Category: Substance Use

Seeing the whole person: Reflections on a journey into employment

Fulfilling Lives South East

This blog post has been written by a colleague with lived experience of multiple disadvantage and is a personal reflection of the employment journey they travelled, including within their role at Fulfilling Lives South East. 

Citrus Ornge

My employment journey began over three years ago, when Rob Robinson who was working with me as part of the IPS (Individual Placement and Support) trial at a substance misuse service introduced me to Jason at Citrus Ornge. At the time I was volunteering, studying and taking part in wellbeing groups but I could not really visualise a pathway into employment for myself. Looking back, I realise I had internalised a lot of stigma and my self-esteem was quite low – I didn’t think anyone would believe in me enough to offer me paid employment. Many of my IPS meetings had been spent agonising over gaps on my C.V, which felt like a road block… something which even if I got to an interview I could be faced with trying to explain or apologise for. I felt I had wasted the career I had before.

Rob came with me to meet Jason informally. It took a while to absorb the fact I was in a room with a potential employer who was in recovery themselves and open about that, and that I was invited to be too. There was no need to explain gaps in my C.V or that my references would be from people I volunteered with rather than worked for. And so, I became the first employee of Citrus Ornge.

I had no media or business experience and did not even own a laptop, so Jason lent me one and I went to work one day a week. I was shown how to do what I needed to do – learning new skills in the process – and I did it. What I did know was that Citrus Ornge had a social mission that I admired and wanted to help with if I could.

Emotionally, it was a time of change and growth. Like many people in recovery, I had experienced trauma and feeling safe in different spaces was something I was working on. Sitting in an open office space surrounded by people with laptops from 9am to 5pm was something new, and I had to learn to be in that space. Facing anxiety and not letting it win, grounding myself in a place where I felt the acceptance of being with someone else in recovery. Continued regular IPS support was vital to keep me focussed on the positives, recognising my achievements and moving forward.

Jason introduced me to the idea that people in recovery have unique assets that should be valued by employers, and I learned from how open and honest he was about his own recovery that it is not something we should be ashamed of in professional spaces.  I wondered if other employers existed that thought about recovery this way.

Months on, Citrus Ornge had grown to a handful of employees. Someone at the service I was still volunteering with showed me an advert for a job at Fulfilling Lives. Having lived experience of multiple complex needs was a requirement for the role, much of my volunteering experience was relevant and I now had recent experience of employment. The project looked too interesting to let the opportunity pass by, so, I decided to apply for the role. I didn’t expect to get the job or even an interview and had prepared for that outcome with people in my support network but saw applying as a step in the right direction.

Fulfilling Lives

I started in a 3 day per week role at Fulfilling Lives and was then promoted to full time. I have been here 2 and a half years now. During my early months, I benefitted greatly from having regular supervisions where I could measure what I was learning against an induction checklist, raise any concerns and set goals. Having a list of what I was expected to achieve during my first six months was a reassuring, clear and objective way to look at my progress – this was important as I was tending to focus on my perceived failures and shortcomings at that time.

Like my experience at Citrus Ornge, I saw others being open about their lived experience but took time to feel I could start to do that myself. After building relationships of trust with my team, discussions in reflective practice sessions, and training about professional boundaries, I became more confident about judging what to share and when, knowing what I was comfortable with, how to speak from lived experience without sharing details I was not comfortable with, how to assert boundaries and making judgements about whether sharing something about myself would be of benefit to someone I was supporting or a piece of work. Over time I have started to make peace with my lived experience, integrate those experiences into my current identity, and rather than making a journey from a person in recovery to a professional, I have become a professional who is also in recovery.   

Monthly strengths-based, psychologically informed supervisions have facilitated development of my confidence and I am now able to recognise my own strengths and interests and more likely to take on new challenges at work. Being in an environment that genuinely supports me to perform at my best means I feel like my team are behind me even when I’m working as an individual. I know that if something is a challenge for me, I can view it as an area to work on rather than something I have failed at. As an example, the first time I had to stand up and speak in front of a room of people, I was so nervous I could not even stand up from my chair and a colleague delivered my part of the presentation. After working with my manager and development worker, and conversations with colleagues who were so non-judgemental and generous with their own stories of taking on challenges, I presented at a conference two weeks later. To date I have taken part in delivering training to hundreds of people.

