The shift from a focus on treatment to one on recovery (which I welcome), and this recent, more widespread questioning of the effectiveness of our drug laws, signal that we are continuing, in some ways at least, to move away from a punitive attitude towards substance misuse and progress further towards one that is recovery-orientated. Recovery, however, cannot be ‘delivered’: the notion of active citizenship implicit in the UKDPC’s consensus statement on recovery, cannot come solely from the top down, or just the individual trying to progress their own recovery. It requires the participation and commitment of both that individual and a wide set of stakeholders within their communities. Consequently, it requires a more integrated approach, particularly around housing and jobs. But there is an important social component too. The RSA’s Whole Person Recovery model seeks to build, among other things, the social networks and attendant empathy and respect that (re)connect people with their communities and the support, information, and opportunities they can provide.
Stigma is a key barrier to enabling this. Research by the UKDPC showed that public attitudes towards people affected by substance misuse are much more negative than, for example, public attitudes towards people with mental ill health conditions; and that service users experience significant levels of stigma from professionals. Such attitudes have the effect of deterring those with substance misuse problems from seeking help, and contribute to worse longer-term impacts for the people concerned and for wider society.
So, taking the above, and as asked for ahead of this year’s national Drugscope conference, here is my suggestion for the next Government. I’ve tried to draw on recent RSA work, and give a non-obvious suggestion that could be adopted now, and that does not depend, for example, on attitudes to things that divide like the decriminalisation/legalisation debate. There is much I would change to better join up different policy domains (particularly between substance misuse, mental health and prisons), and to drive more effective co-commissioning, but these issues sit in a wider debate about public service reform. (You can read the RSA blog platform for ideas on public service reform.) We have to better respond to the risks presented by new psychoactive substances. I would make far better use of restorative justice in cases where use of illicit drugs has driven acquisitive crime, particularly if this is a means for the wrongdoer to become motivated to seek treatment. And I would also take care to protect our successes in a forthcoming parliament that may see austerity take a bigger bite yet out of public expenditure. While there is further to go, investment in substance misuse services has improved the choice of treatment, the timeframe in which it can be accessed, and has driven innovation.
You may think the suggestion below is too abstract and beside the point. For me, it speaks to some of the foundations upon which recovery is made possible.
Building our collective stock of empathic capacity
To address stigma, we need a greater, and more distributed empathic capacity. In the short term, we might, for example, mobilise along the lines of the Time to Change campaign on mental health. In doing so, we would need to clearly understand why stigma persists in different contexts: what is it that produces discriminatory and stigmatising attitudes and behaviour in different settings? For the medium and longer-term, we should continue to grow the focus of public policy on early/childhood years. Within this, we should question the way we teach Personal, Social and Health Education (PSHE) in schools. There is currently a scattergun approach to this aspect of education, with insufficient thinking about how to equip young people with the skills, attitudes, values and capabilities necessary to succeed in the modern world. As the RSA has argued, we need ‘schools with soul’. PSHE (or rather Social, Moral, Spiritual and Cultural (SMSC) education) should be at the heart of a school’s curriculum and purpose, and address head on questions of inclusion, citizenship and community in relation to issues such as substance misuse.
As the RSA Chief Executive, Matthew Taylor, has argued, empathy is a core competency for modern citizens. Developmental psychologist Robert Kegan suggests that a successful society with a diversity of values, lifestyles and experiences requires us to “resist our tendencies to make … ‘wrong’ or ‘false’ that which is only strange” to us and outside our own experiences. Such an approach would not only help to create the conditions in which recovery is better supported, but would similarly support recovery from mental health, rehabilitation from crime, and so on. It is a key part of valuing people as assets in a shared, interdependent society.
Political scientist Richard Dagger suggests that the job of the legislator should be to design the system to foster citizenship and move people towards collaboration. Of course, in order to become the next Government, political parties should construct and communicate a compelling vision and account of what it is to be a UK citizen in a collaborative society, and use this as the basis and decision-making framework to design policy and programmes. This is a vision that must be coherent; that speaks to both responsibilities and the rights of citizenship. It must live and breathe in individuals and in the public consciousness, and act as a touchstone for how we consider what progress is and how we make it. If recovery is about hope and about the participation in the rights, roles and responsibilities of society, there should be a realistic, compelling account of what they are, and how they extend to all of us.
Steve Broome is Director of Research at the RSA, and is on Twitter at @smbroome