0:00

This is a Renew Original Recording . Hello

0:03

and welcome to the Believe in People Podcast . My

0:05

name is Matthew Butler and I'm your host , or

0:07

, as I would say , your facility . Today

0:10

we have a returning guest in Grand

0:12

, dame Carol Black , a trailblazing

0:14

figure awarded the rare Dame Grand Cross

0:16

for her relentless dedication to combat drug

0:18

misuse in the UK . As the

0:20

first female doctor to receive this honour , dame

0:22

Carol's impact is unparalleled . Her

0:24

groundbreaking reviews on drug abuse have not

0:26

only secured the record government-funded , but also

0:29

sparked vital conversations on tackling drug-related

0:31

challenges . Join us as we delve

0:33

into her remarkable journey on advocacy and

0:35

transformation . First of all , would you like

0:38

to introduce yourself ?

0:39

Yes , I'm Carol Black . I wrote the

0:41

independent review for the government

0:43

on drugs and now I'm

0:46

the independent advisor on

0:48

combating drug misuse .

0:50

Thank you so much for coming on Again to the Believe

0:52

in People Podcast . We don't get many returning

0:54

participants . I think maybe the second

0:56

returning participant , we have possibly the third , but

0:59

a lot has happened since we last spoke to

1:01

you and we have to thank you because when

1:03

we did our first podcast review , that did help us

1:06

get some eyes on the podcast

1:08

and the local story and it was the

1:10

podcast where the local authority and the council actually

1:12

really took notice of what we was doing and everyone was very

1:15

interested in what you have to say . So we got some

1:17

really good feedback on it . So we've been really keen

1:19

to do another one since Last time we

1:21

spoke to you , it was a few months after the publication of Part

1:23

2 of your report , and here we are , nearly 18

1:25

months later . Can you perhaps give us

1:27

an update on the landscape since publication , highlighting

1:30

any positives that you've seen since

1:33

changes have started to be made ?

1:35

Well , a huge amount has happened since

1:37

my publication , because after

1:39

that , of course , we had to secure

1:41

or with it , we got the money from

1:43

government . And then the new

1:45

10-year strategy and

1:47

it is important to say this is a journey

1:50

, it's not a one-year journey

1:52

, it's a 10-year journey , and

1:54

that was December 2021

1:57

. And then we had

1:59

all the business of setting up the

2:01

local arrangements . You know , the new

2:03

combating drug partnerships

2:05

. The senior responsible

2:07

officer , the person who we need to locality

2:10

was going to chair that , the

2:12

bringing together of all the different

2:15

organizations that

2:17

might be able to

2:19

help us deliver the whole system

2:21

approach , which is quite different

2:23

from what we had before , which was really

2:25

, by the time I wrote the

2:27

review , we really had

2:30

a treatment service that was not much

2:32

more than opioid substitution

2:34

therapy , quite frankly , so

2:37

little money had been put

2:39

into drugs recovery

2:42

and treatment . It

2:44

was really in a very poor state . So

2:46

I guess the honest

2:48

truth is we're climbing a mountain , it's

2:51

not . You can't just snap your fingers

2:54

and do this quickly . So

2:56

there was all the practical stuff of

2:58

putting in , if you like , the structure

3:01

, the framework , the processes

3:03

, and then there was the

3:05

real and serious problem of the workforce

3:08

, because , you know

3:10

, a lot of people had left the service , a

3:12

lot of expertise had gone . So

3:15

that has been , I think , for most

3:17

providers , a big challenge

3:19

, because we're no longer just

3:21

looking for more drug workers

3:24

. I do not want more of the same

3:26

. I didn't write

3:28

the report to have more of the same . I

3:30

wrote the report to have change . So

3:32

you know , we need more psychologists

3:36

, we need more psychosocial

3:38

interventions , we need people

3:41

who are experts on getting people into work

3:43

. We need expertise

3:46

on housing and how to help people

3:48

find housing . We

3:50

need real recovery programs . These

3:53

all need people to deliver

3:55

them . So I think really

3:57

the big thing to say is we're

3:59

at the beginning of the journey . Yes

4:02

, I've seen some places where they really

4:04

understand what is needed and

4:07

they're actually going about it , shall

4:09

I say in the way I wrote the report and

4:12

they've understood the importance of mental

4:14

health and trauma . They know

4:17

they have got to have proper recovery program

4:19

. They may use

4:21

one of the lived experience

4:23

groups you know the Leros . They

4:26

may do it differently and

4:28

they're trying very hard to

4:30

bring people together , including

4:33

the police , the criminal justice system

4:35

, social care

4:37

. They understand

4:39

collaborative working . Then I've

4:41

seen places that are just doing more

4:43

of the same , and that , of course

4:45

, is disappointing , and

4:48

we need to help them to

4:50

understand that that's not what it's

4:52

going to bring about a change . It

4:54

won't reduce the deaths , it

4:57

won't get us more people in treatment

4:59

and it won't reduce crime . So

5:01

I think it's a mixed picture , but

5:03

there's definitely areas

5:06

where they've really understood it

5:08

and they're getting on with it .

