Transcript Document

Working together to
reduce harm : The
substance misuse
strategy for Wales
2008-2018
Our Strategy: Working together to reduce harm
• 'Working Together to Reduce Harm' is our ten year plan to
tackle the problems caused by drugs and alcohol in Wales.
Published in 2008, it sets out a clear national programme for
tackling and reducing the harms associated with substance
misuse.
• It is structured around four action areas:
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preventing harm
supporting substance misusers
supporting families
tackling availability and protecting individuals and communities.
Preventing harm
• We want to help people resist or reduce substance misuse by providing
information about the damage it can cause.
• We want to ensure that everyone understands the consequences of
misusing drugs or alcohol and knows where to get support.
• We will continue to concentrate on educating children and young
people. The All Wales School Liaison Core Programme (external link) is
a substance misuse education and crime prevention initiative. It is
jointly funded by the Welsh Government and the four Welsh Police
Forces.
• We will also do more to influence attitudes across the whole
population. In particular, we will place a greater focus on increasing
people’s awareness of the amount of alcohol they are drinking and the
associated risks.
• We want to encourage people in Wales to take responsibility for their
overall consumption and follow sensible drinking guidelines.
Supporting substance misusers
• We want to improve the health of people who misuse substances,
as well as supporting and maintaining their recovery.
• We provide support for substance misusers to reduce the harm
they cause themselves, their families and their communities.
This includes:
• basic ways of minimising harm and other advice
• outreach and other services aimed at engaging individuals in
treatment
• the recognised four tiers of service provision and relapse
prevention
• support services aimed at helping substance misusers access
accommodation, education, employment and training
• we will expand harm reduction services for drug misusers and do
more to engage priority and hard to reach groups.
• we will continue to promote existing services and begin to address
gaps in provision
Supporting families
• We want to reduce the risk of harm to children and adults
as a consequence of the substance misusing behaviour of a
family member.
• We want substance misusing parents to have access to
effective treatment, so that they can successfully parent
their children.
• We also have a responsibility, in partnership with others, to
ensure the child’s well being. Local authorities have a lead
role to play in identifying and supporting families. However,
it's important that agencies such as child and adult health
and social services, as well as local police, work together.
Tackling availability
• We want to reduce the harm caused by substance misuse
related crime and anti-social behaviour.
• We intend to tackle the availability of illegal drugs and the
inappropriate availability of alcohol and other substances. This
includes the sale of alcohol or solvents to young people.
Overall, we want:
• local partners to work more closely with local trading standards
departments to tackle traders who persistently sell alcohol to
children
• to make the best use of current powers and legislation
• to ensure that the full range of sanctions are brought to bear
against individuals who drink irresponsibly, and licensees who
continue to serve them
• partners to take a holistic approach to the management of our
towns and cities during the evening and night time.
Substance Misuse Finance
• We invest almost £50m into substance misuse in Wales in 2013-14.
• Substance misuse Area Planning Boards (APBs) are directly funded by
the Substance Misuse Action Fund (SMAF) and Local Health Boards
(LHB) via LHB revenue allocations.
• The SMAF budget in 2013-14 is £32.55m.
• £22.66m revenue and £5.07m capital of this funding is allocated to
APBs to deliver their regional substance misuse commissioning
strategies and to support local capital investment.
• The remaining £4.81m of SMAF funds:
-the All Wales Schools Core Liaison Programme
-Operation Tarian
-The Transitional Support Scheme
-other centrally supported policy initiatives such as the Welsh
National Database for Substance Misuse and the free bilingual All Wales
Substance Misuse Helpline, DAN 24/7.
• A further £17.13m is ring fenced within the Local Health Boards
revenue allocation for substance misuse services to support
prescribing services, psychosocial interventions and inpatient
treatment.
Prevalence
• Increased rates of substance misuse in people with mental
health problems 33-50% of those with SMI
• Welsh inpatient units report 40-60% of their population
have a dual diagnosis
• Alcohol misuse most common form
• Drug misuse frequently co-exists with alcohol misuse
• CMHTs report 8-15% of clients with dual diagnosis (higher in
inner cities)
Issues
• Services have evolved somewhat separately
• Drug treatment focused upon dependence
• Mental health services focused upon mental illness
• Dual diagnosis high risk presentation but likelihood of falling
between the cracks
• Evidence base illustrates a mutual dependence between
services
Issues
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Serial models unlikely to provide integrated care
Parallel models may also fail
Isolated dual diagnosis staff likely to burn out
pump priming vol. Orgs. to tackle issue in isolation likely to fail
One off training of little value
Specialist staff focusing on own caseload likely to be unable to
support mh & sm services more widely
• Mental health strategy clarifies lead role and prescribes link
workers
Service Criteria
diagnosis or
problematic use
need
social/medical
risk
to self/to others
The Criteria trap
Substance Misuse
Highly problematic
Substance Misuse
Less problematic
Substance Misuse
Mental Health Problem
Severe Mental Illness
Common Mental Health
Problems
The Criteria trap
Substance Misuse
Highly problematic
Substance Misuse
Less problematic
Substance Misuse
Mental Health Problem
Severe Mental Illness
Common Mental Health
Problems
The Criteria trap
Substance Misuse
Highly problematic
Substance Misuse
Less problematic
Substance Misuse
Mental Health Problem
Severe Mental Illness
Common Mental Health
Problems
Avoidable Deaths NCI 2006
Dual diagnosis –is one of the central problems facing mental
health services.
1659 (27%) suicides
72 (36%) homicides
In the report were dual diagnosis cases using a restrictive
definition, the contribution of dual diagnosis to patient suicides
and homicides may be substantially more.
Previously we have recommended the development of dual
Diagnosis services in all mental health trusts.
However, this is the Inquiry recommendation with the lowest
take- up Rate of those we have examined.
The Development of a Welsh
Service Framework
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Definition
Preferred model of care
Service aims and Objectives
Service Standards
Linkage to CPA ( Now Statutory Care and Treatment
planning)
Special Needs Groups
Needs assessment and Service planning
Training
Development of a care pathway
Framework definition
• Co-occurring substance use and mental health
problems.
• Taken together these problems give rise to significant
impairment and disability for which people affected
need advice, support and services, in order to follow a
more integrated life course.
• The severity and nature of a persons problems are
liable to change over time.
• Each problem, however, would be significant enough to
merit planned care on its own.
Preferred Service Models
Joint liaison collaborative
approach
Integrated
The care of patients is
jointly managed by both
services
Joint working required
between mental health and
substance misuse services
There is concurrent
provision of both
psychiatric and
substance misuse
interventions by the
same clinical team
(designated service)
Recommendations
• Agree local definition, care pathways and model using Care
Programme Approach (CPA) [Care and Treatment Planning in Wales]
• Develop service standards for dual diagnosis
• Need for tiered joint training programme
• Need for comprehensive staff supervisory arrangements
• Develop supervisory and training networks across voluntary and
statutory sector
• Specialist staff to work on an outreach consultancy model
• Ensure liaison with relevant generic agencies primary care,
homelessness organisations prisons A&E
Policy and Legislative requirements
• Implementation of Part 2 of the Measure: Holistic Care and
Treatment Planning
• Development of Protocols and Care Pathways at a Local SMAB and
MHPB level
• Ensure training delivered for all relevant staff
• Use of the NCISH toolkit within services