This is a guest blog by Steve Bodycomb. Steve is involved with the West Kent Recovery Service and a member of the service’s Research and Innovation Team.
There are good days; very occasionally there are great days. To an addict in recovery every day they stay safe is a good day.
It was psychiatrist Carl Jung who said there were two ways people could find recovery from addiction; through ‘religious experience’ or the ‘protective wall of human community’. This story is definitely the latter and the human community is family. Not blood-relatives but a growing family of recovering addicts helping each other.
So what makes a good day great? Let me elucidate…
After a bad night’s sleep, I was not in the best of humour and the 5am start to the day did little to enhance my grumblings. Getting up and hobbling to the shower on my crutches, I slipped and fell backwards. Knowing I could not stop myself falling, I had no option but to use my one good leg to propel myself onto the bed, rather than risk more serious injury. Fortunately, the landing was a success although not dignified; flat on my back, legs akimbo, with crutches spread even wider like some helpless, flailing insect turned-turtle by a mischievous child.
By the time I had composed myself, made it through the shower, dressed and limped downstairs my daughter had rung to say she had missed the train so could I run her to school. Rather than her be late I agreed, collecting her before heading off in the opposite direction to where I needed to go adding some 40 minutes to my journey. Seeing the bus leave as I neared the stop, the 15 minute wait for the next one turned to a 28-minute wait in the cold wind and rain. After a walk, or hobble, of more than a mile on my crutches I arrived at the Maidstone hub of West Kent Recovery Service where I was due to greet and serve at the breakfast club organised by the RSA’s Whole Person Recovery programme.
Cold, damp and in pain I was, obviously, not in the best frame of mind and after the inauspicious start to the day it certainly wasn’t looking like being a great day.
Whether it was the effect of attending the ‘Action on Addiction’ seminar on the effectiveness of Mutual Aid recently I don’t know, but in the couple of hours following my arrival I witnessed something quite remarkable that had a profound effect on me.
The breakfast club had been going for about 15 minutes when a key worker appeared with a shy and anxious client. They had travelled from another service where they currently have no breakfast club or mutual self-help groups, such as Aspire2Be – a peer support group in Maidstone – and he felt his client would benefit from such groups.
Now I have to break away from the story for a minute; as I feel it only fair to say that the only reason I refer to the persons as the key worker and the client is to respect their anonymity. It is not a case of us and them. In reality it’s all of us together, as equals, no-one being more or less important than anyone else in the group.
Anyway back to the story….
I welcomed the client, introduced myself and the other club members nearby and offered to make them a hot drink. While they sat with their key worker, it was obvious that they were anxious and very nervous. Who wouldn’t be meeting a group of total strangers for the first time? I told her a little about the group and other activities at the hub with her key worker interjecting along with some of the other breakfast club members.
That’s when the magic started….
The client started relaxing, becoming visibly less anxious and started to engage with the group. Soon they were taking an equal part of the conversations. There were lots of smiles and jocularity as there always is at breakfast club. Help and advice being freely exchanged along with experiences, hopes, aspirations, fears and dreams.
We have a saying in recovery that ‘No one understands an addict like another addict’. Within 90 minutes of being at a mutual self-help group, a shy, highly anxious and stressed person was fully engaging with members of the group to the point of discussing which other groups and activities people did and arranging with some to meet at the meetings. New friendships formed in minutes, with the client telling the key worker that they felt safe and happy. They said that within the time they had been there they felt welcomed, listened to and part of the community. New friends that actually listened, understood and knew how they felt.
They also told the key worker that he need not stay as they felt okay to be left with their new friends and had indeed decided to stay on after the breakfast club and try out the Lazy Energy Workshop that followed.
I was still in the building when the participants were leaving the workshop and there were lots of smiles, goodbyes and see you on such-a-such night. The client also made a point to come and say goodbye to me saying that they had really enjoyed their time with us and couldn’t wait till the next breakfast club. They had also signed up to the Aspire2Be sessions.
