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 Kerr´s "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.
-------- Original-Nachricht --------
> Datum: Tue, 22 May 2012 14:03:36 +0100
> Von: Rowdy Yates <[log in to unmask]>
> An: [log in to unmask]
> Betreff: Re: [EFTC] Sad News from Norway.
> Apologies for my delay in responding. I've been at the EWODOR Symposium
> in Thessaloniki and only returned late last night. I received Anthony's
> original message on the last day of the Symposium and made a special
> announcement. It is a huge understatement to say that people were surprised. I
> think the feeling in the room was one of shock and despair. It feels doubly
> crushing that this should happen to one of our most respected and high
> profile members just at the time when therapeutic communities and the recovery
> movement seemed to be staging a real comeback across Europe and senior
> politicians have begun to voice their support for recovery (and their
> disillusionment with the costs and results of substitute prescribing). It would seem
> that that message has yet to trickle down to service commissioners and
> particularly the the Health Sector where there continues to be a great deal of
> resistance to change and a deeply-rooted scepticism towards recovery and
> I really don't think that we should let this go unchallenged. I suggest
> that we issue a joint EWODOR (European Working Group on Drugs Oriented
> Research) & EFTC press statement deploring these developments and pointing to
> the cost savings that can be achieved by recovery-oriented therapeutic
> communities. I believe that there continues to be a belief that residential
> treatment is more expensive than its community-based (ambulatory) counterpart -
> despite the evidence that it is actually cheaper. I further propose that
> this press statement should be in the form of an open letter to the
> Norwegian Government's Minister of Health - who I think is currently Anne-Grete
> Strom-Erichsen (someone will need to correct me if I have this wrong).
> I will draft a short press-release this week and agree it with the Boards
> of both organisations. Clearly we have very little control over what the
> big news agencies choose to take up but the strength of feeling from the
> membership of two major European addiction networks ought to count for
> something here.
> In addition, I plan to write an open letter to all the current residents,
> conveying your thoughts and feelings and offering our support in this
> difficult and unsettling time. I am very concerned that in the worry over the
> future of the service and redundancy issues for the staff we risk losing
> sight of how devastating this will be for those who currently call this house
> home (sometimes the first time they have really had one).
> With best wishes and fraternal greetings.
> Rowdy Yates
> Acting President
> European Federation of Therapeutic Communities
> Scottish Addiction Studies
> School of Applied Social Science
> University of Stirling
> 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 Anthony Slater [[log in to unmask]]
> Sent: 20 May 2012 14:58
> To: [log in to unmask]
> Subject: [EFTC] Sad News from Norway.
> Dear friends,
> It is with a very heavy heart that I have to inform you that Phoenix House
> Haga, Norway has lost its funding from the South Eastern Regional Health
> Authority in Norway.
> The decision was communicated last Monday from the Health Authority.
> If it is not possible to manage to get this decision overturned before the
> end of June, then the funding that Phoenix requires will cease from July
> 1st 2012, as I understand it at this time.
> Although I recognize that drug free therapeutic community treatment is not
> for everyone at all times during recovery, I am left astounded that a
> treatment programme with such a long history of effectiveness during this last
> 21/22 years, is to be closed by the stroke of a pen via civil servants.
> As many or most of you will know, for health reasons my direct involvement
> with Phoenix Haga has been limited over this last 12 months, however
> although I’m now retired from Phoenix Haga, I am committed to assist Phoenix
> Haga as much as is required through this very difficult time. Phoenix Haga a
> not for profit therapeutic community was open in 1990 and admitted the
> first resident group in August of the same year.
> Former residents of Phoenix have created an action page
> https://www.facebook.com/groups/457976380883491/ which can be found ( just look for an icon
> of a loud speaker and go from there) the page has over 17.000 hits at
> present and very moving statements sharing people’s feelings and experiences.
> Although I realize that many of list members will not be able to read the
> Norwegian language, please believe me when I say that the messages truly
> embody the spirit of the therapeutic community.
> I am able to visit Phoenix Haga on Monday 21/May and hope to be briefed on
> the present situation plus receive the contact details of the relevant
> political offices, persons and civil servants to continue to challenge what is
> a devastating blow to many peoples present and future recovery.
> On behalf of the community of Phoenix Haga, graduates, staff’ families,
> the board of directors, I call upon and implore all friends and
> associates to support us during this very bleak time in our history.
> Sincere thanks in advance,
> Anthony Slater ( Former director –Phoenix House Haga, president
> The Sunday Times Scottish University of the Year 2009/2010
> The University of Stirling is a charity registered in Scotland,
> number SC 011159.