5:10

I don't . I mean speaking statistically . I can't

5:12

say too much in terms of what we're doing , but I've definitely noticed

5:14

changes on a day to day sort

5:18

of perspective for us here in Hull . Last

5:20

time we was at your home once

5:22

we finished the podcast we spoke a little bit about individual

5:24

placement support . We never had that in Hull

5:27

at the time and now we have a team of three

5:29

people working on it and they've had some really

5:32

nice success stories as well that we've seen . I

5:34

think one of the problems that they're having is

5:36

getting recovery coordinators

5:38

who were doing the day to day were fighting that uphill battle

5:41

of having a case load of 80 plus people

5:43

to invest in individual placement

5:46

support . What would you say to those

5:48

key workers about the importance

5:50

of getting people involved in IPS

5:52

?

5:52

Well , the first thing I would say having 80

5:54

clients is rubbish . You

5:57

can't do it . You can't do

5:59

proper treatment and recovery . There's

6:01

something wrong with the commissioner , there's

6:03

something wrong with the commissioning process

6:06

that permits a provider

6:08

to have only one worker

6:10

to 80 people . So

6:12

I mean , I think that's an impossible

6:14

task , but

6:16

I think it is . It is also

6:19

, in my humble opinion , the

6:22

responsibility of both the commissioner

6:24

and the provider to ensure

6:26

that the people working for

6:28

them understand that

6:31

part of recovery is having

6:33

something meaningful to do and

6:35

for many people that is

6:37

work , paid work . It might

6:39

not always be paid work , you know . It

6:42

might be volunteering to start with

6:44

. You may need to have to upskill

6:46

someone . But the value

6:49

of a paid job to someone

6:51

who's had no self-confidence

6:53

, who really hasn't got many personal

6:56

assets , it's invaluable

6:58

in helping recovery . But

7:00

I you know you

7:02

shouldn't really have more than 40

7:05

individuals to one

7:07

drug worker .

7:08

I think that's one of the biggest problems that we find is

7:11

just case loads being unmanageable

7:13

and there are differences . I spoke to a colleague

7:16

man called Jamie who works in the making

7:18

every adult matter team , the meme

7:20

team , and he has 15

7:22

people on his case load and I said how was that

7:24

? He said , oh , it's definitely manageable . But even though 15

7:26

sounds like a low number , these are 15

7:29

very complex people and that's why they have

7:31

the meme offer . So even

7:33

then he said it might sound like a low number but he said

7:35

it's still during , it's still very complex . But

7:37

speaking to a key worker who has

7:40

between 17 and 80 people in the books , they're

7:42

looking at him thinking , oh , you've got it easy

7:44

and it's obviously two really different things

7:46

that they're working with .

7:47

But even however easy

7:49

, no person who's taking hard

7:52

line drugs is necessarily

7:54

without challenges and without

7:56

problems . They need time , they

7:58

need input . They don't need a method-owned

8:01

script alone .

8:02

Absolutely . For individuals

8:05

currently struggling with addiction and mental health challenges

8:07

, it can obviously feel like an uphill

8:09

battle . From your extensive experience and

8:11

understanding of these issues , what message

8:14

of hope and support would you like to

8:16

convey to them , and what resources or

8:18

strategies do you believe can make

8:20

a meaningful difference in their journey towards

8:22

recovery ?

