THE STATE OF RESIDENTIAL TREATMENT IN ENGLAND

Patients are arriving at rehab to quit their addictions far sicker, frailer and more physically damaged (than less than five years ago), according to a report commissioned by the Addiction Recovery Foundation and completed by members of the Concordat of rehabs. Staff must spend more time addressing physical needs -- including emergency hospital admissions on arrival.

 

Read the full research paper:
Download The State of Residential Rehabilitation in England - Nov 2011

Related document:
Download Rehabs and NDTMS - Addendum to The State of Residential Rehabilitation in England

HIGHLIGHTS IN THE REHAB REPORT:

• Of the 481 beds in this report, completion rates were  68% alcohol and 62% drug (average)
• 57 clients had cost the state £4,115,749.90 before rehab (including community ‘treatment’)
• Most patients 55.5% (n= 108) had waited between 3 months and 12 years (23 people had waited longer than 6 months) to get into rehab
• Providers observed that people are arriving far sicker, frailer, more physically damaged (than less than five years ago), with less self-esteem, increased levels of DV, sex working, social services involvement, homeless, and fewer social skills – please read attached Rehabs and NDTMS for specific details and how this artificially lowers recorded completion rates
• Staff having to spend more time than ever addressing physical needs (including emergency hospital admissions on arrival)
• Majority of rehabs operating at below break-even levels since 2008/09
• 11 (out of 16) have lost staff, reduced services (including shorter programmes) and are under threat of closure (2010/11) &10 under threat of closure in 2009/10
• Statutory clients are expected to jump through hoops before securing a funded place in rehab – mode for waiting time equal at 2 & 3 months (both at 13 times frequency).

The ARF/Concordat report was collated by researcher Laura Graham. It feeds into the Recovery Partnership rehab report for the Inter-Ministerial Group on Drugs.

Many rehab CEOs said they were "too busy" fighting for survival to complete the questionnaires for the report, but hope to contribute to the next version of The State of Residential Treatment in England in early 2012.

CONCLUSION

The report shows a decline in the use of residential rehabilitation in the treatment of addiction over the past five years. There are several possible factors driving this including the commissioning and referral process which does not easily consider client choice, the culture of the drug and alcohol treatment which again focuses on the need of the service before the client’s progress and rewards for the 'retention' of clients even when the client’s circumstances are on a downward spiral.

In this climate, residential rehab provision is shrinking. This includes a reduction in provision (which in turn will affect availability) by closing, reducing bed spaces, reducing staff, and providing shorter programmes. The ability of clients to fully benefit in a reduced programme is further compromised when many are arriving at rehab requiring an unexpected detox, unaddressed health problems, and greater deficits in their recovery capital bank (requiring housing, social skills, relationship problems, social service involvement) as an increased amount of time within the time in rehab includes addressing many of these issues.

The recent practice of exploiting the good will of residential rehab providers to keep clients beyond the time they are funded for in the client’s best interests cannot be allowed to continue and requires urgent further investigation.

As shown, there are differences in waiting times for people requiring residential rehab based on their ability to pay and those requiring statutory funding. The latter are expected to jump through hoops in order to prove that they are suitable for the treatment they have identified as appropriate for them at a time when they are likely to be at their optimum motivation. This practice in itself can extend waiting times, support a decline in the individual, demotivate them, and evidence that they require a residential rehab is overlooked rather than used in support for their application when the individual struggles with compliance in a community setting. Non-compliance is regarded as a demonstration of a lack of motivation for residential rehab. This is another area which requires review.

With a few exceptions (such as awaiting release from prison), there is no logic to explain why 55.5% of the current clients in receipt of statutory funding had to wait beyond three months (with one person waiting for 12 years) of asking for rehab before arrival when there are empty rehabs across the country. During this time individuals are becoming more unwell and the collateral damage as the result of their addiction has potential to increase.