a fortnight in a one-hour key-working session . We might be able to nudge someone , but realistically it ’ s about what happens in between .’ The beauty of the LERO space was that it became bigger with every person in recovery , he added .
CHOICES AND OPTIONS People needed choices and options , said Beere . ‘ There ’ s absolutely a real need to bring back small and medium-sized organisations – and LEROS are brilliant – that can create that flourishing ecosystem ’, and commissioners needed to genuinely understand the importance of social value and localism , ‘ not just a tick-box on a tender where everybody writes the same thing ’. It now took genuine bravery for smaller organisations to challenge the hand that feeds , and the system needed to take account of that , she said .
There were some encouraging signs in commissioning however , said Green . ‘ We ’ re seeing a bit of a paradigm shift . In terms of price versus quality , quality is creeping up more as a percentage of tenders , which is really good news , and we ’ re seeing longer tenders going out .’
Failure to recognise individual differences – and treatment programmes being too generic – was a major problem , said Ward . ‘ It ’ s not just that there ’ s a lack of evaluation of all the recovery paths , but a lack of monitoring and real-world data around what is it that helps us get and stay well . Our job as professionals is to make sure that people have access to all the paths that will help them , and not to punish people for one particular path not working for them .’
‘ I ’ m an unapologetic and passionate harm reductionist , but I also love recovery .’
LIVED EXPERIENCE ‘ It ’ s really important that we have that lived experience voice , but what we ’ re not very good at in our sector is getting the voice of the people who don ’ t access our services , who don ’ t get through the door ,’ said Beere . ‘ They ’ re the ones I really want to hear from . I think we ’ ve got a job in our sector to find and listen to that voice , even if it ’ s really hard to hear .’
This was especially the case in Scotland , Ward stated . ‘ Sixty per cent of the people who should be in treatment are missing – they ’ re not even showing up . It ’ s not because they ’ re “ hard to reach ”. That ’ s usually the rhetoric , but it ’ s because services aren ’ t attractive enough .’
There were people in LEROs who had ‘ never touched service land ’, said Green , ‘ because people do naturally recover .’ LEROs were not for everyone , he acknowledged . ‘ But if you look at why people aren ’ t engaging in services , it ’ s because we ’ re offering the wrong thing .’ DDN