8:23

Well , I think , first of all , what I've been

8:25

trying to do is to get the message

8:27

out there loud and clear everywhere

8:30

I go , that mental health

8:32

and trauma is part of

8:34

addiction , it is not a separate

8:36

thing over here , and that

8:38

you will only treat somebody's

8:40

mental health problems when they've stopped

8:43

taking whatever is their drug

8:45

of choice . They wouldn't be taking

8:47

the drug , probably if

8:50

it wasn't for the trauma and

8:52

their mental health issues . So

8:54

we have a whole cultural

8:56

change . That's quite difficult

8:58

because professionals have brought about that

9:01

divide , not the people who are

9:03

drug dependent . It is the

9:05

way we have delivered these services

9:07

that we've separated them out

9:09

, and you would never say , let's

9:13

say , if you had prostate cancer and

9:15

let's say rheumatoid arthritis

9:17

, no one would dare say to you

9:19

well , when you've got your

9:21

prostate cancer under control

9:24

, we're going to treat your rheumatoid

9:26

. You might be really crippled by

9:28

then . We wouldn't , we're not allowed

9:30

to do that . So why

9:32

are we allowed to separate

9:34

these two ? So the first thing

9:37

is the message has to be changed

9:39

and then what we're

9:41

really asking local authorities

9:43

to do is

9:46

to think about how are they going

9:48

to co-commission mental

9:50

health and drug

9:53

recovery and treatment

9:55

. Now some of them will say this

9:57

is almost impossible to do . But

10:00

if you look at Staffordshire , staffordshire

10:02

has done it . They have joined

10:04

their resources . They've got

10:06

through all the difficulties of

10:09

protocols , procedures

10:11

, bringing budgets close together

10:14

, sharing back office

10:16

functions . They they actually

10:18

deliver their mental

10:20

health and trauma support and

10:23

their treatment and recovery as

10:25

a whole package . You

10:28

don't have to go to two places

10:30

. So I mean that's the

10:32

ideal and in the meantime

10:35

we just have to do it , I fear

10:37

, almost authority

10:39

by authority , finding

10:41

out what their challenges are . Absolutely

10:45

saying you're not going to get good results

10:47

until you deal with mental health and

10:49

trauma . And there's

10:51

a big push in the Department

10:54

of Health . There's a big piece of work going

10:57

on between NHS England

10:59

, which of course delivers mental health services

11:01

, and OHID , which

11:04

is responsible for the

11:06

treatment and recovery . A

11:08

big piece of work on mental health

11:11

, seeing how do we bring

11:13

, how do we really sort

11:15

this out and bring it together

11:18

in a considered way . So one

11:20

of it may seem like a very small

11:22

success . But talking therapists

11:25

as you probably know , very few

11:27

people with addiction have been able

11:29

to get talking therapists because

11:31

the people who deliver the talking

11:34

therapist say oh no , no , we

11:37

won't be able to work with you because you've got

11:39

a drug problem . Theoretically

11:42

and

11:44

in all their regulations they're not supposed

11:46

to do that and we've now

11:48

met very much at right

11:50

, at the centre , with the top of the people

11:53

in talking therapies and

11:55

that will gradually

11:57

change . Won't change quickly

11:59

. We will have to help

12:02

people who deliver talking therapists

12:04

to understand a bit more about addiction

12:07

and those people who are

12:09

treating addiction

12:11

need to be able to

12:13

treat anxiety , mild

12:15

depression and stress . You shouldn't

12:18

have to refer that into

12:20

a mental health service . So you know

12:22

it needs them to understand each other's

12:24

problems and work together

12:27

. So I would say

12:29

there's huge attention on

12:31

this . I can't sit here and

12:33

tell you there's quick wins because

12:36

it's a big problem , but there

12:38

are several areas in the country where

12:40

they've already managed

12:42

to do the right thing .

12:45

Yeah , obviously , we're kind of going into

12:47

that now because I always say we've

12:49

established a small multidisciplinary mental

12:51

health team , largely based on your recommendations

12:53

from two years ago , and this team consists

12:56

of qualified psychologists training

12:58

assistant psychologists and mental health nurses

13:00

through the joint CGL NHS

13:02

dual diagnosis project . So how do you

13:04

envision teams like this growing and evolving

13:06

both in Hull and across

13:09

the nation ?

13:09

Well , I think they must evolve according

13:11

to the local need . I mean

13:14

it won't look the same in any

13:17

two places . I don't think providing

13:20

a good needs assessment has been

13:22

done by the local authority

13:24

before it commissions its service

13:27

. That needs assessment

13:29

ought to be able to

13:31

inform what do you

13:33

need in a service ? You know ? How

13:35

many psychologists do you need ? What

13:38

do you need in terms of mental health support

13:40

? Or perhaps a mental health social

13:43

worker ? I mean , how complex

13:45

are your cases ? I think you

13:47

can't just say that every area

13:49

of the country is going to

13:51

have the same need when you

13:54

I don't know the level of

13:56

deprivation in Hull , for example

13:58

, but I've just been in Liverpool , one

14:00

of the most deprived cities in

14:03

the country there you

14:05

will really have to put in . You know

14:07

there are going to be numerous

14:10

problems that are related to trauma

14:12

and mental health and you

14:14

probably are going to have to really put

14:16

in you know a really good supply

14:19

of mental health and trauma support

14:21

. So I think it's it's variable

14:23

and I think you learn as you go

14:26

, because we've not been doing this properly

14:28

before and there's not been really

14:30

good mental health support . I think

14:33

one's got to learn how to work

14:35

between the NHS

14:37

and the provider if

14:39

they're not the same organisation

14:41

. And , as I say , I think the

14:44

people who work for the provider of

14:47

treatment and recovery need to know how

14:49

to treat anxiety , stress and depression

14:51

. The NHS

14:53

mental health services need to

14:56

start to understand addiction and

14:58

to be able to do some simple things

15:00

there .

