Drug addiction isn"t going away so why are treatment centres being slashed?

You may not know that your local authority is responsible for funding drug and alcohol treatment. And unless you, a friend or family member have been personally touched by addiction you might not think that these services should be a funding priority for cash-strapped councils.

We’re left to manage a host of intractable problems that we’re not qualified or able to deal with.

I work in a community drug and alcohol treatment centre and my job is to support people to overcome their addiction and support their recovery. When I arrive at work in the morning there is usually a queue of people outside wanting to get help.

They’re vulnerable people with complex needs and demand for our support is increasing. Yet we’ve seen our funding slashed by 42% since 2010. The situation is the same across the country.

I see fewer heroin users nowadays but far more people dependent on alcohol and people getting into problems with so-called party drugs such as methamphetamine and ketamine. The heroin users might be fewer in number, but they require more of our attention as they get older and sicker. They often have hepatitis C and smoke tobacco and succumb to liver and lung diseases as a consequence.

Addiction sits at the centre of a cluster of physical, psychological and social difficulties. Our service users need help and support in all these domains if they are to stand a chance of recovery. Our caseloads have got bigger because we have had to cut posts and as pressures elsewhere in the health and social care system builds, the complexity of the problems we are presented with has increased, too.

Even when there are clear mental health problems, mental health services don’t want to treat people who also use drugs or drink, so they send them to us. The same applies to the general hospitals – with access to liver treatments being rationed. I know they are also under pressure, with ever-expanding waiting lists, but as a consequence we are left to manage a host of intractable problems that we are not qualified or able to deal with.

Some of our clients lead chaotic lives and come to us in desperation with a whole host of difficulties that go far beyond addiction. They might be embroiled in the criminal justice system and need advice, they might have housing problems or be struggling with trauma; it is not uncommon for me to treat clients who used to be in care and have survived institutional abuse. We used to have psychologists in our team who could provide treatment for complex trauma related to sexual abuse but their posts were cut last year.

I have two clients who are so physically unwell that the local residential detox provider does not think they can safely manage them. The NHS-run unit we used to refer to because it had the necessary medical cover has been closed due to the cuts. If they don’t die beforehand, the only hope for my clients is that they will get a detox if they are admitted in an emergency with a physical health crisis to a general hospital.

With diminished resources we have had to prioritise treatments such as opiate substitute medications and needle exchange, which we know can keep people alive. But how are these actually helping people overcome their addiction?

Addictions services are often retendered with contracts being awarded to the cheapest bidder. I work with people who have had their service retendered and employer changed multiple times. This is a massively stressful process and I have friends who have left the sector feeling demoralised and burnt out.

We are judged on figures like the number of people leaving treatment drug-free, and treatment centres know that this can be used against them. The worst-kept secret in our sector is the gaming of this so-called “performance data”.

If a client drops out of treatment it will have a negative impact on our figures. One way to manage this is not to start the most chaotic people in treatment in the first place. People aren’t refused treatment but they are asked to jump through hoops before structured treatment is commenced.

A homeless, mentally unwell heroin user is going to find it difficult to attend a “treatment induction group”, but the consequence is that they never start on the medication that might actually help them.

Some facts are impossible to hide: drug-related deaths are increasing and new drugs and associated problems are causing problems in prisons and emergency departments. Even the shadow health secretary, Jonathan Ashworth, whose father was an alcoholic, has called for greater recognition of the damage done by excessive drinking.

Drug and alcohol use and addiction isn’t going to go away. I try to do the best I can for the people I work with. I try to close my ears to the negative and stigmatising language. Instead I keep my ears open to my clients and I try to find a connection and build a relationship that may help them in their recovery.

This series aims to give a voice to the staff behind the public services that are hit by mounting cuts and rising demand, and so often denigrated by the press, politicians and public. If you would like to write an article for the series, contact kirstie.brewer@theguardian.com

Talk to us on Twitter via @Guardianpublic and sign up for your free weekly Guardian Public Leaders newsletter with news and analysis sent direct to you every Thursday.

Drug addiction isn"t going away so why are treatment centres being slashed?

NHS to create specialist centres for childbirth mental health problems

The NHS is set to overhaul services for women who develop mental health problems around childbirth in a bid to ease the suffering caused by postnatal depression and reduce the number of new mothers who kill themselves or their baby.

NHS England is putting £40m into new specialist treatment centres for the one in five women whose pregnancy, birth or experience afterwards triggers serious psychological problems, including anxiety, depression and psychosis.

