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Learning and growing together

The Chief Executive and Chief Medical Officer of Spectrum Community Health CIC reflects on her experience as a clinical partner in the HMP Holme House drug recovery prison pilot:

As a clinician with almost 20 years’ experience providing community substance misuse services, a sizeable proportion of that time has involved working in and providing drug and alcohol treatment behind and through the gate.

I was eager and enthusiastic to be involved from the outset in the planning of the HMP Holme House drug recovery prison (DRP) pilot – there was something different about it.

As the project starts to embed on the ground, I have been reflecting on its core principles and the underpinning values of the new care model, where we have got to and why I am optimistic for the pilot as it begins to offer insights and genuine learning to the sector.

The DRP is not just about reforming care pathways.

As important as reducing supply and demand, improving the efficacy of treatment and care and the impact and sustainability of the offer of aftercare are to the men involved at Holme House – DRP is all about a shared philosophy; it’s about common values and it’s about hope.

With its emphasis on ‘strength based recovery’, its commitment to evidence based drug treatment and to building an environment that maximises the benefits of integrated clinical leadership and delivery, being involved in the DRP was not a hard sell for me or for any of my team at Spectrum.

As a clinician with an interest in substance misuse, I have seen significant changes in recent years and, having walked the journey of drug treatment in prison right from the very introduction of opioid substitution treatment into secure environments, it is clear to me that prisoners with histories of opioid dependence do not fall into two clearly-defined ‘abstinent’ and ‘prescribed for’ categories.

Men in prison may make different choices at different stages within various sentences. They change their mind sets, their health and wellbeing needs change with age and life course, and they may also change their treatment goals during a single sentence. They are individuals.

The DRP presents an opportunity for health, in partnership with Her Majesty’s Prison and Probation Service. It is a ‘system wide’ approach and aims to develop a ‘blueprint’; a seamless pathway of care between prison and the community in respect of substance misuse recovery – ambitious and very much worth the endeavour. Particularly given the stark and sobering challenges we face and the solutions we must find if we are to turn our ambition into a reality for the men in our care and reverse the trend on drug related deaths, violence and instability on the prison wings and the dangerous levels of access to psychoactive substances.

One of the most significant consequences of this is the distinct lack of hope you begin to see exhibited by some of the men and the vicious cycle that this creates; a lack of hope, which is fuelling worrying risk taking and leading to increasingly desperate behaviours. This is compounded by the impact on clinical and recovery teams who become demotivated, deskilled and concerned for their own health and wellbeing. I have often referred to this as the ‘perfect storm’.

Then there is the critical relationship between healthcare and prison officers on the frontline – this also requires consideration. Drug dependence is highly stigmatised and officers with experience and training in substance misuse and associated risk are rare, but if we can build and nurture that expertise and understanding amongst the prison officer workforce, we know that through close joint working alongside and with health and recovery worker colleagues, we can support the development of a humane, caring and therapeutic environment.

DRP seeks to do this and the project is prioritising officers being recruited to work on the wing where possible with opportunities for co-working and joint training and core involvement in multi-disciplinary team working and care planning.

Trauma informed care and excellent psychosocial support are two of the cornerstones of this blueprint. Psychosocial provision can enable prisoners to begin unpicking the reasons for their drug use, provide them with alternative tools for managing difficult emotions and situations, enhance their motivation for sustained change following release, and link prisoners in to lifelong networks of support.

The DRP investment has enabled partners to bring in new skill sets and enhanced leadership, such as psychology, pharmacy, speech and language. It has also provided the opportunity to marry these new skilled professionals with the traditional skills of recovery workers, addiction specialist nurses, GPs with extended roles and responsibilities in recovery oriented care and psychiatrists supporting patients with complex needs and mental health comorbidities.

I am optimistic that this is an exciting time for drug recovery treatment. But we must allow projects like the HMP Holme House DRP to be properly evaluated and time for researchers, leaders and policy makers to reflect on the contribution of the mix that is cultural change, new ways of integrated working, enhanced skill mix and responding to and building trust with the experts by experience – our service users. Read about the blitz on drugs in prison.

Linda Harris

Dr Linda Harris FRCGP is Chief Executive and Chief Medical Officer of Spectrum Community Health CIC, a not for profit organisation delivering community and health and justice services on behalf of the NHS, local authority public health and other partners in sites across the north of England.

Passionate about integrated care for vulnerable groups and tackling the root causes of health inequality, Dr Harris is the Chair of the NHS England Health and Justice Clinical Reference Group, which plays host to a range of task and finish groups and quality improvement initiatives.

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