15:02

How do you perceive the role of mental health support

15:04

in advancing the recovery agenda

15:06

?

15:08

I don't think you can go through recovery

15:10

. Quite frankly , I will have very few

15:12

people without mental health and trauma

15:14

support . Maybe a few . But

15:17

I think we know statistically

15:19

for those people who are really

15:21

very drug dependent . So particularly

15:24

our heroin and crack

15:26

cocaine users , I think

15:28

near on 70 plus percent

15:31

of them have had a mental health

15:33

or trauma

15:35

. They may have had a terrible childhood , they

15:37

may have been in and out of prison , all

15:39

kinds of things . It's . It

15:43

is so , it is so much

15:45

part of

15:47

addiction and if you

15:49

want people to go on that journey

15:51

of recovery , then for me

15:53

there's no question you

15:56

need you need good communities

15:58

of recovery . You don't

16:01

need a professional doctor

16:03

alone in a recovery unit

16:06

. You need people who've been addicted

16:09

. You need people who've done that journey

16:11

. You need people who are now able

16:15

to walk with someone while

16:17

they go through it . They can do that much

16:19

better than a clinical professional

16:22

. So I'm very keen that we

16:24

develop proper recovery

16:27

communities In

16:29

that there needs to be work

16:32

, there needs to be the ability to get

16:34

a job or to do something

16:36

meaningful , and then there

16:38

needs to be safe housing . I

16:40

mean one of the biggest , biggest challenges

16:43

, especially well

16:46

, for example , in London , where housing

16:48

is just so difficult to get . It's

16:51

no use doing all the hard work

16:54

of helping someone stop their

16:56

drug of choice and

16:58

then sending them back to live in a hostel

17:01

with somebody who's shooting heroin

17:03

. I mean , none of us

17:05

could survive that . None of us

17:07

.

17:07

We had a podcast participant where it's shut now

17:10

. There was a big hostel in

17:12

Hull where a lot of our well

17:14

homeless service users would often

17:17

be situated and when we talked to her

17:19

on the podcast and was like , how do you know about

17:21

Achievement Recovery

17:26

, she said it was I could scar drugs or I wouldn't even get my

17:28

feet wet Because it was just rife within

17:30

the hostel . So if you're

17:32

someone like her in the situation , she wouldn't . The reason

17:34

why I found that story so inspiring was she was . She

17:36

got recovery in that hostel , but the

17:38

difficulty she must have faced when

17:40

, like say she could in the same way that we're

17:42

in this hotel now , she could just scream across

17:44

the room and that was it . Somebody come knocking with her

17:47

and , do you know , two minutes in and there you go , they have

17:49

scored . So to do it under those circumstances

17:51

is exceptional , but almost

17:53

impossible for most as well .

17:56

And you know what we , the work that's

17:58

been going on with the

18:00

Department of Housing is

18:02

to try and understand , because

18:04

we don't understand . You

18:06

know you can't just say , well , I've got you a roof

18:08

over your head . You need to understand

18:11

what sort of housing is

18:13

best required and needed for

18:16

that particular person . Now

18:19

, you might not always be able to get

18:21

it , but you need to be able

18:23

to understand what the

18:25

journey requires , and

18:27

there's no point putting in all this hard

18:29

work if , then , you

18:31

can't provide the wrap around

18:33

that's going to enable the person to

18:36

really come through recovery .

18:38

I had a story today , really inspiring , from a

18:40

lad that really found his recovery

18:42

through the help of religion , and

18:44

that's something that I find really interesting because it's not something

18:47

that as a service that we can

18:49

really push or say here's what to

18:51

do . So , talking to them , there's the project

18:53

there that they have and the

18:55

community that they've set up , that recovery community that's

18:57

set up really inspiring . They've just been

18:59

around like-minded people , but I do find

19:02

it as an aphiast myself . Do you know what ? I've heard ? These

19:04

stories there's that pattern that goes , but

19:06

then there's another pattern that goes . Well , actually , if that's

19:08

what works , that's incredible .

