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local authority . We ’ ve now managed to achieve that , and we are getting results – we ’ re getting people back into work , or into work for the first time . In terms of housing we ’ ve got good collaboration with the department , but it ’ s slow because there are so many other needs in the housing sector . So that needs a lot more attention .’
And it ’ s that ‘ combination of things ’ that ’ s clearly vital , she states . ‘ People used to say to me , “ What if we just didn ’ t do housing ?” or “ Let ’ s forget about getting them into work .” But you ’ ve got to do all of it , you can ’ t pick and choose .’
SIGNIFICANT CHALLENGE Another significant challenge has of course been mental health . ‘ That ’ s been a struggle because of the traditional fighting between the NHS and the drug treatment system over whose job is it to look after it , so we ’ re having to work through that . There are some – but not many – very good examples where NHS mental health trusts and the commissioner have worked together to make it work , so it ’ s often dependent on people in leadership wanting this to happen .’
The review made it clear that mental ill-health and physical , sexual or psychological trauma were issues that needed to be fully recognised as ‘ the drivers and accompaniment ’ of drug dependency issues , not separate problems for dual diagnosis . There ’ s more and more talk of having a trauma-informed approach these days – how much of that is still just a buzzword , and how much is a reality ?
‘ I hate “ trauma informed ”,’ she says . ‘ We can all say it , and it sounds very nice , very modern and trendy . But what you need are proper interventions and treatment for trauma , not just “ trauma-informed care ”. There are proper psychologists with proper validated pro grammes for how you help someone come to terms with that trauma . We don ’ t have that .’
While there are some good
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examples of appropriate treatment being available – HMP Grendon ’ s therapeutic community model , for instance – they ’ re ‘ very sparse ’, she says . ‘ It ’ s something that we ’ ve got to get in there .’
In the meantime , however , it might be more a question of getting the mental health basics right . ‘ So if you ’ re a drug-dependent person who ’ s distressed , anxious , a bit depressed , my dream is to get that treated in the treatment system – not have to wait for a referral , because these are not difficult things to treat . Of course if you ’ re schizophrenic you ’ ll need access to a proper mental health service , but I ’ m talking about simple things .’
‘ We probably underestimated the level to which the system had been destroyed by previous lack of resources to local authorities ...’
KEY THEMES One of the review ’ s key themes was that drug dependency issues need to be recognised as a chronic health condition , like diabetes or hypertension , with all the necessary longterm follow-up that goes with that . Has there been good progress there ?
‘ Not in the way I would like it to be ,’ she says . ‘ I think that ’ s down to a change of culture , and that doesn ’ t require money . It requires people from the very top down to see that addiction is a health condition , with a lot of social implications .’ This also means not treating people as second-class citizens when they go to hospitals , she says . ‘ It means treating them as people who need help .’
The review pointed out that
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the NHS had also been poor at engaging with the wider health needs of people who use drugs , and the range of conditions they can develop – ‘ heart disease , lung disease , cancer . But because of the way they ’ re stigmatised they often just don ’ t use the services ’, she says .
Stigma is clearly something that ’ s discussed a great deal within the sector , but is there a sense that things are starting to improve more widely in terms of how people are treated when they go to the GP , or the pharmacy to get their medication ? ‘ I think there ’ s a long way to go ,’ she states . ‘ But I think what the public probably don ’ t appreciate , and maybe politicians need to appreciate more , is that your best way to get safe streets and to stop drug dependent people committing petty – and more serious – crime is to offer them high-quality treatment and a good recovery system . We know that internationally , from the best research .’
Far too many drugdependent people are sent to prison , she says . ‘ I ’ m not against the law coming in there if people have committed crimes , I ’ m against disproportionate treatment .’ The secure estate and wider society can ’ t simply be regarded as separate issues , she points out , and she ’ s recently completed an independent internal review for the government – which is yet to be published – on the care of drugdependent people in prison .
‘ What we also haven ’ t achieved yet is enough diversion from prison , but I ’ m hoping David Gauke ’ s forthcoming sentencing review will help that ,’ she says . One problem is that diverting people means having somewhere to divert them to – ‘ high-quality treatment in the community where you can hold people carefully and appropriately , and that has not been easy to achieve ,’ she says . ‘ The workforce is simply not there . So it ’ s complex , and it ’ s difficult . But I ’ m a glass half-full person and I think we ’ re certainly better than where I started .’
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WIDER ISSUES Is she hopeful that the new government will continue the general direction of travel ? ‘ Yes , I think so ,’ she says , ‘ and it aligns with four of their five missions .’
I think , rightly , they ’ ll want more that supports prevention and supports young people , but one of the reasons we weren ’ t able to do that is because there isn ’ t the evidence telling us what to do , there isn ’ t the sciencebased research . We ’ ve now put much more money into research – and there is research going on – but it doesn ’ t just happen overnight .’
And all of these issues are inextricably linked with wider – and more intractable – problems , of course . ‘ How do you prevent the poverty and deprivation that means young people are living in really awful circumstances – getting expelled from school , going into care , getting drawn into crime , into gangs , into the criminal justice system ,’ she says .
‘ These are the big generic social issues , and you have to be in this for the long haul . As far as I can see , things can always change . But our change of government hasn ’ t led to a desire for change of direction .
SUSTAINABLE FUNDING ‘ Overall , is the quality good enough ? No , it ’ s not ,’ she continues . ‘ Has there been enough innovation with the money , rather than just going back to “ let ’ s employ more drug workers ?” No . But I would say , overall , we ’ re going in the right direction .
‘ Can we get sustainable funding at the next Spending Review ? We said it was a ten-year strategy , not “ we ’ ve had three years of money and all will be well ”. All is not well . You can ’ t do it that quickly .’
In the end , her view is ‘ thank goodness we did it ’, she says . ‘ Because I dread to think of where we were . I think on the whole we ’ ve done the right things , and I think most people around the world think we ’ ve done the right things . They ’ re just very difficult to do .’ DDN
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