Friday, 12 April 2013

Integrated approaches for women with drug and alcohol problems

I recently joined DrugScope as Policy and Engagement Officer. I have a strong interest in women’s issues, and was therefore particularly pleased that the importance of integrated services for women with drug and alcohol problems is an area that DrugScope has been concerned about for some time.

The LDAN/DrugScope Domestic Violence project, which ran for four years and came to an end in March, worked to encourage collaboration and facilitate partnerships between the domestic violence and substance misuse sectors, given the clear, though complex, links between intimate partner violence and problematic alcohol and/or drug use. Research has, for instance, identified that women who have experienced gender-based violence are 5.5 times more likely to be diagnosed with a substance use problem over their lifetime.[1] 

A 2005 report by the Mayor of London also found that almost two-thirds of the women it surveyed from domestic violence agencies with substance misuse problems reported that they began their problematic substance use following their experiences of domestic violence. All of these women saw a link between their substance misuse and their experiences of domestic violence, with the most common reported being use of substances to dull physical and emotional pain. 

As the final report for the DrugScope/LDAN project – which will shortly be available here –  sets out, national strategies have often failed to address these dual issues, and joined-up approaches have, historically, been lacking in frontline services. We held an end of project event in London on 26th March which also highlighted the continuing limited availability of female-only provision, and the impact that this can have on women using services. Presenting findings from the evidence gathering stage of their ‘Rebuilding shattered lives’ project, Anna Page of St Mungo’s noted that professionals and service users alike have made arguments for both mixed and female-only provision. She highlighted, however, that, according to their analysis, female clients in women-only provision make more positive progress than those in mixed services.[2]

Emerging findings from a forthcoming DrugScope and AVA (Against Violence and Abuse) research report on sex workers’ experiences of drug and alcohol services – to be published in Summer 2013 – also point to a lack of integrated working, in spite of the links between sex work and substance misuse, and particularly use of drugs.[3] This should also be seen in the context of national policies that fail to make the necessary links: the 2010 Drug Strategy, for instance, makes no reference to the words “prostitution”, “woman”, “women” or “girl”.

There is a risk that, as new local commissioning structures come into play, the provision of appropriate services for women will continue to be overlooked. Within local authorities, Directors of Public Health (DsPH) have a broad range of responsibilities, and there are concerns that the needs of the most vulnerable and marginalised groups may go unnoticed. Additionally, from next year, the Community Safety Fund, which Police and Crime Commissioners are responsible for allocating across police force areas, will be rolled into the main policing grant, exacerbating the risk of disinvestment still further.

But the new arrangements also bring fresh opportunities for joined-up, women-specific services. Statutory guidance recently published for Health and Wellbeing Boards, which are responsible for producing the needs assessments and strategies that DsPH will commission on the basis of, specifically sets out the importance of considering “those with complex and multiple needs”. Additionally, the Public Health Outcomes Framework, published by the Department of Health last year, sets out a range of relevant indicators, including on domestic abuse, sexual violence, alcohol and drugs, mental illness, homelessness and reoffending.

At the end of March, the Ministry of Justice also published ‘Strategic objectives for female offenders’, which sets out key priorities in relation to women in contact with the criminal justice system, and announces an independent advisory board to push these forward. After a decidedly slow start on provision for women offenders (particularly disappointing given the lead provided by the Corston report in 2007), these are welcome steps by the Government. Importantly, the new document acknowledges the specific, and often multiple needs of women who offend, and reiterates the importance of services in the community that recognise and address these.

It’s worth noting, too, that the policy focus on multiple needs is being matched by funders’ increasing recognition of the importance of integrated services. Lankelly Chase, for instance, now focuses solely on work that tackles complex needs, and the Big Lottery Fund has recently announced its ‘Fulfilling lives’ programme, which is investing £100 million into services supporting people with multiple and complex needs. It is crucial that, as this agenda moves forward, the multiple and specific needs of women with substance misuse problems are clearly recognised within this, and addressed.

Gemma Lousley, Policy and Engagement Officer.

[1] Rees, S. et al (2011) ‘Lifetime prevalence of gender-based violence in women and the relationship with mental disorders and psychosocial function’, Journal of American Medical Association, 306/5: 513–521.

1 comment:

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