19:10

That doesn't matter . If that's what works , absolutely

19:12

. What works for you may not work for

19:14

people .

19:15

What opportunities do you think exist for developing specialised

19:18

roles , such as social workers , to

19:20

better make the unique needs of individuals

19:22

in recovery and with addiction issues ?

19:26

I think if you're going to develop the role of a social

19:28

worker , first of all we have one role that's

19:30

been developed , not for addiction but

19:33

would be very useful for addiction

19:35

. There is now a training

19:37

to become a mental health social

19:39

worker . That is now a government

19:42

department of health funded

19:44

training programme . It's called Think Ahead

19:47

, so anyone now can

19:49

add mental health . One

19:51

of the things I'm trying to secure

19:53

at the moment is that that programme

19:56

can be expanded so

19:59

that we can train a

20:01

mental health addiction

20:03

social worker . If

20:05

you think about it , those three

20:08

things are things that any person

20:10

who is drug dependent

20:12

might need . So the mental

20:15

health component , some

20:17

knowledge of addiction and

20:19

a social worker

20:21

. So we're in discussion

20:24

with the Department of Health whether

20:27

or not that programme , which is

20:29

delivered on the academic component

20:32

, is delivered by a middle sex university

20:34

and then the clinical

20:37

training is in our mental health trust

20:39

whether

20:41

we can just enlarge that . So

20:45

I think people , certainly centrally

20:47

, are discussing how do

20:49

you utilise other roles ? How

20:52

do you utilise the role of a pharmacist

20:55

and you

20:57

could do a mental

20:59

health addiction nurse

21:01

. I think Do you know , because

21:03

you need people

21:05

who've got a variety of skills . It's

21:11

not a difficult one to use this ?

21:12

No , absolutely not . I mean , we've

21:14

got in our team . We've got a mental health nurse , for instance

21:16

, that's got a really good addiction background , but that isn't

21:19

part of her role as such . That's from a previous

21:21

role that she hasn't understand enough . So it's really beneficial

21:23

that she has that experience , but really

21:25

on paper that wasn't required for her to do

21:27

that role . So , yeah , I think that sort of amalgamation

21:30

of those different things is necessary .

21:33

In these cases , you could train on the job

21:35

could you ?

21:35

Yes , absolutely .

21:37

Mental health nurse . If they

21:39

go into a good treatment

21:41

and recovery situation

21:45

, surely can learn on the job .

21:47

Absolutely Trauma-informed care

21:49

is gaining significant attention and forms the foundation

21:52

of the work of the Renew Mental Health

21:54

Team and many other teams in the city . There

21:57

are ambitions for all to become a trauma-informed

21:59

city . What are your thoughts on trauma-informed

22:02

care and how it impacts the communities we

22:04

serve ?

22:05

Oh , I think it's crucial . So

22:10

many people who tell

22:13

me their story tell

22:15

me about trauma , and

22:18

even if they don't give you all the details

22:20

, you know that

22:23

they've had perhaps a very difficult

22:25

childhood . Perhaps

22:27

they've grown up in a house where their

22:29

parents have been addicted or where

22:31

there's been domestic violence , and

22:34

the trauma doesn't always have to

22:36

be that sort of trauma

22:38

. I still remember one young lady

22:40

who said to me you might think

22:42

that my upbringing was in a good middle-class

22:45

family and you know I didn't

22:47

have any trauma , but

22:50

her parents worked abroad and

22:52

she was sent away to boarding school

22:55

from very young and she

22:57

hated it . She was taken heroin

22:59

by the age of 15 and

23:03

she said it took her a long while

23:05

to recognise and then

23:07

deal with what

23:09

, for her , was her trauma . It

23:12

wasn't the trauma of being physically

23:14

or sexually abused

23:16

, but it was trauma

23:19

, and so I think having

23:21

people who are trained

23:23

to help people deal

23:26

with this trauma is a crucial

23:29

, not just a drug addiction .

23:31

I mean , I've had some interesting conversations about

23:33

trauma through this podcast and one of the things that

23:35

I found really interesting was people

23:38

start taking drugs because of the

23:40

trauma , of course , but

23:42

once they're at that point of , okay , I'm in addiction , they

23:44

experience something called continuous

23:46

trauma , where they're putting themselves in a position

23:48

of sex work , for instance , and

23:50

by being a sex worker to fund their already existing

23:53

drug habit , they're now experiencing sexual

23:55

assault and rape and then that is fair

23:57

to add into the trauma and then

23:59

it just keeps going on . So

24:02

it's not necessarily just a root cause of trauma

24:04

that started the addiction is . You've got to unpick

24:06

the initial trauma , then

24:09

all the trauma that's followed on while they've been using substances

24:11

as well .

