Good afternoon everyone,
I have been giving this email discussion much thought and consider it worthwhile to add some comments as a 'commissioner' (see Marks' email below). The Commissioning Team of which I am part already 'sits' in the local authority and has not been part of a health commissioning organisation - although we do commission in a partnership on behalf of our colleagues in health.
Some time ago our team was allocated the pot of money for Residential Rehabilitation which was previously held and managed by the local authority. We find that this works extremely well as we work hand-in-glove with our treatment providers AND our service users to identify and prepare for the most appropriate residence - we have service users who are in the Ley Community, Phoenix TCs and 12 step residences for both drug and alcohol treatment.
I am a firm believer in the power and efficacy of residences of whatever persuasion to meet the needs of service users who make well-informed decisions about where to go to assist their recovery. Some of these people return to Barnsley. Others do not and choose to remain in their new 'home area', for this is what it becomes for many.
Those who do not choose to 'go away' but follow their recovery journey in their own community are visible recovery champions and we salute their achievements - but we salute them no more or less wholeheartedly than those who choose to go away.
Our DAAT team will always uphold the right of individuals who choose a Residential option for part of their recovery journey, and their messages of good will and encouragement to those 'at home' are of great value to all.
Best wishes,
Diana
-----Original Message-----
From: Therapeutic Communities [mailto:[log in to unmask]] On Behalf Of Mark Gilman
Sent: 26 May 2012 21:03
To: [log in to unmask]
Subject: Re: [EFTC] Back to Basic - A New TC Movement?
All points well made and taken on board (genuinely). I appreciate we do have to be careful and I am very conscious that I am certainly no kind of TC expert at all. That said, I have been very closely involved in the development of the current UK recovery movement since 2005. With the exception of Diana Powell, I think I am one of the people on this list who spends a good deal of my working life with English policy makers and 'commissioners' (the people who make the funding decisions in England). Some will know that in England the commissioning function will move into Public Health England. This means that local authorities and elected councils will be making the commissioning decisions in future. On one level this is exciting because it brings a democratic element into the equation and the idea of "recovery" is a relatively easy notion to sell to council officers and elected members. That is, until, of course, we get to numbers, finance and funding. It is at that point that the TC offer struggles. I know that Rowdy makes a compelling argument that TCs represent value for money. But, it is getting harder to make this case in the current economic climate to people who are having to implement financial savings on an almost unprecedented scale. For example, "Liverpool council says there will be a budget gap of Ģ141m over the next two years. With the council's controllable budget totalling Ģ400m, that means slashing more than 10% of costs each year." (http://www.guardian.co.uk/society/2012/may/22/england-poorest-patients-liverpool-gp) It is a brave decision to fund someone to go to out of town to a TC miles away from home because if they do well they don't come back home to spread the message amongst those still suffering. In fact, they are often encouraged not to go back (although they probably don't need much encouragement not to return to the place that fostered their addiction). Now, I know that this is great news for the individual BUT Public Health is concerned with the whole population and from that epidemiological perspective we need visible, contagious recovery or, addicts "getting well where they got sick". There might be as many as 7,000 heroin and crack addicts in Liverpool (similar numbers in Manchester and in the county of Lancashire) with about half in treatment and (thankfully) very few new, treatment naive addicts coming into treatment. This could be viewed as treatment playing a prevention role in controlling the spread of epidemics and it is in this context that our discussions (in England anyway) will take place. I look forward to taking a few baby steps with you all.
Best regards
Mark Gilman
National Strategic Recovery Lead
[log in to unmask]
Mobile 07867538111
-----Original Message-----
From: Therapeutic Communities [mailto:[log in to unmask]] On Behalf Of Wendy Dawson
Sent: 26 May 2012 08:07
To: [log in to unmask]
Subject: Re: [EFTC] Back to Basic - A New TC Movement?
