Contact

Steve Broome

+44 (0)20 7451 6930

steve.broome@rsa.org.uk

In an article orginally published in Addiction Today, Rebecca Daddow coordinator of the RSA's User Centred Drug Services project, discusses how the economic downturn means we need to think more seriously about recovery communities.

Recession means that times are hard especially for those who might be struggling in the first place. With unemployment soaring, an increasing number of people have reported stress related to the recession, there is a growing danger of a “lost generation”[1] of young people unable to realise their potential, and an associated drift to alcoholand other substances as an escape from their boredom, misery and disaffection.

This does not bode well for services which are increasingly expected to do more for less as public sector spending is cut. Effective and efficient service provision has become more critical. It has been repeatedly argued that the best way for this to be achieved is if provision meets more than only the physical and mental-health needs ofindividuals, and does so in a personalised way.

In 2007, the RSA Commission on Illegal Drugs, Communities and Public Policy argued for a more tailored and expansive approach to drug services. It concluded that drug users should be treated like any other recipients of public services: they have not forfeited their rights to effective public services and, indeed, might need these more than the average person if they are to achieve their full potential. Achieving this is a bumpy road of change that leads from the traditional power dynamics of service provider and service user to a new system placing the client at its heart and enabling that client to essentially become the commissioner.

This user-centred approach is some way from the traditional statutory user “involvement and participation” methods which most often mean consultations, user fora, users on committees and so on. In many ways, user involvement has been tokenistic, a box-ticking exercise. But user involvement, done properly, can have multiple benefits reaching beyond an individual user.

Through such approaches greater levels of communication are developed. These ensure that services understand more deeply the needs of their service users, where there might be gapsin provision, where provision is not effective or delivered in the wrong way.

Such approaches offer greater opportunities to build trusting relationships between staff and service users. They also enable people to develop qualities, such as confidence and self-esteem,which together with trust are prerequisites for empowering them to foster a sense of ownership over their treatment and recovery. In 2009, the RSA launched the User Centred Drug Services Project which set out to test these challenges and add to the slowly increasing evidence base.

The project marked a watershed for the 256-year old organisation. It was one of a handful of new-generation projects which put enlightened thinking to work in practical ways, seeking and releasing human capacity and potential through practical and creative innovation on the ground aligned to themes central to all our work:empowerment, co-production, user-centred approaches, sustainable communities and the power of social networks. These themes form the foundation of the RSA’s account of how we make change in the world.

Located at two sites in West Sussex, the project aimed to help catalyse practical change. We did this by working with local partners and by recruiting and training a group of former and current drug and alcohol users in research techniques, to carry out the primary research which endeavoured to understand the wants and needs of local people with substance-misuse problems. This enabled us to design “ideal” interventions, systems and services based on that understanding.

The first phase of the project culminated in a national event at the end of January. This brought together the projects’ local stakeholders with practitioners, policy makers and academics. In a Dragon’s Den-style competition, eight pitches of the ideal intervention, system or service were made to our panel of Dragons who included a senior official from the Home Office, the heads of three leading service providers, a prominent general practitioner and, most notably, two of the local stakeholders.

The pitches showed something that we already suspected. In designing what will best meet the needs of each person, there are some relatively straightforward and potentially quick wins which are recognised by almost all groups – service users as well as practitioners. The same themes shonethrough across the eight pitches. They emphasised access, information and guidance, attitudes of practitioners and the wider community, the need for meaningful activity, the need for recovery networks, greater empowerment of the service users, more control over the development of care plans, and the importance of aftercare.

There will be a chance to read and watch the pitches in detail later this summer, when the project publishes its findings and lays out plans for the final piloting stage. But to give you a flavour, here is one of the pitches:

RSA symposium idea, 5 January 2010

The ideas are relatively simple but the manner in which they evolved and were developed with users and other local stakeholders from the early stages has ensured that there are established channels of communication andemerging trust relationships between the variety of stakeholders at a local level. This can only smooth the road to taking these ideas forward.

As we enter the final stages of the User Centred Drug Services Project, we are already witnessing notable changes to the local substance misuse landscape. Pioneering service-user-led organisation Exact has been working to ensure there is a legacy beyond the project’s two-year residency, in the form of a recovery community. It will take forward some ideas from the symposium into local pilots with other local stakeholders. The pilots will begin in late summer.

We have learned big lessons through this project. As an action-research project, we are fortunate to be able to incorporate the ideas and knowledge as they emerge and can inform and be informed by changes in government as we goalong. The project has led us on a journey from the relatively narrow, albeit ambitious, focus on personalisation and user-centred approaches to the more all-encompassing recovery model.

This is very much in line with the wider shift in policy and practical discussions across the substance-misuse field which recognise that recovery is an inherently personalised process which might incorporate “formal” treatment butwhich is basically community based.

Picking up this theme, the RSA RecoveryCapital Project was launched in April 2010.

This is one element of a larger programme: the RSA Peterborough Citizen Power Programme.This is a two year programme looking at how active citizenship might improve attachment and networks between people, build local participation and cultivate public-service innovation. It also includes projects on environmental behaviour change, civic participation, evaluating civic health, digital participation and online socialnetworks, arts and social change, and an area based curriculum.

The RSA Recovery Capital Project will draw on the research undertaken by the RSA Connected Communities programme which is exploring how social capital and social networks can be better mapped, understood and used to deliver the resilient, empowered communities we want and need. This knowledge and understanding will be vital in the development of recovery communities not only in Peterborough but also at the two sites of the User Centred Drug Services Project. It will help us to identify opportunities to draw on existing resources and assets, to identify the gaps in provision and plan to enable local citizens to plug those gaps in creative, collaborative ways.

We see potential in these resources to facilitate and catalyse community regeneration in the same way that the national drug strategy sees the potential in these resources in supporting drugs services as they face growing demand and serious budget constraints. There are examples of this already happening in pockets around the UK.

U CHOOSE IT, for example, is a peer led organisation that focuses on the more practical side of recovery. It aims to offer the individualised support that people need to overcome the day to-day obstacles that make recovery challenging. One of the founders, Michaela Jones, recently spoke at an RSA Expert Seminar: Getting Practical about Recovery Capital.

Increasingly, these types of resources and assets are referred to as recovery capital: the “breadth and depth of internal and externalresources that can be drawn upon to initiate andsustain recovery”[2] from substance misuse. It is the access to and ability to exploit this capital which is indicative of successful recovery. The Recovery Capital Project aims to show that recovery capital is most effective when it is created and strengthened through collaborative working between all members of a community, and when it addresses the personal needs and strengths of individuals.

This will simultaneously help to address the stigma linked to substance users and misuse and help to rebuild and strengthen the trust relationships between local citizens. Only when a community is geared up to support recovery can recovery be genuinely successful.

Our ambition is to help support, enable and mobilise local communities to meet some of the major individual, social, health and financial challenges related to substance misuse and to begin to realise the ambitions of developing a community in which sustainable recovery can bea reality. By doing this, we hope to add to the evidence base of recovery in the UK, share our learning, and assist in the development of a robust recovery network through the RSA’s 27,500 fellows alongside those already in the field.

Notes

1. The Prince’s Trust, Dec 2009; Youth Index 2010

2. White WL, Cloud W, 2008; Recovery Capital: A Primer for Addiction Professionals

Published in Addiction Today

User Centred Drug Services is also part of the Citizen Power programme