Making Rehab Work Blog – what does the guidance say about access to residential treatment?
9th February 2022
The first in a series of blogs discussing aspects of residential treatment
We recently launched a report looking at residential treatment in England, Making Rehab Matter, to highlight the severe problems people face when accessing residential treatment. The report makes recommendations about how we can work together to improve access.
Residential treatment is a clinically recommended treatment for people with multiple treatment needs. As a treatment, it is intensive, time-effective and cost-effective. Residential treatment provides an opportunity for people with a number of treatment needs to be comprehensively assessed, supported and treated in a single coordinated treatment episode.
And yet, access to residential treatment is a postcode lottery in England, with wide regional disparities of access. Whilst demand for drug treatment has increased over the last 10 years the provision of residential treatment has declined by 50%. In some local authorities, there is no access to residential treatment at all. Overall just 0.8% of people in drug treatment can access residential treatment compared to 11% across Europe.
By working with people with lived experience, and many other stakeholders from across the drug and alcohol treatment sector, we highlighted how this dire situation could be improved to provide high-quality life-saving treatment to people who can best benefit from residential treatment.
What do international and national standards say about rehab?
There is comprehensive guidance covering access to, and provision of, residential treatment at International, National and local levels.
The World Health Organisation published an updated International Standards for the Treatment of Drug Use Disorders in March 2020
There are extensive references to residential treatment within the standards. Under Principle 1, as an essential service, they state that residential treatment should be available, accessible, attractive, and appropriate.
The standards go on to describe the role of residential treatment in treatment systems saying that
“residential treatment may be required based on an individualized assessment for those with more severe or complex drug use disorders or additional social problems”
Whilst Section 4.1.5 covers “Specialized long-term or residential treatment” provision in detail. It covers a treatment description, target population, goals, models and key components from admission to completion.
The Drug misuse and dependence: UK guidelines on clinical management, known as the Orange Book, provides comprehensive guidance for clinicians treating people with drug problems.
Launched in 2017 The Orange Book refers to residential treatment throughout and references NICE guidance that evidences the inclusion of residential treatment as a vital part of drug treatment as follows
“The range of therapeutic approaches employed in residential treatment makes some programmes especially suitable for those with the most complex needs and for those who have not benefited from previous community-based psychosocial treatment” (NICE 2007).”
And goes on to say
“However, there will be some people who desire to go directly into residential treatment and some may benefit from doing so. Such decisions will need to rely on a best clinical judgement.”
Residential treatment in England is a regulated care activity and services are inspected by the Care Quality Commission (CQC).
CQC inspect and monitor residential treatment services. There are five questions CQC ask of all care services.
Safe: you are protected from abuse and avoidable harm.
Effective: your care, treatment and support achieves good outcomes, helps you to maintain quality of life and is based on the best available evidence.
Caring: staff involve and treat you with compassion, kindness, dignity and respect.
Responsive: services are organised so that they meet your needs.
Well-led: the leadership, management and governance of the organisation make sure it's providing high-quality care that's based around your individual needs, that it encourages learning and innovation, and that it promotes an open and fair culture.
Furthermore, residential treatment provides a wide range of interventions and forms of support which are covered within Orange Book and NICE guidance. For example -
Individualised information and advice, including harm reduction
Triage, risk and comprehensive assessments, including health assessment
Care planning and Keyworking
Interventions for drug and alcohol use including behavioural couples therapy, contingency management and cognitive behavioural relapse prevention
Co-occurring mental health problems
Pharmacological interventions to stabilise health, and safely reduce problem alcohol or drug use, including vitamin therapies, opioid substitution treatment, relapse prevention medicines
Routine testing and treatment for blood borne viruses
Inpatient assessment, stabilisation and detoxification
Recovery-focussed support, including housing, learning and employment, personal finance, healthcare, social connectivity, meaningful activity and mutual aid
There are also a wide range of evidence-based practise standards, and specialist clinical standards, that can be found through specialist organisations such as the Social Institutes for Care Excellence (SCIE), for example on safeguarding practise and Covid infection control, through to the Health and Safety Executive standards on Health and Safety.
With such a wealth of standards covering access to, and provision of, residential treatment along with the recommendations made within Making Rehab Work, we are striving to reverse the severe decline in availability of residential treatment in England.
Residential treatment should be available, accessible, attractive, and appropriate as stated in the 1st Principle by the World Health Organisation.
We have some way to go yet to ensure that is the case.