Claire Murdoch, its national mental health director, said these centres would end a “postcode lottery” in which two in three women currently affected missed out on vital help. While 14,000 new mothers each year received specialised support, the planned expansion of care would enable another 30,000 to do so by March 2021, said Murdoch, a former mental health nurse who also runs the Central and North West London NHS foundation trust in London.

“It’s self-evidently true that the current provision of these services is inadequate. There is a big postcode lottery. Some areas just do not have specialist community perinatal services available,” she added.

The money will be put into new community mental health units solely for women with perinatal mental health problems in 20 parts of England. They will be staffed by consultant psychiatrists specialising in such conditions, nurses with experience in the field, occupational therapists, psychologists and nursery nurses. Each will also run a buddying service in which women who have already experienced childbirth-related mental health problems will support those going through that or at risk of that.

Childbirth-related mental health conditions are estimated to cost the UK £8.1bn a year, or about £10,000 per birth.

Prof Lesley Regan, the president of the Royal College of Obstetricians and Gynaecologists, said: “Around one in five women develop a mental illness during pregnancy or in the first year after delivering their baby, and one quarter of all maternal deaths between six weeks and a year after childbirth are related to mental health problems.

“Despite these alarming figures, in almost half of the UK, pregnant women and new mothers have no access to specialist maternal mental health services and only 3% of [NHS] clinical commissioning groups [in England] have a maternal mental health service strategy,” she added.

The Royal College of Midwives backed the move but said that every maternity unit needed to have a specialist maternal mental health midwife on staff to help women in sometimes desperate need.

“We cannot continue to read the constant reports of the number of women killing themselves because they were not identified earlier and treated or because of the lack of trained staff or as a result of lack of services. It’s heartbreaking and we can do better as a country,” said Janet Fyle, the college’s professional policy advisor.

The NCT, the parenting charity, welcomed the NHS’s “positive plan” but warned that even if all 20 units were set up by 2021 as promised, there will still be “a long way to go” before all mothers who need help get it, said Elizabeth Duff, its senior policy adviser.

“There are nearly 300,000 women in the UK who suffer from mental health problems postnatally or when pregnant each year and the funding aims to reach 30,000 women in 20 areas, so there’s still a long way to go,” she added.

NHS England is also pledging to spend another £120m putting psychiatrists and specialist nurses into A&E units so that patients undergoing a mental health crisis when they turn up at an emergency department get better help.

NHS England plans to introduce new waiting-time standards to ensure that any such patient is seen by a mental health specialist within an hour of their arrival in A&E and also given a plan for their care within four hours.

NHS to create specialist centres for childbirth mental health problems

Inquest blasts immigration centre"s "shambolic" records in US man"s death

Harmondsworth immigration detention centre. Personnel there testified that they obtained restricted mental wellness awareness training. Photograph: Adrian Dennis/AFP/Getty Pictures

An inquest into the death of an American tourist who was detained on arrival at Heathrow has criticised an immigration centre’s medical data technique for currently being “shambolic”.

Returning a verdict of death by natural leads to compounded by neglect, the jury at West London coroner’s court thorough a catalogue of errors in Brian Dalrymple’s care.

The 35-12 months-old US citizen flew into the Uk in June 2011. He was stopped by Uk Border Agency personnel due to the fact his behaviour appeared uncommon. Dalrymple had schizophrenia and dangerously higher blood pressure.

He was carrying only a little cardboard box containing a coat, a minimize-throat razor and $ two,000 in cash. Immigration officers denied him leave to enter the nation and eliminated him to Harmondsworth elimination centre. Just before he could be returned to the US, he claimed asylum.

The jury’s narrative verdict stated: “The United kingdom Border Company contacted the House Workplace at Harmondsworth to request a psychiatric assessment and repeated the request on a quantity of occasions. No action was taken. The US Embassy were not notified of Mr Dalrymple’s detention.”

It continued: “Throughout Mr Dalrymple’s detention at Harmondsworth, healthcare record-maintaining was shambolic.”

Dalrymple was detained for 6 weeks. A handful of days ahead of he died he was transferred to another detention centre, Colnbrook, run by the personal operator Serco, but with out his healthcare information.

Workers at Colnbrook identified him as currently being mentally sick but by the time they had arranged a psychiatrist, Dalrymple was dead. His higher blood strain had brought on an aortic rupture.