This style of supervision has also positively influenced the way I mentor others within my role, by modelling a collaborative approach based on trust, building on and affirming strengths, supporting people to achieve their goals and creating safe strategies to cope with times resilience is tested.

I hope that anyone reading this gets a sense of how grateful I am for the IPS Trial, Citrus Ornge and Fulfilling Lives, and the impact they have had on my life. As I write this, I am about to start a new role and continue my employment journey – a journey I wasn’t sure would ever happen. We acknowledge the critical importance of believing in people whilst they are accessing support services and in the early stages of recovery, but recovery, learning, and growing never stop. Can we say we really believe in people if we only believe in them up to a certain point?

Learn more about employing people with lived experience of MCN

For those who are interested in Fulfilling Lives’ learning about employing people with lived experience of multiple complex needs such as my myself, we have created an employment toolkit which is available to download here:

Download here

For more information about Citrus Ornge and their social mission

Visit Citrus Ornge website

Authors:

Anonymous Fulfilling Lives Team Member

For further information about Fulfilling Lives work in this area, please contact:

Andree.Ralph@sefulfillinglives.org.uk, Co-production and Engagement Lead:

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CGL Women’s Hub: A new Treatment Pathway?

Fulfilling Lives South East

Ideas about who uses drug and alcohol services and how they use them need to be challenged. In Hastings, the CGL Women’s Hub has been quietly doing this. However, in the run up to the publication of a report on its work, the noises coming out of the Women’s Hub are getting louder.

In a way it’s a simple idea. Create a place where service users want to go, that meets their needs… and meet them there.

CGL (or Change Grow Live to give it it’s full name), is the main provider of drug and alcohol support services across Sussex. In August 2021, a new initiative with Fulfilling Lives saw the appointment of Rachel Payne, a practice development worker who identified a need for better treatment pathways for women. Nationally, treatment services have seen considerably more men access their services than women (69% to 31%, PHE 2020). For many this has reinforced the idea that men are more likely to need the service. However, there are a few working in these services who have been questioning whether the way a service is offered can be a barrier to more women accessing effective treatment. The CGL Women’s Hub seems to suggest this is the case.

Katie Lowe went to the weekly Women’s Hub to see first-hand what is happening at a service which is seeing a 78% increase in engagement compared with keyworker meetings and a nearly 300% increase in their participation compared to groups run out of their high street offices. As a psychology student on placement with Fulfilling Lives, Katie had no previous experience with drug and alcohol services and really didn’t know what to expect:

When I got there, I was given a warm welcome and encouraged to get involved in the craft session that had already started. I later found out this is run every week by one of CGL’s volunteers. What struck me early on was how much everyone seemed to want to be there. Not just the women but the staff too. Rachel filled me in on the details: The Hub meets every Tuesday at a local community venue. This allows the service to provide an inclusive women-only space. This neutral venue is not associated with medical treatment, men who may or may not pose a risk or the stigma of being seen walking in from a busy high street. Deciding to run it on a Tuesday was not an accident. Rachel mapped out the other services women might want to attend and found a space that didn’t clash. Staff at the Hub have encouraged women to try out these different services, with small groups arranging by themselves to go together. In some cases, their participation has gone from just turning up for a required medical appointment to attending multiple support groups across the week.

Women can come and go as they please, take part in any of the available activities or just sit and chat. It’s their choice. With an average of 2.6 hours spent at the Hub when they do go, it suggests they get involved in a lot. Local charity Dom’s Food Mission provides supplies for breakfast and lunch. There’s the 2-hour creative group which I dropped in to, often running alongside a beautician offering hair and nail treatments and once a month a hairdresser. After lunch there is an accommodation specialist on hand for drop-in advice, a space to generally chat and get support and regular visits from an NHS sexual health nurse (who reports being able to see as many clients in an hour at the Hub as a whole day trying to meet them in the community). Then there’s acupuncture with a guided meditation followed by a yoga session before everything ends at 3pm. Coming together in this way has allowed women to meet with friends and make new ones in a place that feels safe. It seems to restore social and relational experiences in a way that feels normal in a sector where treatment can be retraumatising for many women.

