Reasonability

Wikipaedia says this is borne from the 12 steps model used in drug and alcohol services. It speaks of a belief in capacity and aims to afford the ‘person in situ’ an optimism that things will get better. In mental health services this alludes to the efficacy of services and to be benefit of ‘working together’.

Sandwell MIND says the important thing ‘is to retain the belief that everyone can move forwad given time and good support. Also that the process is a ‘journey’.

It is perhaps about time that people spoke about things as a kind of ‘work in progress’ and of a philosophy that is aimed to be more politicallyin defense of rights such as ‘privacy, dignity, choice, fulfilment and independence’. I have to ask, though, just how this optimism fits with some of the harsh realities that many mental health and drug work profeessionals experience.

Recovery as was a voluntary thing accepted by the believer and so it followed that the programme associated with it was also accepted. So too were the entry and exit points and the need for an on going awareness of residual vulnerabilities the experience of ‘being in recovery’ yielded. In mental health we struggle to make things a voluntary exercise. It could be said that our clients do too sometimes and this is perhaps where we need to be flexible.

Reasonability is concerned that there are a large number of people that don’t buy recovery. We would welcome any research that showed the take up of this philosophy and also its efficacy as an aide to treatment. It seems as though a very large number of people remain unsure of themselves and/or want to be in control of their drugs, for what ever reason. Can this be said to be ‘recovery’? Certainly the end product is independenceyet we ask qualified questions about the degree of ‘independence’ where someone is drug dependent.

This is to recognise the tensions that can existwhen working with someone where there are a number of treatment and operational philosophies. This doesnot suggest that medication is unworthy, in fact is offers questions that potentially make it easier to explain their validity and usefulness.

Can someone stop recovering in the dual fields of drugs & mental health?

The traditional drug & alcohol recovery model would say ‘no’. Mental health services traditionally stop worrying quite so much when the person has a job and is ’stable’. A psychologist (Dr A Theunink) recently said ‘it is like when do you stop growing and developing?’ and went on to wonder if there the model is best applied where risk is the determining driver.

What of harm reduction?

Is harm reduction a response to the fear of disease contamination and therefore a public education and reluctant small scale pragmatism to prevent spread? It has been shown that key parts of Government agencies use it as a driver for action and agenda setting. Perhaps, therefore, harm reduction is best thought of as a statement of intent. It has become well established in the minds of many as an educational campaign that seeks to optimise personal capacity and responsibility by working with chaos and shaping behaviours to become more healthy. There are certainly those who reject the phrase out of hand believing it to be the means to condone illicit drug use.

Is it a way of taking action and then setting an agenda?

Do we limit recovery by scripting it?

Reasonability is inspired to ask these questions and will greatly appreciate contributions.

UK estimates of ‘drug-related deaths’ (DRDs) include mortalities of drug abusers and non-drug abusers. So these figures may not be the best way of monitoring the performance of Drug and Alcohol Action Teams, a study published in the online open access journal Substance Abuse Treatment, Prevention and Policy suggests.

DRDs are currently used to help evaluate the success of Drug and Alcohol Action Teams in England and Wales, but the term’s exact meaning varies according to European and national definitions. This means it is hard to know what sorts of deaths are included, the demographic profile of those who died, and whether or not individuals were tapped in to services designed to assist drug abusers.

Dr. Caryl Beynon from Liverpool John Moores University and colleagues studied details of 70 DRDs that occurred over an 18 month period in Liverpool - the UK city with the highest recorded number of DRDs in 2004.

They found their sample included drug abusers and non-drug abusers. The latter tended to be older, had no recent contact with drug-related agencies, and had different post-mortem drug profiles - they were more likely to have died from the toxic effects of anti-depressants, anti-psychotics and analgesics than from taking ‘problematic’ drugs (e.g. heroin, crack cocaine/cocaine). Generally the figures also excluded deaths related to drug misuse, such as those caused by bacterial and viral infections via sharing drug injecting equipment or contaminated drugs. DRD figures don’t capture the true burden of drug-related mortality as the figures include a wide range of disparate deaths and exclude others which are clearly related to the abuse of drugs, the authors conclude.

“When is a drug-related death not a drug-related death? Implications for current drug-related death policies in the UK and Europe” Caryl M Beynon, Mark A Bellis, Elaine Church and Sue Neely Substance Abuse Treatment, Prevention, and Policy http://www.substanceabusepolicy.com

Taken from http://www.medicalnewstoday.com/articles/79118.php

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For the first time in 46 years

I often go to the All Party Group on drugs and alcohol and yesterday was fascinating.

