Need rehab? How can we hinder you?

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 funding

Phoenix 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 heavily

Phoenix 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

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Photo credit: http://www.istockphoto.com/johngomezpix under license

2 thoughts on “Need rehab? How can we hinder you?

  1. Hi my name is elaine i am 39 years old I have 4 children 3 boys aged 20,19,18 and my daughter 13 i have applied for leap plus was intouch with phoenix futures last year but was told they very rarely get funding after they had told me they give 2 beds for charity but thats only if your local authoritie pay for one bed my family has got to breaking point my daughter has already been moved out of my care till i sort this addiction out i have also tried methadone but its not changing anything as i have been taken it on and off for 15 years,i just need to get help ive reached out to alot of places but without any help i can truly say i have never felt so alone and no help to get myself away from this debilating disease my family have so much pressure and my sons should’nt have to worry about there Mum ending up dead can anyone please get intouch with any advice or help to see how i could get any further forward as i dont believe people that truly want to start a fresh should have to beg

  2. I made the same experience with rehab with a friend. He is trying for years to get some support and fails getting sober his own. During lockdown he was getting worse again. About 2 years ago he was told by a social worker that he has arranged an appointment with a psychologist for a referral to rehab. Than another department took over and all appointments were cancelled or postponed. He finally saw a psychologist but before the final appointment lockdown started and things came to an end. Also we were told that there is funding available the nurses/social workers involved argued that there is no funding available and after he had a relapse and told them about it they discharged him because ‘he didn’t comply’. His GP just tells him whatever symptoms he has ‘stop drinking or reduce and do some exercise’ but no proper examinations or tests were done for a long time. He now has been to hospital again – had to give blood due to hemochromatosis – and he nearly collapsed afterwards so they had to keep him in. They found out that potassium and sodium were low which was the cause 4 years ago when he ended in hospital and he had the same symptoms but according to the GP everything was fine. It’s frustrating and devastating at the same time to see this. He tried to go to rehab and pay himself but even this was postponed as there are currently too many people waiting. The social worker he was working with 2 years ago is no longer available and he’s talking about suicide again. AS he is suffering from mental health issues too there seems to be no chance to get some support. Appointments for a psychologist or psychiatrist are only available if you are sober for a minimum of 12 weeks otherwise there won’t be anything. They don’t want to see that it’s going hand in hand with the alcohol addiction. And mentioning that he is sometimes talking about suicide wasn’t helpful either as they only said ‘then we have to section him’. This is not helpful at all. And the worst thing is that he’s obviously living in the wrong area as well. Edinburgh or Glasgow or other areas seem to be much better with support than Forth Valley which is a shame as it should be the same support all over the country and not depending on the opinion of some people. And even some other social workers told him that they think that rehab is a waste of time and money and he should stick to the program – but this program failed him for years and didn’t work. There have also been a lot of promises over the years and nothing really was kept. So somehow at the end of the line and no light at the tunnel. And to make things worse he’s threatened with jail if he doesn’t comply and fails again. Done something stupid last year and has to do communal work but also get sober.

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