Friendships, community, meals and clothes are all things we can take for granted if we are not dealing with multiple complex needs. However, Rachel will tell you this busy schedule wasn’t always the plan. Local services have been as much drawn to the Hub as the women themselves, offering support and staff time, all focused on a shared desire for women to get the service they need. Outreach workers, care coordinators and keyworkers from CGL, Seaview and Project Adder have all been involved in running and planning activities. Others have provided quality clothes donations and the combination of a local branch of Tesco and the Hygiene Bank provided items to give to women for free.

Taking this approach has the potential to make a huge impact on the way substance misuse services are structured, and how clients access treatment. There are spaces at the Hub for care coordinators and outreach workers to meet confidentially with women. The Women’s Hub has also been used by occupational therapists, domestic violence workers from Respite Rooms, HomeWorks and the Rough Sleepers Initiative, to meet clients and connect them to CGL’s treatment pathway. So far there’s been cases of women accessing CGL treatment by coming along to the Hub, assessments being carried out at the Hub, and this has even led to women going to detox and rehab. In a way it’s a simple idea. Create a place where service users want to go, that meets their needs… and meet them there. The statistics back this up as a place women with multiple and complex needs want to go. Since it began in November 2021, the Hub has seen 47 different women with an average attendance of 63% – no mean feat for a weekly programme with a service user group often considered ‘difficult to engage.

With Rachel’s own interest and the years-long investment of Fulfilling Lives in specialist women’s services, this approach made sense. However, there is already talk of how this approach might better meet the needs of other marginalised and minority service user groups who are not accessing treatment at CGL’s main offices. With 65% of service users accessing treatment by self-referral or through family and friends (PHE 2020), creating spaces that feel safe for marginalised people will be vital to genuinely inclusive treatment pathways.

Providing the service is inexpensive, with activities and groups being offered free of charge by the different services involved. Many of the staff can use the space to do work that they would have been doing anyway and reach several clients at the same time. There is a small cost for venue hire and arts and crafts projects but that is easily justified by the reach of the service. Creating and chatting with other women is what makes the Hub what it is. Rachel and the team are using these activities to engage with some of the most marginalised and excluded women, reaching out and connecting in a meaningful way.

It’s early days but all the indications are that the Women’s Hub is demonstrating a model of drug and alcohol treatment that is meaningful. There are many positives to this approach; building a safe, inclusive environment for women to access services which otherwise might have felt unsafe. Of course, moving from centralised office spaces would be unfamiliar to most in substance misuse services. There are also some logistical challenges to booking suitable community venues (made easier in the wake of the pandemic as bookings dried up leaving space for new initiatives like this). However, the early signs present an exciting challenge to drug and alcohol services that will be hard to ignore.

Authors:

Katie Lowe, Psychology student on placement with Fulfilling Lives

David Garret, Practice Development Coordinator

For further information about Fulfilling Lives work in this area, please contact:

david.garret@bht.org.uk

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Review on Drugs – will change happen for people with Multiple Complex Needs?

Fulfilling Lives South East

In August 2020, Fulfilling Lives South East (FLSE) responded to a call for evidence to support Dame Carol Black’s Part 2 report that focuses on the treatment, recovery and prevention of substance misuse. FLSE’s Service User Involvement team also contributed directly to Dame Carol’s consultation through the National Expert Citizens Group. The report, which contains 32 recommendations for change across various government departments and other organisations, was published in July 2021 and the Fulfilling Lives’ team now reflects on how far the measures go in meeting the needs of those with multiple complex needs.

Time to reflect and review

The Review is momentous on several counts and relevant to the work FLSE undertakes. When reflecting on the recommendations we made in 2020, altogether, we found 14 recommendations out of the total 32 that speak to our asks related to multi-agency working and integrated services; trained workforces providing trauma-informed support; the criminal justice system/repeat offending; housing and employment support; treatment and access needs for co-existing conditions; healthcare inequalities; assertive outreach; peer mentoring and recovery communities. The Review contains findings that are compelling and serve as a reminder that organisations working to improve systems for people with multiple complex needs are not lone voices.