It seems like a yearly event that an American delegation presents to the gathered interests before attending a conference. It never fails that we are privileged to witness an expert array of partners from ‘over the pond’.

I was mindful that the remit of harm reduction is percieved differently depending on the political drivers in and around the body concerned. It was very interesting that the phrase was little used as a direct strategy. when it was used it was tenuously alluded to as a public health strategy and even then seemed to be carried with baited breath.

The approaches seemed easily delineated;

• The ‘fundamentalist’. This decried evidence based practices as pseudo science and advocated a values based approach to policy. In this sense the mission was to shape the non drug using population at an early age so’s to build a culture of resistance to using at all. It stated that 76% of drug & alcohol users have a problem and don’t see it. A guiding statement made from this presenter, I felt, was ‘in our Bible belt’. It did seem like a mission of conversion of the worthy at the expense of the ineligible and undesirable.
• The ‘enterprising’. A seemingly innovative response to young people and co-occuring mental health and substance misuse problems. Moulded in a medical/clinical vein it is directive, programmed and supported with medication. The presenter stated that ‘integrated programming needs to be active and proactive and integrated with the 12 steps and relapse prevention’. And also ‘mobilising hope that the prognosis is good’ and being clear that ‘addiction is a disease’. Wondering the extent of drug company funding the speaker was asked who funded the organisation and subsequently failed to answer.
• The ‘revisionist’. A speaker embedded in the tradition of associating science with practice spoke of his conversion in light of longitudinal studies. His original interests were assessment and matching profiles to services. Now referencing studies that state no one treatment is neccessarily the best, he particularly referenced Swedish research that stated matching, setting and duration are all weak factors in determining effecftive treatment outcomes. Stating ‘most change is self change’ he advocated ‘diverse, flexible and innovative responses to increase retention and the measures of efficacy.’ Assessment, care management and community care being the central thrust of this delivery.
• The ‘integrationist’. Speaking about self harm the speaker advicated the explicit use of harm reduction in order to work with what exists and offer flexible, creative responses that supports professionals to provide objective services that facilitate trust and safety. Core priority responses being 1st aid training, blood borne visuses and family interventions, deemed as often the roots of over action.

Common to all the approaches is the will to work. This is both the will to work with people in need, the will to make things work for the better of all and the will to be fully involved. Each of these alone provided me with inspiration and motivation to continue to press on so thank you to all that took time out of their schedule to address us at this House of Commons meeting.

It is comforting and assuring to see that the issues of unifying services to facilitate more reasoned and able services is shared overseas. I hope very much that this is something we can all learn from. I am also hoping very much that each of the presenters mentioned above will consider Reasonabilitys mission and presentation and offer a few words of comment.

In sum there appeared to be a value dominance based upon an alliance to that believed to be the best. Within this the inertia to think of harm reduction as anything other than drug promotion and/or a means of education was unfortunate. I referred a key speaker to the SOCA annual report that states explicitly that it is driven by a harm reduction philosophy, a statement of intent to reduce harm. Somehow it felt frustrating not to agree that all efforts spoken of to make things better were efforts to reduce harm.

It’s not unusual that I surf and/or use a fairly decent RSS reader to inform the web site and the past few days have been no different. They have been a little quieter, perhaps, from me as there is so much happening off the web site. Recently though it also seems that drug issues and mental health dilemmas has gone somewhat quiet. There are cases and pressing matters of course but nothing blazing into the public domain.

I did come across this though;

The crisis that never came
“In the 1990s, experts warned that damaged children born to addict moms would overwhelm social systems. Now, science finds exposure to cocaine may wreak less havoc than alcohol or even tobacco — hopeful news for families who yearn to turn their lives around. Lisa Priest reports”

That it is Canadian in origin perhaps suggests something about the attention to particular detail offered here. Yet how it is that we hear so much about scandel yet often we hear very little about the course of whatever the scandel might be.

Ultimately it seems that it is down to interested parties and trainers to keep up to date whilst multivarious demands are made on everyday attention. It is precisely this that fuels Reasonability. Where the terrain can be mapped interventions can be better informed, capacity enhanced and harms reduced. Reasonability would very much like to develop its experiential training remit so that practice skills and developmental areas can be identified in real time and adaptions made with a skilled mentor. Tools are in place to offer basic and advanced training sessions on the three themes of drugs, mental health and harm reduction and skilled practitioners are available to practically help support change and transitions.

Whilst it might appear that we need not be so alarmed about ‘crack babies’ we do well to continue to be dilligent, thorough and together. To quote our current premier “Though left and right still matter in politics, the increasing divide today is between open and closed.” Could we take from this that the divide also pertains to open and closed minds?

