Manchester City Council Report for Information. Report to: Health Scrutiny Committee 23 October The Adult Drug Treatment System in Manchester

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1 Manchester City Council Report for Information Report to: Health Scrutiny Committee 23 October 2014 Subject: Report of: The Adult Drug Treatment System in Manchester Director of Public Health Summary The report provides members of the Committee with an overview of the delivery of city-wide drug services following the redesign in Recommendations The Health Scrutiny Committee is asked to consider and comment on the information in the report. Wards Affected: All Contact Officers: Name: David Regan Position: Director of Public Health for Manchester Telephone: Name: Marie Earle Position: Programme Lead Drug Treatment Telephone: Background documents (available for public inspection): None. 7

2 1.0 Introduction 1.1 The report provides members of the Committee with an overview of the delivery of the city-wide adult drug treatment system, which is known as RISE. 2.0 Background 2.1 Following a system redesign and tendering exercise in 2011, three service providers who are known as RISE were commissioned in July 2012 to deliver a recovery focused, adult drug treatment system. The vision for RISE is: to recognise everyone s potential for recovery from drug misuse including heroin and/or crack cocaine, other drugs and combined drug and alcohol misuse; and improving quality of life for individuals, families and communities. 2.2 The vision statement is closely aligned to the objectives of the national Drug Strategy 2010 Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Live, and the Manchester Community Strategy One of the performance indicators (PI s) in the Manchester Community Strategy and the Public Health Outcomes Framework is on the subject of successful completion of drug treatment (for heroin only and heroin & crack cocaine users.) Historically, Manchester has not performed well against this indicator. 2.4 Prior to July 2012, the adult drug treatment services had evolved over a number of years and were commissioned to mainly engage heroin and/or crack cocaine users in drug treatment. At this time, the National Treatment Agency (NTA) acknowledged that adult drug treatment systems had generally performed well at engaging individuals into drug treatment but, improvement was needed in supporting individuals to successfully complete their drug treatment and re-integrate back into their local communities for example, by maintaining their own homes and acquiring education, training and employment. The redesign and tendering exercise took place to modernise the system that was in place, and to improve performance, and outcomes for Manchester residents. 2.5 Tendering achieved a saving of 1.2m. Over the past 18 months, Manchester s performance against the successful completion of drug treatment (for heroin only and heroin & crack cocaine users) PI has improved at a time when national performance is decreasing. At present, Manchester is one of the top performing local authority areas on this PI when compared against similar other local authority areas. 3.0 Delivery 3.1 As stated above, RISE is delivered by three, 3 rd sector registered charity service providers who provide three different elements. These are as follows: Intake Service which is delivered by ADS (Addiction Dependency Solutions.) 8

3 Clinical Service which is delivered by CRI (Crime Reduction Initiatives.) Recovery Service which is delivered by Lifeline. 3.2 RISE service delivery is provided from a number of sites including city centre, Cheetham and Northern Moor. In addition, service delivery is provided across: 25 GP Practices (city-wide), 2 pharmacies in the north of the city, a number of community centres including the Zion Centre in Hulme, a number of criminal justice based locations including custody suites in three police stations across the city, in Court, in Intensive Community Order provision, in prisons when required, and across Probation Service sites, a number of hospital settings for example, in mental health in-patient wards and on an outreach basis for example, on the streets of the city centre. 3.3 The most recent data confirms that 2,748 individuals were engaged in structured drug treatment in the city at the end of August The majority of these individuals are in treatment because of heroin only or heroin & crack cocaine misuse. 3.4 One of the key outcomes required from RISE is to increase rates of recovery from addiction. In addition, RISE are required to: improve emotional wellbeing, mental health, and physical health; support individuals to maintain independent living including improving access to education, training, and employment; contribute to a reduction in drug related crime & disorder; and ensuring that children, young people, and vulnerable adults are safeguarded. The Intake Service 3.5 The Intake element of RISE provides a single point of contact, engagement and assessment service for adults aged 18+ with drug misuse problems (including heroin, crack cocaine, other drugs, and combined drug & alcohol misuse) and enables individuals to access appropriate recovery focused treatment and support. The service can be accessed by any adult by self referral or any individual or agency is able to refer to the service on behalf of the user. 3.6 A Criminal Justice Team is currently part of the Intake Service. This team works across the criminal justice settings mentioned above to engage drug users in treatment at the earliest opportunity. 3.7 The aim of the service delivery provided by the Intake Service is as follows: Maximise engagement with adult drug users across the city. Operation of robust harm reduction and needle exchange service (in conjunction with pharmacy based services across the city.) Harm reduction advice and screening, testing, and immunisation for blood borne viruses is provided. 9