Hi
We must also remember and recognise there are some of us that still run a TC as a TC without modification or deviation because we know what we do makes a difference. Here at the Ley Community we have 40 years experience and are leaders in the TC field in the UK. We have a capacity of 58 and have 57 residents currently in our programme. We break the cycle of addiction, welfare dependency and offending. All residents who successfully complete our programme do so into full-time employment secured on the open job market and move out in a planned way into independent living, no longer in treatment, clean and sober. We have an huge recovery community in and around Oxfordshire, all of whom are living their dream. Our experience informs us that a TC can and does work. The Ley Community is a living 'Community as Method'
Wendy
On 26 May 2012, at 07:51, Rowdy Yates wrote:
> Hi
>
> Just a word of caution on this. One of our problems is that so much research has been about proving that the TC works that we've had little time for research that explores HOW it works! The result is that we have a model that indisputably "evidence based" (don't you just love firing that back at the MMT wallahs!!) but now definitive view of what the essential elements are or the optimal mix of those elements.
>
> That means we need to be VERY careful about changing the mix to adapt the TC. A good example would be size. We have very little research on the optimum size. When is a community too small to function as a TC - when is it too big?
>
> So... Tiny baby steps my friends!!
>
>
> Rowdy Yates
> Senior Research Fellow
> Scottish Addiction Studies
> University of Stirling
>
> http://www.dass.stir.ac.uk/sections/showsection.php?id=4
>
> http://www.drugslibrary.stir.ac.uk
>
> On 25 May 2012, at 05:39 PM, "Mark Gilman" <[log in to unmask]> wrote:
>
>> I agree with Karen. There is a huge amount to discuss on how TCs evolve and adapt in current economic, social and political context without losing the best of what we have learnt over the last 40 years.
>>
>>
>> ----- Original Message -----
>> From: Therapeutic Communities
>> <[log in to unmask]>
>> To: [log in to unmask]
>> <[log in to unmask]>
>> Sent: Fri May 25 16:52:21 2012
>> Subject: Re: [EFTC] Back to Basic - A New TC Movement?
>>
>> And just to add a TC alternative to the 12 step houses, Phoenix in the Uk is piloting a version of the Oxford House with TC graduates. There are some significant variations from the pure US model and we did that purposefully.
>> We will have results from the pilot by the Eftc conf in Prague and we will submit an abstract to see if we can get a slot.
>>
>> I think there is a huge amount to discuss on how TCs evolve and adapt to out current economic, social and political context without losing the best of what we have learnt over the last 40 years.
>>
>> It is definitely a time for brave leadership and the TC movement is well placed to do that.
>>
>> Karen
>>
>> Karen Biggs Chief Executive - Phoenix Futures ASRA House, 1 Long
>> Lane, London SE1 4PG Call: 020 7234 9743 or 07904 122198
>> View: www.phoenix-futures.org.uk
>> Phoenix Futures is recovery in our communities
>>
>>
>> This message has been sent using a mobile device
>>
>> ----- Original Message -----
>> From: Mark Gilman [mailto:[log in to unmask]]
>> Sent: Friday, May 25, 2012 04:44 PM
>> To: [log in to unmask]
>> <[log in to unmask]>
>> Subject: Re: [EFTC] Back to Basic - A New TC Movement?
>>
>> Sorry I'm coming to this debate a little late. But, Rowdy is correct
>> in his description of the rebirth of interest in residential recovery
>> services that are largely congregated around the 12-step fellowships
>> and it certainly does look very much like an emerging UK version of
>> the US Oxford House movement. Here are some examples
>> http://www.parkviewproject.co.uk/ http://www.eastcoastrecovery.co.uk/
>> http://www.trusttheprocess.org/
>> http://www.thomasonline.org.uk/index.php?/Programmes/residential-reha
>> bilitation-witton-bank.html http://acorntreatment.org/
>> http://www.nta.nhs.uk/news-ils-newsletter.aspx
>> http://www.bacandoconnor.co.uk/ http://www.providenceproject.org/
>>
>> And there are more emerging all the time. In turn, these developments are seeing more focus on Assertive Linkage to Mutual Aid in the shape of SMART Recovery and Twelve Step Facilitation (TSF).
>>
>> For me, one of the most interesting features of all this activity is
>> how the recovery communities come together in the face of relapse.
