Although the signs are good that journeys to residential rehabilitation in Scotland are about to get a lot easier, there are still some challenges to face. We could quadruple capacity, but if the pathways are not there or blocks exist, more places will make little difference. Not everyone is a fan of rehab and in some areas, gatekeepers seem to hold the keys tightly to their chests, sometimes understandably because allocated resources are scanty, but for other reasons too.
It is unfortunate that because of the neglect of this treatment option and lack of understanding and experience of rehab, we can have people making decisions about individuals’ suitability for rehab who know little of the evidence base, the treatment models available and of the essential features for effective pathways, robust assessment, competent preparation and comprehensive aftercare. To be fair, we don’t have up to date guidance on many of these things, though we are working on that.
This week alone, I’ve heard two stories of anguished families, desperate to find a place in rehab for a loved one, who are facing blocks at every turn despite the release of significant funding for capacity building and placements. Their experiences are, sadly, not unique.
Every couple of years, Phoenix Futures survey service users on their experiences around rehab. Last year they made this public in their Footprints report. The 2020 publication captures the experiences of 70 service users. It makes for difficult reading.
Their clients have complex problems which merit intense and prolonged psychosocial interventions – for instance 70% had had A&E attendances in the previous year, many of them multiple times and more than half had experienced homelessness. Despite this pressing need, half of those surveyed had found it ‘difficult or very difficult’ to find information about rehab and to secure funding.
I had to literally beg for fundingPhoenix service user
A similar proportion found access difficult and almost half waited between 3 and 12 months from expressing an interest to having funding confirmed. All this despite a third assessing that their current health condition was ‘an immediate threat to their life’. And there was evidence that the process was so difficult that it caused a deterioration in their condition.
I found it stressful and humiliating. It led me to start using more heavilyPhoenix service user
As part of the work undertaken by the Scottish Government’s Residential Rehabilitation Working Group, we asked the Scottish Recovery Consortium (SRC) to invite a sample of those with experience of rehab to share their experiences. The summary of their discussions has just been posted on the SRC’s website. I recommend that you take a look at it.
What did we learn from the group? They identified their frustrations at the lack of choice, missed opportunities, late interventions and blocks to referral. They highlighted tortuous funding systems and long waits. They also exhorted us to understand the whole journey and to make everything joined up, instead of having to silo-hop.
We are asked to accept that some people may need more than one rehab treatment because of non-linear recovery journeys. The reference group call for longer stays, enhancements in aftercare and a better deal for families (including identifying issues with being treated too far away) as well as improved communication between stakeholders.
What makes this report particularly relevant is that the group’s appeals for improvement are based on their authentic experiences before, during and after residential rehabilitation. This is what currently happens in our systems. We need to do better.
There is good news too. Like Phoenix Futures, who found examples of good practice across the UK ‘that use psychologically informed processes and models of support that build motivation reduce stigma and facilitate fair access to services’, the Working Group also identified examples of good practice in Scotland, where access pathways were clear and funding straightforward, though these were the exception rather than the rule.
Due to the priority the Scottish Government is putting on improving access to rehab and on removing barriers and building capacity, backed up by significant investment, we can now tackle some of these issues. I hope that in the near future, instead of hindrance, those seeking rehab will find that blockages are removed and are replaced by wide and easy pathways. My hope is that rehab will find its place in an integrated treatment system instead of sitting alone its own silo.
Why is this important? Well, because there is no one-size-fits all answer to addiction – we need all the tools we can get in our toolbox. Rehab has the potential to transform lives and ought to be part of a comprehensive treatment and support system. Those who benefit from rehab (and, not only them but their families too) testify to this again and again.
The rehab saved three lives when they took my son into care; they saved my son’s life who had already been on the edge of death twice, due to drug overdoses. They also saved my wife’s life, and my own.Father of a rehab client
Continue the discussion on Twitter @DocDavidM
Photo credit: http://www.istockphoto.com/johngomezpix under license