The inquest had earlier heard that the physician at Harmondsworth had not had any induction training and did not know of the duty health-related practitioners have to inform the House Workplace of detainees with health-related motives for currently being released. There were no computerised health-related data all the detention centre’s records have been handwritten.

Detention centre staff from Harmondsworth testified that they received limited psychological overall health awareness training. 1 mentioned she felt underneath-equipped to deal with the vulnerable people she had to seem following. Two officers explained they had been not concerned about folks in Harmondsworth “muttering to themselves” simply because a great deal of individuals did that.

Dalrymple was taken to Hillingdon hospital nearby but then discharged himself against medical guidance. No clinician saw him following his discharge. His mother was represented at the inquest by Jocelyn Cockburn, of the law firm Hodge Jones &amp Allen, who said: “This situation shines a light on the perilous state of immigration custody in the Uk. It is anything that the British government can no longer disregard.

“There is a worrying trend emerging in these varieties of circumstances, specifically with the enhanced privatisation of what have always typically been public functions, that the standard care and healthcare remedy of detainees gets to be fragmented and specified essential actions are ignored, typically major to devastating consequences and it has to stop now before much more lives are lost.”

Deborah Coles, co-director of the organisation Inquest, which supports family members in coroner’s courts, stated: “This is a shocking death of a mentally and physically sick man who died in his cell as a outcome of corporate neglect and indifference. The catalogue of failings are not special to this situation but expose the plight of people held in immigration detention and the systemic neglect of detainees’ mental and bodily ill well being, as evidenced by the high numbers of deaths, suicide attempts and self-harm.”

A jury at the inquest into the death of Muhammad Shukat, who died at Colnbrook a month earlier, also concluded that neglect contributed to his death.

Responding to the verdict, Lorraine Dalrymple, Brian’s mom, mentioned: “The Uk Border Agency took away my son’s freedom that day and by putting him in a detention centre therefore accepting responsibility for his care. It would be a care so fragmented and disorganised that his psychological problem would deteriorate to the stage of him losing his dignity … and lastly due to lack of appropriate healthcare ultimately led to his death.

“I have accepted my accountability concerning my son’s death. I ignored my mother’s intuition and listened to other folks regarding England not being a third planet nation and Brian being protected … This was a mistake I will have to live with for the rest of my life … If I had acknowledged what I know now of what was happening, I’d have contacted absolutely everyone achievable, carried out every little thing attainable to support my son. My son did come house, but in a box.”

Inquest blasts immigration centre"s "shambolic" records in US man"s death

What is the effect of pro-daily life pregnancy tips centres? | Eva Wiseman

Anti-abortion campaigners protest outdoors a London clinic in 2012. Photograph: Ian Marlow/Alamy

I bear in mind the 12 months I was 18 as getting generally 1 long summer, but the cloying tense kind of summer that can make up coming-of-age novels, and news reviews on unusual crimes. It was a weekday, and my boyfriend and I have been in the middle of our artwork-foundation program, and I was anxious I might be pregnant. Except, pregnancy tests had been £15, and collectively, we only had a fiver.

On the escalators at Oxford Circus, I would observed a series of adverts. They were blue, I feel, and, in large white letters promised free of charge pregnancy testing and impartial advice. We left college slightly early one afternoon our journey into town from Chelsea as rush hour developed was quietly tense. We stood in a tiny crush of commuters and all their linked smells and we joked that I should inquire someone to give up their seat. The train was delayed. We stopped joking. We had been both aware this was a grownup journey. Maybe the most grownup journey we would ever take. On the escalators at Oxford Circus, pen prepared, I copied the handle from the ads on to my hand, and we skittered to the office, in a pedestrianised street near Leicester Square, bickering. Except, when we arrived, it was closed.

Fifteen years on, I can nonetheless keep in mind the hopelessness I felt and the awkward dread I carried with me on the walk back to the station. But nowadays I am also so furiously glad, so impossibly thankful for the problems on the tube. I have believed of that afternoon several occasions because discovering that individuals impartial pregnancy exams had been advertised by a professional-daily life organisation, and even more considering that last week seeing video of the conversations that occurred behind that closed door.