For example, our research found that substance misuse problems always exist in a wider context so it can’t be addressed in isolation. Overlapping complex issues need to be considered when providing support in a trauma-informed manner because addiction is often a response to deep trauma. We were pleased to see that the Review acknowledges that mental health problems and trauma (physical, sexual and psychological) often lies at the heart of drug and alcohol dependence and views them as “co-morbidities rather than separate problems for ‘dual diagnosis’”.

An overwhelming majority of our research respondents strongly felt that peer support and mentoring had been essential to their recovery and peer mentors should be assigned to those finding it difficult to engage with services. In response, the Review recommends that services recruit or include people with lived experience of drug dependence working as recovery champions, recovery coaches and peer mentors, which speaks to our work with the DWP. It further states that they should also provide networks of peer-based recovery support and establish communities of recovery and mutual aid groups. We’re thankful that the Review also calls for increased funding to aid the expansion of local areas’ support for peer-led grass-roots recovery communities and peer mentoring in order to complement professionally led services.

Our Concerns

Whilst we welcome the Review’s recommendations on peer-based recovery support, we are disappointed in the lack of advocacy for more specific women-only recovery and refuge spaces in early recovery and intervention. Our Lived Experience Perspectives Report, which was drawn from a series of conversations with women that have experienced drug and alcohol misuse, highlights the need for women to feel safe while sharing a number of gender-specific intersecting needs and issues including (but not limited to) the experience of coercive and abusive relationships, removal of children by social services and sexual exploitation. Many women we spoke to felt that mixed settings in hostels and temporary accommodation pose a risk to women who may have experienced complex trauma and valued ongoing participation in women’s groups:

“We share and see emotions in a different way to men, so it is essential to be in a safe space where women have similar ways to understand and to communicate emotions.”

Fulfilling Lives South East submission on ‘Lived Experience Perspectives’ for the Independent Review of Drugs by Professor Dame Carol Black

Despite the acknowledgement of overlapping and complex issues, we still feel there needs to be an explicit definition of multiple and complex needs within Dame Carol Black’s part 2 report. We believe that the complexities of overlapping and multiple disadvantage should be named and adequately defined in order to provide more targeted support that is free from judgement, stigmatization or unfair treatment and exclusion.

How will these measures impact those experiencing drug/alcohol misuse and complex needs?

The recommendations – if enacted – have the potential to radically change the way someone with multiple complex needs experiences the support system while on their path to recovery. Agencies working together would reduce the likelihood of service users being left out in the cold or reaching an impasse where no service assumes responsibility. The suggestion of consideration (unfortunately not a requirement) that the NHS target those with substance dependencies, and that commissioned substance misuse services incorporate select mental health treatment, would finally allow those suffering mental ill-health and substance dependency to engage in treatment that is designed to target both at the same time, rather than neither, as is the case for many. This is the official stamp for what many in the sector have been championing for a long time.

Increasing the number of well-trained mental health professionals is a necessary complement to combined mental health and substance misuse treatment, and a trauma-educated workforce would help to build trust with those they support, the importance of which should not be understated. With many mental health professionals and psychotherapists holding the view that early relationships are a significant contributor to mental health problems and addiction, it follows that they are also an important part of someone’s recovery.

The review recognises that the criminal justice system isn’t the most appropriate place for someone with substance dependency, and rightfully suggests that treatment is the most suitable outcome. It goes on to recommend that upon release, everyone has identification and a bank account, with access to benefits services and community drug treatment as soon as possible after release from prison.  If these recommendations are enacted, those already stigmatised could avoid further stigmatisation and damage to their sense of self, the additional barriers that result from incarceration, and the effects of being institutionalised by the prison system.

