nrc.nl - International - Election 2010 - The peculiar nature of modern Dutch populism

nrc.nl - International - Election 2010 - The peculiar nature of modern Dutch populism

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I thought you might be interested in Paul Hayes... See more’ latest-to service users via the Alliance. This is a copy of Peter McDermott’s account of the meeting, and if there’s one person I do trust to put the case for evidenced based treatment to government it is Peter. Here goes, FYI: Meetings with Paul Hayes « on: July 19, 2010, 05:09:22 PM » Last week, I had a couple of meetings with Paul Hayes talk about the issues raised by the remark in the NTA business plan regarding time limits on substitute prescribing. The first meeting was really a meeting with me as an NTA Board Member, in which he gave me some sense of the background and the political context in which all this takes place. He asked me to treat this discussion as being in confidence, and so I am. However, he went on to give me some additional background to the whole issue of time limits which he then shared with Alliance staff and a representative of the National User Network, which I'll share here today. According to Paul, the NTA have been increasingly concerned by the fact that we successfully get a lot of people into treatment, but we don't get quite as many out. They've got concerns, some of which I share personally, about the quality of the psychosocial input that many of these service users have been receiving. As I said, I think that this is, by and large, fair comment. He claims that nothing will take place prior to the establishment of an expert group that will take another look at the clinical guidance and try and assess what that person best needs. That group should recognize that some people will be in treatment for extended periods -- and for some people, perhaps even many people -- their involvement in treatment may be life-long. That said, abstinence is the primary objective treatment, and so there's a hope -- or an assumption -- that for most, that will be the primary goal. So, some of what Paul told us was partly reassuring. He claimed that the expert group will be pursuing an evidence-based approach to the issue. and nothing should make it in if it isn't supported by the evidence. He told us that the group would be chaired by an eminent clinician -- though it will also include some of the more vocal critics of methadone treatment. I suppose I have a couple of major concerns/objections to the issue at this stage. I'll try and list them here: 1.) The Alliance was initially established because of the poor quality of methadone maintenance here in the UK. Back in the 90's, inadequate access to prescribing, sub therapeutic doses and arbitrary time limits were common features of methadone treatment that we've fought long and hard to contest. 2.) Methadone treatment has long been stigmatized as a 'second class treatment' in certain quarters -- somehow inferior to abstinence-based treatment. From here, it's a relatively short step to the idea that people in pharmacologically-assisted recovery are somehow inferior, or that the quality of their recovery is somehow inferior, to abstinence based recovery. This attitude may well reduce the number of people who access methadone treatment, thereby depriving people of a treatment that has proven benefits re. the avoidance of overdose, the reduction in blood born virus infections and involvement in crime. 3.) Drug treatment providers in the UK do nuance and subtlety very poorly. Already, service users are being told by their service provider that treatment is being limited to two years for everybody. This is already beginning to cause anxiety and having an impact on people's stability. It's pretty clear to me that this agenda is being politically driven to some extent. While it is reasonable for politicians to set aspirations with regard to various aspects of health policy, issues concerning patient care currently are, and should remain, to be matters for discussion/negotiation between patient and clinician. In summary, while the picture might not be as bleak as it appeared last week, there are still some significant causes for concern. As usual, The Alliance will continue to monitor the situation on behalf of people who use the drug treatment system, campaign for maximum patient choice and for the availability of optimum care, and will continue to struggle against stigma and discrimination in the treatment system. We're interested in what's going on with regard to this agenda, so if you've been affected by it in some way -- please get in touch and let us know what's happening. mcd Oh, by the way, yesterday's Guardian carried a piece on this issue. No doubt the issue will arise again soon. Best wishes, Francis

Mayday

May. My favourite month. Why is it so bloody cold here in the UK?
May should be soft, warm sunshine on your cheeks, not hovering over the central heating's thermostat.

Inner action music

Time for a change!

They fuck you up your mum and dad
they don't mean to but they do
they give you everything they had
and add some extra just for you

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The single mother's manifesto | J.K. Rowling - Times Online

The single mother's manifesto | J.K. Rowling - Times Online

The Residents - Constantinople

Messing about on the waterway

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Recover plus

Just as it seems some may never achieve their 'full potential' and, having gained control of their drinking/drug use may, if they wish drink or imbibe in a manner deemed Socially Acceptable, having to halt at the abstention stage of recovery and proceeding no further owing to the nature of their particular demons, so users of narcotic drugs-some of them- may proceed no further in the recovery process described than the Substitution /medically treated stage.

In either or both cases I am convinced that health and quality both exists and may improve with assistance. FBC Thursday 19th June 08

Recovery in the UK

Recovery in the U.K.

The diabetes analogy.

