Confessions of a Key Worker……

22 Aug

 

 

 

Introduction……

As regular readers of the Dripping Tap will no doubt have now surmised I have had my fair share of substance misuse over the years.  Thankfully, this is now under control and I have detoxed from the Opiate substitutes prescribed to me by the Drug and Alcohol Services.  This was undertaken with no support from them and by my own choice……

Confessions of a Key Worker……

 

On Friday I had a two hour meeting with my Key Worker during which we discussed the service, its objectives and the motivation behind its very existence.  It was during this exchange that my Key Worker stated; she hates her job and is overloaded with more clients than she can offer full support to, covering not just my home town but several others as well.  She also stated that she felt that the service was not based around the needs of its clients and that it was primarily a service for reporting statistics to a central Government office.  Amongst the data they collect is a ‘Treatment Outcomes Sheet’ (TOS).  This contains questions about daily drug usage, reported mood and, interestingly, it asks how many times you have shoplifted or used illegal means of supporting your habit.  My Key Worker admits that the TOS has little bearing in making clinical decisions and is primarily for reporting to central Government, although this is not made clear to the service user.  This is clearly at odds with the services mission statement which is all about ‘The individual needs of the client and a structured program of rehabilitation’.  In my own experience and that of other service users I have asked, the trend seems to be prescribing high doses on a maintenance basis with no plan in place to cater for detox and rehabilitation.  The new LiberalTorycrat Government has decided, probably for cost cutting reasons, to have a clamp down on this method of maintenance prescribing and, suddenly, an emphasis has been placed on reduction of medication.  This would be fine if they followed the NICE guidelines and the eight principals, the first of which states ‘Substitute prescribing alone does not constitute treatment without psycho-social interventions’.  My Key Worker insists that a once fortnightly session with them is the psycho-social intervention.  We disagree on this point as the guidelines also state that, for people with multiple psychological problems ‘a face to face meeting with a Key Worker does not meet the threshold considered as a structured psycho-social intervention’.  In my own case I have many complex mental health issues which they have singularly failed to address……

Manipulation of the Statistics……

Having researched the subject and printed all the relevant information from the NICE guidelines, Dr Dickhead, the consultant who has overall responsibility for the service, made the recommendation that my Methadone dose was increased, whilst writing to my GP to advise him that in his opinion my prescription for Diazepam should be reduced at 10mg per week.  This is at odds with the recommended reduction of 2 to 5mg per month.  This would enable him to manipulate the data to show an overall reduction in medication, even though the medication prescribed by him was to increase, therein increasing my dependency on Opiate substitutes whilst lowering other prescribed medication, giving the impression that progress was being made.  I believe this eloquently demonstrates the manipulation of statistics, the only aim being to secure the funding for Drug and Alcohol Services……

Conclusions……

Drug and Alcohol Services fail to meet either their own stated objectives, those set out by NICE and are failing the service users by not addressing the complex issues surrounding drug misuse. It causes damage to both individuals and their families.  I was tempted to get involved with the Service Users Forum but was told by someone who went to the meetings it was basically a den of iniquity attended by dealers who take the opportunity to use it a central point to distribute their wares……

Unless something changes at the very heart of the services offered to drug users, they simply end up with two habits instead of one.  The fact that the clinicians work in several towns means that there is limited access to the doctors, who only attend each clinic once or maybe twice per week, leading to many suspensions of prescription due to missing a one day collecting your medication, under which circumstances the prescription is revoked until one is able to see a doctor on the next available occasion.  In my own experience, once a prescription has been suspended it can take up to two weeks to get it reinstated.  Again, this fails under the guidelines surrounding ‘Contingency Management, leaving the client with no choice but to source illicit medication or to go back to using street drugs.  When this happened to me I was actually advised by a Key Worker to ‘use street drug but be careful’.  I have a witness to this meeting who also works in the healthcare sector and found this advice both disturbing & astonishing……

One final point; because I chose to detox myself to free me of the burden of jumping through the hoops demanded of me, my Key Worker stated that I no longer fell under the remit of the service as I was no longer being prescribed by them.  This is nonsense as, even though free of the chains of the service, it is at this very moment that you are at your most vulnerable and need the ‘support’ they offer……

I’ll keep you informed of any further developments……

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