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‘There is no place for
a drug user to engage from
a policy point of view
– people who don’t want
to use services.’
Stephen Malloy
health challenges presenting with
substance misuse challenges and I know
we could do more for them in one place,
but we have to move them on.’
What was needed were integrated
services that could do more for clients in
the same place, he stated. ‘We support
people with complex needs, that’s the
issue, and we need to do that in a way
that’s both integrated and that
responds to the simple fact that we’re
working with people at the sharp end of
the inverse care law – that those in
need of health and social care the most
tend to get it the least. We have to keep
moving forward because, frankly, we have no choice. Your professionalism and your
understanding of substance misuse is done on behalf of the people who aren’t in
this room, and we have to work together like never before. We don’t have a choice
but to keep on moving.’
T
he numbers of people accessing alcohol treatment had fallen by 19 per
cent over three years, Public Health England’s (PHE) director of alcohol,
drugs and tobacco, Rosanna O’Connor told delegates – from 65,000 to
just over 52,000. This was compared to only a 5 per cent fall in numbers
entering treatment for other substances. ‘It’s a significant fall and one
we’re taking a lot of notice of. Only one in five of those who need treatment for
their alcohol use are actually getting it,’ she said, and that trend would continue
unless local areas ensured that their strategic and commissioning plans, service
specifications and referral pathways were able to meet the need.
Nearly all services were now commissioned as drug and alcohol services
together, she said. ‘There’s something about the way those services are operating
that appears to make it more difficult for people to get in if they have an alcohol
problem.’ PHE would be distributing £6m next year, with a focus on asking local
authorities to develop and deliver plans for improving access to alcohol treatment.
Homelessness had also become an ‘alarmingly obvious’ and visible problem, she
said, with the numbers of rough sleepers in England up by 165 per cent since 2010,
and more than half of all deaths of homeless people the result of drugs. ‘We are
working very closely with other departments and with NHS England towards a
vision of halving rough sleeping by 2022 and ending it by 2027.’
Mental health was another crucial issue, with up to 70 per cent of drug service
users and 86 per cent of alcohol services users experiencing mental health
problems. Information on whether a person starting treatment had reported a
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‘it’s important that
your voice is heard
and helps to shape
policy and practice
in the future. it’s
important... that we
have opportunities
to listen and learn
from you. i can only
half do my job if i’m
not being influenced
by what are your
real experiences.’
mental health need was now being
recorded for the first time, she said, and
PHE had published guidance on better
care for people with co-occurring
mental health and alcohol and drug use
conditions. ‘We know there’s a gap and
we’re working with government
partners on how to close that gap,’ she
said. ‘It’s obvious that we should be
working better together to reduce harm
and enhance recovery.’
While smoking prevalence in
England was now very low, at around
15 per cent, among people with mental
health problems it was three times
rosAnnA o’connor
that, while 59 per cent of opiate clients
were smokers when they started
treatment. ‘There’s a myth that it’s
impossible to address someone’s smoking if you’re also addressing their drug and
alcohol use. We are supporting the development of effective treatment
programmes to help people in drug and alcohol services to stop smoking.’
Drug-related deaths remained high, she said, and many were among people in
their 40s and 50s. Heroin-related deaths ‘not surprisingly’ continued to make up the
largest proportion, with the highest rates in the North East and Yorkshire and
Humber. PHE had published guidance and tailored support to what was happening
at local level, she said. ‘A lot of these drug-related deaths are of people who aren’t in
treatment – reaching out to these people is something that we should all be doing.’
March 2019 | drinkanddrugsnews | 7