A harm reduction advocate in the U.K. wrestles with the idea of a system organized around recovery:

So, hang on, if I'm a substance user who voluntarily controls my own substance use but who chooses not to have participation in the "rights and roles and responsibilities of society" I can't be in recovery? Who says so? What you going to do? Make voting and working and watching Eastenders mandatory for all ex users? Recovery is what I define it as.

Or say I want to participate in the "three R's" of society but every 6 months or so I have a binge. Am I not in Recovery? Don't I have any say in deciding that?

For me, defining Recovery as a process to be controlled by the individual, but then imposing a whole set of values and outcomes upon what "characterises" that recovery is to miss the point. You have to let me judge what my Recovery is. It is not up to you to normalise me. These are my choices, my hopes and my decisions. You make them yours, then you do exactly what those early mental health activists feared. You create "a cosmetic initiative that maintains the dependence of individuals on the system".

I suppose I understand the apprehension, that a recovery-oriented system just being a new set of parameters for doing the same old thing--controlling people. We've certainly had the experience of seeing systems earnestly describe themselves as recovery-oriented when, in practice, they still blame clients for the client's "failure to change" when, in truth, the system failed to provide the support the client needed. Also, there is some history of recovery advocates (before they were called recovery advocates) imposing one narrow path as THE way to recover.

Before I get into my reactions, let me say that I mean no disrespect. I see her blog post as a constructive attempt to articulate her concerns rather than dismiss or attack.

However, there's a way in which I bristle at the statement above. I think it paints a caricature of recovery advocates and addicts. The statement suggests that those who advocate recovery may be invested in forcing some sort of conformity onto addicts. I also believe that it hints at a view of addiction of a nonconformist lifestyle choice rather than an illness characterized by loss of control. The truth, in my experience, is that they're suffering terribly due to their addiction and often don't dare to hope for recovery. Once we impart some hope for recovery, (by offering success stories, hope-engendering relationships, respect and love) they want recovery. They may be concerned that we're asking them to give up their identity and become conformist but this is quickly dismissed by experiencing the recovering community first hand--it could hardly be characterized as conformist.

My response to the concern would be that a recovery-oriented system doesn't force anything, Can a client choose to use every six months and consider themselves in recovery? Sure. They're free to do whatever they want. Would I consider this recovery? If the binge is unintentional, I might characterize this as serial recovery but continue to work toward a more stable recovery. If the binge is planned, ("I'll just go on a binge once every 6 months!") I suppose I would not consider that recovery. I believe that part of recovery is participating in self-care to maintain recovery. However, if a person is capable of "tying one on" once every six months in a way that does not create problems in their life, I wouldn't consider that person an addict. My reaction is not some sort of moral reflex. I'd have the same reaction to a diabetic who goes on a sugar binge every six months and lands in the hospital. That person would not be in recovery from their diabetes. Now, does my judgment that this hypothetical is not recovery mean that I would try to coerce the client into my definition of recovery or abandon them? No. My response to this would be to try to be a fellow traveler and recognize that this is the client's journey.

Recovery is all about freedom. The freedom to live one's life in the way one chooses without being a slave to addiction or being controlled by treatment or criminal justice systems.

That is not to say that we cannot as professionals, service users and policy makers do what they did in mental health and begin to explore what we need to do to support Recovery, to define the conditions in which opportunities for people to achieve Recovery are optimised, or to find new ways of working which return the power to the service user and rebalance old inequalities. This is how Recovery became the dominant philosophy in the UK mental health field. I spent some time with an old friend last week who has spent years as a service manager working towards Recovery oriented mental health services. She told me that in the late 90's and early part of the century Recovery rapidly gained credence in mental health. Through the work of user groups and coalitions, the developmental work of NIMHE and other organisations across the field, and through live projects and action research, consensus was built around the Recovery model. She said the biggest challenge she faced was in changing the staff culture. No longer were people there to make decisions for people, to impose their will on people or even to ‘lead by example’. Staff had to find a new role, one that was about first of all helping people define their own ideas of what Recovery would mean – whether that was feeling completely well, or finding something they owned and understood in their own experience of illness (for example having a positive experience of hearing voices). But once that challenge had been dealt with, she said the battle was not over. Key for the success of the Recovery model was the ability of staff to empower service users to access the help and support they needed in the community.

This is the key. We've struggled mightily with maintaining a professional culture that is focused on recovery. It often conflicts with human nature and the instincts of professional helpers, so we have to accept that it will be a constant struggle. On the subject, we contributed to this paper.