The latest investigation into crisis pregnancy centres (the unregulated outlets that encourage themselves as confidential advisory solutions) noticed counsellors supplying advice that was not tips. It was an anti-abortion banner diluted into speech. It was these photographs of bloody foetuses, and the tiny pink dolls girls get handed outside abortion clinics, all crammed into soft-spoken lies and a weak cup of tea. They informed youthful ladies who explained they’d just found they had been pregnant that abortions could lead to “an increased statistical likelihood of little one abuse” because girls had to break “natural barriers that are all around the child that you don’t cross” in purchase to terminate a pregnancy. They said that females who had terminations have been 25% much less likely to be in a position to have infants in the long term, and talked about “a website link with breast cancer”. One undercover journalist was advised that an abortion carried a quantity of dangers, like “sterility”, and that infection was “fairly common”. “Obviously the instruments that are utilized are sharp,” the counsellor mentioned, “and they can cut the wall of the womb.”

The older I get, the angrier I get. By the minute. How dare they topic ladies – vulnerable, younger females, who have gone to these locations due to the fact they have nowhere else to go – to their dark and prejudiced lies, ones designed to scare them? And at a moment when they’re currently terrified, too. How dare they call it impartial advice? It really is nevertheless unclear specifically who funds these clinics, but I know that if they’d advertised as professional-life, I would never ever have visited. You need to know exactly where you’re going. What they are selling. They must be forced to state their aims, appropriate there on the door. Laminated.

What would I have done, frightened and 18, with an grownup calmly telling me that I may well turn out to be a little one abuser if I had an abortion, and that I would practically certainly split up with my spouse, and that I would potentially, probably die? Would I have walked out instantly, back into that dusty syrupy heat, and gone over my overdraft in Boots? Or would I have stutteringly nodded along with the grownup in charge, and allow my life be driven west?

Email Eva at e.wiseman@observer.co.uk or follow her on Twitter @EvaWiseman

What is the effect of pro-daily life pregnancy tips centres? | Eva Wiseman

Abortion scandal: MPs urge Jeremy Hunt to act on Crisis Pregnancy Centres

His sentiments are echoed by three other MPs nonetheless, the Well being Secretary has so far refused to comment, regardless of repeat attempts by The Telegraph.

The report, compiled by Brook, a nationwide sexual well being charity, discovered that a additional 36 (on prime of the two previously exposed by The Telegraph) of 135 CPCs distributed misleading information or attempted to emotionally manipulate vulnerable women who had entered their centres for tips. These centres are dotted across the Uk and can be discovered in each key city, like Manchester, Birmingham, Oxford and Edinburgh.

A single counsellor informed an undercover researcher that terminations can lead to ladies committing criminal acts, the report claimed.

Two other CPCs presented females ultrasound scans, with promotional materials that ‘make it clear that scans are carried out with the sole intention of persuading men and women not to have abortions’, in accordance to Brook.

The disclosures will anger advocates of impartial abortion advice, who argue that the centres are bankrolled by ‘pro-life’ religious organisations.

Dr Sarah Wollaston, a former GP who is now the Conservative MP for Totnes and a member of the Health Choose Committee, reiterated her calls nowadays for Mr Hunt to overview the abortion counselling providers: “There has to be transparency about who is funding these organisations and whether or not they are anti-abortion.

“If a ‘clinic’ is providing healthcare guidance it must come beneath the remit of the Care Quality Commission which ought to then have the powers to shut it if it is giving out entirely false info.

“It is time for a standard review of these counselling services.”

The Brook report, which builds on The Telegraph’s findings, also discovered that at least four CPCs with religious affiliations had infiltrated GP practices and hospitals.

Other CPCs, none of which are regulated, were receiving referrals from local GPs and hospitals, the report explained.

Issues have been raised in latest many years more than the objectivity of guidance provided ladies considering termination. Anti-abortion campaigners think that women need to go to an independent centre ahead of undergoing the process because they say there is a likely conflict of curiosity in ladies acquiring counselling from an organisation that also carries out terminations, such as BPAS.

Brook researchers were also provided pictures of foetal growth, medically unsound tips and counselled by advisers with ‘a clear bias in direction of adoption’.

In 2011, a bill launched in the Commons to stop abortion suppliers from pre-abortion counselling was defeated. The government also scrapped ideas for a consultation on whether women need to be necessary to undergo independent counselling prior to an abortion.

Nadine Dorries, MP for Mid Bedfordshire, who proposed amendments to the Overall health and Social Care Bill 2011, mentioned in light of the Telegraph’s investigation:: “Jeremy Hunt demands to create how abortion counselling must appear.

