Is your Drugs Policy fit for purpose?

I've been doing a lot of work lately reviewing organisation drugs policies. Some of these have been big organisations, some small. But a clear issue to emerge is the difficulty organisations still seem to be having in writing their Drugs Policies and the accompanying procedures.
The problems seem to fall in to three main groups:

1: No policy: I remain astonished that so many organisations still don't have drugs policies at all. It's almost fifteen years now since the Wintercomfort trial which saw senior Day Centre staff in Cambridge prosecuted for offences under the Misuse of Drugs Act, and this case should have ensured that every organisation engaging with people who use controlled drugs would have a workable policy in place. But this isn't the case. And the worst offenders? Local Authorities! On numerous training sessions, the social housing providers and day centres tend to have a drugs policy, but the Local Authority staff don't. All too often, the explanation is that the Local Authority has a "zero tolerance" approach to drugs and this is meant to form the basis of the drugs policy. Which leads on to...

2: Unworkable policy: where policy is in place, all too often it is so keen to demonstrate its anti-drug credentials, that it introduces unworkable clauses that are wholly unrealistic. These policies, if implemented, would see Police being called out for any suspicion of drug activity, and empty buildings where transgressors had been evicted. In truth such policies are never adhered to, leaving a void of confusion where staff, managers and residents interpret their policies as they see fit.

3: Mismatched Policies: sometimes, the policy itself is fine - but is at odds with the organisation's stated aims. All too often an organisation which should be working in an accessible and flexible way with homeless drug users has a robsutly zero tolerance policy which drives drug use underground or sees people being evicted - the very people the organisation is seeking to house.

The problems organisations have with their drugs policies are going to be compounded at present by the financial climate and funding cuts. To provide safe, supportive housing in an average sized hostel with people with significant drug related need, higer staffing levels are essential. Realistically three members of staff should be on shift at all times - less than this makes it hard to manage a crisis safely. One member of staff to tend casualty, one to go and summon help and admit emergency services and one to ensure that the rest of the building and residents are safe. Less than this is an accident waiting to happen. And "less than this" will increasingly become the norm.

Low staffing levels are likely to be worsened by under-trained staff. As budgets are slashed,. so is staff training and so organisations are likely to reduce the amount and quality of staff training which leaves both staff and residents at risk.

This is all happening at a time where, as part of the BS (Big Society, but interpret as you see fit), we are likely to see more wholly-volunteer run provision for the growing homeless population - including drop-in provision and nightshelters. While such provision my represent a much-needed response in areas of high need and low provision it brings its own risks. The well-meaning, but undertrained and under-resourced provision can become unsafe. Again, it is imperative that such provisionhas suitable training and policy in place so that it can run both safely and lawfully. The spectre of Wintercomfort hangs over provision that fails to do so.

There is one more factor that may drive some organisations towards ill-considered and mismatched policies. This is the increasingly common elision of "recovery" and "abstinence" and the proposal in the new Government drug strategy that housing provision for drug users should, along with treatment providers, increasingly receive payment by results.

The need for suitable and stable housing, with appropriate support, represents a critical aspect of the recovery journey. A lack of housing, or the wrong housing can make it much harder for people to start and sustain the process of change. BUT, and it's a big but, refusing housing to people who are not yet abstinent, or returning people to homelessness when they lapse is not beneficial.

Let's be clear: there is a need for housing which is wholly drug free and has minimal tolerance to drugs. This housing is urgently needed for people who are in recovery and abstinent and are striving to remain so. In such cases a minimal tolerance drugs policy would be wholly in accordance with the organisations aims. But where the primary aim is to provide housing to people who are homeless, and who may also use drugs, such a policy is misplaced. Organisations can and should support and nurture and aspire to the prospect of change and as this happens move people in to appropriate housing. But to use the threat of eviction to stimulate the process of changed hasn't been demonstrated to work. It just drives use underground, increases overdoses and hampers honest dialogue regarding use.

Given all these challenges and problems besetting housing providers working with drug users, it seems an opportune moment for us to relaunch the Sample Drugs Policy - a document that was originally written after the Wintercomfort Trial and has been revised regularly since then. This version - the seventh - is substantially rewritten with a longer introduction about how to develop a drugs policy. There are some more extensive procedures and flowcharts to help understand how to implement policy.

This version of the Policy is unashamedly a "high tolerance" model, aimed at organisations working with ongoing users. It will shortly be joined by other models - a moderate tolerance, low tolerance, and minimal tolerance version for use in different settings.

The development of this version has been much assisted by Homeless Link, and by Stoke On Trent Supporting People, without whom this revision wouldn't have seen the light of day.

The Sample Drugs Policy 2011 can be downloaded here

Reporting in - News from the South West

I have maintained radio silence for the last couple of months watching how things unravel, but now it is time to break cover.

