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Contributors’ biographies 2014

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MUTUAL AID

The focus of discussion for the Mutual Aid group was on the benefits Mutual Aid brings to the recovery scene. Mutual Aid is free, it works, it has a long history and set of traditions to protect it. It is inclusive, it has a wide geographical presence; it is international. It is well known and recognised, with a good evidence-base.  It provides positive social networks. It is independent from any professional group, pecuniary interest or outside agenda. Mutual Aid offers fun and laughter, healing and catharsis. It is structured yet anarchical, with every group being independent.  It is ‘already there,’ naturally, in the community, and in theory has the capacity to expand infinitely. However, Mutual Aid groups do face challenges in the current environment. There is widespread public and professional misunderstanding of the spirituality found in the anonymous fellowships, though it was not completely unanimously felt that this was a problem for the anonymous fellowships. Some members of this workshop felt there was something inadequate about with the image and ‘branding’ of Mutual Aid.   Although Mutual Aid has a known evidence base, the fellowships do not use this to promote themselves, because that would be at odds with the Tradition (11) of favouring ‘attraction rather than promotion.’  Most Mutual Aid groups are dominated by white males with an older age profile. This lack of diversity makes them inevitably less attractive to some sections of the population.  There are some areas in the UK that are not well served by meetings, especially of the smaller fellowships such as NA; and SMART, which, though growing, is doing so from a small base.  Workshop members saw the new policy environment as very beneficial for enabling Mutual Aid to be of use to ‘harder to reach’ populations who may not otherwise access meetings. This would be a chance to enhance fulfilment of ‘primary purpose.’ They also felt it would have an overall beneficial effect on the service structure as there would be more people available to take service positions and thereby deepen their recovery, whilst supporting others.  The workshop group welcomed the interested shown by policy makers and saw this as an opportunity to address the issues of stigma around recovery in Mutual Aid. Whilst the anonymous fellowships do not affiliate with organisations, nor change what they do under pressure from the outside, they do view this as a chance to communicate their message more clearly and inclusively. However, they also noted that changing group dynamics resulting from newcomers with a range of complex needs may present challenges to a minority of conservative fellowship members.  The members of the workshop were very clear that any type of coercive referral would be out of line with the Traditions of the anonymous fellowships, and would be ineffective, so whilst they welcomed ‘Facilitated Access’ they would cease to do so were it to become directive or coercive, and were aware of a possible systemic risk of this.

Two possible projects were identified for consideration:

1. The development of meetings in areas of low Mutual Aid presence.

The possibility of using the service structure of fellowships to help identify appropriate areas was considered. The group wondered whether there might be a role for service positions for a ‘growth officer’ or intergroup/region ‘outreach committees.’ Both the anonymous fellowship reps and the SMART reps were enthusiastic about helping to effect a culture change towards being more proactive in this respect. The question of social media was also one that fellowships were prepared to explore.  It was proposed that Convention Workshops could be used to get the information about the new policy environment out to fellowship members, and to assist fellowship members in thinking about how this will impact them, and what they might do about it pro-actively.

2. Produce some literature to clarify the religious/spiritual aspects of the anonymous fellowships and to communicate inclusiveness.

The Conference (i.e. the members of)  AA have mandated the Literature Committee of the General Service Board to produce a leaflet based on what was is already published designed to clarify this issue. There was a very helpful offer from a professional present in the workshop to read and comment in advance of publication, and the workshop considered consultation to be worthwhile.

It was also noted that FAMA (Facilitated Access to Mutual Aid) had a crucial role to play in clarifying the inclusiveness of AA/NA Spirituality, and fellowship members could make a contribution to this.

Workshop Report: Professionals

This group comprised principally professionals from a wide range substance-misuse services, but there were also representatives from mutual-aid groups and the wider recovery movement.

Before undertaking the SWOT analysis and identifying priority actions, there was a general discussion on the culture change required for the new recovery policy of engagement with mutual-aid and recovery communities to be fully and effectively implemented. Several professionals expressed their feelings of vulnerability around the policy change, questioning what their roles would be, if any.  Concerns were expressed regarding how changes could be implemented in the context of the current risk-averse ‘CQC’ regime and whether professionals could rely upon mutual-aid and recovery groups to safely accommodate a large influx of new members.

SWOT Analysis:

STRENGTHS

Clinical Interventions will continue to be required by many in addition to referral to recovery groups and these will need to be provided by professionals.

Liaison with other professionals (e.g. probation, social services) will still be necessary to address individuals’ issues that will not be resolved through mutual aid/recovery groups.

Long-term ‘safety net’ provision will be required – some individuals are not suited to participation in recovery through groups and will drop out of programmes temporarily or permanently.

Supervision and Monitoring of clients can only be undertaken by professional services – recovery groups (e.g. the Anonymous Fellowships) are unable or unwilling to do this.

WEAKNESSES

Lack of awareness of Mutual Aid / Social ‘model’ –studies have shown that many professionals have had no direct experience and a limited understanding of recovery groups and programmes.

‘Believe our own hype’ – “professional preciousness” and belief that professionals themselves offer the best solutions.

Not involving service users – the level and means of current engagement between professionals and mutual-aid/recovery groups is patchy. There is widespread concern expressed by service users that they are not involved enough and that there is a culture of “we know what’s best (for you)” . Improved awareness, understanding and local liaison between professionals and recovery groups will be required in order to fully implement the new policy of engagement.

OPPORTUNITIES  

Humility –working with others on equal terms, being receptive to others’ views and experience.

Choice – extending the menu of options available to service users, including abstinence-based and other recovery solutions.

