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.

Life after alcohol addiction - Russell & Kaleidoscope Project Powys

The headline news in the County Times earlier this year read: “Champion boxer turns life around after fight against addiction”.

Russell Pearce from Welshpool is the boxer behind the headline, and following his own recovery journey from alcohol addiction has recently taken on a new role as an Engagement & Support Worker with Kaleidoscope, working to support people who have a drug and / or alcohol dependency in Powys.

We asked Russell to tell us more about his recovery journey, his role at Kaleidoscope and what support is available in Powys for people struggling with drug and alcohol misuse.

Tell us more about the work you do at Kaleidoscope Powys

I’m the first point of contact for most people when they first come in. I do the referral for them and the initial assessment. Referrals then go to the team meetings where people are allocated to a key worker.

When I do my assessments of people I always tell them a bit about my background because they are often nervous or embarrassed. So I just tell them straight away away – don’t worry, I came through Kaleidoscope. And If you’re worried about any of your questions, I’ve answered them before, nothing you say will shock me.

At the moment the key workers are really busy so I’m taking some of the less problematic clients. Hopefully I will go through the training and become a key worker myself.

Across the county, Kaleidoscope supports more than 450 people, and operates four projects.

What led you to this particular role?

I started boxing professionally at 18 after winning a British Championship fight in my teens. I was representing Wales, but my dream career developed into a means of funding my alcohol habit. I would take on difficult fights, knowing I’d get paid whether I won or lost, and then I’d spend the money on alcohol regardless of the outcome.

My addiction to alcohol started as seemingly harmless but it got to the stage where I was drinking too much and much faster than my mates. It was a slippery slope. Before I knew it I was relying on alcohol to feel I belonged – to be outgoing, funny, one of the lads – it just got worse from there.

Drink took over my life, leaving me alone and desperate to continue funding my habit. My desperation reached a peak when I could no longer afford to sustain my lifestyle. With my addiction still strong, stealing alcohol felt like my only option.

Then I came into contact with Kaleidoscope after being arrested for stealing alcohol. People are routinely referred after arrest, but then it’s up to them to follow up and probably 90% of referrals never engage with us, but I decided I’d had enough. Kaleidoscope got me into rehab and that was the start of my recovery.

Russell (in the pink tutu!) at his stag party

Why do you think it is important that people working at Kaleidoscope have lived experience of substance misuse? 

I think it puts people at ease. If they tell me something, it’s likely that I’ve had that same kind of feeling. You could have the same emotions about heroin, just because it’s a different substance it’s the same kind of thought process behind it really. It’s that common knowledge thing – you learn football better off people that play football basically.

Why do people start to become dependent on drugs and alcohol?

It can be anything. There are people who have been through trauma and manage not to go down that road and some people just do. When I was in rehab we used to have our group chats. There were lawyers there who had the occasional lunch-time drink that just got out of control and then there were the people who had experienced severe trauma in their lives.

A lot of the time it’s unseen circumstances. People only see the addiction, they don’t see the background of it, and it can be anything from family fall-outs to relationship failure. Maybe a couple broke up, they’ve only been together for a month, and one partner is really depressed about it and just chose to do the wrong thing. Alcohol, or substance misuse, is just a way of coping with things. So some people have the gym, others go for a run. Others just turn to alcohol and / or drugs.

How does drug and alcohol misuse impact on people’s mental health?

It’s really hard to deal with mental health when you’re drinking because if all you’re doing is to use drugs or alcohol to suppress the kind of emotions and feelings that you have then all that you’re doing is pushing that down. Things can get out of control really really quickly and that’s what people don’t understand. You can put things off, like bills and debts, and things snowball and before you know it you’ve got this weight on you plus the addiction. I used to deal with all my problems through alcohol. I’d end up stealing alcohol and then you have the stress of – have I been seen, or will I get caught?

It’s all of that and on top it’s people’s opinions of you as well. I know from experience that the people that come into Kaleidoscope, or any kind of drug and alcohol agency, aren’t bad people. Once you sit down with them you realise they’ve had a bit of bad luck in their lives. It’s hard to change people’s opinion on that. But they are actually good people.

On popular TV soaps, street drug people or alcoholics, they’re just portrayed as always doing bad things. Even celebrities are shown when they’re looking really haggard after a night out, you don’t see anyone after they’re recovered. And I think that’s why a lot of people don’t come into the service. It’s actually embarrassing to admit the problem and ask for help.

How might the Covid-19 pandemic have impacted on people’s unhealthy use of alcohol?

I think people are drinking more unknowingly. People have been furloughed and they can drink during the day and not really think anything of it. Then their intake slowly increases. It’s the same with the drug side of things. People might have used drugs at the weekend but now they can get away with doing it during the week too.

And I think Covid is a lot of stress for people too. I think that’s what it boils down to – just people’s stress and how they have dealt with it. I know some of my clients have really struggled through it. There are no barriers in place, people have time on their hands, and no one really knows when it’s going to end. You have all day to worry about your bills and some people have had bereavement to cope with too. Then a drink is going to seem very appealing.

