In Scotland, “community treatment” (i.e. addiction care from home or at day clinics locally) is often seen as the alternative to the kind of residential treatment provided at Castle Craig.
Of course, “community” is something of a misnomer, as Castle Craig fosters its own community environment, and places great emphasis on this sense of community and the health of the community.
The word ‘residential’ in terms of addiction treatment can also be misleading as it can conjure up images of “drying out houses” or old fashioned mental health institutions, rather than a thoroughly modern and professional addiction treatment facility.
In Scotland, community treatment has become something of dogma for certain professions and institutions – and in most parts of Scotland, it is now the only type of treatment available through the NHS and social services.
Community addiction treatment is struggling
It is significant therefore that a group called, “General Practitioners at the Deep End,” have published a survey showing that community addiction treatment is struggling to keep up in Scotland’s most deprived areas.
The report is framed mainly in terms of “the devastating impact of austerity cutbacks,” however another picture emerges of a chaotic environment for addicts and the mentally ill, as well as a treatment system that can’t cope.
Amongst a litany of difficulties we hear about:
- Increasing antidepressant and antipsychotic use.
- Self-medicating with drugs and alcohol.
- Pressure on access for appointments
- Pressure on appointment duration
- Addiction workers struggling to do any structured addiction work because they are too busy trying to help patients in crisis.
- Rehab services are harder to access.
- Funding and access barriers to residential detox
- Difficulty in accessing respite care.
- Overworked and understaffed services.
- Addiction services being told turn to charities for support.
- Low staff morale due to stress and extra workload
- Detrimental impacts on patient care
- Patients suffering long waits
- Increasing patient contact with GPs and psychiatry
An environment for recovery
Is this the right environment for people to begin their recovery from addictions? Are these the best treatment services Scotland can offer? The report paints a grim picture. While community-based care clearly has a large role to play, where have previous approaches to addiction care gone such as ‘stepped care’ and providing a ‘range of services’.
No one-size-fits-all approach
In many cases, people need to be taken out of their chaotic environments in order to address their addictions and other mental health problems. Let’s not forget that the community also include the off-license and the drug dealer. There should be no “one size fits all approach”. Access must be available both for local, day treatment, as well as full residential rehabilitation even when that means referring people out-of-area.