Andrew Brown (@andrewbrown365) summarises the latest new data on alcohol and other drugs, including statistics on substance misuse in secure settings.
The Making Every Adult Matter (MEAM) coalition – formed of the national charities Clinks, Homeless Link and Mind – has today welcomed £2.78 million in new funding from the Big Lottery Fund to significantly expand support for people with multiple needs across England over the next five years.
People with multiple needs face a combination of problems including homelessness, substance misuse, contact with the criminal justice system and mental ill health. Working together, the MEAM coalition charities support local areas across England to develop effective, coordinated approaches to multiple needs that can increase wellbeing, reduce costs to public services and improve people’s lives.
This is achieved using the MEAM Approach, a framework to help local areas better coordinate services for people facing multiple needs, and by providing support to local areas that are part of the Big Lottery Fund’s Fulfilling Lives: Supporting people with multiple needs programme.
The new grant will enable MEAM to:
- Significantly expand the number of areas that it is supporting
- Bring together data from MEAM Approach and Fulfilling Lives areas to make a strong case to government about the impact of local interventions for people with multiple needs
- Share good practice across the MEAM Approach and Fulfilling Lives networks
- Ensure that more individuals are empowered to tackle their problems, reach their full potential and contribute to their communities.
MEAM will work closely with people with lived experience of multiple needs to deliver this programme, and to ensure that they are involved in the plans developed by local areas.
Recruitment for new staff across the coalition charities has been launched alongside a ‘register your interest’ process for areas wishing to use the MEAM Approach and benefit from the support made possible by the new funding.
Oliver Hilbery, Director of the MEAM coalition, said:
“We are delighted to be working with the Big Lottery Fund and all the local partners on this new phase of our work. Together we want to build on the wealth of expertise that exists in current MEAM Approach and Fulfilling Lives areas and draw this learning together into a powerful case for national change. For too long, people with multiple needs have received a poor response from local services that are designed to deal with one problem at a time. We are committed to working with local areas and with government at all levels to change that for good.”
Baroness Claire Tyler, Chair of the MEAM coalition, said:
“We strongly welcome the support from the Big Lottery Fund for this expansion of our work. We know that by using the MEAM Approach local areas can improve the lives of some of the most disadvantaged people in our society. I’m very excited that more areas will now be able to develop joined-up services that respond to individuals’ needs and aspirations. This new funding will significantly extend the reach and impact of the MEAM coalition and allow us to ensure that learning from local areas is used to shape national policy responses.”
James Harcourt, Big Lottery Fund Deputy Director of Responsive Programmes, said:
“We are very pleased to have made this award to the Making Every Adult Matter (MEAM) coalition. Through their previous work with the Fulfilling Lives programme and their own network of MEAM Approach areas they have shown themselves to be committed to changing the way that people with multiple needs are supported in local areas. This new funding will allow us to bring together the two networks and reach even more people”
You can learn more about the MEAM Approach by watching our new video about local areas’ experiences.
Andrew Brown (@andrewbrown365) rounds up new data related to alcohol and other drugs, including statistics from Public Health England on young people receiving specialist support for drug and alcohol problems.
Over the course of 2016, Andrew Brown (@andrewbrown365) has collected the most interesting statistics around alcohol and other drugs. Here he picks some that you might have missed.
When someone takes their own life, the consequences – for that person, their family and their loved ones – are deep and permanent. Suicide can be prevented, and we have a responsibility to do everything possible to ensure that people receive the support they need at times of distress or crisis.
In an interim report published this week, the House of Commons Health Committee sets out the evidence on suicide prevention, and makes a powerful argument about the inadequacy of our current systems of support:
“Approximately one third of people who end their lives by suicide have not been in contact with health services in the year before their death. However, this is not because they are in some way ‘unreachable’—on the contrary, we should regard all suicides as preventable. In Liverpool we met a bereaved mother who said simply ‘my son wasn’t hard to reach—it was the services that were hard to reach’. If such a high proportion of people in need of help are not accessing current services, then we must adapt the services we offer.”
There are many reasons that people commit suicide, and they are often difficult to identify and separate. Nonetheless, we know that people experiencing multiple needs face greatly increased risks. St Mungo’s interviewed forty people with experiences of rough sleeping, and found that one in four had considered or attempted suicide while homeless. Research by the University of Manchester also suggests that people using heroin have rates of suicide at least three times higher than the general population, with official data suggesting that women are particularly vulnerable.
It’s especially concerning that this year the Howard League for Penal Reform reported the highest number of people in prison taking their lives since records began in 1978. The rate of self-inflicted deaths in prison is over 12 times that of the general population. There is widespread concern at the levels of isolation, violence and lack of constructive activity in prisons, with not enough being done to address the mental health and substance misuse needs of people in custody.
The Committee makes a number of welcome recommendations for action, ahead of the expected publication of a revised Government suicide prevention strategy in the new year. In particular, they call for measures to identify those most at risk in the community, particularly in non-traditional settings where the voluntary sector can play an important role.