>> There is growing practical interest in developing a UK version of
>> 'Warrior Down'
>> http://www.whitebison.org/welbriety-training-programs/documents/Warri
>> orDown.pdf
>>
>> We (in the North West Recovery Communities that Rowdy and I have written about elsewhere) came across 'Warrior Down' as a result of our close working relationship with Phil Valentine and CCAR http://www.ccar.us/ as ever we were wrestling with recovery not just being about getting off drugs and drink "...vbut as a way of experiencing life through new eyes, new thoughts, and indeed a new spirit". That working class addicts in the North of England should have so much in common with Native Americans is at first baffling. But, on closer examination, we know that "...re-establishing one's life following treatment for alcohol or substance abuse, or following incarceration requires a community effort. Without the support of a knowledgeable family and community, many who try return to healthy, productive lives find themselves frustrated by the need for job, training, education, housing, transportation, mental health care or medical support, social services, spiritual and cultural support or connections with others who value sobriety and healthy life ways."
>>
>> So, there will be hundreds of heads on pillows in beds up and down
>> the UK tonight. Most will have spent the evening at a 12 step
>> fellowship meeting and many will go to another tomorrow night maybe
>> after playing a game of NA rounders or a CA picnic or an AA fishing
>> trip during the day. So, a new TC movement? Looks like it from here
>> in sunny Manchester
>>
>> Best regards
>>
>> Mark Gilman
>> National Strategic Recovery Lead
>> [log in to unmask]
>> Mobile 07867538111
>>
>> -----Original Message-----
>> From: Therapeutic Communities
>> [mailto:[log in to unmask]] On Behalf Of Rowdy
>> Yates
>> Sent: 24 May 2012 11:04
>> To: [log in to unmask]
>> Subject: [EFTC] Back to Basic - A New TC Movement?
>>
>> Martin
>>
>> I agree with the sentiment, I simply think that the European TC movement has probably gone too far down the professionalism route to turn back now and that what would be required would be some sort of new movement. In the UK, there is a rebirth of interest in recovery (after years of MMT being the principle treatment offered) and this has largely congregated around the 12-step fellowship (principally AA/NA) - mainly, I think because there was little else visibly on offer. This is because TCs and residential rehabilitation in general, have become marginalised (and thus, much less visible) in the past 2 decades.
>>
>> Whbat might be required is something entirely new. In the USA, the Oxford House movement (http://www.oxfordhouse.org/userfiles/file/index.php) is a very extensive chain of self-managed sober houses lying entirely (or almost entirely) outside the normal state funding systems. Most Oxford Houses in the USA are 12-step oriented, but since the movement has yet to be established in Europe, there may be possibilities to encourage the growth of TC-oriented Oxford Houses, perhaps using the many TC-related after-care houses which already exist. Since I do want to maintain the integrity of our discussion thread around our potential campaign to save Phoenix Haga, I have re-named this message so that it will form a separate thread on the list. I do think this is something that might be worth discussing further and the EFTC list would be the place to do it. Leonard Jason and colleagues at De Paul University have studied the Oxford House movement for some years now and ight be able to offer interesting insights on this issue. Leonard is not a member of the EFTC list so I will forward this message to him and relay back any comments he is able to offer. But George De Leon IS a member of the list and I'm sure that he would have interesting perspectives to share (no pressure there then George!!).
>>
>> Anyway, I think Martin has raised an interesting issue that we might like to discuss further - and of course that is precisely what this list is for.
>>
>>
>> Rowdy Yates
>> Senior Research Fellow
>> Scottish Addiction Studies
>> School of Applied Social Science
>> University of Stirling
>> Scotland
>>
>> T: +44 (0) 1786-467737
>> F: +44 (0) 1786-466299
>> W: http://www.dass.stir.ac.uk/sections/showsection.php?id=4 (home)
>> W: http://www.drugslibrary.stir.ac.uk/ (online library)
>>
>> ________________________________________
>> From: Therapeutic Communities
>> [[log in to unmask]] On Behalf Of Martin
>> Lutterjohann [[log in to unmask]]
>> Sent: 24 May 2012 04:41
>> To: [log in to unmask]
>> Subject: Re: [EFTC] Sad News from Norway.
>>
>> Rowdy,
>>
>> of course you are principally right. We have that German "Synanon" which proved for decades that it does work, although this is a special case as it had been heavily supported by the Berlin Senate. We shall try here - maybe one last time - to convince the funding institutions that they can have the same success for much less money. We only need a few professional "coaches" as David Kerr puts it. As a psychologist I also profited from the present system. But too many different professionals tend to spoil the soup. We have developed TCs for chronic alcohol and substance abusers, some already dement and with Korsakoff syndrome, but they do not have a single doctor or psychologist on board. Anyway, it is again an interesting thread.