Whether or not they do return, time will tell, but I have no reason to doubt they will, seeing the smiles as they left. They saw in that short time, that recovery is possible and life in recovery from addiction can be fun and fulfilling. The very worst case scenario is that they were safe for the half-day they spent with us.
Personally I have always known the power of mutual self-help groups whether they be Fellowship 12-step higher power groups or non-secular groups such as Aspire2Be, or the even more informal breakfast clubs.
People helping people for the simple reason of wanting to give back what they have received. Real altruism in action.
The work and involvement of the RSA in the help and support of these mutual self-help groups cannot be quantified by me, other than anecdotally. All I can say is stories like the one in this blog happen far too often to be a mere coincidence. This isn’t some clever smoke and mirror trickery; designed to fool those whose only interest is the data on a spreadsheet. This is real, tactile, holistic healing. For those of us fortunate enough to witness, and be part of the power of these groups we have only one word to describe it….
And the people who were once the story are now telling and sharing the story. And with the continued support and encouragement from organisations such as the RSA (part of the West Kent Recovery Service), this amazing self-help community will continue to grow and flourish.
Myself, I am honoured and humbled to be able to serve and know such amazing people. So what started out as a good day turned into a great day. And the secret of its success?
Well, it’s a kind of magic!
March has been National Bed Month.
For me, this is an event that I can really get into, so to speak. I have always taken a professional and personal interest in sleep quality, even more so since having a child, when life and sleep can become so disrupted that you hardly know which way is up, let alone have the energy to venture there to find your bed.
There’s a wealth of research into how quality of sleep affects us, and many an argument as to how much of it we need. But the general consensus is that poor sleep equals poor health, reduced performance and less effective coping.
In the recovery field, there is a commonly used acronym – HALT. It stands for Hungry, Angry, Lonely, Tired, and it’s what you are supposed to stop and assess yourself for if you are struggling with cravings. I don’t know where it originated from but I’ve found it to be of immense value, not only working in the recovery field, but relevant to my action around my own wellbeing.
Although not necessarily easy, I find the first three to be the most immediately solvable issues. Hunger, of course, can be remedied by paying attention to diet and eating regularly. Anger, can be resolved by dealing with the situation, either directly or by finding ways of letting it go – counselling, meditation or physical activity for example. Loneliness can be a huge challenge for people – but Apps like Social Mirror can be of benefit, and most communities offer social groups if you are willing and able to get out there and engage. Tiredness, I think, can be the most challenging of these issues to control.
There are of course, many natural ways to improve the quality of your sleep. In recovery, the use of ‘sleep tea’, a combination of herbs such as chamomile and lavender is commonly used. Sour cherry juice has also been proffered as a proven natural way to improve sleep. Yoga and meditation is used for relaxation and to reduce anxiety. But how many of us, in recovery or elsewhere, make getting quality sleep a daily focus? If you are anything like me, sleeping is not the period of the day that I attend to the most, but it is probably what I should prioritise. Anxiety about specific events can keep me awake at night, and that is the time that a person needs sleep the most.
We see sleep problems a lot in this sector, especially in the period after people have detoxed from substances. Waiting for your body to reach a state of equilibrium again can be an arduous process, and people describe waking in a sweat following dreams where they have drunk alcohol or used drugs, when that is the exact thing they are working so hard to avoid. Often GPs will prescribe sleeping tablets, but these of course are not meant to be a long term solution, and do not serve to provide any sort of ‘sleep training’ or encourage us to think further about our own role in getting good sleep.
The New Economics Foundation created a list of five everyday actions that people can take to improve wellbeing. So much of our own work within Whole Person Recovery is anecdotal, but based on that, and my own experience, I would add a sixth ‘way to wellbeing’ – work to improve your sleep.
Perhaps, if we all spared thirty minutes a day to take action around our sleep – taking a warm bath before bed, meditating, writing down our thought summary of the day, or doing some active relaxation, our wakeful periods may be enhanced, and we could really focus on the other five ways.