Between now and the end of February councils will be setting their budgets for next year and then we will have a much better idea of the fate in store for some of the most vulnerable members of our society.

It seems that unitary authorities are being as short sighted as the executive councils when it comes to removing the funding for a whole swathe of services which currently provide a safety net for those people with multiple vulnerabilities, none of which hit a threshold for a statutory service. Admittedly a lot of the statutory services are being cut too probably by setting the priority criteria even higher.

A colleague of mine who works for a district housing department bemoaned that it is as if this government have decided on a full on attack on housing;

The grant given to Housing Associations to build new social and affordable housing has been completely cut, but they are still supposed to deliver new housing stock, how? by taking out loans - but how will they repay the loan I hear you ask - through the rent they charge. "affordable" rent = 80% of the market rent, social rent can be whatever (interestingly, I saw a bedsit for rent from a housing association for £103. per week today how affordable is that!!).

The bottom line is with loans to repay the Housing Associations are going to take less risks on who they give a tenancy to; the young and upwardly mobile for "affordable" housing or those on 100% benefit (social housing).

Already the place of last resort social housing will become the sole residence for the sick, unemployable and the dispossessed with that social calamity of the sink estate making an unwelcome reappearance.

Changes to housing benefit will shut yet another escape route for those trying to dig themselves out of the poverty hole. Changes to the Local Housing Allowance will mean that those receiving Housing benefit will only be able to afford property with a market rent that falls in to the lowest 30% (so that will be all the crap accommodation then). but if you are under 35 and single then you will only qualify for the rent for a single room in a shared house.

All is not doom and gloom. If there is a will there is a way.

In the face of cuts to the Supporting People budget Exeter City Council are looking at innovative and cost effective ways to maintain some housing in the city for non priority homeless. The STAR scheme which has been running for 2 years can offer a temporary flat to someone rough sleeping giving them among other things a reference for a rent deposit scheme. This scheme uses part of the housing act which says a council can house someone without accepting a duty toward them, it counts as temporary accommodation so the council can claim top rate housing benefit and the excess is then used to buy in a bit of floating support. Any local authority could do this even if they don't own their housing stock.

I guess what I am trying to say is things are bad, the outlook for the year ahead is grim, but there are ways to keep on ensuring that there is some support available for those people who traditionally slip through the net and we have to keep trying.
The time for moaning is over, the time for action is now

Over and out.

Council Cuts Cornwall

Reports in the media suggest that at Cornwall Councils emergency budget meeting, today, the Supporting People budget could be cut by £5.6m - around 40% of their budget.  The Government have cut the grant to the Council by a much smaller 12%.

Regardless of the reports and today's meeting, it has already been decided that there will be no more funding for the Floating Support service provided accross Cornwall by Stonham Housing after 31st march.  Thats a quick saving of £3m, about 100 redundancies and huge numbers of vulnerable clients left without vital support to enable them to maintain their tennancies. 

No other services do this same job in Cornwall, and being surrounded on three sides by the sea, there are no similar services in neighbouring areas. 

The client group is wide ranging but includes drug users.  The Government's Drug Stategy acknowledges the important role Supporting People services play with this group, but this important Floating Support service can be wiped out locally in one hit.

Its clear that this quick saving will be a short term gain to the local authority and will probably cost them (or the tax payer) dearly over time, and cost other services like the NHS etc..

Other Supporting People services have yet to decided on but face 're-stucturing' at best. 

Things seem to go from bad to worse and can't even be entirely blamed on our new coalition government!

Eyes Wide Open Housing - Awards Not Courts

Ten years after the first Eyes Wide Open housing was trialled in the UK, a hostel working with ongoing users has received national awards. It is long overdue. And now there can be no excuse for others not to follow suit

We are immensely pleased to report that the King Georges Hostel in London, part of ECHG, were the recipients of two awards at the Chartered Institute of Housing/Inside Housing Awards for Outstanding Achievement In Housing (England) and Meeting the Needs of Vulnerable People. King Georges are one of the growing number of housing providers who have adopted and adapted the “eyes wide open model” of housing provision that has been pioneered here for a number of years.

The Gateway Programme at King Georges Hostel is a pioneering initiative to provide housing, drugs education and harm reduction interventions to some of the most vulnerable dependent drug users in housing need.

The Programme takes in dependent drug users in housing need, provides housing in attend education and awareness sessions on injecting, overdose, and blood borne viruses. Despite the low level of obligations at admission, residents have been engaging with a wide range of initiatives, including Turning-Point provided drug treatment, nutrition and cooking programmes, outdoors fitness sessions and football clubs. The take up of interventions such as Hep b vaccinations is exemplary and despite the high-risk client group drug deaths have been prevented.

