'Why do so many people die in Scotland of drug and alcohol related issues?'
As the Chief Executive of a charity working in Scotland to support people affected by drug and alcohol issues, it’s a question I often get asked.
The answer of course is complex – the answer to many of the questions worth asking in health and social care policy usually are.
But a mix of social factors and a shift in the drugs people are using, is at the root of it.
The stark devasting reality is that if we had effective health and social care interventions accessible to everyone who needed them, when they needed them, many of those deaths would be prevented.
The Scottish Government have published a 9 year Alcohol and Drugs Strategic Plan to try and address these issues. As Maree Todd, Minister for Drugs and Alcohol Policy and Sport says in her foreword to the strategic plan
‘People’s lives are often complex, and substance use may be just one of the several challenges faced. Many people use substances to cope with distress, trauma and mental health issues.’
Despite the progress made under the previous National Mission the new strategic plan doesn’t shy away from the challenge we face in Scotland.
And we have made progress. At Phoenix, we have been able to open a unique family residential service – Harper House that supports mums and dads and their children to recover from their drug and alcohol use. We have also created 3 services in Aberdeen and Aberdeenshire – a residential service, a community day hab and a housing service. All working together to create additional treatment options in the region and providing pathways into and out of residential treatment.
But there is so much more that needs to be done, so I welcome the Scottish Governments continued focus on accommodation based services. The continued commitment to reducing the barriers people experience accessing residential treatment including on release from prison. A new focus on detox pathways into residential treatment and the provision of more housing support to help people maintain their recovery.
The Scottish Government have had a longer history in addressing stigma than the UK Government and this strategy pushes us all to go further ‘Supporting service providers to identify, interrogate and amend policies and procedures that inadvertently or otherwise result in stigmatising practices’. A critical step if we are to address systemic stigma.
A recognition of the need for gendered services is very welcome, because ‘women affected by substance use face unique challenges, including stigma and discrimination, when accessing substance use treatment and wider services, and these challenges are often compounded by experience of gender-based violence and fears around societal expectations, pregnancy and parenthood’.
At Harper House we know that ‘women face unique barriers, including stigma especially around pregnancy and parenting and fear of child removal when opening up about substance use issues.’ The focus on perinatal care for women who use drugs with the specific commitment to ‘embedding good practice on supporting women who use substances and their babies during the perinatal period’ will help Harper House support more women at that critical time for them and their babies.
The Public Health approach to Justice –recognising that people in contact with the justice system are often experiencing trauma, poverty, homelessness, addiction, and untreated health conditions, is I think groundbreaking. It might feel like a rephrase of the ‘diversion/ alternatives to custody’ agenda we hear the UK government talking about. But for me there is fundamental difference. Yes both approaches are trying to relieve pressure on prisons. But the principles or dare I say values, behind the public health approach in Scotland is to create a community justice system that rehabilitates and creates better outcomes than prison. And the way to get there is to create a change in attitude within our justice and health systems and a transformation of community justice approaches and pathways.
Compared to an approach of diverting just enough people to ensure the prison system doesn’t collapse and ensure ‘tough on crime’ message is evident in all policy shifts. And get there by using existing services and pathways, accepting capacity will limit success and put pressure on already stretched services and budgets.
There is so much in this strategy, it will take time to absorb and understand how we individually and collectively can bring it to life.
As we get to work to understand what we can do to support the implementation of this plan I take comfort from the fact that the unique role charities like ours play is recognised and valued in Scotland ‘in tackling stigma and promoting inclusion, demonstrating that recovery is not only possible, but visible and valued’.
So I welcome this strategy its well informed, honest and ambitious. Some might say too ambitious in the range and depth of the challenges it has set. I wont be criticising anyone for having ambition for the people the strategy aims to support. That for me is well overdue and I will be ensuring at Phoenix we do all we can to make that ambition a reality.
It is after all the opportunity for us all to play our part in the effort to reduce the number of people who are dying of drug and alcohol related causes.
Karen Biggs,
Chief Executive of Phoenix Futures