Hopefully, you have managed to stay awake whilst reading this blog……………
We all have those days. The ones when we wonder why we do our jobs. Why we manage a team, take our place on a factory plant line, or decided to be a stay at home parent. Those days that are frustrating, unfulfilling and unproductive. Many of us do our jobs because we need a steady pay cheque. Some of us do our jobs because most days it’s not too bad. The lucky amongst us do our jobs because we generally enjoy it.
When I have those bad days, I tend to think about the people I work with. This tends to extend way beyond the team here at the RSA who will always pick me up when my day has been challenging, to the recovery community that I work so closely in West Kent. I have often heard people in this sector say something along the lines of ‘one person committed to their recovery can make up for ten that are not yet ready to change’.
I work with an amazing team of volunteers. The other day, one of them sent me a passage of text that he had posted on a social media website (through which he has many professional contacts including his employer). What struck me most about this was not only the amazing change he has been through, but how proud he is of the journey he has made. Using volunteers and peer mentors who are in recovery in the West Kent Recovery Service is a visible and inspiring demonstration that recovery can happen, but many people still remain anxious and concerned about the stigma placed on addiction and recovery in the wider community. For me, this was an inspiring account of change. Someone who has not only faced their problems and sought out the support they needed, but is not afraid to talk about it, to anyone.
Here is what he wrote:
“Addiction is not something you decide to do. It’s an illness and unfortunately there is NO cure. Some of us are lucky and learn to live and control the condition BUT ask any addict – it is a battle that is very difficult to fight. Many addicts relapse and when they do the addiction takes even stronger hold. It is so easy for non-addicts to judge and say it’s easy to stop. But to all you non-addicts, imagine trying to live your life, constantly swimming against the tide. Every now and then the tide is too strong and carries you back downstream. Some of us lucky ones manage to start swimming upstream again. Unfortunately far too many don’t get another chance. It doesn’t matter what the substance or thing; addiction is addiction.
In a previous part of my life I used no substances whatsoever but was going to the gym three times a day and taking a run at stupid o’clock at night. I now begin to understand; same addiction different substance. For years I kept my addictions secret thinking I was somehow at fault or had no self-control; not knowing that I was wired differently from those non-addicts around me. For me, one of anything was never enough.
I now am learning to live with a co-existence of addiction and other mental health issues. At the moment I am in remission but each day, every breath, every step is a battle to keep my head above water. Every day I can think of a good reason to use. And every day I then find a better reason NOT to.
So to you all. Get this straight. I am an addict! I am currently in a period of remission BUT know I’ll be an addict for the rest of my life. I will fight the fight not to use and take each day as it comes. I’ve accepted my fate and have no secrets from anybody”.
So that’s what will inspire me, for today at least. I hope that everyone finds the same sort of inspiration in their work. I wish you an inspiring rest of your week.
In October I co-curated an exhibition of artwork for the London Feminist Network’s Feminism in London conference. The conference was open to all and attracted women and men with diverse and clashing views on the state and future of feminism. Within the exhibition there was a particular focus on art by women who had experienced addiction, prostitution, incarceration, mental health issues and abuse. Many of these artists attended the conference but had never been to that sort of event, let alone grappled with feminism as a history, movement or ideology. With all my energy trained on fixtures and untangling artists’ instructions for installation pieces, frankly, I was distracted from the activism and debate of the event as well. For me, the best reward for all the hours I poured into logistics and hanging was from the surprise, pleasure and pride on the faces of the women whose art took centre stage and captured the attention and empathy of the attendees.
Women in recovery from problematic drug and alcohol use are up against so much more than addiction. Struggles with a history of abuse, mental health issues, poverty, homelessness, lack of education and opportunity often underlie reliance on drugs or alcohol. In highlighting the different shape of women’s experiences with substances my aim, and that of my colleagues at the RSA and collaborators at the Feminism in London conference, is to take a wide angle view of the influences that shape a journey into recovery and how services can be tailored to support the whole person.
