Crisis response to the consultation on the 2010 Drug Strategy September 2010

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1 Crisis response to the consultation on the 2010 Drug Strategy September 2010 Introduction Crisis, the national charity for single homeless people, welcomes the opportunity to respond to this consultation on the 2010 Drug Strategy. Sadly the links between homelessness and drugs are all too clear with drugs being both a cause and a consequence of homelessness. Problems with drugs can be part of a person's spiral downwards into homelessness. For example, a family bereavement may lead to depression or mental illness and drugs might then be used as a coping mechanism, to numb the pain. Two thirds of homeless people cite drug or alcohol use as a reason for first becoming homeless 1 and those who use drugs are seven times more likely to be homeless than the general population 2 There are high levels of stress and mental illness associated with being homeless and it is not uncommon for those traumatised by homelessness to seek solace in drug or alcohol abuse. It can be a coping mechanism once people become homeless particularly as they may be surrounded by other people using drugs and indeed four out of five people report starting using at least one new drug since becoming homeless. 3 This then makes breaking out of homelessness and transforming their lives far more difficult. Of course, not everyone who has problems with drugs becomes homeless and not every homeless person has problems with drugs. However, levels of drug abuse are relatively high amongst the homeless population. 53% of homeless people say their biggest expenditure is drugs 4 and amongst those sleeping rough in London, 38% have a substance misuse issue. 5 Sadly it is often the case that people who most need support are the least able to access it and indeed people who are dependent on drugs or alcohol are almost twice as likely as nondependent users to be banned from homelessness services. 6 Managing a drug addiction is difficult at the best of time but when coupled with the problems of homelessness, the results are often disastrous. Chaotic lives make it more difficult for people to access services. In many areas, there are insufficient mainstream drug services available, even fewer specialist services for people who 1 Crisis (2002) Home and Dry 2 Kemp P et al (2006) Homelessness amongst problem drug users: prevalence, risk factors and trigger events' Health and Social Care in the Community 14 (4), Crisis (2002) Home and Dry 4 Crisis (2002) Home and Dry 5 Broadway ( ) CHAIN Street to Home 6 Crisis, Home and Dry (2002) 1

2 are homeless and those who suffer from both a mental health and a dependency also face particular difficulties in accessing appropriate services. Crisis believes that in order to end homelessness, it is essential that a comprehensive drug strategy is introduced which looks at tackling drug use in a holistic sense and within that considers the specific needs of homeless people It is a welcome acknowledgement that addressing people s problems with drugs is about more than just treating the addiction but is also about looking at issues around housing, skills and work. At a time when budgets are facing severe pressures, it is hugely important that sufficient resources are made available to support people with drug problems. Not only is drug dependency costly for the individual but it is also costly to society and can lead to wider problems such as homelessness. Below are answers to the specific questions we feel best placed to respond to. Response to consultation questions A1: Are there other key aspects of reducing drug use that you feel should be addressed? A2: Which areas would you like to see prioritised? Crisis believes that in reducing drug use, it is important that the particular issues faced by homeless people are recognised and addressed. This must include giving more consideration as to how to increase the uptake of drug and addiction services by homeless people. More proactive services such as assertive outreach as well as specialist, flexible drug services are needed to stop the most vulnerable people slipping through the net. We welcome the focus on taking a more holistic approach. At Crisis, we have long known the importance of meaningful activity, skills development and progress towards employment in helping people overcome problems with drugs. Housing too must be considered, as the stress and instability of homelessness or other housing need can both lead to people using drugs as a coping mechanism and can also make it far more difficult for people to address their dependency issues. A3: What do you think has worked well in previous approaches to tackling drug misuse? A4: What do you think has NOT worked so well in previous approaches to tackling drug misuse? In many areas, there are not enough services available to tackle drug misuse. There is a particular issue with a lack of specialist services for people with chaotic lifestyles, such as homeless people, and those who suffer from both a mental health and drug problem. It is often the case that the most excluded people who most need support have the most difficulty accessing the appropriate services. C2: Do you think the Criminal Justice System should do anything differently when dealing with drug-misusing offenders? For some people, drug dependency issues can mean getting dragged into a cycle of petty crime and high levels of contact with the police. Fines and prison sentences are an inevitable part of this cycle but involvement with the criminal justice system 2

