Powys Substance Use Harm Reduction Plan launch

Linda Hutchings, Brecon peer support worker

“Developing a partnership response to Harm Reduction across Powys 

to meet the needs of people with drug and alcohol concerns.”

The first thing I picked up at this Harm Reduction Plan launch recently was a flyer about nitazenes (synthetic opioids known for their potent nature) and the changing face of heroin. I hadn’t even pinned on my attendee badge. The bizarre names of drugs like naloxone (a potentially life-saving medication) and nitazene (an extremely harmful drug) were scattered throughout the day and I realised I had a lot to learn.

Fortunately this highly informative day at the Metropole Hotel in Llandrindod brought together a multitude of statutory and voluntary sector agencies with a wealth of knowledge and experience around substance misuse. But perhaps even more importantly it called upon those with the lived experience of the harm that can be caused by substance misuse - be that alcohol or drugs - and the often catastrophic effects resulting in damaged mental and physical health, relationships, living arrangements (homelessness and debt being extreme but not unusual outcomes) and an increased likelihood of coming into contact with the criminal justice system.

Jan Roberts (Suicide Prevention, Harm Reduction & Postvention Quality Improvement Lead), Joy Garfitt (Interim Executive Director of Operations, Mental Health Services) & Carol Daly (Harm Prevention & Reduction Lead - Substance Misuse)
Powys Teaching Health Board

Joy Garfitt, Interim Executive Director of Operations - Mental Health Services in Powys, and chair of the Area Planning Board, welcomed everyone. She explained that the APB brought together agencies across the county with the shared ambition of reducing harm from substance use. (There is a longer definition in the Welsh Government document Working together to reduce harm). The APB plans, commissions and delivers services and also brings networks together. As Joy explained, Powys is actually as long as the distance between the Severn Bridge and the Marble Arch, so this is quite challenging!

What is harm reduction and how can it benefit Powys - Rick Lines, Public Health Wales, Head of Programmes, Substance Use

Rick described how he was first introduced to harm reduction 30 years ago in his hometown of Toronto in Canada. He worked supporting prisoners who, he explained, were inevitably using drugs. His experience supporting people who had been traumatised by early life events, and went on to use drugs, led him to ask in court: “Have you heard this woman’s story? Why is the state looking at it through the context of drugs?” Rick highlighted that putting this particular woman in prison repeated the trauma she had experienced from authority figures when she was a child.

Rick saw the same scenario play out when he later worked in Eastern Europe. He said 90% of drug use is not problematic (how many people do we know who use alcohol on a regular basis socially…?) and asked what we can do to reduce deaths, to show that we care whether people live or die, and to help reduce the risk of using drugs in a risky fashion. We should be respecting the dignity of people who use drugs by providing services, and reducing feelings of vulnerability and stigma.

Recent concerns are around changes in the drug market whereby synthetic and highly dangerous drugs (like nitazenes) are increasingly coming onto the market. Rick championed the ongoing work in the 3rd sector and community pharmacies to provide harm reduction services - “it is the people on the ground who are making the difference”.

Welsh Government policy is committed to harm reduction, and is unique in the United Kingdom, and rare in the world. This policy influences how the police, prisons and partners regard substance use and filters down to the statutory and community organisations.

Current position in Powys and the focus of Harm Reduction - Carol Daly, Harm Prevention and Reduction Lead (Substance Misuse)

Carol’s aim is to set up a multi-agency Powys Harm Reduction sub-group (one of seven across Wales) to drive action across the county. This would draw on the knowledge of local organisations to deliver the key priorities, including:

Supporting the work of the Health Board in working to the World Health Organisation's global aim of eliminating Blood Borne Viruses by 2030. Powys is rolling out treatment and testing for people at risk of Blood Borne Viruses such as HIV, Hepatitis B and C.

• Training up peer supporters and carers.
• Developing pharmacy services to increase the uptake of Needle and Syringe Provision and Blood Borne Virus Testing.
• Raising awareness of the real risks of synthetic drugs coming onto the market.
• Increasing availability of Naloxone across partner agencies.
• Addressing the stigma (it was again pointed out that most people use some sort of substance, for example, alcohol).
• Prevention - the APB has commissioned services to educate children and young people about drugs, and Carol is working with Child & Adolescent Mental Health Services (CAMHS) to increase knowledge of new synthetic opiates.

This important agenda would save lives - and has saved thousands of lives already with the information and tools to help people who take drugs do so in a safer manner.

