Transport for London’s Drug & Alcohol Assessment & Treatment Service enjoyed a success rate exceeding all properly researched treatment outcomes, can pay up to 50% of costs, offers six months’ aftercare and monitors clients for five years – but now finds it so hard to work with London Drug Action Teams that employees must be fired instead of treated. Manager Nigel Radcliffe pleas with its managers for lives.
First, I wish to offer you all my respect, and to acknowledge that the job you do is far from easy. I have worked in the addiction field for over 20 years and cannot recall a more difficult time in terms of funding problems and confused government direction.
I am writing to you because of my concerns about the increasing difficulty of my organisation to work in conjunction with your locally based resources. I am having to use this forum because of our inability to do so in any other way. Last year, we organised an open day to which we invited all London DAT managers and care managers; only five attended.
For many years, we worked jointly with many London borough drug and alcohol services, which understood our needs and helped our employees to access resources which enabled them to remain in their jobs. Anyone who has worked with us and our employees knows the spectacularly successful outcomes to most of these cooperative efforts. But, over the past few years, these arrangements have become harder and harder to facilitate.
For instance, in 2001-2002 we jointly funded 11 residential treatment episodes with local authorities – nine are still employed five years later! But in 2007-08, it was two employees and last year only one person.
With 30-40 candidates for treatment each year, we cannot – by ourselves or even with the employee’s contribution – meet the total financial costs. So 2009, for the first time, sadly led to a number of clients failing to access treatment of sufficient standard to enable them to return to vital safety critical posts. Instead, they have had to face medical termination.
There are three major problems. The first is the ever-growing timescale involved in processing somebody for consideration for residential treatment.
We are dealing with employees granted generous but limited time to sort themselves out. A wait of five or six weeks before they can even access a care manager often pushes that time limit beyond the brink.
It used to be that we enjoyed some informal ‘fast track’ arrangements, in recognition of our professional expertise and willingness to part fund. But that also appears to have gone by the board.
Second is an increasing problem recognising the special needs of this client group. These are almost all heavily safety-related employees who need to make profound and substantial changes in a very short period of time. 12-step abstinence-based treatment is not everybody’s cup of tea but, from our view, it is often the only way to achieve our goals. We have to be able to monitor returning employees; trying to do so other than in cases of genuine recovery is both dangerous and impossible.
Nor is it an option – as we have been offered several times lately – for our employees to access low-tariff programmes first then, if unsuccessful, to be offered residential treatment later. They get one chance; if they fail, they will be dismissed. It is not possible for us to work any other way.
Third, and this is something we are encountering increasingly, there appears to be within local drug and alcohol teams either an antipathy towards, or an ignorance about, 12-step-oriented residential treatment. It is not a panacea but, if our employees cannot stop drinking/using and have attended work under the influence, there is little effective alternative other than residential treatment.
To be brutally frank, I have been surprised recently at the low levels of awareness about the nature of addiction displayed by some front line workers. It feels like we are not heard – which is a real shame, given what we previously achieved together.
In terms of what local authorities will get for their part in working with us, we can offer a considerable package. First of all, we have a success rate which exceeds all properly researched treatment outcome rates; and the quality of the data involved is unparalleled, because of the way we track employees. We have a 55% retention rate five years after treatment. Those retained clearly remain employed and productive, as opposed to being a drain on the taxpayer, which would occur if they were sacked.
Further, we are usually prepared to pay up to 50% of the total cost, on top of the employee contribution which in many cases is considerable.
Finally, we offer not only professional monitoring during treatment, but also six months of ongoing continuing care, with the individuals having to attend our unit for half a day per week throughout that.