24:12

And that probably would be the trauma

24:14

might well be made if you were sent to prison

24:16

.

24:17

Absolutely . Yeah , prison itself can be traumatic .

24:19

I mean you can think of all kinds of things whereby

24:23

it's additional trauma . So

24:26

you've got multiple episodes .

24:28

Yeah , absolutely .

24:30

And I don't . I mean , I think that again

24:32

is a journey . So I

24:34

think trauma informed care is invaluable

24:36

.

24:37

Yeah , as it's been really interesting and

24:39

I managed . The volunteers and our service and all

24:41

those that have taken on the trauma informed

24:44

training have found that

24:46

so beneficial , not just for their practice

24:48

but look at their own behaviours as well

24:50

. Like they said , it's weird , you know , really unpicking their own

24:53

past lives and that's why I react in this way

24:55

in that situation . That's why I don't enjoy

24:57

working with someone who has this status

24:59

and authority and there's all these sort of things that

25:01

really interests someone . Pick with it . Despite

25:04

two decades of evidence based and expert

25:07

led guidance on supporting individuals with

25:09

co-occurring conditions , ie mental

25:11

health and substance use disorders , change

25:14

of in mental health systems and the culture

25:16

of some mental health service seems

25:19

slow to progress and perhaps even resistance

25:21

to change . What

25:23

do you believe needs to be done to accelerate

25:25

the process ?

25:26

Well , I think I answered that right at the beginning

25:29

, really , because I think you've

25:31

just got to keep talking

25:33

about it . Every time somebody

25:35

says to me they need

25:37

to be treated separately , I stop

25:40

them and say , stop , this

25:43

is not like that . Addiction

25:46

is so related

25:48

to and connected

25:51

to mental health and trauma . You

25:53

cannot . So I mean you

25:56

first of all got to change the language

25:58

, you've got to get the mental health professionals

26:01

to think differently

26:03

about this , and we need the

26:06

support of the Royal College of Psychiatrists

26:08

, you know , because they could be a great

26:10

advocate for us in

26:12

changing this language , in

26:14

changing the attitude of people

26:17

. We need the psychologists

26:19

to change their attitude . So

26:22

culture isn't easy to change

26:24

. And then we need the practical

26:27

steps that allow two

26:29

services to come much more closely

26:31

together and , as I say , in the very

26:33

best of all worlds be co-commissioned

26:36

, absolutely .

26:38

I mean , I think I spoke to you when we did the first

26:40

podcast , but I remember years ago the difficulties

26:42

of mental health and in the sense

26:44

of we'd work on an individual

26:47

, mental health problems , substance use problems

26:49

We'd refer them to mental health because they

26:51

need mental health support and they would bat

26:53

them back to us and say , no , the reason why they have mental

26:55

health is because they've got addiction issues and because

26:57

they're taking substances . That doesn't

27:00

happen as much now . We actually have well , I don't think

27:02

it happens at all . We actually have really good pathways

27:04

with mind , the Holonese Shorker

27:06

Service and obviously , as I mentioned already , the

27:08

multidisciplinary team of clinical psychologists

27:10

that we've created in terms of a real

27:12

mental health team . So there's definitely

27:15

improvements . But I completely understand what you're saying

27:17

about the co-commissioned service for

27:19

mental health and substance abuse .

27:21

I mean that is all under one roof . That

27:23

is ideal , but I think

27:26

it may not be possible everywhere . But

27:28

surely the communication and

27:31

surely each of

27:33

the mental health sort

27:35

of providers and the addiction

27:37

providers , the people who work for

27:40

them , should to widen

27:43

their minds and learn how to

27:45

deal with each

27:47

other's challenges

27:49

to a certain degree . Of

27:52

course , I don't expect an

27:54

addiction provider

27:56

to deal with schizophrenia . I mean , that

27:59

would be ridiculous .

28:00

Yeah , of course .

28:01

And therefore you need a proper referral

28:03

into a proper mental health service . But

28:06

I do expect people working in addiction

28:08

in the future to be able to deal

28:10

with a person's mild anxiety

28:13

, mild depression or

28:15

stress . That is not

28:18

difficult , I mean , I trained as a rheumatologist

28:20

. Yes , I remember you saying I didn't

28:23

refer people with hypertension

28:25

that was ordinary , straightforward hypertension

28:28

or somebody with irritable

28:30

bowel . I didn't bother the cardiologist

28:32

and the gastroenterologist they're too busy

28:34

and I'm a doctor and

28:37

I have been trained , so I'm

28:39

perfectly capable of treating

28:41

hypertension or treating

28:43

irritable bowel in its mild

28:46

you know , ordinary form . So

28:48

that's what I mean by

28:51

people just stretching

28:53

their minds , realizing

28:55

they just have to be a little bit more

28:57

elastic and

28:59

flexible in what they're prepared to

29:01

do .