3 can often just exacerbate a person's problems, as its focus is on punishment rather than treatment. Substance misuse is a significant issue for single homeless people. Where homeless substance users encounter the criminal justice system the emphasis should be on diversion and resolution, not containment and enforcement. D1: Thinking about the current treatment system, what works well and should be retained? D2: Thinking about the current treatment system, what is in need of improvement and how might it need to change to promote recovery? Greater effort is required by a range of bodies and organisations to increase the uptake of drug and addiction services by homeless people, with a focus on engaging with the harder to reach groups who may have negative experiences of mainstream services provision. Drug services themselves as well as information about the support available should be offered within existing services such as hostels and day centres in order to reach people more effectively. Drug treatment services which are accessible, rapid and can respond to individual needs should be developed for homeless people who are often living chaotic lives and experience high levels of vulnerability. Services for homeless people should have low access requirements (drop ins being a good example). More services should be provided for homeless people who continue to use drugs, in order that their drug use does not remain hidden and so that interventions including harm reduction initiatives can be implemented. It is also important that homeless people are able to access primary healthcare services and so use this route into specialist drug services. Homeless people are currently 40 times less likely to be registered with a GP than the rest of the population. 7 GP services should be reformed to remove the barriers which homeless people face to accessing their services, such as making it easier to register without a permanent address and providing more out-of-hours services. D8: Treatment is only one aspect contributing to abstinence and recovery. What actions can be taken to better link treatment services in to wider support such as housing, employment and supporting offenders? The acknowledgement that treatment is only a part of the solution to reducing drug misuse is to be welcome. Homeless people face a range of issues which may be related to or compounded by their drug use and solutions therefore need to be holistic so that the range of problems encountered by homeless people - from housing to mental health issues - are addressed. Those with problem drug use need a wider offering including meaningful activities away from their drug using peer group. There needs to be joined up support to address the many different issues they may face, otherwise treatment will be less effective. A rehabilitation plan must be meaningful and realistic and include addressing housing need. This requires an increase in the joining up of services such as healthcare, housing and support for substance misuse. Looking at a person s range of needs will ultimately lead to better outcomes than trying to address each one in isolation. 7 Your Health, Your Care, Your Say, Crisis (2005) 3

4 Drug services should be aware of and proactive in identifying the different issues and support an individual may require, particularly those who are homeless or have other vulnerabilities. We would like to see people better connected to the appropriate advice and support including housing, skills and employment services. E2: What interventions could be provided to address any issues commonly facing people dependent on drugs or alcohol in relation to housing? Lack of access to housing is a significant problem, particularly for single people. This can exacerbate or indeed cause a drug dependency issue. Someone may become homeless with relatively low support needs but if their housing need is not addressed, they can quickly gain more complex needs, including a substance misuse problem, making it far harder for them to then break out of homelessness. Our experience and research shows that single homeless people often receive low levels of assistance when approaching their local authority for help. Crisis recently undertook some mystery shopping 8 of local authorities Housing Options services to investigate the level of assistance single homeless people receive. Whilst there were some advisors who made real efforts to assist people, our mystery shoppers experiences were overwhelmingly negative. Frequently the authorities homelessness services were not accessible to homeless people, with receptionists acting as gate keepers, and even where the mystery shoppers did see a housing officer they rarely received any meaningful help. They were often given little or misleading advice, signposting to other agencies was poor and they left with no solution to their housing need. For people with drug dependency issues or other vulnerabilities, it is likely that they will find it even harder to advocate for themselves and so to access the support they need. Crisis believes that local authorities must work with single homeless people on a proactive basis through providing high quality advice and assistance and housing options, such as private rented sector access schemes. If authorities fail to address someone s housing need at an early stage, there is a risk the individual will end up rough sleeping and/or developing greater support needs (including a drug dependency), ultimately costing the authority and the public purse more. There is a debate between service providers about the balance between provision of accommodation and support services. Some providers believe a housing first approach where clients are accommodated then offered treatment is the most effective, however some believe treatment first approaches offer more incentives to stick to treatment regimes and recovery plans. Tension can therefore often arise between housing providers who are unwilling to house problem tenants and drug treatment providers who want stable housing for their clients before they will offer treatment. This can leave a homeless person with a dependency effectively stuck in the middle unable to access treatment without stable accommodation and unable to achieve stable accommodation without accessing treatment. This tension must be addressed and appropriate accommodation for homeless people with drug dependencies made available alongside support. For those who have been through drug treatment programmes more aftercare is needed, for example through supported housing schemes. Those undergoing detox programmes can find themselves left in unsuitable transitional accommodation for long periods of time. This kind of instability can make it harder for people to recover from a drug dependency and can undermine the progress that has been made in 8 Crisis (2009) No one s priority 4