In the lead up to the conference I ran a focus group with members of the Women’s Group from the Gravesend West Kent Recovery Service Hub, some of whom had contributed pieces for the exhibition. In initial conversations to feel out interest in the focus group the majority of the women said they were not sure if they identified as feminists or were even sure of what it is. So many approach feminism from the same place, claiming, as William Hague did in a recent interview for Stylist magazine, ‘I wouldn’t really describe myself as a feminist but I believe in women’s rights.’ The very definition of feminism is ‘the advocacy of women’s rights on the ground of the equality of the sexes’ but barriers have been built in the layers of meaning history has piled upon the term. When it came to the discussion the women defined their own feminism through their personal experiences. Many of the artists I worked with were not making consciously feminist statements with their work, but by simply expressing their diverse passions, pains and pleasures as women they reached the very core of the feminist movement, and bolstered the call for compassion, solidarity and action for equality.
Filed under: Recovery, Social Brain, Social Economy, Uncategorized
In mid-summer I received a phone call from Lucy Stewart, a researcher working with Ossian Communications www.ossiancommunications.co.uk. Ossian is an Edinburgh based agency commissioned by the Substance Use Network Edinburgh (SUNE) to undertake research into UK-wide developments in cross-sector (public and third sector) partnerships developing new approaches to service design, partnership working and service user involvement within the field of substance misuse recovery. This initial conversation led to a longer and wide-ranging interview where I shared with Lucy, some of the experience I had gained as Lead Recovery Community Organiser within the Whole Person Recovery (WPR) project in west Kent. As some of you will already know, the RSA’s WPR project is part of a consortium that includes CRI and Sussex Partnership NHS Foundation Trust. Our project is a working example of the type of partnership that SUNE, was looking to draw learning and insight from in preparation for imminent reforms within the Scottish public and third sector social welfare communities.
Following the interview with Lucy, I was invited to attend the SUNE event, Getting Ready for Better Services: Learning Day. This whole day event in Edinburgh organised by SUNE, provided an opportunity for Edinburgh-based third sector organisations to participate in a knowledge exchange regarding cross-sector partnership working and service user involvement in service design and delivery. As a guest presenter / facilitator, I offered an overview of the genesis of the Whole Person Recovery model within the RSA’s work, which began in 2007 with the publication of the report Drugs – facing facts, The report of the RSA Commission on Illegal Drugs, Communities and Public Policy. I drew attention to the different contexts in which the WPR model has been developed, first in west Sussex during (2008-2010), as an independent project run with partners form across the public, third and voluntary sectors including GPs, criminal justice system and drug rehabilitation professionals, substance users and individuals in recovery from substance misuse. A further report: Whole Person Recovery: A user-centred systems approach to problem drug use was published offering an account of this work, to the current context of the WPR project. Presently (2012-2014), the WPR project is operating ‘within the system’ i.e. as part of a consortium working within the Payment by Results (PbR) mechanism. The WPR project is one of eight national pilot projects delivering social welfare programmes under the PbR model. In the PbR context there are rigorous governance and reporting frameworks that service delivery partnerships must comply with. These relate to the clinical elements of programme delivery where service users draw on the expertise of specialist nurses, doctors and psychiatrists as they move towards abstinence on their journeys of recovery, and to programme completion rates for service users under the care and supervision of service providers.
I made an effort to foreground the realities of the challenging dynamics and realpolitik expediencies that one has to exercise in partnership working, especially in the dual-contexts of working with relatively unstable user groups and rigorously prescribed reporting obligations. I also made a particular effort to open up our experience of working to engage service users in the co-design and co-production of the RSA elements of the WPR programme. These are challenging and iterative approaches to service provision and are not necessarily straightforward in their development or implementation. This kind of fluidity and the contingent nature of the work can sometimes be at odds with conventional organisational processes and cultures. The business of partnership working and service user involvement is sometimes gritty not pretty; it requires a particular resilience and steadfastness on the part of professional partners.
