How Turning Point in Somerset tackled difficulties of providing a rural substance misuse service

The amalgamation of three Somerset substance misuse services has paid dividends.Natalie Valios reports

(Pictured: team leader Amanda White and Turning Point regional manager Darren Woodward)

The amalgamation of three Somerset substance misuse services has paid dividends. Natalie Valios reports

Project details

● Project: Turning Point Somerset; the integrated community drug and alcohol treatment service.

● Location: County-wide with main offices in Glastonbury, Frome, Bridgwater, Taunton and Yeovil.

● Annual cost and source of funding: £3.7m per year from Somerset Drug and Alcohol Action Team.

● Service users: About 2,000 each year. About 70% self-refer. Minimum age is 18.

● Number of staff (including role breakdown): Just over 70 paid staff, 25 volunteers and mentors. This is a mix of clinical and non-clinical posts, including doctors, nurses, psychologists, counsellors and criminal justice workers. The team is managed by senior project workers, team leaders and a service manager. It has a clinical lead and a regional manager.

● Objectives: To enable all individuals who present to the service with drug and alcohol problems to overcome them and live healthy, crime-free lives and realise their potential.

● Savings: Increased the capacity of specialist prescribing by 52% and increased shared care by 20%.

● Outcomes: Reduced the waiting time for a service from three weeks to zero within six months.

In April 2008, Turning Point Somerset integrated three community substance misuse services into one. The move was backed by Somerset Drug and Alcohol Action Team (DAAT) and a recent cost-benefit analysis of the service by economic forecasting consultancy Oxford Economics has justified the DAAT’s faith. Interim findings for 2009-10 estimate that the service saves over £2m per year in gross NHS treatment costs and prevents criminal activity that is estimated to save society more than £12m each year.

Darren Woodward, regional manager for Turning Point in the south west, says: “The DAAT decided that Somerset’s large rural area meant clients needed to use a spider’s web of transport to reach different offices. People were dropping out of treatment because of the difficulty in keeping appointments.”

Now there are five offices – all providing the same services under one roof, from drop-in and needle exchange, to group sessions and aftercare support, giving drug users access to a one-stop shop.

Integrating services meant combining 45 NHS staff and 30 Turning Point staff. There are still a few specialist posts, such as community detoxification nurses and blood borne virus nurses, but most were renamed project workers and a generic workforce was born.

“The generic workforce is key to the service and all the efficiencies that come with that because the workforce can respond to need as it happens,” says Woodward.

Team leader Amanda White explains: “Take this morning; one of our custody workers was on annual leave so I went to the police station to interview someone who had been detained who had just started treatment with us. A generic workforce means that any gap I have in the service can be covered by any member of staff. Training has been intense but it means we are all trained in things like needle exchange and managing people on their prescription.”

The majority of clients (83%) are primary drug users, and of these, 80% are heroin addicts; 17% of clients are primary alcohol users. Priority generally goes to those on the most harmful drugs, to those who have children or to those who are involved heavily in crime to fund their drug habit.

Someone with a low level cannabis problem will wait for a service, but if, for example, he or she is an 18-year-old with a history of mental health problems who has been smoking cannabis for several years, they are prioritised, says Woodward.

When they are taken on they are given a project worker as their key worker. If, as in most cases, they are a heroin addict, they will be assessed, see a doctor and given a methadone prescription. “This gives them a bit of breathing space to look at the issues that are precipitating or sustaining their drug habit,” says Woodward.

These issues are examined in one-to-one sessions with their key worker or group sessions, of which they can attend as many as they want.

There are different groups for different needs, for example, for those who are still using but want to stop; those who have just stopped; and an abstinence-based intensive day programme for those who stopped a while ago. A peer mentor scheme has just started and an in-house counselling service is due to start soon.

Supporting drug users out in the community is also integral to the service which has access to 78% of GP practices across the county. This is where shared care comes in: the GP takes on the responsibility for prescriptions and the clinical management of the patient while a project worker can assess them at the GP practice for treatment and support. Their one-to-one support can be based at the practice too if it is difficult for them to get to one of the offices.

An aftercare service helps clients link up to education, employment and training. “Some have had no time in their life for anything other than drugs and then [the drugs are taken away and] they have a lot of time on their hands that they don’t know how to fill,” says White.

As many young people get into drugs in the first place because of boredom it is vital to fill this gap so that they don’t relapse. “If they are bored they’re going to think ‘what is the point of this?’ It’s about capturing that and showing them that life can be different.”

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Case study: ‘One-to-ones with my key worker were really helpful’

After finishing a prison sentence for stealing to fund his heroin and crack cocaine habit, Steven* left his home town of Walsall seven years ago to make a fresh start in Somerset.

“In prison I’d seen an advert in Inside Times [the national newspaper for prisoners] for Langley House [provides resettlement accommodation for ex-offenders] saying ‘do you want to break the cycle?’ and I thought, ‘yes’.”

Ironically, Steven only got into class A drugs in prison. “I’d started glue sniffing at 14 and moved on to cannabis. But when I was in prison in the 1990s they introduced urine drug tests. Cannabis stays in your system longer than heroin so everyone started smoking that.”

Steven moved to the House of Martin, Langley Trust’s residential training centre near Taunton. “At first I was clean, but I started using again and got a drug rehabilitation requirement for two years and then I got done for theft, then burglary. I was given a 12-month supervision order. It took a long time to realise that the input had to come from me.”

Steven started using Turning Point’s integrated service. “I found the one-to-ones with my key worker really helpful, to talk through what had happened in the past and what I could do to go forward. I go to groups including the relapse prevention group which helps you recognise the things that get you into drugs and crime. The service has football once a week that I go to and I do voluntary work for the National Trust on Exmoor through Turning Point’s community access programme.”

He has now been clean since December but at one stage he swapped heroin for alcohol. “You think you’re having a drink you’re not doing heroin so it’s OK. But the drink would trigger wanting to get some gear. Turning Point helped me with that too. I saw one of their alcohol workers who helped me see that you are just swapping one drug for another.”

For the future, Turning Point has arranged for him to attend a football coaching course, he is planning to be a peer mentor for the service and already runs some of their overdose prevention workshops. He doesn’t feel that he has completely turned his life around yet but says, “I’m aware that I’m on the right road.”

* Name has been changed

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