A ‘recovery agenda’ has shifted our focus on support for people with drug and alcohol problems in recent years, but how much does recovery still equate to treatment, and how far do we understand the parts that happen next - the parts that so far, remain largely unmeasured and undefined?
As we come to the conclusion of our Whole Person Recovery project, where we’re trialling interventions in drug and alcohol rehabilitation for long-term recovery, we ran a workshop pooling the knowledge of experts, partners, service users and Fellows to discuss the emerging project findings, share learning with others in the field, and explore the priorities we want to see in future policy and deliver.
The discussion was incredibly useful and very wide-ranging, and the discussion broadly focused on some key themes:
Systems should place more trust in the community. We heard about one recovery centre, where service users ran a daily drop-in session, complementing the structured treatment. Putting that level of trust in service users requires a shift in the way we understand a service user’s journey – giving them the reins not only for their own recovery, but also for those around them. However, there’s a fine line between enabling communities and institutionalising the community, and services should be wary of that.
We often miss a service user’s recovery ‘eureka’ moments. Seizing their positive energy can contribute to their recovery, and set them up as prime candidates to inspire the next group of people going into a recovery programme. Having the space to explore and understand oneself better in recovery is also a key chance to identify what makes that person tick - but often we haven’t got the structures in place to support that.
Measuring effective recovery services is challenging. Commissioned services require measurements and performance indicators. But how can you develop an effective transactional contract for a human journey? Also, recovery is a journey, not a fixed moment in time.
“If you design a service with fixed, rigid outcome targets you’re probably not going to hit them.”
Recovery uses loaded language: “Relapsing” implies you’re not past your addiction – but it’s an important part of the journey you go through - and in using language like abstinence, relapsing, and lapsing, we fall into a trap of definition rather than functionality. As a service provider, asking questions like “Are you doing alright at the moment?” may not be quantifiable, but gives you answers.
Recovery is a long process, and the structured treatment is only one part. Language can be used for good though – through encouraging community participation and creating a ‘recovery community’, we can help people realise that they are more than a “person in recovery” and are actively part of their local community – be it recovery, locality or interest.
“The one thing everybody wants is to belong somewhere”: What people are recovering from is often conflated with substance misuse – but it’s more than that, it’s about a disconnect from ourselves and others. In one survey that was mentioned, 75% of service users said they wanted to volunteer within their recovery community, but not necessarily within the recovery service. (This dropped to 25% who said they wanted volunteer in the wider community.)
There are still assumptions and stereotypes in place that need talking about: “There’s a weird perception that because I’ve done drugs I’m stupid, and because people’s lives have been a metaphorical car crash, they’re not capable. In fact, they may have picked up skills that make them the most phenomenal staff.”
Put the person, not the service, first: Recovery services work in silos – with competitive commissioning different services are reluctant to share information and mistakes. How can we share learning across different services and peer support groups when you’re constantly competing? And in a Payment by Results model, what is the scope to ensure services are personalised, and owned by the service user rather than the commissioner or the services?
And put the person, not the illness, first: When you take the condition out of the equation - be it drug and alcohol addiction recovery, cancer, depression or Alzheimer’s - you have the same issues: housing, stress, family relationships, and finance. If, structurally, we can’t undo the fragmented system we’ve created, should we be looking at stronger links between care teams and services, to focus on the individual rather than the condition?
If you’re interested in this side of the story, do explore the work of Making Every Adult Matter (MEAM), a coalition of charities fighting so that people experiencing multiple needs are supported by effective, coordinated services, and empowered to tackle their problems, reach their full potential and contribute to their communities.
We should shape systems to focus on people who use them, not on the services and structures - so that people can recognise their individual power and creativity, and can thrive.
A huge thank you to the speakers from the RSA, CRI, aspire2be and MEAM, and attendees who came and contributed their views, stories and experiences at the workshop.
If you do want to be involved then the best way is to ensure your profile on our website is up to date and that you select any of the interests on our list that are applicable to you. This is one of the main ways we find Fellows who might have an interest in a particular area of work. The final report will be launched in November – in the meantime, contact me to find out more.
Recovery in terms of ‘health’ care, rather than ‘sick’ care, and a long term focus on wellbeing, instead of simply treating the symptoms, is at the core of our latest report.