Russell on his wedding day

What barriers might prevent people from seeking support and how do you work to overcome those?

Again, it’s stigma. People see it as embarrassing to admit to this kind of problem. And also not recognising it as a problem. If you ask ten people on the street – do you know what kind of daily alcohol limit you’re supposed to stick to in a healthy world, 8 out of 10 people wouldn’t know the answer.

We get people in to Kaleidoscope through just being friendly. Everyone loves coming into our office. We try to be as normal as we can because we know it’s daunting to come in and admit you have a problem.

Are there particular issues which arise in rural areas like Powys for people with drug and alcohol dependency?

I think a lot of people struggle with rural life. It makes sense – whether they’re cut off from family and friends in the middle of nowhere, so the loneliness, or just because of the way they live and problems with public transport, which means it is difficult for people to have regular access to our services. One good thing that has come out of the pandemic is that we now understand that sometimes phone contact can work.

And now people can drink at home, and when they go out shopping the first thing they see in the supermarket is a big pyramid of crates of beer on sale – which is pretty hard, especially for someone in the early stages of recovery.

Are you working differently, and if so how, to support people due to Covid-19?

So, we’ve been working from home since March now. We are providing phone support to clients. Some of the SMART meetings are taking place online in the evenings with one of my colleagues. A SMART meeting is from UK Smart Recovery, it’s like Alcoholics Anonymous but without the religious side. It’s been nice for some clients to join so they can see other people, especially as some live alone.

From 7 July we have partially opened our doors on a part-time basis in Newtown, Llandrindod Wells and Brecon.

Russell with his daughter

Do you provide support for the families of your clients and if so what?

We will speak to people if they’re worried about their son or daughter or partner – we can have a chat over the phone but obviously everything is confidential so we can’t tell them anything about the client. We normally point them in the direction of Al-Anon – an organisation set up to support the family and friends of alcoholics. 

Which other organisations do you work closely with to provide support to people? 

We do work closely with the Community Mental Health teams across Powys.

What is the most challenging aspect of the job?

Not being able to help everyone. I think you can’t come into this job with rose-tinted spectacles thinking you are going to change the world and everyone’s going to recover. I think everyone has their own journey – it’s just finding different ways of working with each individual.

One of the hardest things is when people are rude to people with addiction. If by telling my story, here, or on TV and in the paper, I can change a few people’s opinions on addiction, I’d really like that.

And the most rewarding?

Just people saying thank you really. They come into Kaleidoscope, like I did, pretty broken. And seeing them make a conscious effort to change their life – because I know how hard it is to get sober – and it’s really nice and rewarding to see. Next week I’ll be taking a client to the rehab I went to which will be nice – going back. I’ve been back a few times. My best man at my wedding and my ushers were all lads I met in rehab!

And also, on a personal level, being able to tell people what I do for a job after everyone knew me as a national champion boxer who threw his career away.

What is the most valuable thing you have learnt since starting your role?

Probably that everyone’s got a story. Don’t judge a book by its cover.

When you are not working for Kaleidoscope, how do you enjoy spending your time?

I still do a bit of boxing. We’re planning a Yorkshire Three Peaks Challenge to raise money for Kaleidoscope. We had to postpone it this year because of Covid. And I’m starting to learn to play the bass guitar. And spending time with my wife, and Facetiming my daughter who lives in Poland.

And finally

Now I’m a better father, husband, brother and son. I want people to know that addiction can grip anyone, from any background.

But, there is support out there, walk through our doors and you’ll be greeted with a warm smile and a cuppa. 

Many thanks to Russell for sharing his recovery journey. You can contact him by emailing: russell.pearce@kaleidoscopeproject.org.uk or phoning: 01938 554013.

Alcohol dependency and families

Blue - from the Kaleidoscope Project exhibition - information below

by our guest author from North Powys

It was recently Alcohol Awareness Week and there were lots of stories and comments online about the effect alcohol dependency can have on society. This got me thinking about my own experience and I wanted to write down my thoughts and share my story to help people understand what is like for the families affected by alcohol dependency.

So, let’s start by looking at what exactly alcohol dependency is.

"Alcohol dependence, sometimes known as ‘alcoholism’, is the most serious form of drinking problem and describes a strong, often uncontrollable, desire to drink.

Drinking plays an important part in the day to day life of alcohol dependent people, which could lead to building up a physical tolerance or experiencing withdrawal symptoms if they stop."

The reason I use the above quote is because all too often nowadays people believe that alcohol dependency is a choice. No. No. No!  Alcohol withdrawal is one of the most dangerous and painful of all the addictive substance withdrawals with some awful symptoms such as hand tremors, sweating, nausea, hallucinations and seizures.

