Residential rehabilitation in Scotland: what’s going on?

For a significant number of people in recovery, rehab has been part of their journey, yet the truth is that we know very little about residential rehabilitation in Scotland. 

In the summer of 2020, the Scottish Government public health minister, Joe Fitzpatrick, set up a working group to explore the subject. I was asked to chair the group. We were tasked to take a look at provision; location of rehabs; bed numbers; programme types and duration; referral criteria and support; waiting times; staffing; costs; involvement of families; regulatory frameworks; outcomes; relationship to mutual aid and community recovery resources and finally, admissions and discharges.

How did we do it?

  1. We explored the evidence
  2. We developed a mapping tool
  3. We surveyed the field
  4. We reviewed Alcohol & Drug Partnership reports
  5. We discussed the findings
  6. Finally we made recommendations

What did we find?

We found 18 treatment centres with 365 beds across the country. We estimated that just under 5% of total treatment starts in Scotland in 2019-20 were for residential treatment. This compares to an average (in a 2014 EMCDDA report) of 11% of all treatment in Europe, and 2% of treatment episodes in England.

Across these facilities, around half (48%) of the beds/places were provided by third sector organisations, around a third (33%) by private companies, and a small minority (6%) by statutory providers.

It is estimated that a total of around 1340 individuals started a residential rehabilitation placement 2019-20, with around 830 of these individuals estimated to have been resident in Scotland prior to their placement. There are some caveats around this which we detail in the report.

Access and treatment elements

We found that access across Scotland is not even. The group heard evidence of areas where there was little or no access in practice, with the only option locally being self-funding.

Seventy percent of providers said they used the therapeutic community approach – an evidence-based treatment model. The majority of services offer cognitive behavioural therapy and motivational interviewing. All provided aftercare and assertive linkage to mutual aid. There were high levels of linkage to community recovery resources. 

Two thirds of those responding said they offered family support and many reported integrated peer support. All reported measuring short-term outcomes. Completion rates varied, but were generally good.

Pathways and funding

From our analysis of the thirteen services for which data were available, Alcohol and Drug Partnerships fund only a small proportion of treatment places with the bulk being self-funded or funded through health insurance, benefits or charity.

We also found that pathways to rehab are confusing with a variety of potential barriers in the way and wide geographical variations in referral rates. It’s apparent for many seeking recovery that routes to rehab are not easy to navigate. Indeed it became clear to us that there were lots of unanswered questions. Part of the reason for this is the dire lack of research on rehab (and recovery) in Scotland.

It did seem to us that although we found much to celebrate, we also found that there is work we need to do. That work forms the basis of our recommendations to the Scottish Government. I’ll come back to that in a further blog post. 

Joe Fitzpatrick, the minister for public health, said:

I welcome the findings of the group. This research will help us to improve the provision and quality of residential rehabilitation services

Meantime you can find the published report on the Scottish Government website.

I’d like to thank the members of the working group and everyone else who contributed. Thanks also to Nick, Ruth, David and Anniek from SG for their support, advice and hard work.