“We need to go to a professional organisation like the British Association for Counselling and Psychotherapy and inquire them to build, on behalf of the government, a non-directional, agenda-totally free, abortion provision counselling model that we can then adopt into the guidelines.”

The Brook report concluded that the top quality of services supplied by CPCs was ‘extremely variable’ with significant numbers of CPCs spreading ‘myths’ about abortion via web sites, leaflets and counselling sessions.

Simon Blake OBE, Chief Executive of Brook, stated: “It is merely immoral and unacceptable to masquerade as a support that assists clients make decisions through exploring selections, when the reality is – as this report primarily based on younger women’s experiences displays – at some CPCs you will get a mixture of misinformation, coercion and fright tactics.”

Luciana Berger MP, Labour’s shadow public well being minister, said:

“Anyone studying these comments produced to ladies by people purporting to be counsellors will be disturbed.

“In light of this emerging proof on ladies obtaining incorrect details, we have to look once again at the lack of regulation in this region.

“Abortion counsellors need to be neutral. It are not able to be correct that they provide advice to women not based mostly on evidence.”

A spokesperson for the Division of Wellness stated: “The provision of non-judgemental counselling about abortion is obviously essential. It is for NHS suppliers to make certain that the companies they advocate meet this want.”

Abortion scandal: MPs urge Jeremy Hunt to act on Crisis Pregnancy Centres

Professional-life Crisis Pregnancy Centres "give very greatest details possible"

David Burrowes, parliamentary chairman of the Conservative Christian Fellowship, mentioned: “There’s surely a position for independent suggestions solutions.

“I know that the independent suggestions companies in my constituency are quite professional, very effectively-run and offer you caring, careful, sensitive tips that is welcomed by constituents.”

Andrea Williams, Director of the Christian Legal Centre, explained that it was “crucial” that females have “access to correct info about the impact of an abortion on them.”

She explained that the “pro-life Crisis Pregnancy Centres up and down the nation… fee the offering of data and the care giving to the women who come via their doors, as a extremely crucial and delicate matter and do all they can to give out the extremely greatest details achievable.”

Professional-life Crisis Pregnancy Centres "give very greatest details possible"

What are Crisis Pregnancy Centres and in which are they in the United kingdom?

CPCs declare to provide ladies the likelihood to speak to ‘trained advisers’ and nevertheless the details they share about the physical and psychological effects of an abortion is frequently not supported by healthcare proof or in line with the official suggestions of the Royal College of Obstetricians.

These centres are not regulated by the Department of Health and it is uncertain who runs them, in spite of repeat attempts by the media and charities to locate out. Even so, it is understood by BPAS employees that CPCs are linked to church groups in the United kingdom. It is because these centres are not regulated and are entirely independent of the NHS that they are not obligated to give females medically exact details.

There are more than 100 centres across the United kingdom, in accordance to Brook, the sexual well being charity, which has been monitoring the rise of CPCs in excess of latest many years.

CPCs declare to supply women the possibility to speak to “trained advisors” and but the information they share about the bodily and psychological effects of an abortion could not be supported by health care evidence or in line with the official advice of the Royal School of Obstetricians.

Nonetheless, worries have also been raised in recent years in excess of the objectivity of guidance provided girls contemplating termination. Anti-abortion campaigners feel that females must visit an independent centre ahead of undergoing the procedure due to the fact they say there is a prospective conflict of curiosity in ladies acquiring counselling from an organisation that also carries out terminations.

In 2011, a bill launched in the Commons to end abortion companies from pre-abortion counselling was defeated. The government also scrapped strategies for a consultation on regardless of whether ladies should be necessary to undergo independent counselling prior to an abortion.

Final September, the Advertising Standards Authority (ASA) banned an advert for a CPC in London, the Central London Women’s Centre (CLWC), since it misled ladies into believing it “offered terminations and was consequently an abortion clinic”. The ASA stated that the centre’s advertising was “irresponsible, simply because females seeking a termination could be unnecessarily delayed by contacting the advertiser beneath the false impression that CLWC was an abortion clinic and would offer impartial advice”.

Several ladies locate out about the centres by means of the world wide web or by means of posters in their local region and mistakenly believe that these advisors will be ready to organize an abortion for them. Women have to contact up and make an appointment to see an advisor.

Equivalent groups exist in America and are component of the powerful pro-daily life motion across the Atlantic.

This graphic does not always represent every single single CPC in the Uk.

What are Crisis Pregnancy Centres and in which are they in the United kingdom?