The event was deemed a success by the SUNE members and I had the opportunity to visit Edinburgh’s first Recovery café – The Serenity Café www.serenitycafe.co.uk, which is an initiative of community development charity COMAS www.comas.org.uk. I was given a tour of the space and a summary account of the genesis of the project from John Arthur, who chaired the SUNE event and is also the Recovery Coaching Development Manager at COMAS. It was interesting to see the way that the cafe was used as an ‘ordinary’ community resource by a range of people from the general public. It was inspiring to see the way that former service users make use of the cafe as community members seeking a social space and a creative and learning space for a range of activities that take place over the course of each week. The grassroots take-up of the recovery model as a real, achievable and desirable path back into the wider community is clearly alive and kicking. There is much that commissioners and others involved in policy level decision making could learn from these projects, particularly the ways in which service users are determining the speed and trajectories of their personal development and reintegration into society as proactive citizens with hard-won experience and inspiring stories to share.
In June this year, the Whole Person Recovery Programme posed a question to the recovery community, ‘what matters to you as a group, and how can we build on that?’ The Maidstone recovery community had an interesting response – ‘fun in recovery’.
In the recovery arena, we focus a lot of time on treatment, some time on trying to equip people with learning and opportunities to increase their networks of support; building on skills such as entrepreneurialism, but how much time do we dedicate to encouraging people to just get out there and have an enjoyable time in their recovery?
They say laughter is the best medicine. That’s often what I see from the Maidstone recovery community as a dozen or more people gather in the mornings to meet up and have breakfast. They welcome newcomers as if they were old friends, chat and make so much noise that it often disturbs whatever report I’m writing in my office, as I wander out to check on the source of the hysterical laughter.
How often do we have to justify just doing something nice with positive people that we enjoy? Certainly many of us will wish we had more time for it. Getting down to the seaside, or experiencing the cultural opportunities of our cities. All are far more enjoyable with a friend.
Laughter is one of the first emotions we display in human development, and we typically seek out things that will make us laugh rather than experience painful emotion. But for those who are sinking into the spiralling challenge of mental health problems or addiction, emotions become flattened and whilst the painful emotions are being avoided, there is also usually not much to laugh about.
It has been shown that laughter has both emotional and physical benefits. It can reduce stress and blood pressure. It can increase one’s sense of wellbeing and coping. It can benefit your circulation and reduce anxiety. So that’s what they wanted to build on. More time to spend doing fun things with people who all want to be healthy and happy and have some fun. The group applied for –and won – the very first Whole Person Recovery Super Sparks grant – £500 to support the recovery community with this exact goal.
Whilst I’m typing this I can envision the reaction from some people – ‘shouldn’t we all be so lucky as to have the time and money be able to go out with our friends and just have fun?’ Of course we should, and if we have the skills and the resources we could count ourselves very lucky. To have a good sense of wellbeing there is evidence to say that we need to achieve five things. They are Connect, Be Active, Take Notice, Keep Learning and Give. Simple for most, but if your life has been taken up with just trying to cope and get through the days, hours or minutes, it takes practice to learn how to let yourself just be…….and to enjoy it.
And the Maidstone Recovery Community is practising hard! Having just completed their second day trip to the sea side, it was fantastic to see how their trips had ticked all of the boxes. The connection between a group of people who are all trying to achieve the same goals. Being active –getting out as a group –taking a walk in conservation areas. Taking notice – of each other and the change of environment. Keep learning – about themselves and their recovery. Give – of support and time to each other.
Shaun, expedition leader and celebrator of five years in recovery said about the last trip;
‘We had a lot of laughs, everyone was really grateful to get away from their old haunts and get away together’.