During discussion Barry Eveleigh from Kaleidoscope (the local substance misuse service provider) highlighted the financial element - if you can keep someone out of A&E you can save £2000. A liver transplant is £150,000. It costs £1000 a week to keep someone in prison. In comparison to these figures the costs of providing safe drug alternatives are minor.

There were also questions about decriminalising drugs as has happened in other countries such as Portugal, where the person using drugs is regarded as a patient rather than a criminal. Michael Curties from the Welsh Government explained that the criminal justice system is not devolved to Wales so this is not an option open to the Welsh Government.

What’s already being done and what are our priorities? - Neville Brookes, Area Planning Board Manager

Neville asked: “how can co-production work with this agenda?” We need to learn from people with lived experience, and spend time with individuals in the treatment system. “Who better to talk to when waiting for a service than another peer?”

Peers design relapse prevention programmes - they know what works. If people become part of a peer mentor programme they often give back to services and there is an onward pathway to work within the field if they choose.

He also said:

• Harm reduction should be on all our agendas - not just thought of as a clinical intervention.
• Out of hours community support is needed (this was identified by focus groups).
• We need to simplify the service so that individuals have a single pathway.

The overall outcome would be to enhance and improve systems and processes for everyone involved.

How we use peers, with lived experience, to enhance service provision - Elwyn Thomas, Co-production Lead, Kaleidoscope

Elwyn has been in post for 18 months now. He started as a peer on a script in a prison cell. He worked on a Welsh Government peer to peer support project providing the heroin substitute naloxone - over an 8 week period 237 kits were delivered! Amazingly eighty people did not even know that it existed.

There are now seven teams across Wales delivering this important service. Everyone was trained in just a year, and other initiatives have also been put into place including creating pathways to treatment and needle exchange schemes. Elwyn spoke of how people’s esteem and self-worth was raised after having access to the training, with peer uniforms (branded “ask me about Naloxone”) and lanyards breaking barriers.

In 2 years the delivery of harm reduction has changed massively in Wales, from prescribed scripts from nurses to working alongside peers.

Linda Hutchings, a Brecon peer, has lived experience for many years using drugs but is now drug free. She agreed that people can be the best they can be with training and involvement. She is now accepted in her community, not as a drug addict, but as someone with lived experience. “I built up belief in myself as I didn’t have any.” Linda started work with peer mentoring service Cyfle Cymru on 8 February.

Round table discussions & feedback

In round table discussions we looked closely at Powys challenges and priorities. The top three challenges on our table were: rurality, silos and stigma. We were very keen to promote the idea of a support bus which could travel the whole length of the county, the distance from the Severn Bridge to Marble Arch - and back again!

Our priorities were - prevention, communication and collaboration. We agreed that it was important to reach out into the community (it’s that bus again!) rather than expect people to come to us.

Overall it felt that there was a great enthusiasm in the room for genuine collaboration and partnership working to make real change so that people using drugs and alcohol, for whatever reason, could live well in the county.

Closing remarks - Michael Curties, Substance Misuse Policy Team, Welsh Government

Michael raised many relevant and important topics in his summing up in relation to the APB, data sharing, working more closely with GPs and prevention, etc. To finish off I’ll highlight just a couple of his comments that particularly resonated with me:

The Harm Reduction challenge is the same as it is for all other services - we solve it by working together. “How do we get to the point where there is no wrong door? Where people walk in and get a service wherever they are?”

“Coproduction is about learning - what do we say that gets in your way? We need to hear if there are those barriers. Ask - can we do it differently?”

I look forward to finding out more about developing drug and alcohol services in Powys as Carol continues her vital work on the Harm Reduction plan.

You find out more about Alcohol and Substance Misuse resources

on this Powys Teaching Health Board website page.

Dual diagnosis - changing times

Dual diagnosis - co-occurrence of a mental health problem with a substance misuse problem.

This week’s post is from our guest author Kate van den Ende. 

Kate is one of three representatives on the National Mental Health Forum in Powys. There are ten such networks across Wales, feeding in to the National Partnership Board – where those using services, carers, professional groups, the statutory and voluntary sector and government departments across Wales meet three times a year to oversee the delivery and implementation of "Together for Mental Health – A Strategy for Mental Health and Wellbeing in Wales".

The bad news

If you live with a mental health problem, you are more likely than the rest of the population to have to manage a problem with substance misuse as well......and vice versa.