4 Staged triage, screening, and comprehensive assessment of individuals leading to the development of a recovery plan with goals. Provision of advice, information and extended brief interventions to individuals for up to 16 weeks and not requiring clinical or further recovery interventions. Supported rapid access to community or in-patient detoxification or other clinical services when required. Onward referral to Clinical and/or Recovery when required. 3.8 The Intake Service are engaging with higher numbers of heroin only or heroin and crack cocaine users in treatment than users of other drugs. In 2013/14, 84 individuals on average were engaged by Intake on a quarterly basis from this group. In comparison, during 2013/14 57 individuals on average were engaged by Intake on a quarterly basis because of cannabis misuse. 3.9 Engagement and promotional work continues to be carried out across a wide variety of organisations and individuals across the city. One particular initiative that has developed over the past 12 months is the in-reach work at a number of mental health in-patient wards in the city. The in-reach is provided by an Intake practitioner who provides substance misuse interventions to mental health patients. The majority of patients have had problems with other drugs not heroin or crack cocaine. The Clinical Service 3.9 RISE provides a Clinical Service often referred to as medically assisted recovery to enable individuals to stabilise, reduce their drug use and become drug free. The service provides a range of recovery focused substitute prescribing, other drug treatments, and psychosocial interventions including groups that are referred to as pods by the service provider. Referrals to the Clinical Service are made by the Intake Service and by GPs who deliver an enhanced service for drug misuse Prescribing interventions for heroin dependence can include: reduction, stabilisation, detoxification, and maintenance. Psychosocial interventions (PSI) are intended to enhance motivation, treatment readiness, engagement, and facilitate behaviour change The Clinical Service includes a team of practitioners who support the delivery of the clinical service provided by GPs who are commissioned to deliver an enhanced service for drug misuse in primary care settings The aims of the service are to: Assist the individual to remain healthy, and maintain/improve their physical and mental health and emotional wellbeing. Stabilise individuals, where appropriate, on substitute medication to alleviate withdrawal and to reduce craving. Reduce the use of illicit, prescribed and over the counter drugs. Reduce problems relating to drug misuse, including health, social, and 10

5 psychological. Reduce the dangers associated with drug misuse including the risks of blood borne viruses and drug related death. Reduce the need for criminal activity to finance drugs. Reduce the risk of prescribed drugs being diverted onto the illegal drug market. Improve overall personal, social, and family functioning. Facilitate and support the individual in moving through the adult drug treatment system The Clinical Service have developed and implemented a number of treatment packages over the past 12 months. For example, the low dose clinic is operational, a treatment pathway for over the counter medication has been developed, and pre and post detoxification groups are being piloted. Representatives from the service user group (DRIVE or Driving Recovery in Venues Everywhere ) have a presence in service sites to promote peer support and visible recovery. The Recovery Service 3.14 The Recovery element of RISE provides a range of interventions to enable individuals to become drug free and/or recover from their addiction to drugs. This involves promoting and support re-integration for example, housing and employment. The interventions provided include: recovery motivation, recovery communities development, psychosocial interventions and employment skills training. In addition, the service provides a family support programme based in community centres for families or concerned others who may be facing difficult issues The recovery motivation element is delivered across a number of settings and the aim is to motivate individuals to reduce their drug use and to advise and motivate those who are considering abstinence The recovery communities development service aims to develop and facilitate a range of peer support/mutual aid groups across the city. This also includes volunteering options and the opportunity to become a peer supporter or recovery coach. The coach is a role model to users who provide support to navigate the system alongside motivation/ engagement work In August 2014, the Recovery Service reported that eleven SMART (Self Management and Recovery Training) Groups were now being delivered across the city by volunteers who have been trained to become facilitators. SMART is peer led and based on the principles of self help/ mutual aid. All three elements of RISE facilitate access to mutual aid such as SMART and Narcotics Anonymous (NA.) A number of groups meet across the city including at RISE service sites The Psychosocial Interventions (PSI) element covers 1:1 support/key working, and a range of group work activities. This includes person centred counselling, Cognitive Behavioural Therapy (CBT) and CBT based recovery, therapeutic 11

6 group work, diversionary group work such as music group, radio group, writers group, art group Of particular importance is the education/training/employment (ETE) skills group work that includes vocational courses, on-line training, IT skills development, CV development and interview techniques. The recovery service supports individuals to become job ready and manage the transition back into the labour market whilst at the same time ensuring issues such as housing are addressed The Drug Social Work Team based in Manchester Council also work as part of RISE. This team provides community care assessments on behalf of individuals who are referred to residential rehabilitation. RISE including the Social Work Team meet on a weekly basis as a panel to make decisions on referrals to in-patient detoxification and residential rehabilitation Finally it is important to emphasise that the Recovery Service is integrated with the Intake Service and Clinical Service and does not operate in isolation. There are currently nine Recovery & Therapeutic Groups with an average of 11 individuals attending in Quarter 1 of 2014/15, six Diversionary Groups with an average of 16 individuals attending in Quarter 1 of 2014/15 and six Education, Training and Employment Groups with an average of 4 individuals attending in Quarter 1 of 2014/ Summary Performance Data and Conclusions 4.1 At the end of August 2014, 2,748 individuals were in drug treatment with RISE, the majority for heroin only or heroin & crack cocaine misuse. From 1 April August 2014, 90 individuals in treatment for heroin only or heroin & crack misuse successfully completed treatment (i.e. drug free.) 5 individuals successful completed treatment (occasional user.) This is 8.7 % of the heroin only or heroin & crack cocaine misuse population in treatment. This compares against a national average rate of 8.0 % at the present time. 4.2 Out of the 2,748 individuals mentioned above, 225 were in treatment because of other drug misuse (for example, cannabis, crack cocaine only, powder cocaine.) RISE is currently working to engage more individuals with other drug misuse problems into treatment. 4.3 The redesigned service has delivered performance improvements over the past two years and the three service providers recognise the challenges in adapting and responding to changing patters of drug use. There is now a much greater focus on recovery and the successful UK Recovery Walk held in Manchester on the 13 th September 2014 at the Castlefield Arena highlighted the strong collaborative partnerships that now exist between commissioners, providers and recovery communities across Greater Manchester. 12