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ensure that they are overcome.
The MSIC and indeed my ongoing work at the Kirketon Road Centre, where
we deliver a comprehensive range of integrated harm reduction and sexual
health services in the same area of the city, have convinced me that local
solutions are needed for local problems – one-size solutions will not be a neat
fit for all communities.
Experience at the local level of service delivery has also taught many of us
public health practitioners that what works in a local community today may not
be appropriate tomorrow, so an ongoing dialogue between the diverse
community stakeholders is needed to keep checking in on existing issues and
identify emerging ones, hopefully enabling intervention in a timely way.
These stakeholders should be tasked with developing community indicators
of both public health and public order, to objectively monitor how well they are
achieving a balance between both.
But the sustainability of harm reduction service provision on the ground will
ultimately rest on the legitimacy of the provider in the eyes of the community.
Providers are often considered by the community, especially in the first instance,
as the default ‘representatives’ of people who inject drugs. This may be
appropriate given this group’s own social marginalisation and transience, which
may be a barrier to effective participation in community processes.
But providers need to be conscious from the outset of the often common
perception that they are ‘outsiders’ coming into the community to foist their
client base onto the ‘legitimate’ community. To be recognised as full
members, service providers need to gain local community respect and
understanding, which requires a genuine long-term commitment to being part
of the community to achieve solutions for all its residents and not just for
their particular constituency.
The supervised injecting facilities in Sydney, Europe and Canada, are, I
believe, prime examples of local solutions to both public health and public order
issues associated with street-based drug injecting.
Dr Ingrid van Beek was the founding medical director of the Medically
Supervised Injecting Centre in Sydney, Australia, the first in the English speaking
world. In 2008 she resigned from this role to continue as director of the Kirketon
Road Centre in Kings Cross, Sydney.
She will address the upcoming City Health 2013 conference being held in
Glasgow on 4-5 November. www.cityhealth2013.org
November 2013 |
drinkanddrugsnews
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www.drinkanddrugsnews.com
Harm reduction |
Policy Scope
‘It is important to delineate real
threats to public order from
perceived threats and it is here
particularly that law and order
authorities have a central role to play.’
alance
POLICY SCOPE
IN THE LAST COUPLE OF DAYS
I've been involved
in two ‘summits’ organised by DrugScope on
behalf of the Recovery Partnership: one on older
people’s experience of drug and alcohol
problems; the other the latest in a series of
regional summits on ‘building recovery in
communities’ that we hosted in Leeds for the
Yorkshire and Humber region.
Three big (and related) policy themes
emerged as common ground across these two
events – the relationship between ‘recovery’ and
‘public health’, the distinction between ‘services’
and ‘interventions’ and the challenge of ‘keeping it real’ on disinvestment and
balancing an appreciation of the financial constraints on commissioners
(notably local authorities) with a robust defence of investment in our sector.
The older people summit focused on two distinct groups – an ageing
population in existing drug and alcohol services, and a larger group of people
in later life who may be using drugs (including prescription or over-the-
counter drugs) or (much more commonly) alcohol in harmful ways, often as a
way of ‘self medicating’ to cope with experiences associated with aging such
as bereavement, loneliness and isolation.
I don't need to spell out the significance of the distinction between
‘recovery’ and ‘public health’ in this context. What was less obvious to me is
that the wider public health agenda for older people looks like it is more about
‘interventions’ than specialist ‘services’. We heard from some great projects
working with this age group which clearly have an important role to play, such
as DASL’s Silver Lining project in the London boroughs of Bexley and Greenwich.
But there is also a big agenda of work to equip and support generic and older
people’s services to deal confidently with drug and alcohol issues – for example,
GPs, mental health services and residential care programmes.
The wider significance of this point was brought home at the Regional
Summit in Leeds where one of our speakers observed that public health
naturally thinks and works with ‘interventions’ rather than ‘services’ as such.
This raises the question of when, why and to what extent specialist drug and
alcohol services are best suited to deliver the interventions that are part of
the wider public health agenda now emerging on drugs and alcohol.
This links to the broader issues about funding. The point was also made at
Leeds that with local commissioners facing swingeing cuts they would be
‘laughed out of the room’ if they sought increases in investment in drug and
alcohol services in the coming years, with the implication that it is not easy
arguing for sustaining current levels of investment in local authorities facing
budget cuts of 30, 40 or 50 per cent. Even allowing for a lot of creativity and
collaboration this raises the obvious question of how this circle can be
squared without either reducing access or cutting cost and quality.
Marcus Roberts is director of policy and membership at DrugScope, the
national membership organisation for the drugs field, www.drugscope.org.uk
When do specialist drug and alcohol
services play a part in the wider public
health agenda, asks
Marcus Roberts
RIGHT
FOR THE ROLE