Drink and Drugs News DDN October 2018 | Page 18


Giving the

This year ’ s NHSSMPA conference was dedicated to creating lasting behaviour change , as DDN reports

How can we give the best chance of long-term behavioural

chair Danny Hames . There were many challenges – loss of expertise , disinvestment and diminishing resources , and
change ?’ This was the question 13 NHS trusts gathered to discuss at the NHS Substance Misuse Providers Association ( NHSSMPA ) conference in London .
The context for this debate was not easy , said NHSSMPA
increasing needs from all areas of the population .
‘ As a sector we really need to think about how we do stuff and the quality of what we do ,’ he said . While the sector had ‘ held up pretty well ’ against recession , we should not be measuring success by successful completions .
We needed to address the critical loss of expertise right the way through the workforce – from addiction psychiatrists , to recovery workers , to commissioners . Add to this the loss of many small valuable organisations and it gave a ‘ bleak picture ’ and many separate challenges . ‘ We need to up the ante and be more dynamic ,’ he said . We had lost ‘ vital capital ’ so we needed to understand how to use investment to the best effect .
‘ One of the things we could be doing better is finding allies and forming alliances ,’ he suggested . We needed to think about how we worked with commissioners , improved influence in local authorities , and sought out meaningful partnerships with service users . Our culture should focus on being transparent – making the effort to understand where risk is , focusing on evidence and ‘ sharing what works more openly ’.
Cutting the numbers of specialists was a backward step , agreed Dr Luke Mitcheson , a consultant clinical psychologist at South Maudsley NHS Foundation Trust , who said that the loss of clinical psychologists was one of the biggest challenges faced by the sector .
Psychosocial interventions ( PSI ) contributed significantly to positive treatment outcomes , but delivering them effectively depended on highly trained staff and good governance , he said . Cutting down on the level of supervision and on skills such as motivational interviewing undermined our capacity to use PSI effectively .
Many clients had experienced trauma and abuse – in fact ‘ we should start from the premise that clients have trauma ,’ he suggested . The skills to deal with this had to go hand in hand with a flexible approach – the capacity to do different things at different times and ‘ step things up or down ’.
It was important to keep the perspective of delivering PSI as part of an integrated service that included opioid substitution treatment ( OST ) and other harm reduction initiatives , said Mitcheson . ‘ Some recovery services don ’ t understand harm reduction , and that ’ s a problem .’
Another major challenge was the ever-changing drugs market – how was the sector meant to keep abreast of new information ? Since 2009 there had been 803 new substances identified by the UN , said Dr Dima Abdulrahim , of the Central and North West London NHS Foundation Trust . She was the main author of guidance for NEPTUNE – the Novel Psychoactive Treatment UK Network – which had been developed to improve knowledge around club drugs and NPS and was funded by the Health Foundation .
Many clinicians lacked confidence in dealing with the rapid growth in new substances , she explained . A panel of experts , including experts by experience , had developed a system to simplify guidance to new drugs by categorising them into stimulants , depressants , hallucinogens and synthetic cannabinoids . This framework had proved effective in helping clinicians to orientate themselves when they came across a drug they were not familiar with .
More than 70,000 downloads over the past two years had confirmed the need for
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