The most commonly used 'substance' is alcohol, but, in the world of addiction, the understanding is that, at different times, we use different 'substances' to support us, to self-medicate - a horrible term used by professionals! So alcohol can be interchanged with food, drugs, relationships and/or gambling as the 'substance of choice' at different stages of our lives, depending on which is available or which fills the need at that time.

The double whammy of co-occurrence used to be considered a rarity but, as any of us could have told the professionals, statistics show that it is more like the norm..... and if you have a severe and enduring mental illness like schizophrenia or bipolar disorder, your chances of having to cope with both is considerably increased again.

Assuming that co-occurrence was a rarity meant that the two sides to the problem tended to be treated separately, as if they were symptoms of two completely different, unrelated conditions. People were shunted between the separate services and, surprise, surprise, they fell through the gaps!

Our experience was just that.

An appointment would be made to see the mental health team or psychiatrist. Nervousness and self doubt resulted in large quantities of vodka. The professionals refused to see a drunk patient. An appointment was made to see the drug and alcohol service. Nervousness and self doubt resulted in large quantities of vodka and a failure to attend the appointment. This in turn fed into the 'I'm rubbish, just see how rubbish I am....I can't get help even when it's offered.' Vodka again, with pills this time. A&E admission and a couple of days to check liver function before discharge either directly home to exhausted and lost carers or mental health ward, with or without Section. Medication, escapes to buy vodka, discharge to the even more exhausted and despairing carers.

An appointment would then be made to see the mental health team....vodka.....no change in mental distress......appointment with drugs and alcohol service....vodka......further reason to beat herself up.....vodka and pills.....A&E.....Section.....revolving doors, escalation of the problems.....further desperation for carers....

And so we went on, for 18 months, with the reliance on vodka and the self harming reaching ever higher, dangerous levels. Neither service looking beyond their particular remit. Nobody was looking at the whole distressed person, with all her complexity of problems.

The good news 

Changes are being made to the way help and treatment are offered to people battling with co-occurrence. Indeed, changes are being required by the Welsh Government. If you talk to service providers in Powys, they will tell you that they have already started on a new, joined-up approach. Drug and Alcohol services are provided in Powys by Kaleidoscope and CAIS. They have started to work out ways of joining forces with the local mental health services, to deliver 'seamless' provision.

But the new legislation demands far far more. Seamless delivery is just a start.

It includes:

"It must not be left to the service user to navigate between substance misuse, mental health and other related support services themselves." They and their family will have a nominated, responsible key worker to help them find their way.

There must be "absolute clarity on which agency is leading and coordinating care."

An integrated approach, with clear treatment protocols and care pathways will provide "holistic, person-centred care."

To deliver these improved services, the Welsh Government recognises that:

Professionals on both sides will need considerable training "to overcome institutional and cultural assumptions."

So, from December this year, when Powys teaching Health Board resumes complete control over, and responsibility for, the commissioning and delivery of services to those in mental distress in this area, they have been offered a fine example of the kind of services we want, whether or not we have a co-occurring substance misuse problem.

Integrated, holistic, person-centred and individually tailored to our needs, delivered by teams of well trained professionals who work together and who listen!

That’s the kind of support we need to recover control over our lives.

My Recovery

This week we feature a blog post by a new guest author from South Powys. The author writes about the impact of creating art on recovery from heroin addiction, and the invaluable support provided by a number of organisations, including Brecon & District Mind.

I am 49 years young and about 3 – 4 years ago I tried heroin. I had never done any kind of drugs until then and because of the circumstances and one thing and another I got hooked on heroin. It is all true what they say about it, it’s so addictive you would not believe. I would not want my worst enemy to try it.

Anyway back to my journey.

It all started about a year ago. I was told by a friend to “go to Kaleidoscope, they can help you”, so I did. When opening the door of Kaleido I did not know what to expect. I was shocked, it was friendly and had a good feel about the place, not what I thought it would be like.

Anyway, I made an appointment. The first meeting you have is to discuss your addiction and how best to deal with it. After that you have an appointment to see a doctor. Then you have a chat and they will tell you how much methadone to put you on. I started with 50mg which took away any kind of cravings for heroin, gear, brown, smack, whatever you want to call it.

Then it’s back to Kaleidoscope to arrange courses and other things you may be interested in. At the first meeting there were about nine people all with different addictions. A few people I knew, which was good. Did not make me feel as nervous as I may have been. The course was a varied amount of topics. By the end of the course I felt good and more to the point looked good (LOL). And life was starting to look good too.