The RSA Whole Person Recovery Project makes individual grants to people in recovery of up to £200.00 through the Small Sparks Award scheme, and to group applications of up to £500.00 through the Super Sparks grant to support our recovery communities. These grants are designed to encourage people to take the next step in their recovery, whatever that may be. We are currently fundraising to ensure the future of this scheme. You can help support recovery in West Kent by visiting our JustGiving page, and making either a one off or a regular donation. We really appreciate your support and can assure you that all donations are pooled into a fund that is used solely for the provision of these awards. There is no diversion of funds for administrative or other costs.
The Whole Person Recovery Project is committed to improving recovery outcomes in West Kent for people in recovery from drug and alcohol misuse. Social anxiety issues can be a major barrier to building strong support networks for recovery, which was why our recovery centre in Tonbridge was a perfect place for Martin Webber FRSA and his team to try out his new game ClearFear.
Martin explains the project much better than I could in his recent RSA blog but the experience of myself and a wide range of volunteers and service users regarding this project, a social game to combat anxiety, is one worth sharing.
When the day began we were a group of nervous individuals. The set up was reminiscent of many of the standard group sessions that take place in the centre every day but what we were about to experience was quite different. There was little time to think as we split up into groups, talked to each other about our lives and interests and constructed cartoon superheroes with names and special powers. These would be our alter egos for the day. After reporting back we created secret missions for ourselves and others which we took out onto the streets of Tonbridge. Our missions included finding interesting facts about the town, asking people to draw their favourite superheroes and a particularly gregarious member of the group tried to get as many hugs as she could. I can’t remember the exact total but, impressively, she got to double figures.
The idea of the day was that we all combatted our social fears together. If someone was uncomfortable with a mission, the rest of the group helped them or they could swap to something else. It’s hard to explain how, but it worked exceptionally well in bringing the group together and even the quietest members came back to the hub and were eager to get up in front of everybody to tell their stories and share their pictures. One guy who has had a particularly difficult year reflected that “It made me feel like a kid again”. The most striking thing for my colleague, who was working on a different floor at the time we returned from our missions, was the sound of laughter that echoed through the building. He had observed the group at the beginning of the day, quiet and slightly agitated, and the difference he witnessed was, in his words, “transformative and heartening”.
What we experienced in Tonbridge was a pilot project, but to really get the game moving – building a website, creating mission cards and developing a full version of the game – it needs funding. Martin, with support from the Fellowship team, has created a Kickstarter campaign where hopefully he will secure the necessary funding to take the game to the next level. If you would like to know more about this campaign and others, please visit the RSA curated area on Kickstarter and remember, if you’re a Fellow, the RSA will match your contribution up to £10.
Whole Person Recovery Programme Coordinator
Filed under: Arts and Society, Design and Society, Recovery
As Lead Recovery Community Organiser within the WPR programme, one of my responsibilities is to ensure there is a quick and responsive capacity on the part of my team, to meet the emergent requirements of the community of c.600 service users within the west Kent region that we work in. Earlier this summer in June, I had a seemingly random conversation with one of my colleagues from our principle partner organisation CRI – www.cri.org.uk about the prospect of somehow transforming the rather standard and corporate ‘social care facility’ non-aesthetic (that is a space designed and decorated, without any real design-sensibility informing the look, feel and function of the space) at the Tonbridge hub.
I jumped at this opportunity as I immediately saw it as a chance for us to work in a genuinely co-designed / co-produced approach with the service users in the programme. I was quickly able to speak with other colleagues within the Hub, specifically the key workers who are the principle formal point of contact between service users and the WPR programme. From these informal conversations, a meeting was scheduled to explore with service users that had expressed interest in what such a project might look like in terms of the process, timeframe and the outcome(s). The meeting was very dynamic, lively and really good fun. Many of the service users at the meeting commented on how exciting and positive it was to actually feel they were involved in shaping the direction of a real project that would have concrete outcomes and reflect their ideas and concerns. We explored quite a lot of possibilities as to how the design / build project could progress. Some of the ideas were pretty crazy, some of them were rather tame, but a lot of them were really creative and achievable – given the real constraints in terms of money (low thousands) and time (just three months) to get from first meeting to post-snagging of designed, built and installed solution…Heady stuff!