5 treatment. For those who have been through detox, it is harder to stay away from drugs if they are stuck in accommodation with others who are using them. We are also concerned at the Government s plans to cut housing benefit which we believe will force many people with dependency issues to move to different areas and so away from services which may be supporting them. Homeless people and those with drug dependency already find it hard to access the services they need. Relationships with public sector and voluntary agencies take time to build up but once established can be a key factor in helping people to take control of their own lives and address their drug problems. Insecure housing can undermine this progress and because several waves of cuts are planned some vulnerable people may find they have to move several times. E3: How might drug, alcohol and mental health services be more effective in working together to met the needs of drug or alcohol dependent service users with mental health conditions? The combination of mental health and drug issues is common amongst the homeless population with 18% of rough sleepers having a mental health need combined with a substance misuse issue (dual diagnosis) 9 Unfortunately people with dual diagnosis (DD) can find that there is a lack of communication and understanding between mental health and drug and alcohol services. Inflexible service boundaries can prevent people from accessing the appropriate support because it can be difficult to establish responsibility for an individual s care across health and social service provision. This can mean that those with DD who approach mental health services often find the services unwilling to treat people with dependency issues and vice versa. Specialised services need to work together more effectively to ensure people with multiple needs don t slip through the net. This is particularly true of people with dual diagnosis who need effective, collaborative support from mental health and substance misuse teams. We believe that services could be more effective and make better use of resources if a more joined up approach to service provision and commissioning was taking. There is a need to train frontline services in dual diagnosis skills. We believe that better trained staff and more joint working between agencies will provide better value for money as people will be able to access more effective support which will promote faster stabilisation and recovery. E4: Do appropriate opportunities exist for the acquisition of skills and training for this group? Crisis research has shown that high quality learning and skills provision can help people develop the structure and meaningful activity as well as the wider social networks they need in their lives to help tackle substance misuse problems. 10 Education, training and employment services must therefore be part of the package of aftercare put in place following treatment. The funding of learning and skills for homeless people can have a direct impact on the achievement of sustainable treatment outcomes. Mainstream adult education programmes are often not very useful for people with drug dependencies who have specific and complex needs. Government funding 9 Broadway (2009), Profiling London s Rough Sleepers 10 Crisis (2006), Missed Opportunities: the case for learning and skills 5

