Over the past month, Coronavirus has had a significant impact on the lives of people experiencing multiple disadvantage. Many have been quickly rehoused in new accommodation, being told to self-isolate and social distance in settings that are unfamiliar and over which they have little personal control. The support they receive from local services has changed rapidly and nowhere perhaps has this been more true than in regards to substance misuse treatment services.
Substance misuse providers across the county have been quick to adapt their working processes to the new environment and ensure that changes don’t jeopardise clients’ wellbeing. Frontline staff are doing their utmost to ensure that people get the support they need as Oliver Standing, director of Collective Voice, outlines in his recent blog. The government is also taking action, with new guidance for substance misuse providers and commissioners published yesterday.
This week, as part of our “Ask the Network” series, we speak to Forward Leeds, looking at the approach they have taken to substance misuse support in the city.
Below we set out some of issues and opportunities facing all substance misuse providers at this time:
Outreach
Assertive outreach is a vital way for substance misuse services to reach people facing multiple disadvantage, especially those who have been repeatedly failed by the system and may mistrust services.
Unfortunately, outreach support is likely to be reduced by substance misuse services during this crisis period due to shifts in priorities and in order to protect the health and safety of staff. However, despite this the crisis is presenting opportunities for people to engage with substance support perhaps for the first time. The new accommodation settings mean that there are a large number of people with support needs in one location. Placing substance misuse support workers in those locations will potentially allow them to quickly engage with numerous people who might otherwise have seemed out of reach.
In addition to this, the potential disruption to dealing and drug supplies may encourage individuals to turn to treatment support for the first time as an alternative and services should be ready to respond to this need.
Key working and peer support
For people who are successfully engaged in substance misuse support, often the most critical element is the relationships they have with key workers and the trust that has been built over time that allows them to work together to address some of the underlying causes for the substance issues. The ability to see these key workers face to face has rapidly reduced as a result of the pandemic.
Services are making every effort to ensure there is continuity of care and support, by offering online meetings or phone calls. However, for those living chaotic lives this level of change is likely to be extremely challenging and disorientating. For some, overcoming the practical issues such as accessing IT facilities and phones with adequate credit is only part of the issue. There might be less of an ability and desire to discuss emotional issues without being face to face and there is a real risk that some people may disengage as a result.
Everyone in their daily lives relies on the support of peers around them, particularly when confronting problems. This is often of particular importance for people experiencing multiple disadvantage who are attempting to address their substance issues. Peer support can be vital, the ability to share with others around them who are going through similar experiences, to see they aren’t alone. Unfortunately that is much more difficult at the moment which may add to anxieties and temptations to revert back to previous behaviours and substance use as a response.
Harm reduction
A large proportion of people facing substance misuse issues and multiple disadvantage will have underlying health conditions. Providing harm reduction is more vital than ever to protect their health and reduce the burden on the NHS.
Many individuals will be engaged with Opioid Substitution Treatment, receiving methadone or buprenorphine to manage their issues with opiates. It is likely that their prescriptions for these drugs may alter as a result of the crisis, both for people’s own safety and in order to protect staff in pharmacies. For example, the frequency in which they need to pick up them may reduce and locations may change.
For some people, this may be a positive. They will no longer have to go to a pharmacy daily and be supervised while they consume their medication, something we wouldn’t dream asking of others collecting prescriptions. It will enable people to go about their daily lives more easily and reduce anxieties.
However, for some individuals it will pose additional risks, especially individuals living chaotic lives or facing multiple disadvantage. They may not be in a position to manage their medication for a period of more than a day or so. They may be likely to consume it too quickly or be vulnerable to others exploiting them for it. We are pleased to see that the guidance asks substance misuse providers in these circumstances to provide a flexible and personalised response that takes into consideration an individual’s background and their level of need and prescribe accordingly.
In addition, access to needle exchange and naloxone will be impacted significantly during this period, services that we know that individuals experiencing multiple disadvantage frequently utilise. There are opportunities to provide these services within the new accommodation settings, but additional innovations will need to be developed in order to ensure they are readily accessible to those who need them most.
Coping with restrictions
We know that for people who have active substance issues social isolating and distancing will be difficult, even more so for those experiencing multiple additional issues. They might need alcohol or other substances to function and prevent themselves from going into exceptionally painful and sometimes dangerous withdrawals. As a result people may struggle to cope with government restrictions. Substance misuse staff have a vital role to play in supporting these individuals and working alongside other providers, including hose within the new accommodation settings. They are most suitably positioned to demonstrate how best to manage circumstances in which individuals might need to acquire and use substances.
Prison release
The government has announced that some individuals will be released from prison as part of the Ministry of Justice response to the Coronavirus crisis. It will be important – as always – to ensure that people leaving prison who need it have clear substance misuse support in place, as the transition from prison to the community can be a challenging and dangerous time for individuals seeking to manage addiction.