The agreed outcomes of this kick-off scoping meeting were to recruit a team of service users interested in continuing to contribute to the project (about 10) and agree a process – this consisted of a mood board workshop session and a number of visits to some (hopefully) inspiring working-spaces in London that demonstrated a pared-down fairly minimal ‘boot-strap’ / up-cycling aesthetic. It was also agreed that a good move on our part would be to find a partner organisation that could help us to take the project forward. Enter The Glass House Community Led Design! – www.theglasshouse.org.uk We were fortunate that Maja Luna Jorgensen, Strategic Projects Manager with the charity was able at very short notice to be available to help us with design and community engagement input. She helped to shape a schedule of appropriate buildings and locations around London that we could visit for inspiration and insight, into what makes a successfully designed creative working space, able to accommodate multiple uses, designed and built on a shoestring budget that works well and looks beautiful. Not only did she help shape a schedule, but she accompanied us on our first visits and provided us with the very capable input of her colleague Melissa Lacide for our second trip. The first journey consisted of our co-design team visiting the following organisations / locations:
Our second Learning Journey consisted of our team visiting:
All of the organisations, buildings and environments we visited delivered! Where we were hosted by representatives of the organisations, they were friendly, open and generous in sharing their time and some of the backstory of how their projects had developed, and how they’d come to make the design choices they’d made. We were definitely inspired as a team by what we saw and we gained a real sense of the creative possibilities open to us through the diverse examples we got to see across the six sites, in terms of materials, scale, construction methods and feel.
The next stage for us in our design process is to get down to the actual designing bit of the project. We’re all very excited and I know that within the team we have some very creative and considered thinkers and makers. Check back in a month’s time for an update on how the project has developed. By then we should be a good way through the fabrication stage and maybe have even started installing the Pods too.
A big thank you to all the generous staff and volunteers form the six organisations / locations we visited. A big thank you too for the expertise and guidance we received from our colleagues Maja and Melissa from The Glass House.
We are bombarded with encouragement to help our neighbours, to participate in our communities and to fight for change in our towns. But how many of us stop to consider whether our actions are the most effective use of the money, time or energy that we are able to give? Maidstone hosts one of the West Kent Recovery Service hubs where the RSA’s Whole Person Recovery project focuses on supporting people to move away from problematic drug and alcohol use and to become responsible and contributory members of society. It is a lovely town, with an abundance of public services and yet also seems to have a disproportionate amount of people who are rough sleeping.
The Council in Maidstone has recently followed a number of other boroughs and launched the controversial campaign ‘your kindness could kill’, aimed at educating people that sometimes providing hand-outs to people who don’t have the skills or willingness to make healthy choices is not the best use of cash. The narrative attached to this campaign is extreme – the inference that if you choose to give money then you are choosing to put someone else at risk. I wonder how successful a campaign like this is, and how exactly success would be measured. Publicity around the campaign states the aim is ‘to tackle begging’ and ‘get homeless people off the streets’, but one wonders what the real motive is behind such an arresting call to action. Undoubtedly, some people are forced into rough sleeping and this is for a myriad of reasons. Britain has a shortage of social housing and in some areas there are reported twenty year waiting lists for appropriate housing. The Maidstone Day Centre, who provide direct services for homeless people, state on their website that they are aware of 25-30 people who will be sleeping rough in Maidstone tonight. Isn’t this what we should be focussing on?
Begging is an emotive issue. Is it better for a person to beg others for money than to commit crime? The aim of the campaign is ostensibly to deter people from donating money to those that may not in fact be homeless and would use it to buy drugs or alcohol, but it seems to me that this micromanagement of the wider problem is a little lacklustre. Is the aim to deter people from begging by cutting them off at the source? Is it to reduce substance misuse amongst the population or is it an attempt to drive funding towards those charitable organisations that are struggling to fill the void created by public service cuts with a harsh reduction in available funding? One of the main problems not identified by those behind the campaign is that giving money to someone in the street is reactive and immediately gratifying, while giving money to a charity often requires planning and is easier to put off or forget about. I wonder at what point it was considered a better idea to try this convoluted campaign over channeling resources into a more direct approach – say more resources for the support homeless services directly, or for street wardens and Police staff. Perhaps street wardens could carry a charity box that the public could immediately divert their funds into?
