Phoenix Chief Exec Karen Biggs discusses how we address the tragic increase in deaths from drug misuse
Quite rightly a lot has been said about the tragic increase in drug related deaths across the UK.
Drug deaths in Scotland have risen by 15% between 2014 and 2015 (from 613 to 706) the latest Drug Related Deaths figures for England and Wales show a further increase of 8% last year to a record high of 3,674 deaths a year. Each statistic is a life lived and a bereaved family left behind.
Patterns can be seen within the statistics; across Scotland, England and Wales the majority of deaths were people aged between 30 and 39 years of age. The majority were men and heroin use was implicated in the deaths of more people than ever before. A significant proportion of the deaths occur amongst people not in treatment and complex health conditions are often a factor such as lung disease and hepatitis. There is also an increase in deaths as a result of suicide.
Whilst it would be convenient to identify a single simple cause amongst all the data that has been collected from statutory agencies and providers across the country, the issue is undoubtedly more complex.
• A significant proportion of the deaths occur amongst people not in treatment. Whilst we have successfully improved access to treatment for many, some people are being left behind.
• Drug treatment is a ‘protective factor’ - which means it reduces the likelihood of people overdosing, however risk is increased significantly at the points people enter and leave treatment. Gaps between services are a risk.
Some people have proposed simple solutions but the needs of those dying are complex, they require support from a wide range of different specialist sources; healthcare, housing, substance misuse to name a few. This is recognised in recent reports into each of these areas, for example the recent DCLG report on homelessness, the PHE report on understanding and preventing drug deaths and House of Commons Health Committee report on Public Health.
The homeless inquiry report called for a renewed cross departmental government strategy addressing a range of issues from the shortage of social housing to the impact of welfare reforms and recommends more support for people with multiple needs. Uncertainty over the future of supported housing clearly compounds the risk
Whilst the health committee report discusses issues of fragmentation across healthcare services and confusion over roles and responsibilities between services and states that improving health requires tackling the wider determinant of health in local communities such as “…employment, income inequality and housing “
The PHE report states that “People who move between services for drug treatment, mental health, housing support or physical health, and have the most complex needs, are at significant risk of drug-related deaths”.
All are good reports and all call for the same kind of joined-up response and yet real progress is slow.
Disinvestment in our substance misuse services is clearly an issue and the substance misuse sector has experienced cuts of 25% over the last 3 years, more in some areas. Arguably disinvestment in our communities across multiple areas of support over the same time period creates a much larger issue, at best it compounds the risk. Disinvestment causes fragmentation as services all contract at the same time and so the gaps between services increase.
Disinvestment also reduces our ability to give voice to people in need. Our focus as providers is shifted to providing the basics and away from empowering and advocating for those in need so that their voice is heard.
Disinvestment and fragmentation hurts those with the greatest need and the least ability to demand equal access to services.
As each of those reports tells us, we need to re-orientate healthcare, housing and substance misuse treatment and focus around the needs of those people that we are at greatest risk of losing.
Housing that supports basic health needs and the wider determinants of a healthy life, as well as specialist support, is a gap we can close. It requires some investment but mostly it requires collaboration and the willingness to think outside of our traditional sectors. Specialist recovery-orientated housing is vital to providing people with an access point to treatment, and a safe foundation to move between services. It enables a package of services to be brought to the individual’s door. It is an approach that is at the heart of our strategy for coming years.