Presentation on theme: "History of substance misuse in Lancashire"— Presentation transcript:
1Substance misuse services: Lancashire Chris Lee Public Health Lancashire County Council
2History of substance misuse in Lancashire Difficult history, under spends, poor servicesLacked design, no clear system, inequitable provision, unacceptable waiting timesDifficult commissioner/provider relationshipsVaried performanceLack of political supportBlock contracts (substance misuse tied up with mental health)Alcohol: Historically little funding, Long waiting lists, Very little performance data
3Modernisation of adult treatment system 2008 – North Lancs – Integrated substance misuse services2009 – East Lancs follows North and adds CJ2009 – Central follows East adds IDTS– further redesign in North and CentralIntegrated prison and communityRecovery orientated, asset based, 5 Ways to Health and WellbeingIncludes prison based therapeutic communities (2 of 4 nationally)
4Present day Alcohol fully embedded in substance misuse services Use all budgets as substance misuseSystem designed to meet the needs of the population – not just opiate/alcohol (cannabis/stimulants/NPS)Applied drug targets where alcohol target missing eg waiting timesSignificantly improved performance: Successful completions growing, waiting times very low, improvement in wider outcomes – housing, employment, reducing injecting, growth in detox etc
5Alcohol now equates to approx 2/3 of all referrals Case loads still opiate dominatedShorter ‘in treatment’ period for alcohol 89% of alcohol users in treatment 12 months or less (opiates – 34.4% 2 years or less; 28.8% 6 years plus)Majority of community and inpatient detox = alcoholAlmost half of alcohol users living with children (less than 10% for opiate users)
6AUDIT-C(3 questions)Where individual scores below 7, no further action requiredWhere individual scores 7+, ask remaining 7 AUDIT questions for total scoreAUDITScore 0-7AUDITScore 8 -15AUDITScore 16+Congratulate and reinforce benefits of lower risk drinking.Complete Brief Assessment and Deliver ‘Brief Advice’Signpost - groups/SMART/mutual aid/peer mentorsOpen Access as per Strength based assessment PathwayFor Abstinent Service Users assessment sessions to be completed then refer directly to DEAPTo all who scoreAUDIT 16+PLUS offer: Welcome group, 1 x Recovery plan session, 3 x sessions or delivered as 3 group work sessions, 1 exit sessionSADQ score 20+ also refer to Alcohol Detox Team regarding medically assisted withdrawal and pre-detox groupSADQ 30+ offer above as appropriate and consider referral to Tier 4 as per pathwayseek advice fromAlcohol Detox Team regarding medically assisted withdrawalThose who score Audit 16+ who require community alcohol detox will be encouraged to work on the alcohol sessions and attend pre-detox group, RAMP or Intuitive Recovery.A referral to DEAP will be made where identified in the recovery plan.People who cannot undertake the Sessions, or who work, can still access community detox: related clinical need will drive this journey
7IssuesProfessional resistance to joining drug and alcohol together (not from service users)Dual diagnosis:DD is the norm, not a rare eventOften present asCJ issuesHomeless/housing needHistory of service disengagementAlcohol and cannabis (largest cohort)MH issuesWhat appears to be a fragmented service response from MHSM services commissioned to work with partners – will adapt to changes in partner providers etcSm services offer an inclusive approachMH services commissioned differentlyExclusive approach, different teams with differing criteria, more fragmentedLiaison model difficult when one side commits and the other disengages.Would be great to include SM providers and commissioners in MH redesign to ensure effective care pathways.