6 tends to be focussed on people achieving level 2 or above qualifications. People who have no qualifications are often unable to access the sort of learning provision they need. We would like to see a wider definition of skills which recognises the importance of pre level 2 skills. It is hard to find the entry level and non accredited training opportunities which are key to putting people on progression pathways and building up soft skills. For example, the Learning Power award, developed by Crisis and partners in the homelessness sector, was a course aimed at a learner gaining a range of soft skills, such as time keeping and team work. This was reliant on LSC funding but unfortunately this funding was not consistent. It is important that such courses which put someone on the path of learning and towards employment are supported nationally and locally. Voluntary agencies who have experience of working with vulnerable people are often best placed to deliver learning and skills services to them, and should be supported to do so. E5: Should we be making more of the potential to use the benefit system to offer claimants a choice between: a) some form of financial benefit sanction, if they do not take action to address their drug or alcohol dependency; or b) additional support to take such steps, by tailoring the requirements placed upon them as a condition of benefit receipt to assist their recovery (for example temporarily removing the need to seek employment whilst undergoing treatment). Crisis welcomes flexible approaches to helping an individual overcome their drug or alcohol dependency which seek to remove the barriers someone may face to accessing treatment. It would be perverse if the threat of benefit sanctions prevented an individual from taking up treatment for a substance problem. We therefore welcome flexibility in the conditionality placed upon people with a drug dependency in order to support their recovery. We would be concerned however, at proposals to make someone s benefit dependent on them addressing a dependency. We have concerns that Jobcentre Plus staff are not qualified to make judgements on drugs issues and many drug users are likely to be vulnerable individuals with complex needs who we do not want to see being penalised for their addiction. Additionally, if individuals do not access treatment and lose their benefits, there is a risk that they will resort to illegal means to support themselves. We know that people with these problems need support and encouragement not compulsion to access treatment to help them move on with their lives. What s more, if an individual is unwilling to access treatment then the treatment is unlikely to be successful. This approach will mean money is ultimately being wasted on expensive treatment places that have little effect on the individual. Our experience is that, in many areas, there is a lack of drug treatment places currently available. If people are being compelled to access drug treatment when they are not ready or willing to stabilise their drug use, this could be a waste of limited resources. Without significant extra investment and increased drug treatment places, there is a risk that there will not be the places available for those who are ready and willing to access treatment. 6

7 E6: What if anything could Jobcentre Plus do differently in engaging with this client group to better support recovery? (For example, greater use of specialist advisers and outreach, use of different communication channels for benefit advice and administration) Jobcentre Plus should be looking to provide more holistic support which takes into account the wider factors in someone s life, such as a drug problem. The role of JCP should be to offer support, direct and encourage individuals (which could take the form of additional financial incentives) to access the right services but it should not be to force them to access treatment. For some people an integrated system of employment support and drug treatment could be effective. We would like to see this support becoming more holistic and look at other barriers to progression someone may face such as a skills shortage, detrimental social networks, health issues and housing need. A rehabilitation plan must be person centred focussing on an individual s needs. Jobcentre Plus or a prime welfare to work provider may not be best placed to support an individual with a drug dependency. Consideration should be given as to which agency is best to support people with their substance misuse and on their journey to work. This may be the welfare to work provider but could also be a homelessness agency, housing provider or other agency. Sometimes other agencies have built up a positive relationship with clients that is built on trust. This trust may be the most suitable basis on which to build a rehabilitation plan. Jobcentre Plus should recognise this and work closely with other agencies supporting an individual to determine the best course of action for that individual. Additionally, consideration should be given as to how people with particularly chaotic lifestyles are best supported by JCP. This may for example include outreach visits to hostels or communicating with people in a way that best suits their needs. (for example face to face, by phone, etc) E7: In your experience, what interventions are most effective in helping this group find employment? Welfare to work programmes should allow, for example, early entry to more intensive support for many vulnerable people. Homeless people and those who have alcohol/substance misuse issues are amongst those likely to have additional support needs and to require extra support on their journey back to work. It is critical that they are able to access the additional levels of support at an earlier stage than 12 months. The longer someone with complex needs goes without the support they require, the greater these support needs are likely to become. There is currently a gap in the provision of employment support for particularly disadvantaged individuals, for which the third sector is paying. Many charities work with the most vulnerable to support them on their back to work journey without receiving any financial remuneration from Government. We would like to see the Government doing more to make sure money gets to agencies working with the very vulnerable. They will achieve less job outcomes but impact across a range of other agendas (health, criminal justice etc) and help reduce drug misuse amongst this group. We think there needs to be more of an emphasis on advisors taking a holistic view of someone s circumstances and being enabled to deliver genuinely individual tailored support. For homeless people, their accommodation situation must be considered. Vulnerable housing situations will often impact upon someone s prospects of finding employment. People living, for example, in temporary accommodation often face 7