I've been thinking about a model of recovery-oriented harm reduction that would address the historic failings of abstinence-oriented and harm reduction services. The idea is that it would provide recovery (for addicts only) as an organizing and unifying construct for treatment and harm reduction services. Admittedly, these judgments of the historic failings are my own and represent the perspective of a Midwestern U.S. recovery-oriented provider:

• an emphasis on client choice--no coercion
• all drug use is not addiction
• addiction is an illness characterized by loss of control
• for those with addiction, full recovery is the ideal outcome
• the concept of recovery is inclusive -- can include partial, serial, etc.
• recovery is possible for any addict
• all services should communicate hope for recovery--recognizing that hope-based interventions are essential for enhancing motivation to recover
• incremental and radical change should be supported and affirmed
• while incremental changes are validated and supported, they are not to be treated as an end-point
• such a system would aggressively deal with countertransference--some people may impose their own recovery path on clients, others might enjoy vicarious nonconformity through clients

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Addenda to report to Treatment Strategy Group

(Q3 2006).

It is worth noting the opportunities afforded service users who make up InnerAction, such as training for substance misuse work and including basic resuscitation training for overdose situations have been matched

Networking with other agencies –partnership working even has developed this year; as with the previous three years, Wirral Mind has accommodated InnerAction and C The Difference meetings. In the last three months a number of service users seeking to become drug-free have become involved with the “Choose Life” program.

This program is available for stable people looking to increase their work activity and at the same time contribute the lessons they have learned during their experience with drug use, by performing dramatic pieces to schoolchildren and local police forces and others. The use of drama is not a new idea to members of the group –as the case of the brothers MacEneany, Patrick and John, who were showcased by the Wirral Globe as success stories of the DIP program. It is gratifying to work with this relatively small group as we believe it fits well with the InnerAction ethos and appears to contribute great benefit in terms of self esteem and future employability. We look forward to develop further links with Choose Life, as we also do with Advocacy in Wirral. Mandy from Advocacy has become a member of the group and it is hoped that a dedicated advocacy session for the group may be established, probably once a month, with confidential sessions on a one-to-one basis being made available.

FBC

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Mersey Care Trust - Get Clean Campaign

DRINK & DRUGS NEWS :: DDN NEWS LISTING

Merseyside Trust under fire from service users over use of shock tactics Merseyside Care NHS Trust has provoked an angry reaction from online service user forums with a campaign that uses a 'Get Clean' slogan and imagery to get drug users into treatment. But addictions service manager Bob Dale has defended the Trust's use of controversial tactics as a way of getting noticed to save lives. The campaign uses pictures of a mocked up range of household cleaning products, including washing powder, shower gel and washing up liquid, with the words 'get clean', 'fast track drug detox and treatment', a freephone number and the address of a local drop-in centre. The large images have already been posted on local bus shelters, sides of buses and phone boxes. Members of the National User Network (NUN) say the campaign could not have had genuine input from service users and reported that groups in their areas were 'horrified' at the insulting and negative labelling of drug users. An ex-drug user, Kevin Manley, called for Mr Dale's resignation on his online blog. But Bob Dale told DDN that his research had been thorough; that a focus group from the Kevin White Unit, a local inpatient detox unit, had chosen the name and theme of the campaign and suggested the advertising sites. He had then previewed the campaign at an event with a lot of drug and alcohol treatment services in the area, and had made a point of gaining approval from the NTA's regional representative. According to Mr Dale, just one person at the open meeting suggested that the campaign might upset a few people, but in the main it had been 'positively received and highly praised'. 'We were in the dark about how best to reach people,' he said. 'We wanted to give them simple access into treatment. Before, we were getting a lot of anecdotal stuff about how long you had to wait to get into treatment. This campaign gives one message, one number. A lot of the time it's about windows of opportunity - you've got to grasp them'. Mr Dale added that he welcomed suggestions for future initiatives, but had no intention of withdrawing the 'Get Clean' campaign, as it was already attracting a 'steady response' from new treatment clients

Technorati Tags: Get Clean campaign, Mersey Care NHS Trust, Drug treatment, detox, rehab, stigma, mental health, patients, service users, carers, addiction, Drink & Drug News, National User Network, NUN, NTA, representation,

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Scrub your soul clean!

Seen around Merseyside, North West England, recently; this advert reminds me of my catholic upbringing. 'Still got that old "Original Sin?" well just buy **** and scrub it all away!'
The reason I wanted to post this is because Nobody gets "clean" in 6 weeks or 3 months or whatever they are suggesting in this ad: it takes dedication, will-power, good friends with clear heads and above all TIME to get rid of a drug or alcohol habit.
If this 'product' (the same product -or 'treatment' -as we in the health service prefer to call it) does what it says on the cover, then Praise The Lord, cos our problems are all magically and suddenly over (in the substance abuse field anyway). If not, on the other hand, then I thought there was this rule about adverts having to be "open, honest and truthful" about their product's claims.
Or did I dream that bit?
Anyone know the Advertising Standards Authority address?

InnerAction and the Cure

Hey, it's me. You are my audience and I am your writer. Good to meet at last, though I have had this feeling, all my life really, that you've been around - sniffing at the bins for my discarded second rate poetry, looking over my shoulder at my filofax entries. Maybe not?
To bed now. Carol calls