A new RSA project seeks to give drug users greater control over their treatment services. Stuart Honor introduces the initiative and makes the case for putting power in the hands of the ‘alienated undeserving.’
The idea that the relationship between professional workersand communities and citizens should be one of equality remains novel to many in healthcare. But it is an idea that is gaining ground. In examining the concept of ‘co-production’ in social care, the current government is hoping to move beyond traditional welfare solutions for those who are poor, excluded and in need. This month, the RSA has commissioned Baseline Research and Development to conduct the research for an exciting new project that it is launching in West Sussex, aiming to make the case for user-centred, personalised drug services.
Problem drug users might be classed the ‘alienated undeserving’. As a group of citizens, they are extremely socially excluded. In addition the public regard them as very unworthy of support. As a result, user-led approaches have been slow to develop. But there is a need to test the kinds of personalisation initiatives, previously piloted in social care, in the difficult area of drugs policy. The challenge is how to develop packages of user-centred care that tackle the needs of these individuals and build on their own resources and capabilities.
Transforming this field into a more egalitarian, partnership approach will be a major piece of change management. The ‘professionalisation’ of the drug field in the UK is associated with an implicit disempowerment of the user group. This ‘undeserving’ group is not seen as having the ‘expertise’ required to make decisions about their own needs. The philosophy and practice of previous harm reduction measures have produced disillusionment and instrumentalism among staff and low expectations of service users, with the overall effect of stigmatising treatment. Services control access to valued resources such as substitute drugs, meaning relationships between service users and workers become relationships of dependency.
In West Sussex, we are developing a project that can form the foundation for change. We aim to ensure that service users move from passively receiving ‘treatment’ to actively shaping their own drug services, breaking the cycle of powerlessness and giving them a stake in their own future. We believe that truly user-centred services will create a more holistic approach to problem drug use, will help address the socio-structural causes of the problem drug user, and will tackle the range of disadvantages experienced by drug users.
Partnerships have now been built in the area between all key players who have the access and authority needed to deliver the project. During the first phase of the project we will recruit and train a team of current and former drug users. We will train them in basic research techniques and support them in carrying out ‘peer-led’ research, interviewing 150 individuals across the area. The American social scientist and early drugs researcher, Howard Becker (1967) coined the term ‘the hierarchy of credibility’ to describe the ways in which “credibility and the right to be heard are differentially distributed through the ranks of the (social) system”. Our aim is to represent, in however small a way, the experiences and views of a highly marginalised group whose voices are almost never heard or listened to. From the outset, the methods used to gather the data will be through the people in the target group. We need to understand the population we are dealing with. Who are they? What drugs do they use? What are their aspirations? What are their lives like? What role does drug treatment play now? What role could drug treatment play in the future? What would a user-centred service look like?
Based on this peer research, a user reference group will meet with the local steering group to design a new user-generated operating system for delivering personalised, expansive services targeted at users’ needs and aspirations. This new system will be tested and embedded into the wider area framework to offer ‘real’ choice and support lasting change.
These themes are central to the RSA’s account of how we make change in the world. Knowledge does not exist within ‘users’ to be extracted by professionals, but as something that is co-created through the interaction between researchers, users and practitioners. We are excited by, and wholly committed to delivering the potential of this project.
Stuart Honor is Director of Baseline Research and Development
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