Our Strategy Working together to reduce harm Working Together to Reduce Harm is our ten year plan to tackle the problems caused by drugs and alcohol in Wales Published in 2008 it sets out a clear national programme for tackling and reducing the harms associated with substance misuse ID: 344767
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Working together to reduce harm : The substance misuse strategy for Wales 2008-2018 Slide2
Our Strategy: Working together to reduce harm
'Working Together to Reduce Harm' is our ten year plan to tackle the problems caused by drugs and alcohol in Wales. Published in 2008, it sets out a clear national programme for tackling and reducing the harms associated with substance misuse.
It is structured around four action areas:
preventing harm
supporting substance misusers
supporting families
tackling availability and protecting individuals and communities.Slide3
Preventing harm
We want to help people resist or reduce substance misuse by providing information about the damage it can cause.
We want to ensure that everyone understands the consequences of misusing drugs or alcohol and knows where to get support.
We will continue to concentrate on educating children and young people. The All Wales School Liaison Core Programme (external link) is a substance misuse education and crime prevention initiative. It is jointly funded by the Welsh Government and the four Welsh Police Forces.
We will also do more to influence attitudes across the whole population. In particular, we will place a greater focus on increasing people’s awareness of the amount of alcohol they are drinking and the associated risks.
We want to encourage people in Wales to take responsibility for their overall consumption and follow sensible drinking guidelines.Slide4
Supporting substance misusers
We want to improve the health of people who misuse substances, as well as supporting and maintaining their recovery.
We provide support for substance misusers to reduce the harm they cause themselves, their families and their communities.
This includes:
basic ways of minimising harm and other advice
outreach and other services aimed at engaging individuals in treatment
the recognised four tiers of service provision and relapse prevention
support services aimed at helping substance misusers access accommodation, education, employment and training
we will expand harm reduction services for drug misusers and do more to engage priority and hard to reach groups.
w
e will continue to promote existing services and begin to address gaps in provisionSlide5
Supporting families
We want to reduce the risk of harm to children and adults as a consequence of the substance misusing behaviour of a family member.
We want substance misusing parents to have access to effective treatment, so that they can successfully parent their children.
We also have a responsibility, in partnership with others, to ensure the child’s well being. Local authorities have a lead role to play in identifying and supporting families. However, it's important that agencies such as child and adult health and social services, as well as local police, work together.Slide6
Tackling availability
We want to reduce the harm caused by substance misuse related crime and anti-social behaviour.
We intend to tackle the availability of illegal drugs and the inappropriate availability of alcohol and other substances. This includes the sale of alcohol or solvents to young people.
Overall, we want:
local partners to work more closely with local trading standards departments to tackle traders who persistently sell alcohol to children
to make the best use of current powers and legislation
to ensure that the full range of sanctions are brought to bear against individuals who drink irresponsibly, and licensees who continue to serve them
partners to take a holistic approach to the management of our towns and cities during the evening and night time. Slide7
Substance Misuse Finance
We invest almost £50m into substance misuse in Wales in 2013-14.
Substance misuse Area Planning Boards (APBs) are directly funded by the Substance Misuse Action Fund (SMAF) and Local Health Boards (LHB) via LHB revenue allocations.
The SMAF budget in 2013-14 is £32.55m.
£22.66m revenue and £5.07m capital of this funding is allocated to APBs to deliver their regional substance misuse commissioning strategies and to support local capital investment.
The remaining £4.81m of SMAF funds:
-the All Wales Schools Core Liaison Programme
-Operation
Tarian
-The Transitional Support Scheme
-other centrally supported policy initiatives such as the Welsh National Database for Substance Misuse and the free bilingual All Wales Substance Misuse Helpline, DAN 24/7.
A further £17.13m is ring fenced within the Local Health Boards revenue allocation for substance misuse services to support prescribing services, psychosocial interventions and inpatient treatment.Slide8
Prevalence
Increased rates of substance misuse in people with mental health problems 33-50% of those with SMI
Welsh inpatient units report 40-60% of their population have a dual diagnosis
Alcohol misuse most common form
Drug misuse frequently co-exists with alcohol misuse
CMHTs report 8-15% of clients with dual diagnosis (higher in inner cities)Slide9
Services have evolved somewhat separately
Drug treatment focused upon dependence
Mental health services focused upon mental illness
Dual diagnosis high risk presentation but likelihood of falling between the cracks
Evidence base illustrates a mutual dependence between services
IssuesSlide10
Serial models unlikely to provide integrated care
Parallel models may also fail
Isolated dual diagnosis staff likely to burn out
pump priming vol. Orgs. to tackle issue in isolation likely to fail
One off training of little value
Specialist staff focusing on own caseload likely to be unable to support mh & sm services more widely
Mental health strategy clarifies lead role and prescribes link workers
IssuesSlide11
Service Criteria
diagnosis or
problematic use
need
social/medical
risk
to self/to othersSlide12
The Criteria trap
Substance Misuse
Mental Health Problem
Highly problematic
Substance Misuse
Severe Mental Illness
Common Mental Health
Problems
Less problematic
Substance MisuseSlide13
The Criteria trap
Substance Misuse
Mental Health Problem
Highly problematic
Substance Misuse
Severe Mental Illness
Common Mental Health
Problems
Less problematic
Substance MisuseSlide14
The Criteria trap
Substance Misuse
Mental Health Problem
Highly problematic
Substance Misuse
Severe Mental Illness
Common Mental Health
Problems
Less problematic
Substance MisuseSlide15
Dual diagnosis –is one of the central problems facing mental
health services.
1659 (27%) suicides
72 (36%) homicides
In the report were dual diagnosis cases using a restrictive
definition, the contribution of dual diagnosis to patient suicides
and homicides may be substantially more.
Previously we have recommended the development of dual
Diagnosis services in all mental health trusts.
However, this is the Inquiry recommendation with the lowest
take- up Rate of those we have examined.
Avoidable Deaths NCI 2006Slide16Slide17Slide18Slide19
Definition
Preferred model of care
Service aims and Objectives
Service Standards
Linkage to CPA ( Now Statutory Care and Treatment planning)
Special Needs Groups
Needs assessment and Service planning
Training
Development of a care pathway
The Development of a Welsh Service FrameworkSlide20
Co-occurring substance use and mental health problems
.
Taken together these problems give rise to significant impairment and disability for which people affected need advice, support and services, in order to follow a more integrated life course.
The severity and nature of a persons problems are liable to change over time.
Each problem, however, would be significant enough to merit planned care on its own.
Framework definitionSlide21
Joint liaison collaborative
approach
The care of patients is
jointly managed by both
services
Joint working required
between mental health and
substance misuse services
Integrated
There is concurrent
provision of both
psychiatric and
substance misuse
interventions by the
same clinical team
(designated service)
Preferred Service ModelsSlide22
Agree local definition, care pathways and model using Care Programme Approach (CPA) [Care and Treatment Planning in Wales]
Develop service standards for dual diagnosis
Need for tiered joint training programme
Need for comprehensive staff supervisory arrangements
Develop supervisory and training networks across voluntary and statutory sector
Specialist staff to work on an outreach consultancy model
Ensure liaison with relevant generic agencies primary care, homelessness organisations prisons A&E
RecommendationsSlide23
Implementation of Part 2 of the Measure: Holistic Care and Treatment Planning
Development of Protocols and Care Pathways at a Local SMAB and MHPB level
Ensure training delivered for all relevant staff
Use of the NCISH toolkit within services
Policy and Legislative requirements