Access to rehab at all time low
Phoenix Futures’ new report: Making Rehab Work by Mike Pattinson (@MikeP_mpass) and Kevin Crowley (@KevinCrowleyHD) looks at the declining use of residential rehab in England over the last decade, analyses the reasons for this decline and sets out recommendations to reverse it. The headline findings of the report are:
- Residential treatment is an evidence-based intervention which is effective in terms of treatment and cost.
- Residential treatment is delivered to a higher standard than ever before. It enables people with more complex needs to recover and lead happy and healthy lives.
- But fewer and fewer people are able to access it.
- The report finds that the system that enables access isn’t working.
- Thousands more people every year should be benefiting from life-saving residential treatment.
The numbers
Currently fewer than 2,000 of the approx. 270,000 people in treatment for substance use in England have been able to access residential treatment. That is 0.8% or 1 out of every 125 people in the treatment system. This is less than half the number of ten years ago — in 2010/11 more than 4,000 of the 200,000 people in treatment for substance use in England were able to access residential treatment, 2% or 1 in every 50 people in the treatment system. That figure is bad enough, but when you compare it to the European average of 11%, you can see how big the unmet need really is.
The report highlights the facts that the numbers of people in community-based treatment have increased and that the residential treatment sector is more highly regulated and effective at treatment delivery than ever, in terms of outcomes and cost. So why have the numbers of people accessing rehab gone down instead of up? The report provides feedback from different stakeholders:
- Providers says that after years of funding cuts their primary focus is on survival.
- Funders of residential treatment say they need help to justify why someone should get the funding for this specialist form of treatment.
- People seeking treatment too often tell us that even though they had approached a number of professionals for support no one told them residential treatment was an option for them. Others tell us the process to access residential treatment is inaccessible, focused on funding rather than need, and traumatising.
My own work from some years ago echoed these findings. Because access to rehab has always been via a small specialist funding pot, commissioners have tended to want to ensure it goes to people with the best chance of completing the programme. This led to convoluted and complex assessment procedures which often ruled out those most in need. I have witnessed funding systems which have embedded a “Catch 22” predicament. Those who could negotiate all the barriers and tests of motivation could probably have fared well in community services. Those who desperately needed the respite and intensive support of rehab were not able to navigate the application process because of the chaotic nature of their current situation.
This is a lengthy report and well worth a careful read by all substance misuse commissioners and those interested in the sector. The authors dig into the outcomes of residential rehab and come up with important findings including that people from Black, Asian and Minoritised Ethnic communities are underrepresented in residential rehab vs community treatment (7% vs 11%) but when people are able to access Residential Rehabilitation treatment outcomes are as good as, if not better than, non B.A.M.E groups. Similarly, the outcome data finds that women do better in residential treatment compared to community settings.
The case for increasing access to rehab is a no-brainer, making it happen is more of a challenge. The report concludes with nine key recommendations but the main one is the need for renewed focus on the place of Residential Rehab within a range of service provision open to everyone in need. This will need clear spending plans in every area with funding coming from public health, the Universal Grant, Rough Sleeping Initiative etc.
Given that we have had an explicit focus on recovery in our national drug strategy for years now, it is inexcusable that access to rehab has fallen off a cliff. We must hope that Dame Carol Black’s report galvanises central and local government action, and most importantly, dedicated funding pots.