Just how naïve are people who choose to give money in this way? One comment on the local newspaper’s website stated “there was me thinking every time I bunged a beggar a quid or 2 that they were running straight to the bank to pop into an ISA account”. Even though the public is aware of the risks, they clearly still choose to give.
My concern is that this type of campaign further stigmatise a group of people who already face extreme challenges. Is it the case that people who would give cash to beggars will find a more appropriate way to give? I would be interested to see if the charities that offer homeless support report an increase in charitable donations as a result of this campaign.
If you would like to get involved with any of the wonderful causes that help to support homeless people in Maidstone click here for information, or you could just pop down to the town and start handing out 20p pieces. But that’s for you to decide.
In May 2013, the RSA and Drugscope convened a meeting of the providers that deliver the eight national ‘Payment by Results’ (PbR) substance misuse pilots. The RSA wore two hats: one reflecting our role as a think tank with a now longstanding concern for substance misuse policy and practice; and one reflecting our role as one of the providers. (As readers of this blog will know, the RSA is part of a consortium lead by CRI and including Sussex Partnership NHS Foundation Trust, which delivers the West Kent PbR substance misuse pilot.)
The purpose of the summit was to explore the provider experience over the first 12 months of operation from April 2012, and in doing so to highlight good practice and identify practical recommendations for implementing PbR schemes. You can download a short summary of the themes discussed and the learning points that emerged below:
I will not summarise or repeat the main points here, but I want to add a reflection on some conversations I had very recently about these points and what they mean for PbR. The pilots represent significant system change, that is happening within significant wider system change, that is happening within wider change still. The move to recovery-oriented systems, delivered through PbR mechanisms in the case of the pilots, is happening in the context of wider health-system change (move to public health, introduction of Clinical Commissioning Groups and Health and Wellbeing Boards, and so on), which is occurring in the context of multiple and complex changes to public services and the welfare system and wider economic stress for many groups and areas (all of which impacts on ‘recovery outcomes’ to varying degrees). Levels of public service performance can often dip after major re-organisations, so isolating the effect of PbR specifically appears difficult.
Further, it was interesting to note that when providers spoke at the summit of the ‘effect of PbR’ in terms of the value-adding change it had made to service delivery and emerging outcomes for service users, it was usually difficult to see how PbR itself had actually brought about this change. Rather, PbR had acted as a catalyst for change – something to shake up the system; a stimulus or opportunity for new thinking and innovation. It seemed that changes could have been brought about by some other catalyst (and in most cases, it seemed that these changes would have happened anyway, given local capabilities and concerns, and as the focus on recovery given by the national drugs strategy washes through the sector). Again, any change measured will be difficult to attribute to the impact of the financial mechanisms and incentives of PbR. The diversity of PbR designs in the pilot sites (and the corresponding diversity of the responses delivered by the providers), and the wider roll out of PbR into other (non-pilot) sites make comparisons across areas difficult. Even with a sophisticated realistic evaluation design, it will be difficult to take account of this much noise. The risk is therefore that we mis-interpret what PbR does (both positively and problematically), and do not consider whether there are better mechanisms for driving transformation, innovation and improved outcomes. At least the pilots are generating a significant amount of data that can help to unpick the puzzle (this is PbR without the black box in practice).
The RSA will be publishing a report in the Autumn that will explore our experience of delivering under PbR arrangements. In the meantime, one clear lesson to emerge from the summit is around the speed of the PbR design phase and the turbulence encountered in the early stage of delivery. Transforming Rehabilitation should take note.