The report notes the elevated risk that people face when leaving mental health services, and the Committee recommend that all patients being discharged from inpatient services should receive follow-up within three days rather than seven. Alongside this, they highlight the need for liaison psychiatry – the provision of psychiatric support in hospital settings such as accident and emergency – to be adequately staffed and resourced.
We very much hope that the Government acts on these recommendations, and that the forthcoming strategy takes into account the wide range of factors – homelessness, substance misuse and contact with the criminal justice system – which can contribute to heightened risk of suicide. A strategy alone is not enough, though: it is the responsibility of all of us – as practitioners, policymakers and citizens – to ensure that people receive the specialised support they need, when and where they need it.
In July 2015 the then Prime Minister David Cameron asked Dame Carol Black to undertake an independent review into the impact that drug and alcohol problems and obesity have on employment outcomes. In this blog we respond to the findings of the review, which have been published today
MEAM welcomes Dame Carol Black’s long-awaited review as an expert opinion on how we can improve the services and systems that should support people with drug and alcohol problems towards employment.
Many people with multiple needs have substance misuse problems and the report has implications for how they are supported to overcome barriers to work. We agree with her conclusion that treatment, the benefits system and employers all have vital roles to play.
Effective substance misuse treatment is vital to helping people move towards work, but as the report acknowledges, providing treatment alone is insufficient to achieve better employment outcomes. Instead, it needs to form part of a wider approach that addresses the full range of people’s needs, such as resolving housing challenges and improving skills.
As the report recognises, the journey to recovery “can take many paths [and] have some false starts”. It’s therefore welcome that the review has carefully considered the effect that problems with housing and contact with the criminal justice system can have on people’s ability to move towards and secure employment.
The report recognises that the benefits system must do more to recognise the needs of people facing drug and alcohol problems. We particularly welcome the recommendations to design an enhanced Jobcentre Plus drug and alcohol offer for benefit claimants, and trial the use of peer mentors with personal experience of recovery in Jobcentres.
As the report also notes, to be effective this must form part of a wider joined up approach to health and work across government. This echoes recommendations MEAM has made previously that Department for Work and Pensions and its partners should “provide appropriate, flexible and personalised support to help people with multiple needs move towards independence.”
Finally, there is a corresponding role for employers in supporting people with drug and alcohol problems, as well as providing employment opportunities. The report makes a number of constructive recommendations on encouraging good practice and addressing negative stigma.
The MEAM partners have carried out extensive work on how to support people experiencing multiple needs into employment, closely informed by the experience of practitioners and people with lived experience, and we were glad to assist the review team in drawing on these perspectives in its research. We also wholly support the response our partner Collective Voice has made on behalf of the substance misuse treatment sector.
We are grateful to Dame Carol Black and her team for their thoughtful contribution on this topic, and for engaging constructively with us throughout the process. We hope the DWP uses the findings of this important review to improve the support provided to people facing the most significant barriers to work.
Andrew Brown (@andrewbrown365) provides an update on new statistics on alcohol and other drugs, including a focus on the latest data from the substance misuse treatment system in England.
This week MEAM director Oliver Hilbery (@OllieHilbery) participated in a House of Commons event to mark the 50th anniversary of Ken Loach’s landmark film Cathy Come Home, speaking alongside the director and Liberal Democrat leader Tim Farron MP.
In this blog, based on his contribution to the debate, Ollie explores why many of the issues around homelessness first raised in Cathy Come Home are still with us today, and shares some of what MEAM has learned about what needs to change in the future.
Ken Loach has inspired multiple generations to social action and created a better understanding of the problems that many people face, from homelessness to problems with the welfare system.
Cathy Come Home and his most recent film I, Daniel Blake, are 50 years apart yet they are sadly connected by a common strand. They both show services and systems that should be person-centred, supportive and enabling, but instead are regimented, rule-orientated, risk-averse and all too often part of the very problems they are trying to solve.
In my speech at the event I suggested five ways in which we can make services and systems better in the years ahead.
1. Services and systems need people’s voices
Services and systems need to be shaped by the voices and experiences of the people who use them and work in them. All too often, we fail to take these voices into account and we end up with poorer services as a result.
At MEAM, we’ve seen that people and workers feel distanced from the big policy and service decisions that impact on their lives. That’s why over the last two years we’ve worked with over 100 people with first-hand experience of multiple needs to bring their views into the heart of the political debate. We’ve also helped local areas strengthen their capacity to influence local decision-makers.
2. Services and systems need local collaboration
Since the beginning of the welfare state we have set up services in silos that reflect the systems they are in, not the people using them. By contrast, no-one experiencing problems categorises them in this way. Ken Loach’s work shows us human problems that need human solutions.
It is not uncommon for us to meet people who have 10 – 15 active ‘caseworkers’ and a series of appointments that they can’t manage and can’t attend. Those with the most complex problems bounce around this system, with no one willing to take responsibility until they end up on the very margins of our communities.
To address this, we need to build more coordinated and collaborative interventions across sectors in local areas. We must design personalised interventions that start with the question “What do you need?” rather than “My service does this – do you want some of it?” This demands that we turn the accepted wisdom about how to do things on its head.