29:03

So what role do you see service users playing

29:05

in the development of mental health services within

29:07

drug and alcohol treatment ? I

29:09

mean , one of the big things at the moment is the

29:11

buzzword that I'm hearing a lot right now is

29:13

co-production and obviously having service users

29:15

involved from the beginning up to the end

29:17

and stuff like that . So what do

29:20

you think of that ?

29:21

Well , I wrote very clearly in my

29:23

review that I saw service

29:25

users and people who'd

29:27

been on this journey as

29:30

a crucial part of recovery . Now

29:32

I think that could either be

29:35

that they are part of

29:37

the treatment and recovery service

29:39

, so they

29:42

are related to the

29:44

treatment and recovery service

29:47

and part of that whole service

29:50

, or it could be that they're

29:53

the Leros , that they're lived experience

29:55

groups and they then

29:57

won't be necessarily

30:00

the people who are obviously doing the

30:02

more clinical treatment , and I don't

30:04

think that matters . I think those two

30:06

different groupings need to

30:08

learn to work with each other . But

30:11

I do think and

30:14

the department and O-HIT has

30:16

just published its framework of recovery

30:18

, so it's just a

30:21

reasonably lengthy

30:24

document . It really defines

30:26

what is recovery and

30:29

the different sorts of you like of recovery

30:31

, gives you the evidence base

30:33

why is recovery important

30:36

, where's the evidence that show it makes any difference

30:38

at all , and then how

30:40

any local area should develop

30:43

its recovery services

30:46

, and gives a variety of

30:48

ways of doing this . So again

30:50

, I don't think there's any right or wrong

30:53

, but I , as I said

30:55

in my review , do not think

30:57

you should misuse people who've

31:00

been drug

31:02

dependent and are now wanting to

31:04

work in the service by treating

31:06

them as cheap labour . That doesn't

31:09

really impress me at all

31:11

, and I think there

31:13

also should be the opportunity

31:15

for education

31:18

and training and a framework

31:20

in which these

31:22

recovery services

31:24

will be delivered , just like we have for

31:26

the more clinical services . So

31:29

I think the contribution

31:31

that the Centre has just made with

31:34

this document , which is really for commissioners

31:36

and providers of services

31:38

, lays out some quite sensible

31:40

rules and

31:43

to really encourage

31:46

people to work together . So

31:48

I think there's a big learning curve

31:50

for commissioners and indeed

31:52

for providers to work well with

31:55

people who have been service

31:57

users .

31:58

Absolutely . I mentioned it to

32:00

you before . But I'm the volunteer lead for our service

32:02

, so service user

32:04

involvement that's my bag

32:06

sort of thing getting people involved and I've always had frustrations

32:09

and I've had those frustrations in the past around

32:11

it , always feeling tokenistic and not

32:13

really needed and always

32:15

coming to me at an opportunity and we're always got a report

32:18

to fill in . But the one thing I found interesting recently

32:20

was looking at the way CQC

32:23

registered sites are going to be inspected and

32:26

how much more of an emphasis on service user

32:28

involvement and service user voices is going to be

32:30

than any other time . And I mean

32:32

we've continued to try and push our

32:35

connection with care , opinion and the subscription

32:37

that we've got there . So service users can

32:39

feedback and that feedback is

32:41

public , it's in the public domain , people can see

32:43

it and I think that in itself encourages

32:45

a service to take on the feedback

32:48

that they're given much more promptly

32:50

, as opposed to a service user just

32:53

saying in passing oh I think you should do this , I haven't

32:55

got it off , you go , and that sort of thing . So

32:58

we're taking on that information in a

33:01

different way to how we would have previously , but

33:04

there's still a way to go . I think the

33:06

CQC thing will change things , but there

33:08

definitely needs to be more of an emphasis on

33:11

services , user voice , because and

33:13

in the day , they're the majority and , as our

33:15

service manager will always say , it's

33:17

their service . We just have the pleasure of

33:19

working here with them , so

33:21

we have to listen to them every second

33:23

.

33:23

And they know what works . Absolutely yeah

33:25

, exactly yeah , they will receive

33:28

an end of it .