Although the review didn’t go on to recommend any direct action to improve housing for those with substance dependency, it was a step in the right direction to suggest the relevant government departments work together to gain a better understanding of the needs of this cohort. Similarly, regarding health inequalities, there was no proposed solution, more of a stern word to the government to get a plan together by the end of 2021 to integrate specific health service provisions for this group into the local integrated care system.

Final reflections

The recommendations vary in their assertions and don’t always provide direct solutions. Regardless, the Dame Carol Black review has laid bare the barriers faced by people with multiple complex needs who suffer from addiction. The proposals are a clear message to the government to take responsibility for the systemic shortcomings that, at best, hinder recovery and at worst, add to the physical and psychological decline of the most vulnerable in society. The announcement of a 10-year drug strategy provides the government with the opportunity to implement the recommendations put forth in this report, ensuring that the road to stability for people experiencing addiction and associated problems would be smoother and easier to navigate than ever before.

“The government’s 10-year strategy looks great on the surface, with commitment to delivering on all recommendations laid out in Part 2 of the report being a highlight. There is some cause for concern though. It doesn’t reflect the lack of control faced by people with substance addiction, as judges will still be able to issue custodial sentences for non-compliance of community sentences. The ‘tougher consequences’ line is also baffling. Tough consequences don’t deter people from using drugs and the idea of taking away someone’s passport/driving license is bizarre. They haven’t alluded to what other ‘tough consequences’ are being considered, so that is a bit of a worry. It also would have been nice for the government to legitimise the role of peer supporters by referring to the post as a paid role’’

– Engagement and Co-Production Worker

Authors: Ian Harrison, Emily Page, Aditi Bhonagiri

Resources:

Lived Experience Perspectives Report: Fulfilling-Lives-Lived-experience-Dame-Carol-Black-Independent-Review-of-Drugs.pdf (bht.org.uk)

Dame Carol Black’s Part 2 report that focuses on the treatment, recovery and prevention on substance misuse: Review of drugs: phase two report – GOV.UK (www.gov.uk)

For further information about Fulfilling Lives work in this area, please contact Rebecca, Systems Change Lead: rebecca.rieley@sefulfillinglives.org.uk

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A New Approach: The Trauma Stabilisation Pilot  

Fulfilling Lives South East1 Comment

Gemma Harfleet shares her thoughts on the first few months of the new Trauma Stabilisation pilot; Outreach support for women who want to go to rehab but their trauma experience has made it difficult to get there or stay for as long as they need…  

The Problem

For years I have seen and felt the frustration of women with complex trauma and addiction being told they are too complex to access a service or they need to stop using substances to receive any support – as if they should somehow have held things together a bit better if they really wanted help. As a Specialist Women’s Worker with Fulfilling Lives, I’ve seen how tailored trauma stabilisation work in an outreach model can really make a difference and help those who’ve been all but written off. Training in trauma stabilisation shifted the way I was able to work by talking about the present symptoms of trauma and ways of managing this, so it doesn’t get in the way of achieving recovery goals. Now I’m excited to see what happens with a focus on trauma for women who want to go to rehab in Brighton. 

We have fewer women going into rehab but they are accessing community support. There isn’t much research on why this is and what can be done to improve women’s experiences in recovery. We’ve known for a long time that men seem more likely to need the support of rehab. However, not a lot of attention has been paid to voices questioning if this might also be because women’s needs are often different. We know men and women survive addiction and homelessness differently – which often leads to more complex trauma because of domestic abuse and sexual exploitation.  

The Complexity

Since the start of the pilot, I’ve been meeting with women in rehab, those with lived experience, with services that have supported them and those who work in rehabs. I wanted to know what preparation women had before going into rehab, what was their experience when they were there and what they thought was missing. Yes, I had this idea. But I wanted to check that it would meet the needs of women right from start. These women have been so generous with their experiences of addiction and rehab, sharing with the kind of infectious courage you get from people in recovery. We know more trauma support needs to be done with women in addiction but doing this survey made this even clearer. Particularly we are hearing how those supporting women can be understandably cautious about giving space to talk about trauma for fear of making things worse. However, I’ve experienced how building a sense of safety and having the training to talk about trauma (but not asking about specific experiences) can equip women with the understanding they need to start their recovery journeys. What women want is to understand their trauma, how it impacts them and those closest to them, to know it’s not because they’re broken and have a space to think about what they want to do about it. 