King Georges has made use of the resources, policies and guidance produced on the KFx website to help shape and develop this provision and we are pleased to have contributed in this small way to the establishment of the project.

Whilst offering King Georges staff and residents our congratulations for their win, this award is pleasing as it is, at last, recognition for a model of work which has been increasingly widely adopted or considered but has lacked the imprimatur of “official” recognition.

Ten years ago, Single Homeless Project (SHP) in London became the first housing provider in the UK to deliver inclusive housing to active drug users, where drug use was not only fully acknowledged, but fully engaged with, including access to sharps boxes, needle exchange, harm reduction services, and treatment modalities.

Whereas previously organisations had turned a blind eye or prevented drug use, SHP were early adopters of an “eyes wide open” model which they have used successfully used in their housing provision in several London Boroughs.

Since then a growing number of Housing Providers across the UK have been working within an “eyes wide open model.” Many have found marked benefits from this approach – better engagement, more openness, increased referral to treatment, reduction in public drug use, reduction in overdoses and drug deaths.

These agencies, including Brighton and Hove Housing Trust, Thamesreach, Look Ahead, Society of St James, Wallich Clifford Community, Manchester Methodist Housing Group, Foundation Housing, St Mungos and a number of others were courageous early adopters of such an approach.

It should be remembered that at this stage there was no official endorsement of such a model of work. Ten years ago, at a conference, it wasn’t even possible to get Ian Brady, then of the Rough Sleepers Unit, to publicly endorse the placing of sharps boxes in hostels! The Home Office was pursuing a policy of extending the Misuse of Drugs Act 1971 which would have made such provision illegal. And the repercussions of the Wintercomfort case made many housing providers wary of pursuing such an approach.

Since then there has been moderate progress. Norfolk DAAT embraced and endorsed an eyes wide open model in their superb document The Spectrum of Possibility. Research from Shelter demonstrated the benefits of the model in “Safe as Houses.” Papers from Cymforth Cymru reinforced the message that full spectrum, eyes wide open housing was a safe, lawful inclusive model of working with housing drug users.

Unfortunately, official recognition has been slow in coming. In 2006, an agency receiving a Housing Corporation Gold Award for Homelessness Strategies was pursuing a policy where suspicion of use (including drowsy symptoms or paraphernalia) was grounds for eviction – and this from an agency purporting to work with ongoing users.

But despite the absence of official endorsement, support or sanction, the work has crept on.

Even amongst organisations working in this way, all too often it has felt like a “dirty secret” where organsisations don’t explicitly acknowledge that they house ongoing users and manage use on site. All too often, the same organisations starting to undertake the work have to battle not just NIMBYism, public and political barriers but also too often their own organisational policy and hierarchies.

The decision by the DCLG to (quietly) endorse the “eyes wide open” model in their paper Improving Practice in Housing Drug Users was of course highly welcome, albeit that the paper fell short of an unequivocal statement acknowledging the importance of managed use on site.

So the presentation of two awards to King Georges Hostel is hugely welcome. It is not just an important acknowledgement of their work, and the progress that they have made in working with drug users.

It is also an endorsement of a model of work developed and pioneered here. From the early days, developing a model after leaving the Big Issue, through the time working and promoting it at Release, and over the past five years working with the growing number of organisations who took the work forwards, it has been a decade of change, innovation and progress.

For agencies thinking about adopting ‘eyes wide open’ models, the award to King Georges should provide the impetus to move from contemplation to decision. The resources on this site and the Drugs and Housing website provide some of the tools that such agencies will require to take this work forwards.

Eyes Wide Open housing has been a rare step change in the provision of services to drug users. In its own way it has proved as significant as the provision of needle exchange in representing a brave break with orthodoxy and the provision of pragmatic, life saving and life changing interventions.

One of the managers at King Georges got in touch a while after putting in place a lot of the changes and expressing thanks for the support and inspiration. He described what he’d got from here as “lighting the touch paper a few years ago that made me realise it could and should be done.” I am immensely pleased, proud and gratified that after ten years of work the “eyes wide open” approach is gaining acceptance and endorsement.

For myself, the drive to establish a new, inclusive model of housing which would take people who still used drugs and move them in to appropriate, supported housing began because of the tragic, senseless deaths of two young men on the streets of London, Chris Crowther and Chris Readman (aka Cockney Chris and Geordie Chris). They were murdered on Berwick St, London, on the 24th June 1997. Then, appropriate, suitable housing didn’t exist. They’d been routinely excluded from housing because of their drug use. They could and should have been housed in the right housing with the right support. There wasn’t anywhere for them then. Now there is. It’s a legacy worthy of them. And I wanted to make sure that amongst the awards, the professional congratulations and the backslapping, the small, personal tragedy that was the spark that lit the touchpaper is not forgotten.