Creating healthy forests to plant healthy trees

Lou Boyd, Winston Churchill Memorial Trust fellow, talks about his adventures in North America, supporting families through substance misuse treatment journeys

In the Autumn of 2016 I travelled to New York and Toronto to look at how urban, community-based services support families through treatment for substance misuse.

Using my role within an integrated substance misuse service in central London, I was able to focus on how our services deal with issues such as family and whole-household mental health; dual diagnosis; PTSD; and cultural influences and evaluations of family health.

I attempted to align my studies within each city by visiting comparable services with some culturally based and serving niche populations, others providing universal access and others providing specific structured family interventions.

I was able to spend time with a range of service users, professionals, commissioners and community stakeholders. As someone who identifies with familial dual diagnosis issues,at times I opted to participate and observe family specific peer-support and mutual aid groups. I managed my own mental health throughout the exhilarating and exhausting process through maintaining the exercise, counselling and relaxation regimes I practised at home.

I remained aware of my own cultural, individual bias and the impact my presence had in one-to-one interviews, group participation and observations of treatment.

I was fortunate enough to access family drug courts, family treatment services, prisons conducting family support pilots, cultural centres, street pastors and I was invited to meet with the families of service users to discuss the treatment experience from both a professional and service user context.

My findings were encouraging, even when addressing complex problems facing care systems across all three cities. Long-established stigma, funding cuts to public health, environmental gentrification, social isolation, over criminalisation and institutionalisation of families with mental health needs were common threads, although so was resource ingenuity, increased use of digital tools and community assets to support families.

What is asset-based community development?

All communities have assets and provisions of some sort. These include employment, training, education and cultural and material assets. Asset-based community development focuses on using these existing assets rather than focusing on the problems, needs and deficiencies in a community. Using existing community provisions can empower people and communities to take charge of and improve their own health and wellbeing.

The emergence of ‘making every contact count’ and asset-based community development, alongside challenging traditional family stereotypes, silos and barriers within the treatment system was incredibly encouraging.

In all three cities there is evidence of a renaissance in a cultural approach that seeks to serve not just a nuclear, biological, anglicised concept of the family but broader, more fluid concepts of family that support LGBTQ clients, secondary carers, communities, workforces and families spread across borough, city and national borders.

The traditional notions of substance misuse recovery in the face of severe or enduring mental health issues were also being constructively addressed with non-abstinence support growing beside the established medicalised and abstinence-focused strands.

Actions coming from my study include developing a bespoke family, household and community care plan. This includes clients nominating significant others who they would like to engage in their treatment programme, and developing their own personalised action plans with co-dependence, family dynamics and broader health themes.

Lou with New York Cosmos football club's community engagement team

This is focused on utilising asset-based community development  in a fluid manner rather than a rigid lineal treatment journey defined entirely by the perceived ‘success’ of the individual with whom the treatment episode began. I am currently working with both the mental health and substance misuse development teams at my employer, Turning Point, to look at rolling this out – firstly as a pilot and hopefully nationally as a standard element of treatment provision.

We have already developed an online asset-based community development tool for central London service users. They can then invite family members to use this as well, to empower them to utilise the resources available for them to improve their health, social functioning and self-care.

My learning from the study is that we should continue to open up communities to service users, professionals and families alike and address dual diagnosis needs in the constructive, holistic and creative manner mirroring the ways in which families seek to address the challenges of everyday life.

Some quotes from the study

"We know that even within a single city, different boroughs and districts can feel like different countries and our families are spread all over them. It seems bizarre to send members of the same family in different directions because of their zip codes so we do our best to pull them together for support." Substance misuse professional, New York

"While we try to frame treatment in as positive a manner, we still need to acknowledge that many people have experienced risk as part of the substance use in their family. It would be naive at best, dangerous at worst, to ignore that and people get a rounder view of their use when they can acknowledge the good and bad it has brought."  Substance misuse professional, New York

"Isolating the 'user' from their family and just working on their use whilst ignoring the other health needs of they and their family members is like taking a tree out of a rotting forest, nursing it back to health, then planting it back into the rotting forest." substance misuse professional, Toronto

"It felt like, 'well you're better now so you've got to pay us back.' I was not expecting that. I kind of thought maybe it’d be alright and we’d all be happy. All the feelings about the betrayals, the money, the lies were still there just we were all older. If I could have fixed it in treatment I think we would have but this stuff is deep, it’s taking years." substance misuse service user, New York

"In here (prison) I've got a family, on the streets I got a family then I've got the family I came from and the family I've made. So when you say family I got all these ideas going round my head." substance misuse service user, New York