>> Cheers,
>>
>> Martin
>> -------- Original-Nachricht --------
>>> Datum: Wed, 23 May 2012 15:07:11 +0100
>>> Von: Rowdy Yates <[log in to unmask]>
>>> An: [log in to unmask]
>>> Betreff: Re: [EFTC] Sad News from Norway.
>>
>>> Martin
>>>
>>> Actually, it's an attractive idea. But I'm not sure the clock can
>>> be turned back. In order to get our hands on all that lovely
>>> Government money, we made a series of compromises long ago. Most
>>> significant amongst these was to move away from a totally self-help
>>> model to one which included professional staff. To go back to the
>>> original model would almost inevitably mean giving up all that
>>> official funding. I don't see many in the modern TC movement clamouring for that.
>>>
>>>
>>>
>>> Rowdy Yates
>>> Snr. Research Fellow
>>> Scottish Addiction Studies
>>> School of Applied Social Science
>>> University of Stirling.
>>>
>>> W: http://www.dass.stir.ac.uk/groups/showgroup.php?id=4 (home)
>>> http://www.drugslibrary.stir.ac.uk/ (library)
>>> T: +44 (0) 1786-467737
>>> M: +44 (0) 7894-864897
>>> F: +44 (0) 1786-466299
>>> E: [log in to unmask]
>>>
>>>
>>> -----Original Message-----
>>> From: Therapeutic Communities
>>> [mailto:[log in to unmask]] On Behalf Of Martin
>>> Lutterjohann
>>> Sent: 22 May 2012 17:57
>>> To: [log in to unmask]
>>> Subject: Re: [EFTC] Sad News from Norway.
>>>
>>> excellent proposal, Rowdy,
>>> but we should also fight for the right or chance to wind down
>>> therapeutic communities from what they typically are today to their
>>> true basics. I do not mean that we have to return to the TCs of the
>>> pioneering days in the 1960s and 1970s, but to a development of
>>> modern TCs that contain all the effective elements as we know them
>>> today but consequently stick to cost-effectiveness. If we compare
>>> David Kerrīs "Ten Competencies of the Therapeutic Community (TC)"
>>> that you sent around last week, especially competence 3 & 4, with
>>> the reality in many present-day therapeutic communities, we can see why TCs appear so expensive.
>>>
>>> Addiction treatment & rehabilitation in Germany is usually financed
>>> by social insurance and social welfare, while health insurance pays
>>> for detoxification. The social insurance institutions put very high
>>> demands on the staff composition of a "Fachklinik" (specialized
>>> residential addiction treatment and rehabilitation centers most of
>>> which are convinced they incorporate TC elements). To give you an
>>> example of staff composition at a Fachklinik for
>>> 100 residents where I worked in Southern Germany: 1 psychiatrist + 2
>>> additional medical doctors, 4 psychological psychotherapists
>>> (clinical psychologists)and about the same number of social workers,
>>> 3-4 ergotherapists, only one of them a recovering alcohol addict, 2
>>> sport therapists. I may have ommitted one or two more professionals
>>> apart from administrative staff. Hard to avoid TC counter-productive dynamics with so many professionals.
>>> The cost of TCs in Scandinavia has traditionally even been much more
>>> expensive than in Germany I believe. I was amazed at the daily rate
>>> per resident in Swedish TCs, say 2 decades ago, but within a short
>>> period they disappeared one by one. I had always considered Phoenix
>>> House Haga a lucky exception in Scandinavia, possibly because of
>>> wealthy Norway that still could afford "the luxury of a TC". But obviously this is not the case any more.
>>>
>>> Martin Lutterjohann
>>>
>>> Hon.Vicepresident EFTC
>>>
>>
>> --
>> The Sunday Times Scottish University of the Year 2009/2010 The University of Stirling is a charity registered in Scotland, number SC 011159.
>>
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>>
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> --
> The Sunday Times Scottish University of the Year 2009/2010 The
> University of Stirling is a charity registered in Scotland, number SC
> 011159.
>
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