Despite promises in the drug strategy to review the funding arrangements for residential treatment we are still in a strategic no mans land. With the significant risk that progress made in the drug strategy doesn’t impact residential treatment. As an example:

  • None of the 2500 additional drug and alcohol workers nurses, psychiatrists and psychologists recruited through the additional funding have gone to residential services.
  • Responding to the instability created within the sector through 3-year contracts for community services those contracts are increasingly commissioned for 8 – 10 years. Residential funding is still spot-purchased for each individual for a 3-month placement.

Of the 290,635 people in treatment in 22/23 only around 1% were able to access residential treatment, in 41 local authority areas fewer than 4 people managed to access residential treatment and in 6 areas, not a single person was able to navigate the system. 

What does all that feel like for people who want to access this form of treatment?

After 17 years in my role, you can imagine I have many people's stories in my head (and my heart). Many of them inspiring, all of them fraught with trauma, too many with sad endings. 

Recently I heard of a man who had joined us in our residential treatment service in Glasgow this month. He had come to us through the prison to rehab pilot the Scottish Government fund. He was from the NE of England and had stayed there for a long time. Recently he moved to Glasgow, frustrated that he couldn’t access residential treatment from his hometown. He had worked out if he spent some time in a Scottish prison, he would have a better chance of accessing residential treatment. The plan worked. His own traumatic sole destroying marathon paid off. It’s the stuff of fables but I assure you it’s true. 

What is the alternative?

There are a few options but at its core we need to create strategic ownership of residential treatment provision at a national and regional level to maximise their value to the full range of stakeholders (NHS, Mental health, social services, prisons and wider justice services). That would include 

  • Commissioning residential services on a basis that allows access by the full range of stakeholders
  • Broadening access, creating pathways to all stakeholders
  • Longer term funding for residential provision that recognises the same instability issues that have impacted the rest of the sector
  • Not viewing residential treatment as outside of the sector
  • Treatment durations to be individually assessed as appropriate to need, not time limited contrary to evidence

If you extend the trajectory of the current declining access to residential treatment, we will cease to have a residential treatment sector by the end of the life of this drug strategy (2031)

We know that this would be a tragic loss and I can point to thousands of people who would agree with us. People across the country that have indeed ‘run that marathon with a broken leg’ and showed real resilience and bravery to access a treatment option they should have been entitled to.

 

Karen Biggs, Chief Executive