33:28

They know what works , they know what won't

33:31

work Absolutely and I think this is

33:33

it sometimes is going back to that , incentivizing

33:36

appointments and coming in . I

33:38

don't think that would . I don't personally . I don't think that would work

33:41

and I don't think they've not said anything about

33:43

it . It's just an idea that was thrown out there from to being involved

33:45

. But , as you've said , I think the incentive is

33:47

good quality treatment and helping

33:49

them with their problems and it not feeling tokenistic

33:52

or like a long drawn up process

33:54

with a thousand questions at the point of triage

33:57

, just human

33:59

stories . Professor

34:02

Dem Carole Black , the UK recovery walk is an annual

34:04

gathering which obviously you've joined us for

34:07

this weekend , so you're meeting individuals in recovery

34:09

from addiction , their families , friends , supporters

34:11

and its allies . Its primary aims

34:13

are to combat the stigma surrounding addiction

34:15

, increase awareness about the potential for recovery

34:17

and foster a sense of community which

34:19

we've spoken about today . We're excited

34:21

to share that you'll be present at this event in Hull tomorrow

34:24

. Can you share what significant

34:26

, what a significant event like the UK recovery

34:29

walk could hold for you ? Obviously , this

34:31

is your first one . You've done so much work around

34:33

this . What's it like for you coming and being

34:35

part of this ?

34:36

Well , it's wonderful to actually walk

34:38

with people who have actually walked

34:40

the journey of recovery which I

34:43

have not done and

34:46

to really be and see people

34:48

who have made

34:50

it through that journey . I

34:52

mean , not everybody manages it

34:54

, but maybe some of them walking

34:57

tomorrow are still very much on that

34:59

journey . But

35:01

I always believe when you do any

35:03

work you can

35:05

read all the books and reports and papers

35:07

. Of course you should look

35:10

absolutely for the evidence , but

35:12

in the end actually

35:14

you need to go

35:16

and talk to

35:18

the people and be with the people who

35:20

have this challenge

35:22

. And that's true . I mean , I'm

35:24

a medic and you practice medicine

35:27

with human beings

35:29

. You learn , if

35:32

you like , the theory of medicine and

35:34

all the pathology and the physiology

35:37

, but in the end I was a hospital

35:39

doctor . You do it with

35:42

your patient , you don't do

35:44

it in some theoretical blank

35:47

space , and you learned

35:49

very much that you got the best

35:51

result if you and the patient

35:53

work together , and

35:55

so for me it's

35:59

been part of a community of recovery

36:01

.

36:01

And you went to the recovery games last week as well

36:03

and we spoke about it

36:05

briefly in the lobby , but tell me about that . What

36:07

brought you to the recovery games this year ?

36:09

Well , I was invited . What was it

36:11

like there ?

36:12

Was that one of the first

36:15

events that you've been around such a positive

36:18

or high amount of recovery ?

36:19

Yeah , I mean it was fantastic because of all these challenges

36:21

. Some of them , you know , they

36:24

were just so much fun . There was a climbing

36:26

wall . They had a lot

36:29

of them were inflatable things , as you know

36:32

. So a lot of water sport

36:34

. When they were racing each other around

36:36

the water sports

36:39

, it was just so much fun to see

36:41

the competition . A lot of music

36:43

prizes

36:46

to be given away .

36:48

We did it a few years ago and again it was probably

36:50

in my entire time working in drug

36:52

and alcohol treatment , probably one of my favorite days

36:54

where I came out of there just thinking I

36:56

love my job , such a positive community

36:58

to be a part of , and it's infectious as well I always

37:01

say this the camaraderie that comes with

37:03

people , especially in fellowship meetings , like

37:05

the 12 Steps , and the way they hug and

37:07

embrace each other . I was like everyone needs

37:09

, everyone needs community . But

37:11

it's for all the trauma

37:14

and negativity that these people have experienced

37:16

in their lives how

37:18

nice it is to come together and experience such a positive atmosphere

37:21

.

37:21

And do you know , what was also very nice was

37:23

I met some of the families .

37:25

Yes , because you often just you don't

37:28

often get to talk to the families you

37:31

often you may .

37:32

You may be fortunate enough

37:34

to talk to the people during

37:36

the journey , but not necessarily

37:38

their families .

37:40

And we always say no one goes into addiction alone

37:42

. So it's nice to hear and

37:44

the pride that people will

37:46

have with a guy who's working with us now

37:49

. But he went through addiction and speaking to his daughter

37:51

and she was just saying how nice it is to have

37:53

her dad back Because of addiction

37:56

. He wasn't there . But no , professor

37:58

Stame Cowell Black , once again , thank you so much for coming

38:00

on the Believe in People podcast and if you've enjoyed

38:02

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