Vernon Coaker, UK Home Office minister, states that Harm Reduction is the priority for the Government.*

He is quoted as saying;  “Our priority is harm reduction and to achieve this we focus on enforcement, education and treatment.

“This strategy, backed by unparalleled investment of £7.5 billion since 1998, has contributed to a 21 per cent reduction in overall drug misuse in the last nine years and a fall of 20 per cent in drug related crime since 2004.”

Nevertheless, Mr Coaker added: “The government is not complacent and will continue to work with all of our partners to build on this progress.”  

With the phrase ‘going to rehab’ generally at the fore of popular conception of responses to drug treatment and with the ‘informal’ efforts made by carers could there be a more inclusive conception to the issue?

Professor Colin Blakemore says: “Drug policy is primarily aimed at reducing the harm to individual users, their families and society. But at present there is no rational, evidence-based method for assessing the harm of drugs. We have tried to develop such a method. We hope that policy makers will take note of the fact that the resulting ranking of drugs differs substantially from their classification in the Misuse of Drugs Act and that alcohol and tobacco are judged more harmful than many illegal substances.”

The government has no plans to review the drug classification system, despite claims it is “not fit for purpose”.*

Radio 4 this morning carried the story of an impending review to consider offending and treatment. I spent quite a while trying to find a document that directly referred to this but kept coming back to the BBC news website. It referred to a ‘policy review document’.

It must have been this; http://www.cabinet-office.gov.uk/policy_review/documents/bop_crime.pdf

There have been a number of development reviews aimed at core threads of the Governments agenda. Some interesting seminars are available that address mental health, addictive behaviours and also social exclusion (to name a few). This seemed to link in well with the recent consultations (3 March 2007) where sixty members of the public visited Downing Street “to continue their contribution to the renewal of public services”.

It would seem as though the news piece was also referring to;

House of Commons votes in favour of Offender Management Bill 1.3.07;

“MPs voted in favour of passing the Offender Management Bill through its third reading in the House of Commons yesterday.

The bill will enable all sectors to play their proper part in reducing re-offending. Under the bill, NOMS will be able to commission services from a wide range of organisations in the public, private and voluntary sectors and ensure access to the best providers for the job.

Ministers have responded to concerns about the pace of change by including a statutory commitment in the Bill to return to both Houses of Parliament before any of probation’s court-related work is commissioned from outside the public sector. Ministers have also made a number of commitments to strengthen local accountability as the Bill progresses.

NOMS Chief Executive Helen Edwards says the bill will end the statutory monopoly of the 42 local probation boards to provide probation services.

“We think they are trying to do too much and many third sector organisations, many with a long history of working with offenders, have made it clear to Ministers that they feel under-utilised and that their role has diminished. They want to play a greater part, as do some private sector organisations.

“NOMS can only deliver through its service providers, partners and alliances. Most of these are at a local level.
These partners will also help us overcome some real delivery challenges. The Bill will enable this by allowing us to respond flexibly at the local level, building on local partnerships and the development of Local Area Agreements.”

The Offender Management Bill will also clamp down on illegal activity in prisons by reinforcing measures to prevent the smuggling of mobile phones and other banned articles. A new amendment will also make mandatory polygraph testing a licence condition for sex offenders after their release from a minimum 12 month prison sentence, following an initial pilot in three regions.”

The passage of the bill can be found & followed here

INTERESTINGLY ~ the radio piece made more of the use of medication for those with mental health problems. It seems more and more evident that there is an ‘inclusion lobby’ that believes in the extended use of medication to manage behaviours. This does not appear to be a new effort; the extension of the clinical to define & manage problematic states is core to the new Mental Health Act.

As ever it seems prudent to ask questions of the operational philosophy underpinning this. At a glance there appears to be a number of themes at work and the latest news is merely an example of the one that has been focused upon this time. But before these efforts are missed under various banners and become disperate because of the challenges each ‘wing’ is exposed to please let us consider a unifying theme.

The agenda appears to want to work WITH issues and it appears bold enough to want to know more, to learn from others and to make sure it is making good use of what works. These must surely be the founding stones of Harm Reduction. Where is the harm reduction in the NOMS proposals? They are surely there though perhaps the will to draw them out is tempered by the fear of a political backlash. It must be wrong that a philosophy of intent is thwarted by a perception that it is an advocacy to the contrary.

How does this happen? Thankfully the front page of the most recent paper on the passage of the bill says; “This is a pilot committee stage report and we would welcome all feedback on its contents and format. This should be sent to papers@parliament.uk or to the director of the Research service; Rob Clements (x3622).” If you would like Reasonability to represent your views please do get in touch.

