Fiona Nicol has worked in Addictions for the NHS in various guises for over 20 years, having moved from NHS Lothian to manage the Borders Addictions Service three years ago. Kate Ainslee has been a nurse with the Borders addiction service for five years. They are both passionate about working in addictions, looking at a different ways to work, offering a holistic approach and striving to offer a service that people want to engage with rather than feeling they ‘have ‘ to engage with. They both, along with the team, work hard to try and break down barriers and myths about the service and work to empower people and endeavour to offer a collaborative journey.
The significant rise in drug related deaths within Scotland has been central to Borders Addictions Service (BAS) exploring ways we can improve overall engagement; focusing on how to get people into treatment and improve their recovery journey. This test of change work in the Borders have demonstrated the MAT standards in action, through rapid access to treatment (Standard 1), choice (Standard 2), access to harm reduction (standard 4, and retention (Standard 5), whilst providing this in a trauma informed way (standard 10).
In Eyemouth a drop in has been developed to more effectively and realistically meet the needs of the community; bringing together NHS, council and voluntary sector staff to collaboratively support people trying to overcome problems caused, or affected by, drugs and alcohol. The development of this service sees an important shift in practice, moving away from a formal clinical format to one that promotes inclusion and equality through its relaxed and enhanced person centred approach. Additionally, greater emphasis on MDT working offers Eyemouth improved access to early interventions and new opportunities for participation in care, treatment and service design. The drop in has empowered individuals to take owner ship and responsibility in communicating their needs, and through a greater understanding of roles and responsibilities there has been enhanced development of trusting therapeutic relationships; promoting open and frank discussions that centre on risk.
A service evaluation in 2018 highlighted the need for greater flexibility and availability to services within Eyemouth. Service user feedback in particular drew attention to environment in which support was being offered and the insufficient access to additional resources; such as psychology and benefits advice. Likewise there was a general consensus that people waited too long for treatment. With this in mind the drop in was set up with the aim of providing rapid access for anyone using or affected by drug and alcohol use; including the commencement of pharmacological and psychological treatment. Additionally it aimed to promote greater support relating to harm reduction, including improved access to sterile drug equipment, blood born virus testing, Naloxone overdose training and distribution and greater access to sexual health. Social prescribing was another significant objective of the drop in, aiming to provide access to benefit and housing advice along with employability training. In addition the drop in aimed to provide food and hot beverages to anybody accessing the service, along with the opportunity to participate in activities that promoted personal and physical wellbeing; these included complimentary therapies and haircuts.
Results would indicate that the drop in has provided a more flexible way of working, that has improved individual experience, engagement and overall attendance. It has been instrumental in getting more people into treatement and providing enhanced support for carers and loved ones of those using drugs and alcohol. There has been a reduction in time waiting; since the development of the drop in there is an average wait of 6 days from referral and in total 77% of all referrals being commenced on a prescription within 7 days. The drop in has facilitated the commencement of same day prescribing, with 44% of all referrals commenced on a prescription of OST on the initial day of assessment. The drop in engaged in a food share scheme, supported by local food distributors, in total 75% of individuals that attended used this service. Likewise 25% of individuals present at the drop in engaged in complimentary therapies including acupunture and haircuts.
Service users have reported that the drop in has now become integral to their care and treatement within Eyemouth; creating a reliable and regular environment that is considered supportive and crucial in creating structure and daily activity. In total 76% of individuals attended the drop in for social support, this is echoed by one individuals comments in which they stated “The drop in allowed me to meet people in a similar situation, and hearing other peoples stories allowed me feel less alone”. Other service users comments include;
“If it was not for the drop in I would never have got on to my prescription, it was only through meeting the staff and getting to know them that I felt like I could fully open up and tell someone I was using heroin”
“ I have been working with BAS for over 10 years, I feel I have got to know staff and other people working with them more over the past 6 months than I ever have. It feels much more human now, and I don’t worry about telling my worker that I have used”
“It’s nice to just get a cuppa. Sometimes I don’t even talk about my Methadone or my drug use”
“I have told folk to get themselves to the drop in to get on a prescription, I wouldn’t have done that before the drop in”
“Staff organised a birthday party for my 50th at the drop in, I can’t remember ever having had something like that done for me before”
A poster visualisation of this initiative is available here