A Dying Breed

Drug service providers are warning that the problem of substance
misuse could slip “to the bottom of the list” in the new children’s
services proposed by the Every Child Matters green paper.

The trigger for the concerns has been a decline in adolescent
units at residential rehabilitation centres. This has fuelled fears
of a rise in young people entering custody if the help they need
disappears.

Over the past 12 months, adolescent units at Kenyon House in
Prestwich, Promis in London and Middlegate in Lincolnshire have
closed, causing some service providers to label them a “dying
breed”.

Martin Barnes, chief executive of charity DrugScope, says the
closures highlight “a mismatch” between young people’s needs and
the help available. He adds that, despite this need, some existing
units are not used. “It seems counter-intuitive that, at a time
when drug treatment services are being expanded, rehab units have
closed or remain empty,” he says.

The National Treatment Agency for Substance Misuse (NTA), an
arms-length government body working to improve drug services, is
concerned by the lack of residential services. Tom Aldridge, young
person’s manager, says the agency has responded by establishing a
group of residential providers to look at ensuring good quality
provision continues and developing more.

Aldridge says there is a “small but significant” group of young
people who would benefit from rehabilitation units. Among them are
injecting and chaotic drug users and young people returning from
prison who need intensive support so that they can integrate into
the community.

Campaigners cite the high cost of residential services as the
main reason for the decline, along with an increase in community
services. These are seen as a better option for many young people
as they can be kept closer to home.

Aldridge says drug action teams no longer commission residential
services as often because only a small number of young people need
them.

With fewer residential beds, some of the most challenging
children and young people with substance misuse problems are left
in the hands of the community, but more resources are needed,
service providers say.

Jonathan McDonnell, a project manager for substance misuse
charity Addaction, runs a service in Buckinghamshire with links to
the adult drug service and the local child and adolescent mental
health service (Camhs).

Although he points to the need for support to “address the young
person as a whole”, he says the limited funding provided to
community services makes this difficult.

He argues that allocating more resources at the start of a young
person’s substance misuse career could bring greater savings
later.

McDonnell says: “What we need to ask is if we prevent young
people becoming problematic drug users of the future, how much will
we save?

“Political short-sightedness means we are not nipping the
problem in the bud.”

Although the government’s children’s policies emphasise the need
for a multi-agency approach, drawing together agencies such as
Camhs and substance misuse services can also be problematic.

The NTA has found that, although nearly half of all drug action
teams involve Camhs, Camhs’ targets exclude substance misuse, which
could leave some young people without enough support.

There are also concerns that young people receive services only
after they enter the criminal justice system – where an increasing
amount of the resources lie.

According to the NTA and the Youth Justice Board, young people
in contact with youth offending teams are getting help more quickly
than others.

Chris Chaston, policy officer at young people’s charity Rainer,
warns of an “imbalance” in resources. He says: “In the main, young
people with substance misuse problems receive support through the
criminal justice system.

“Although this is delivering pretty well, there has to be a
balance between this and community services, otherwise the danger
is that they will find themselves in custody because that is the
main way to access treatment.”

Chaston argues that young people needing support “are not
exclusive” to the criminal justice system, and calls for the issue
to be seen primarily as a medical one.

Barnes also points out that those who enter treatment this way
may be less likely to successfully complete it and argues that the
quality of service is “crucial” to success.

With an estimated 20,000 young people going on to become problem
adult drug users every year, services need to improve but there are
doubts about whether the recent changes to children’s services will
achieve this.

Some drug service providers are concerned that children’s trusts
will lack the specialist knowledge needed to keep substance misuse
high enough on the agenda.

McDonnell says input from specialists will be “key” to ensuring
that the right services are created.
“We need to see a growth in understanding of young people’s
substance misuse issues,” he says.

Aldridge is worried about an “emerging trend” to consider young
people’s needs based on the five outcomes outlined in the
children’s green paper, which he says may cause “specific” issues,
such as substance misuse, to become marginalised.

He argues that the NTA is “committed” to ensuring that money
available for substance misuse treatment is spent on this or
“allied initiatives”, but service providers warn that “costly”
facilities, such as residential rehabilitation units, will be
pushed to the bottom of trusts’ spending priorities.

Barnes acknowledges the government’s keenness to promote and
expand interventions for young people, but he has few illusions
about what lies ahead. “The Every Child Matters agenda is ambitious
and complex, and it will be a challenge to ensure that substance
misuse is given the focus it deserves.”