Last week I wanted to respond to the story that, as the Daily Mail put it; “Life for cannabis addict who murdered two friends in frenzied knife attack”.

 It seemed the right thing to do to wait a bit and see what was going to happen as a result. As it turned out there does not seem to have been a witch hunt that some might be more familiar with. However I was inspired to think about the history of drugs & ‘madness’.

Before making more of this I should add that a Google search of ‘cannabis & madness’ returned as many hits as if I’d used ‘heroin & madness’. When I put in ‘cannabis & mental health’ the hit returns are even higher though in searches these are surpassed by alcohol. And this is by almost 20:1 in the latter.

When I look for a timeline about drugs & mental health I seem to come up against a comon problem. Namely that there are very similar things out there for issues that have concerned people for a great many years but very little otherwise. Chronologies abound for histories of interpretation of mental health, similar things exist about the buildings and policies. Also there are relatively easily found examinations of substances and how they have developed and been adapted both for purpose and in understanding. There is reference to the drugs and mental health phenomena in an ad hoc fashion and I am sure a great deal of information is further hidden in the accounts of spiritualism and witchcraft, or in times before drug control and substance manipulation became more a matter for unified authorities.

It would seem that the issues of drugs and mental health (’madness’) are a very modern phenomenon. By memory I believe that the first mention of the association between cannabis and ‘madness’ was made by an Egyption minister in the 1930’s when the plant first became an issue of British national control. Certainly after this time there have similar high level discussions and research pieces aimed at shedding light on the connections between the two.

For now I shall continue to look for a chronology of concern about drugs and mental health.

Please do get intouch if you can help or know of any anomalies that can be evidenced. I hope a piece of work like this would make it easy to see how the issue has developed ‘at a glance’.

davidchaisty@reasonability.org

‘Calls to reinstate Harm Reduction’ that is available in ‘Drug & Alcohol Today.

‘There is a risk that harm reduction is being taken for granted. Despite saving many hundreds of thousands of lives from HIV and AIDS and the ongoing value it provides to drug & alcohol treatment, its principles have not travelled well - and at worst are being forgotten or shunned by some hard liners. Here, David Chaisty champions the logic and power of harm reduction to reassert its use not just among drug or alcohol problems, but also for people with mental health issues.’

Pavillion Journals (Brighton) Ltd. Vol 6 Issue 4

Click here to go to Reasonabilitys blog site 

Today on Radio 4 Ian Duncan-Smith spoke in response to the RSA report that challenged the current drug laws head on. Whilst calling for a revision of the way that substances are classified (well in line with the Association of Chief Police Officers) the RSA state that the scheme to ‘control’ illicit drugs is inappropriate.

Mr Duncan Smith posed the challenge that the system is uncoordinated. Some might say this is only natural for opposition parties, though condemned harm reduction as a practice that failed people wanting to get off drugs. He stated that rehabilitation was needed.

Certainly rehabilitation is a key tool though to say that deploying a practice that aims and intends to work WITH the presenting dilemma towards achievable ends is a failure is misguided and possibly misinformed. though I suspect this is not the definition Mr IDS was referring to. The Governments own definition of Harm Reduction (’Harm Reduction - Tackling drug use and HIV in the developing world”) is sophisticated enough to recognise that there is no precise or agreed definition. Also it frames its applicaton ‘In the context of HIV transmission and other blood borne diseases’. We will do well to keep this application of the theme in mind when thinking about any percieved laissez faire implications. I wonder if we are now fully used to politics in this area of our lives and so look for more detail than solely visible behaviours.

Rehabilitation and harm redcuation will benefit from not being two different things, both are about aiming for change. Of course there is a chance that either approach could be misused and/or done to another rather than done with. Similarly, either could be implemented without any reference to other systems. Success lie in the integration of these models. Rehabilitation generally suffers from being concieved as a thing a person goes away to do and comes back different. In practice a more robust and sustainable definition is more likely to stick. In particular as this is a means to also include informal carers and credit them with the knowledge and skill they have acquired in caring for the person concerned. Rehabilitation is a method to reduce harm and harm reduction is a method to rehabilitate, particularly where the application has consent and is seen to be of value.

Can recognising the value of something be the sole property of rehabilitation? What of impact assessments? Are these not core to harm reduction too?

It would seem that Mr IDS might be more of an exponent of ‘harm prevention’ since having visited a Glasgow estate.  ‘He is the only one who seems to realise the drug policies in this country are useless - far too soft.’