The Pilot

Of course, we learnt so much more from these journeys and we will be bringing that together in a report to help guide the pilot. I’m also reaching out to other services in the city that support women – to work together, share resources and show the strength of the networks of women they can be a part of. We are not alone. 

My thanks and appreciation go out to the BHT detox and recovery projects, CGL, Oasis, the Rita Project, Cascade Recovery, Nelson Trust, Jen at the Africa House café, Move-On, RISE and Threshold. None of them needed convincing, all of them have given their time and thoughts and many have also nominated women to the pilot. 

Author: Gemma Harfleet

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Independent Review on Drugs: Perspectives of women and creative recovery groups

Fulfilling Lives South East1 Comment

In 2020, the Service User Involvement team at Fulfilling Lives South East fed into the public consultations towards the Independent Review of Drugs by Dame Carol Black, commissioned by the Home Secretary. This blogpost outlines the process of gathering the unique lived experience perspectives of women who had used the substance misuse services as well as creative recovery groups. The findings from our submission have now been published into a report which provides the local context of accessing drug treatment and recovery in East Sussex.

Context

In February 2019, the Home Secretary appointed Professor Dame Carol Black to undertake an independent review of drugs to inform the government’s thinking on what more can be done to tackle the harm that drugs cause. The study took place in two phases; the first phase was published in February 2020 and included a rigorous and ground-breaking analysis to understand the complex and overlapping markets for illegal drugs, which can be read here: https://www.gov.uk/government/publications/review-of-drugsphase-one-report/review-of-drugs-summary.

In July 2020, public consultations began for the second part of the review and focussed on understanding the challenges involved in drug treatment, prevention and recovery and opportunities for improvement. Fulfilling Lives South East Partnership (FLSE) fed into the public consultations though the National Expert Citizens Group (NECG), who were approached to gather the views of people with experience of substance misuse as well as other intersecting complex needs such as mental ill health, homelessness, domestic abuse, and removal of children.

The NECG is a partnership of people connected to all of the 12 Fulfilling Lives projects across the country, who also have direct experience of multiple disadvantages. Their aim is to raise the bar on co-production and to demonstrate how lived experience leadership and insight can change systems and services.

Collecting Insights

As part of our contributions, team members from FLSE’s Service User Engagement team conducted a series of 1-2-1 and group discussions to collect unique perspectives from women who have experienced drug and alcohol misuse as well as with mixed gendered peer-led creative recovery groups. The conversations centred around four questions:

1. How can we make it easier for people to access drug treatment and recovery services, and stay in contact with those services?

2. How can we ensure the mental health needs of people in treatment are met?

3. What is the best way to meet the employment and housing needs of those in treatment and recovery?

4. What else stops people recovering and why might they relapse? What would help?

Summary of Findings

Throughout these conversations there were common threads; regardless whether the individuals were currently using services, had used them in the past, or were themselves providing support at present. These consistent messages highlighted the following:

1. Trauma needs to be addressed as part of any treatment.

2. The need for a holistic approach to treatment and support; mental and emotional health, access to employment and housing, community support, etc.

3. The importance of personal development; rebuilding one’s identity, develop self-esteem, focus on assets, learn healthy interactions and relationships.

4. The power of peers; they act as role models, inspiration and aspiration.

5. The impact of the Recovery Community; that it’s not necessarily focussed on addiction, develops creativity, sense of community, enjoyment and fun.

Author: Aditi Bhonagiri and Nelida Señoran-Martin

The full report on FLSE’s submission with in-depth findings on the lived experience perspectives from our target group for the Independent Review of Drugs by Professor Dame Carol Black can be found here: Fulfilling-Lives-Lived-experience-Dame-Carol-Black-Independent-Review-of-Drugs.pdf (bht.org.uk)

Dame Carol Black’s recommendations on the second phase of the Review can be found here: https://www.gov.uk/government/publications/review-of-drugs-phase-two-report