03 September 2008

“No-one Written Off” – The Perils of the DWP Green Paper

First they came for the crack users…(part 4)

A long time ago, I used to work with the homeless people in Central London, back in the days of the “Cardboard Box City.” The vast majority of people with whom I worked had a range of factors that contributed to their exclusion: drug and alcohol dependency, mental health problems, basic skills needs, long offending histories and so on.

However, the initial biggest obstacle to helping these people re-integrate with any services, including housing, was the need for some identification and the need to start a claim.

For some clients, this initial hurdle was massive: a person had to regain their identity: their full name, date of birth, NI number and an address. For younger people this was easier, but for older people, and those with the most enduring health problems, this was a massive issue.

Many people needed some initial help to get a copy of their birth certificate, then support and encouragement to put in a first claim for benefit. This step was critical for so many reasons. Without it, securing stable housing was impossible. But it also represented a stepping stone away from begging, away from the street culture. For some people it also might mean “facing up” to the past. It might mean surrendering to an arrest warrant, to previous debts, or to previous failures.

Having secured the holistic trinity of ID, benefit and housing, the next step – access to treatment – became more realistic. Over the past ten years, there are only a very small number of people who are cut adrift – the massive visible street population has dwindled and the vast majority of people who are drug dependent are in some sort of housing, and have a greater level of stability than was hitherto the case.

The Department of Work and Pensions, with their Green Paper “No-one Written Off,” seems determined to reverse this process. They appear to believe, based on this paper, that mandatory referral and engagement with treatment, and the threat of benefit-related sanctions will act as a spur away from drugs and in to work. What it will do for most problematic drug users is push them away from benefits (as desired) but back to street-existences instead. The prospects of going full circle, back to the cardboard box cities of last century, are all too real.

The DWP Green Paper is a long document but the section related to drugs is in Chapter 2 The report claims that 75% of problematic drug users are in receipt of benefit (some 240,000 people) and of these some 100,000 are not currently engaged in treatment.

The report explores a number of proposals. The least tendentious of these is investing and promoting better joined up working between drugs services, benefit agencies, housing and employment. This would be a welcome development, and experience elsewhere shows that this can have a positive impact.

But the Paper doesn’t stop there and with a rallying cry of “we must go further” the report proceeds to outline the draconian sticks to get problem drug users off benefit.

These proposals include:
Where claimants are identified as having a drug problem, they will be referred to a drug treatment provider. Failure to meet that provider could result in a benefit sanction.

This proposal is featured in the 2008 Drug Strategy and does not appear to be a “consultation item” but a firm Government commitment.

This proposal is very ambiguous in the paper. At some points the paper says that there should be a requirement to “meet that provider.” However, only a couple of lines later the paper goes further and says “where drug treatment is available and considered appropriate, then there should be an obligation that individuals will take it up.”

These two proposals are radically different: one requires a person to attend a meeting or an assessment; the other obliges the person to take up a treatment package, even if a local provider offered a limited range of treatment modalities.

In response to an article in the HSJ Paul Hayes wrote a letter (reposted in full on the NTA website here) that describes as misleading the assertion that the Government “intends to force people in to treatment.” It is hard to see how the line from the paper that “there should be an obligation that individuals will take [treatment] up” can be viewed as anything other than forcing people in to treatment.

The Paper then go further outlining how Job Centre Plus will be able to identify problematic drug users before imposing treatment requirements. Several approaches are mooted:

A requirement to make all applicants for benefits declare whether they are “addicted to heroin or cocaine” and face sanctions or prosecution for a failure to disclose.

This wording deserves close attention. A willingness to admit to a drug problem is a huge problem for people with a drug dependency who are not engaged with treatment. As a group, they are one who are most likely to be unable to admit to having a drug problem. This problem or reticence is likely to be compounded in a Job Centre interview setting where the client has not had a chance to build up a trusting relationship with their interviewer yet is expected to disclose personal information of a deeply personal and illegal nature. The majority of Job Centre staff are still ill-trained to deal with problem drug users.

This proposal also becomes embroiled in a semantic argument about the definition of addiction, and the substances involved. If a person views themselves as being in control of their substance use, would it be feasible for them to be sanctioned for “misleading” the Job Centre if their assessor felt otherwise?

Job Centre Plus to be notified of all cases where person has tested positive for heroin or cocaine and been referred for a Required Assessment, those who have agreed to a Drug Rehabilitation Requirement and those leaving prison who have an identified drug problem.

To make these information sharing schemes work, legislation would be required. While the DWP already leads the way in behind-the-scenes information sharing, substantial expansion of the existing databases would be required to store and process the 200,000 plus notifications per year that such a scheme would generate.

Before even contemplating the practicalities of such a scheme, it’s worth stressing the extension of State power and information sharing that this represents. At present, a positive drug test triggers a Required Assessment; it does not mandate an engagement with treatment. Only 35% of people tested received a Care Plan following an assessment within two months, and of those receiving a care plan 47% of people attending enter a treatment plan. (http://www.homeoffice.gov.uk/rds/pdfs07/horr02b.pdf) The green paper claims that “those who test positive (there are around 80,000 positive tests a year) are referred for a Required Assessment by a drugs worker which in nearly half of cases leads to an agreement to engage with drugs treatment and support.” This assertion is not evidence based and probably misinterprets the facts. The Paper purports that some 40,000 of the 80,000 positive tests engage with drug treatment. In fact it would probably be closer to 15,000, although no comprehensive assessment of Tough Choices is currently available to the public.

In this respect the Green Paper goes further than Tough Choices; a Required Assessment merely requires attendance at an assessment, not engagement. The Green Paper threatens benefit sanctions for a failure to engage with treatment.

The Paper makes no bones about this: it says “in return for this access to drug treatment and specialist employment support, there will be an obligation on individuals to take it up. Failure to do so without good cause would result in a referral back to Job Centre Plus and a potential benefits sanction.”

At present the proposals relate only to opiates and crack cocaine. While most of the text refers to heroin, the later reference to opiates could have implications for people who are dependent on prescription opiates. This is unclear. However, the paper ominously concludes that “over time we will consider the case for extending this approach to others – for example, those dependent on cannabis, powder cocaine, or dependent on alcohol.

But ultimately, why stop there? Hampered from re-entering work by a weight problem? Why not sanction people who fail to join a dieting club and cut off benefit. Smoking-related respiratory problems contributing to worklessness? Get those nicotine patches on or lose benefit! This is a wonderfully clear example of “first they came for the crack users…”

Without any evidence, the authors of the paper seem to think that the threatened sanction of benefit removal will act as a spur to engaging with treatment. But as those who have had extensive contact with problem drug users will attest, the stick, all too often doesn’t work as hoped. Rather than driving people towards treatment it is more likely to drive people away from benefits. And while this may have some statistical appeal to the DWP it will bring with it a slew of attendant problems; increased homelessness, further distancing from treatment and increased offending. It is to be hoped that wiser heads and evidence will prevail in the face of these measures. But given the Home Office’s resistance to listening to the experts when reclassifying cannabis, one has little hope that they will do so in this case.

The green paper No-one Written Off is a consultation document and comments are invited until the 22nd October 2008. The body of the text invites comments on specific questions. It does not ask the question “should benefits be removed from people with drug problems who are not engaged with treatment?” Respondents will want to answer questions and pose challenges which are not currently invited by the (limited, specific) questions in the Paper.

The Paper can be viewed here. http://www.dwp.gov.uk/welfarereform/noonewrittenoff/

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