8 instability & high housing costs. This means that they both lack a stable base from which to find employment and also face sharp withdrawals of Housing Benefit which may mean they are little if at all financially better off in work. Employment programmes must be genuinely flexible and should avoid being overly prescriptive. In particular, we would like to see greater flexibility around when an individual can enter an employment programme or access higher levels of support, how long someone should remain on a programme and what an individual s back to work support and activity plan should include. Employers have emphasised the importance of soft skills for employability, such as communication skills, ability to teamwork, self-presentation. It is these same skills that enable vulnerable people recovering from drug dependencies to reintegrate successfully into society. However feedback from funders and homelessness agencies has highlighted the much narrower range of basic skills that is generally funded by learning and skills councils, and an increasing focus on achieving the level 2 targets and working with those closest to achieving qualifications at that level. This must be addressed and appropriate skills provision made available for those with lower level skills. E8: What particular barriers do this group face when working or looking for employment, and what could be done to address these? Housing Benefit (HB) is currently a major barrier to people moving into work and is overdue for reform. The system is hugely complex, and overly sensitive to changes in circumstances offering little security to claimants with fluctuating incomes. According to DWP s own figures, a single person working 16 hours a week on the national minimum wage is only 8.63 a week better off than if they were unemployed, once housing costs are taken into account. However, we are very concerned that the cuts to HB announced in the Budget are ill thought through, will leave people facing hardship and homelessness and could in fact undermine work incentives. This is highlighted in the DWP s own equality impact assessment looking at the first tranche of cuts to Local Housing Allowance which could have negative impacts for Housing Benefit customers who are working if they have to move to an area where they need to extend their commute to their place of work 11. We believe that there will be a similar impact on claimants currently out of work who may have to move away from training and employment opportunities, putting further barriers in the way of their journey to work. The 10% cut to HB for anyone who has been on JSA for a year which was announced in the Budget risks punishing all claimants, regardless of their situation or the progress and effort they are making to find employment. This seems against the very principles of fairness particularly at a time when unemployment looks set to rise and when in some areas it is likely to be especially difficult to find work particularly for those who face disadvantage in the labour market, such as people with drug dependency issues. There is a fundamental injustice in a measure which punishes people regardless of the efforts they may be making to improve their situation and find work. This measure is likely to particularly impact upon those furthest from the labour market, such as those recovering from a dependency, who may be making every possible effort to move towards work. It is unlikely to be an effective work incentive but instead will greatly affect people s housing stability and could in fact undermine 11 DWP (July 2010) Equality Impact Assessment Housing Benefit 8

9 their efforts to find employment. This kind of stress and pressure is also detrimental to people s recovery. We would therefore urge the Government to reconsider the hasty and ill thought through cuts to HB announced in the Budget. Instead, we would like to see the introduction of proposals which were being considered by the previous Government and those which were proposed by the Centre for Social Justice to help remove barriers to work. These included the introduction of fixed payment awards for those in work, extended benefit run on when a claimant moves into work and bringing down Marginal Deduction Rates so that work always pays. Moves to simplify the benefit system and make it easier to understand for claimants are also to be welcomed. There must however, be sufficient support for those for whom work is not a short term possibility such as people with drug dependencies and the system should incorporate top up payments for those with conditions which incur extra costs 9

10 About Crisis Crisis is the national charity for single homeless people. We are dedicated to ending homelessness by delivering life-changing services and campaigning for change. Our innovative education, employment, housing and well-being services address individual needs and help homeless people to transform their lives. We measure our success and can demonstrate tangible results and value for money. We are determined campaigners, working to prevent people from becoming homeless and advocating solutions informed by research and our direct experience. We have ambitious plans for the future and are committed to help more people in more places across the UK. We know we won t end homelessness overnight or on our own. But we take a lead, collaborate with others and together make change happen. For further information, please contact: Katharine Sacks-Jones Policy Manager Crisis 66 Commercial Street London E1 6LT Tel: Company Number: Charity Numbers: England and Wales , Scotland SC

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