That is why we’re working in 27 areas across the country using a framework called the MEAM Approach to help local areas design and deliver coordinated services. It’s why Homeless Link is championing Housing First, which gives people the immediate housing they need followed by support. And it’s why Homeless Link is pleased to be working with partners in the refugee and migrant sector on the Strategic Alliance on Migrant destitution.
3. Services and systems need national funding.
Local collaboration is hard and it needs to be backed by national government. Sadly, however, there are real difficulties for local areas when it comes to funding at the present time.
The supported housing sector is currently at risk. Over the last year there have been two proposals that have risked a massive impact, not just on homelessness but on all forms of supported accommodation. One is the plan to reduce supported housing rents by 1% and the other is a proposal to cap them at the level of Local Housing Allowance rates.
Homeless Link has carried out analysis on the impact of these changes and campaigned for the protection of supported housing. Twelve months later, while these proposals have been modified, there is still a lack of clarity for the sector as we wait for the output of the supported housing review. This is not a good way to help the sector build and develop the support it provides.
4. Services and systems need national strategy
Services and systems need more than just money – they need strategic backing. Despite rough sleeping rising by 102% between 2010 and 2015 there is currently no national strategy on ending homelessness and there hasn’t been one for many years.
National departments are not fully aware of what their role should be in ending homelessness and this ethos drips down to local level, driving services apart rather than pushing them together.
We will not end homelessness if we continue to have some government departments creating it, while others try to solve it. The recent benefits caps and sanctions shown in I, Daniel Blake are a good example of this.
5. Services and systems need to focus on prevention
We have seen good progress in recent months on action to prevent people from becoming homeless in the first place. The Homelessness Reduction Bill passed its second reading recently with unanimous cross party backing.
With the right package of support to local authorities this could lead to a fundamental change in how local areas are supported to tackle homelessness and prevent people hitting crisis points.
Cathy Come Home and I, Daniel Blake show us that despite the progress we have made, problems continue to occur in our systems and services. By exploring these five things – voices, collaboration, funding, strategy and prevention – perhaps we can bring about sustainable change for the future.
The latest update on new statistics about alcohol and other drugs from Andrew Brown (@andrewbrown365), with a particular focus on mental health including data from the Adult Psychiatric Morbidity Survey 2014.
MEAM welcomes the announcement last week of £40 million across three new national programmes to prevent and tackle rough sleeping and multiple needs. The three programmes are:
- £20 million for local authorities to pilot new initiatives around prevention
- £10 million to support people at imminent risk of sleeping rough or those new to the streets
- £10 million in Social Impact Bonds to help long-term rough sleepers with the most complex needs
Most relevant to the work of MEAM is the new SIB, which will fund coordinated services for people with the most complex needs. MEAM has been leading the development of coordinated interventions since 2011 and currently supports 27 local partnerships across the country – fifteen using the MEAM Approach and twelve as part of the Big Lottery’s Fulfilling Lives programme.
The new SIB is timely and we encourage local areas to explore the opportunities that are available. However, to be truly effective the SIB needs to be part of a broader strategy and must draw on evidence from existing networks, government programmes and research. There are four things that we would urge government and the local areas applying to consider:
- Payment structures: Significant care will need to be taken to ensure that the payment models used in the new SIB are appropriate for the issues that it seeks to address. The draft ‘rates card’ in the prospectus currently takes little account of rewarding incremental progress, which is so vital when working with people experiencing multiple needs. We are pleased to see a commitment to discuss this rates card with applicants. Evidence from the National Audit Office, the recent evaluation of the Troubled Families programme, and our work with people with lived experience all point to the challenges of using payment by results for complex interventions, and we would not want to see similar mistakes repeated here.
- Local partnerships: True cross-sector partnerships are a vital foundation for local work on multiple needs. These take time to build and they can be both helped and hindered by the presence of money. We are pleased to see that the prospectus requires mental health and substance misuse support providers to either apply directly with the local authority or formally offer their support. However, a major challenge will be ensuring that one local provider is not rewarded under the SIB for results that have been jointly achieved.
- Cohorts: The SIB is due to run for four years, but local areas will only be able to refer people into it for the first year and must work with cohorts of 100–350 people. Evidence from across the country suggests that it is very difficult to keep people with the most complex needs engaged over this period. Drop-out rates are therefore likely to impact on payments. We would encourage local areas and the government to give much stronger consideration to ‘tranche cohorts’ if their aim is to support people over a four year period.
- Systemic change: If the new investment is to have a lasting impact, it must result in interventions that work with and for the wider system of support services that surround them. They cannot be layered on top. The risk for the SIB is that inappropriate payment structures, partnerships driven around money, and a cohort model that creates separated support structures in a local area could end up having a less-than-positive overall impact on long-term systemic change.
All the issues discussed above can be designed out, and we know that partnerships across the country are beginning to consider these issues in their applications. We look forward to working with DCLG and applicants for the new funding to share our learning and evidence. We are pleased that advice will be made available to those selected and would be happy to discuss support opportunities with areas that are considering applying.
Applications for the SIB are invited by the deadline of 5pm on 28 November 2016 and the prospectus can be downloaded here