While on this journey of mine, I was living in sheltered accommodation through Gwalia. They have helped me with items for the flat, trips away for the day and just a chat. I was told about a place in town that would be good for me. So I went, it is called MIND, and that is where I met two painting artists. They got me painting and now I have won competitions and other things with my art work. I do watercolours mainly, I like working with this medium.

So it was thanks to everyone from Gwalia and Kaleidoscope for getting me involved with these activities. Otherwise I would never have known that I had a raw talent for painting, which was a shock to me because I could not even draw before let alone paint. So, just proves that it is worth going to activities and things with Kaleidoscope, Gwalia and Mind.

Even though I was taking my medication there were a few times that I was tempted to have a smoke as they say. Then I think back to how it was when I was on heroin. The sleepless nights, the stomach cramps, sweating and feeling like shit. So you could say that sometimes I do struggle with my addiction. Sobriety can seem like an impossible goal. But with the treatment and support that Kaleidoscope gave me, by addressing the root cause of my addiction - the road to recovery often involves bumps, set backs - but by examining the problem and thinking about change I was already on my way.

Another thing I thought about was the cost and how I looked when I was taking the drug. And believe me I could not believe what I looked like and when people found out I was on drugs, they would not talk to you or give you the time of day. That felt bad.

Addiction affects your whole life, relationships, health, work and psychological well being. And the ways to handle stressful situations.

The other good thing about my recovery is that I was taking a small amount of gear. Because the longer and more intense the heroin use, the longer and more intense the treatment will be. But regardless of the length in weeks, months or even years, the follow up care is crucial to the recovery. Another thing I did was not to bother with anybody that is on drugs. To stay away from some of the boys I used to smoke with. And I do not drink any more. That was down to heroin. Made me sick if I had a drink, so good in a way. I don't even like the smell of beer at all.

One of the main things that has helped me is my art. I paint every day without fail because I love it. Never knew how painting can bring back and raise so many emotions. So I look at life differently now.

Also I would like to say that the staff at Kaleidoscope are an invaluable asset in my recovery. I was very reluctant to turn to my family for help, because I felt I let them down before, so it can be hard. But remember, there is help out there no matter how you feel. Or think that the whole world is against you. All you've got to do is believe. Who knows, maybe you will find you have a raw talent. There are some of my mates that are helping me get back to some kind of life. Some of them know what it’s like to be where I've been, so that can be a great help.

Back to my recovery. Like I said before, I was with Gwalia who helped me get off the streets. You would not believe the help and commitment these people have doing their job. They helped me no end. That is why I have got where I am today. Because of the staff there and other bodies that have helped me.

After discovering this talent for drawing and painting I have not stopped. I am always out walking to see what catches my eye to paint. I can't describe the feeling I get when painting but it’s a good one, and I get lost in my artwork. I spend a lot of my time at my painting table. Well happy.

Without Mind and the staff there, I would never have been able to get where I am today. The staff at Ty Croeso (Brecon & District Mind) are brilliant and friendly. You just feel welcome, safe and at home there. Everybody is brilliant. So thanks to the staff at Mind.

So my recovery journey to now, you would not believe. The transformation from me being a smack head to now an Artist. I owe a lot of it to Kaleidoscope for getting me where I am today with the art and recovery. And the staff of Gwalia and Mind.

So a big thank you to everybody.

I hope your recovery journey is as eventful as mine.

Once again. Thank you all for helping me, on my recovery journey.

You will never know how much you have done for me.

Many thanks to our guest author for writing about a very personal recovery journey. If you want to tell us about your experiences you can comment  below.

Mental Health: The Myth of the Chemical Cure

Last week my colleague Glynis Luke attended a really interesting event organised by Lewes Skeptics down in East Sussex. She was very lucky to get a ticket at all, as they sold out in 24 hours! Dr Joanna Moncrieff, Senior Clinical Lecturer in psychiatry at University College London, spoke to a packed audience at The Elephant & Castle pub in Lewes. As it said in the publicity blurb:

"Joanna Moncrieff challenges the view that drugs like ‘antidepressants’ and ‘anti psychotics’ remedy mental disorders in the same way that medical drugs treat asthma or diabetes. She argues that psychiatric drugs cause rather than cure chemical imbalances, and change the way we normally think and feel."

Glynis felt that Dr Moncrieff spoke with real passion and knowledge about her subject, and asked me to share a podcast of the event with a wider audience. The podcast concludes with a very robust question and answer session.

You can link to the podcast on the Lewes Skeptics blog page.