Transcript Challenges to the provision of substance misuse support to

Providing substance misuse support to
LGB & T people
New trends, challenges and developing a
strategic approach through commissioning
Monty Moncrieff
Overview
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Recent trends
Meeting new needs
Club Drug Clinic – NHS partnership
Commissioning for LGB & T users
Who are we?
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London Friend – since 1972
Antidote – since 2002
Antidote @ Friend – since 2011
Antidote funded via Big Lottery Fund 2011-15
Recent trends
Issue
2005
2011
GHB/GBL
3.2%
27%
Crystal meth
0%
39%
Mephedrone
0%
14%
Referrals from GUM, A&E,
statutory drug services
8%
63%
Recent trends in MSM
Of G and crystal users:
• 95% using to facilitate sex
• 80% injecting (70% shared equipment)
• Prefer to use ‘bareback’ sites to find sex
• Average 5 partners per episode
• 75% HIV+
• 90% attribute diagnosis to drugs and alcohol
• 60% non-adherence to ARVs whilst ‘high’
• >50% of HIV negative men had at least one
course of PEP in past year
More worrying trends
Recent trends
• Dependent use of G (requiring medical
detoxification)
• Unable to prescribe substitute
• Acute psychosis
• A & E presentations with acute intoxication or
withdrawal
• Game-changer for drugs services and the LGB
&T population
Meeting new need
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Different interventions
Different awareness
Educating mainstream providers
Satellite & partner provision – especially GUM
– Code Clinic
• Awareness in sexual health settings
• Informing policy makers
Club Drug Clinic
Club Drug Clinic
• Central & North West London NHS Foundation
Trust
• Drug Treatment Centre at Chelsea &
Westminster Hospital
• Response to number of men presenting via
GUM with substance misuse needs
• Innovation funding from CNWL - £200k/year
for two years (Apr 2011 – Mar 2013)
Club Drug Clinic
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Open to all – not LGBT specific
Not restricted by local authority
Multi-disciplinary team
Antidote – LGB & T expertise, structured
psychosocial interventions and recovery
support
• For service users = seamless ‘one-stop’ service
responsive to need and aware of LGB & T
issues
Club Drug Clinic
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> 250 clients
High level of LGB & T clients (84%, mostly MSM)
68% new to treatment
Distinctive divide in patterns of use LGBT/nonLGBT
• 60 G detoxes (58% of G users)
• 87% feel made progress with drug problem (10%
uncertain, 3% no progress)
Commissioning
• Central government funding (Pooled
Treatment Budget)
• Via DAATs according to local need
• Traditional focus on opiate and crack cocaine
users
• Strong criminal justice focus
• Poor focus on LGB & T diversity
Scoping Study
• Department of Health IESD funded
• Reports in 2014
• Explore options for commissioning for LGB & T
need – strategic inclusion
• Offer additional training and support
• Share learning to national commissioners
Challenges
• Lack of data – clients outside of PTB-funded
services being ‘missed’ centrally
• Comparable data – mirroring NDTMS
• NDTMS existing data – poor LGB, no T
• Challenging commissioners’ performance
Opportunities for commissioners
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High level of new-to-treatment clients
High level of drug-free discharges
Low rates of offending
Payment by results potential
Synergies with sexual and mental health
providers
LGB & T Audit Tools
LGB & T Audit Tools
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Organisation policies
Needs assessment
Commissioning intentions
Outcomes for LGB & T clients
Workforce competence & development
Meeting Public Sector Equality Duties
Creating a welcoming environment
Interventions and referral pathways
Questions for Commissioning
• Are LGB & T populations analysed in your JSNA or
DAAT business plan?
• Does LGB & T need feature in your joint health &
well-being strategies?
• Are you setting objectives that are LGB & T
inclusive?
• Are you utilising LGB & T health research in your
planning?
• What goals are you setting to fill any gaps in
evidence for the next strategic review?
Questions for Commissioners
• Are you asking your providers to monitor
sexual orientation and gender identity?
• Are you asking your providers (and potential
providers) to demonstrate how they will
achieve outcomes for your LGB & T
populations in tender documents?
• Are you monitoring outcomes for LGB & T
people with your providers?
Questions for Commissioners
• What engagement have you carried out with
local LGB & T people and organisations?
• How are you ensuring your providers are LGB
& T competent?
• How can you demonstrate you’re meeting
your Public Sector Equality Duty in regards to
sexual orientation and gender reassignment?
Invitation to Join
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Commissioners
Providers
Carry out audits
Work to develop local action plans
Work cross-boundary in London
Share knowledge nationally
Contact details
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www.londonfriend.org.uk
www.londonfriend.org.uk/antidote
[email protected]
020 7833 1674