The incident that finally led to my mother’s recovery started with a seizure. She was trying to do the right thing but ended up having seizures. I didn’t live at home at this point, and I got a call from my mother’s boyfriend nonchalantly informing me she was having a seizure. I screamed down the phone whilst running home. I called an ambulance and she went into hospital. It was horrifying but she was released and went into rehab. I found out later that she had been given three months to live.

Does that sound like she had a choice?

Then you hear the other argument people often come out with.

"But when someone starts drinking then surely that’s their choice?"

What they don’t know is what happened to start that person drinking. I suffered from anorexia and self-harm. When I was severely ill would you blame me? After all it was my choice to stop eating. Or when I turned up at the A+E department needing to get stitched up, embarrassed and ashamed after self-harming, am I a waste to society because I did it to myself? Unless you have no compassion or empathy the answer is no. 

I struggled with these issues because I was abused. I believe that my mum’s guilt for not realising what was happening to me was one of the reasons she began drinking unhealthily. I was very ill with my own mental health when my mum found out she was pregnant again. My brother had his own issues which didn’t help and she had a new-born to look after. She was struggling. Who wouldn’t be? Everyday stresses, job worries, financial issues, a mentally-ill child who was stockpiling pills and running away. It was no surprise when she was diagnosed with post-natal depression and sent away with a supply of pills and an appointment with a doctor in a few weeks. A can of lager in the evening was the norm.

It’s so gradual. It’s hard to pinpoint when it became a noticeable problem. That can of lager in the evening becomes a few more, a bottle of wine a day which becomes a bottle of vodka. She was very good at hiding it. She drank to hide her anxiety. Every time she left the house she had a panic attack so she found a coping mechanism to continue to function. And it worked. For a while. We had no idea, we knew about the anxiety but she was ‘out and about’ so that was ok. However, we started to notice she was drunk more and more often and empty bottles were turning up around the house. That’s when it came to a head and we all knew she needed help.

People can forget about those who are around an alcohol dependent person because of the stigma involved. It becomes a family secret and if you do try to reach out people don’t know what to say. It can be incredibly isolating. I would dread coming home as I didn’t know what I would find there. Mum usually passed out, us having to make tea and look after my sister. If she was awake there might be a huge row between my mum and her boyfriend whilst I had to try and keep peace for the sake of the children. I felt responsible and that I had to keep it all together. I was taking time off college to help look after my baby brother whilst my mum was drinking. I would attend the parent evenings, and I was always the one who people offloaded their problems on. My mum, her boyfriend, my brother. I was there for them to vent at, but there was no-one for me to turn to. 

It was soul destroying at this time seeing my mum going to the doctors, begging for help. She was referred to the local Community Mental Health Team but was discharged after two weeks because she ‘didn’t want to help herself.’ I was missing college, and I was continually stressed and glued to my phone. I went to a GP. This was the same GP that had prescribed Diazepam for my mum for her anxiety which she was now dangerously mixing with the alcohol. I told him what was happening, and how stressed I was, and I hoped he could do something for my mum. He called the child protection services, which unsurprisingly left me unpopular with my family after that, adding to my poor mental health.

I used Google to find out about a national organisation called National Association for Children of Alcoholics (NACOA). I sent them a lot of emails and received good advice and support back from them. I saved the emails, and re-read them when I was struggling. Those emails got me through some dark times and difficult choices.

I am very lucky that my mum was finally able to get the support she needed. She made a full recovery with very little damage to her body. I am so proud of her as it is a huge achievement. Not everyone is so lucky. Some people cannot access treatment because they don’t have a permanent address, or the health professionals they are in contact with don’t understand their illness. They might not have the support or strength to recover.

A big issue is with dual diagnosis. If somebody is diagnosed with depression and alcohol dependency you need an assessment to access the service. To have the assessment you need to be sober. Do you see the issue here? It’s a vicious circle where the cause of the problem can’t be treated until the problem has been treated. But the alcohol dependency can’t be ‘cured’ until the depression is. One feeds the other and we need to understand this more as a society.

The idea that ‘they did this to themselves’ is so instilled in society that when someone tries to recover they are turned away. We need to fight the stigma and celebrate and nurture recovery.

Photographs

The photographs in this blog post feature artwork from a Project Kaleidoscope exhibition held in May 2019 in Newtown in Powys. Kaleidoscope is a charity which seeks to tackle the stigma that people with drug, alcohol and mental health issues face.

The exhibition was inspired by using forms of art in individual care plans to address drug and / or alcohol use. Service users and volunteers worked together to develop the display at the Oriel Davies Gallery, which showcased the creativity of individuals who had accessed support for substance misuse at some point in their lives. What their work has in common is how creative activities have played a significant role in exploring emotions, reducing anxiety, improving a sense of self-worth and helping to resolve other psychological conflicts.

Sources of support

Kaleidoscope Project - 01686 207111

Alcoholics Anonymous - there are regular meetings in Brecon, Newtown & Welshpool

National Association for Children of Alcoholics - 0800 358 3456

Drinkaware - 0300 123 1110

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.