Here at Phoenix Futures, we believe that the strategy must take wider determinants of women’s health into account, including access to universal and specialist services, and experiences of services, which will be different among different groups. Gendered inequalities fostered by service design are compounded when women have multiple health and social care related needs. For example, it is widely acknowledged that access to statutory mental health services is severely curtailed if an individual is experiencing drug or alcohol dependency. Likewise, people with mental health conditions can struggle to jump through the hoops required to access drug or alcohol treatment. [1] Women are particularly disadvantaged by these strictures because women are more likely to experience mental ill health than men. [2] They are also more likely to have caring responsibilities, to live in poverty, or to experience interpersonal violence in the home, all issues that can cause health problems as well as impact on ability to access services that provide treatment.
Phoenix Futures worked with nearly 4,000 women across our community, housing, and rehab services last year. All were using substances problematically. 66% additionally were experiencing mental health problems, a proportion that rises to 90% amongst women who accessed our residential rehabs. Rehab operates as a particularly good treatment setting for people who are experiencing multiple needs, taking away some of the challenges inherent in delivering treatment in the community to those who may lack a stable base or support network, struggle to attend structured appointments, or who require additional treatment. For those women facing the most complex needs time in residential rehab affords the opportunity to receive intensive support across a range of areas in addition to drugs and alcohol, including mental health, housing, offending, and family support. Treatment is delivered within a supportive community. Time away from stressful lives gives participants the opportunity to reflect, contemplate, and affect change. It is an evidence-based treatment and it is effective.
In 2015, following consultation with women we worked with in HMP Holloway, we opened a gender-specific residential rehab in London, developing a trauma-informed psychosocial programme alongside highly personalised access to mental health treatment, including specialist eating disorder support and one-to-one clinical psychology input. The women we worked with had multiple, and often complex, needs. 71% had a mental health need for example. Almost half were homeless at admission. 39% had a history of offending. A significant number of them were also mothers, and this was central to their identity. They had found it impossible to access and coordinate the range of support they needed in the community – residential treatment was a must for these women. The service was inspected by CQC, who rated it Outstanding. It was among the very best in the very small sector of rehabs for women.
It had been our hope, when we set the service up, that we could use evidence gained during delivery to successfully advocate for increased funding and provision for this group of women because more specialised treatment comes at a slightly higher cost, but unfortunately, funding restraints meant that we had to eventually close the service. Since we set up the service in 2015, the number of people who are able to access any form of inpatient or residential treatment have declined by 41%.[3] This figure must be understood in the context of a year-on-year increase in numbers of people dying from drug or alcohol related conditions: in 2019, the ONS reported the highest number of drug-related deaths in England and Wales since records began, with the increasing female mortality rate driving the overall rate upwards.[4]
Substance dependency is a treatable condition. Access to that treatment however is not equitable. Presenting at drug and alcohol services can pose difficulties for women who may:
- Lack childcare – women are more likely to be a primary carer;
- Fear that their children will be removed if they admit they have a problem;
- Have limited financial resources – women are more likely to live in poverty;
- Have co-occurring mental health conditions – more common in women;
- Have a partner who uses – women are less likely to seek help if a partner is unsupportive;
- Be subject to interpersonal violence, including control and coercion.
Stigma can also present a barrier. Women who use drugs are far more reviled in the public imagination than men, particularly if they have children.
And we have a system that is designed for men, who make up the majority of those within substance treatment services. Research by Agenda has shown that women are ten times more likely than men to have experienced extensive physical and sexual abuse, an experience that can have devastating short and long-term effects, and lead to use of drugs or alcohol as a coping strategy.[5] Women who have been abused by men can find it difficult to maintain treatment in mixed-gender settings. Yet fewer than half of all local authorities in England deliver gender-specific substance misuse support.[6]
This matters because people who recover from drug or alcohol dependency go on to contribute enormously, to communities and to society, and we at Phoenix see evidence of that every day. It matters because in the long run it saves us money that would have otherwise been spent on interventions. And it matters because every single one of those people who are affected by drug and alcohol use matter.
[1] Jumping-Through-Hoops_report_FINAL_SINGLE-PAGES.pdf (meam.org.uk)
[2] Women and mental health | Mental Health Foundation
[3] Adult substance misuse treatment statistics 2019 to 2020: report - GOV.UK (www.gov.uk)
[4] Deaths related to drug poisoning in England and Wales - Office for National Statistics (ons.gov.uk)
[5] Hidden-Hurt-full-report1.pdf (weareagenda.org)
[6] Home - Mapping the Maze