Working with commissioners – contracts that incorporate the provision of mutual-aid and recovery community options need to be developed.

THREATS

Uncertainty – the turbulent environment resulting from the proposed reduction in resources and organisational change can mitigate the development of new working relationships.

No code of ethics – Generic drug workers, unlike nurses or social workers, have no cod eof professional standards that can be used to promote best practice. A code of ethics needs to be developed.

Job security – individuals and organisations feel threatened by the current organisational changes and this can result in resistance to embracing the policy of engagement with the recovery community.

Sector-wide politics – the resistance to change of all vested interests will have to be challenged and overcome.

PRIORITY ACTIONS

Whilst the members of this workshop expressed feelings of optimism and positivity, there was also some scepticism and frustration, and questions about where the professional sector fits in.

PROPOSALS

Two firm proposals were suggested by the group:

1)      Use FAMA to ensure staff attend mutual aid groups

• Go to meetings
• Enthusiastically link clients to groups
• Fellowship presentations to professionals
• Applying FAMA principles to training staff
• Find out what meetings are available and establish contacts

2)      Ask for help from the recovery community and service users to influence the professional service ‘quality agenda’

• CQC requirements are perceived as onerous, risk-averse and therefore a barrier to implementing the changes required by encouraging engagement with Third Sector groups.
• Red Tape Challenge – this might be met by expanding the CQC’s policy making body to include representatives from mutual-aid and recovery organisations.

REPORT

As a workshop on the wider recovery movement, chaired by a professional (Dr David Best), the focus was mainly on ‘how can the wider recovery movement and the professionals work together and complement each other to enhance the goals of ‘recovery’ and its growth in the UK?’

Strengths

Experience – while some delegates were not keen on the phrase ‘expert patient’, it was generally agreed that the first hand experiences of the wider recovery movement were without parallel as a tool.

‘Infiltration’ – sounds subversive, but in the context of the discussion meant that recovery oriented services were no longer the preserve of the ‘professionals’ but that the recovery movement were increasingly finding genuine work settings and a clear place for the recovery community in the wider treatment system. In some areas, this reality was embraced by the professionals.

Visibility through Unity – this was discussed as a challenge to itself by the wider recovery community to consider that ‘unity’ is how strength is demonstrated. The sense of the group was that this is real and happening now in the UK.

Pro-active, flexible partnerships – this was seen as a challenge to both professional and the wider recovery movement. The need for cooperation between the professionals and the recovery community is paramount to the success of both and both have unique skills and attributes that complement each other.

Passion, compassion, love – these humanistic qualities of the recovery movement were considered as genuine and appealing assets from the perspective of professionals and critical to supporting the initiation and continuity of recovery.

Non-judgemental – the wider recovery community is less likely to ‘stereotype’, ‘classify’ or ‘stigmatise’ those engaging with professional services. A genuine empathy was available.

Recovery Communities –the people that populate the recovery communities can act as the gateway to recovery for those who are trying to get in from the fringes.

Opportunities

5 ways of wellbeing – the UKRF have adopted this model as one of its guiding principles and is a good set of basic guiding principles for both individuals starting their recovery journeys and for recovery groups to work to.

Reduce Stigma – stigma was almost universally considered to be a major problem. The difference between public perceptions of addiction and recovery in the US and the UK was noted and the group discussed how we can change negative stereotyping into the welcome on to the professional platform of ‘recovering professionals’.

Genuine partnerships WITH professionals – ultimately, if achieved, this would be an incredibly powerful tool for making progress in areas where previously there had been a loss of direction.

Give opportunities and responsibilities –  there has to be real and structured incentives. This means offering professional roles and responsibilities to members of the recovery community who are contributing. People develop self-esteem and efficacy by being given and taking responsibility

Learn mutual respect and roles – recognition of limitations and capabilities. These can be explored through genuine partnerships. Knowing the difference between passion and expertise and marrying the objective skills of the professionals with the personal commitment, sharing and passion of people in recovery.

Turn professional fear into professional love – Professional fear was acknowledged as a barrier between the professionals, those engaging with services and those seeking to help in those communities. A very emotionally charged working environment has become unloving in some areas and the result has been polarising. This must be turned around.

Weaknesses

Learning/communication – members of the wider recovery community need the necessary training and skills to be effective in their roles in the professional arena. Steve Dixon from Changes talked about the ‘Recovery Academy’ in Birmingham as a model where those who wanted to work in field of recovery are given opportunity to train for NVQ level 3 Health and Social Care as standard. This helps to ensure they are taught how to communicate in professional circles.

Maintenance culture -there are areas of health and social care and ‘treatment’ services where the ‘maintenance culture’ is still embedded. There is recognition of the need for the service but whether or not as an off the shelf solution is another question. Engaging the maintenance population in recovery is a major challenge – for staff and clients.

Threats

Is PHE focus too narrow – Does mutual aid hold all the potential solutions that PHE is hoping for? Are they looking at the right areas?

Professionals fears about their role –Are ‘recovering workers’ going to be cheaper, more efficient, more passionate and more effective? Don’t forget the families – families may offer crucial support for recovery, or alternatively be part of the problem, feeding the cycle of addiction.

The workshop developed a Seven Point Plan to address these problems.

1. HUMANISING EDUCATION – which involves joint working with mental health and alcohol and other drug workers as well as showing professionals the power of love and sharing – and how the recovery community can teach and support this.
2. COMMITMENTS TO THE LIVED COMMUNITY – which involves human voices and coalitions that are embedded in a range of community activities
3. POLITICAL VOICE which includes pressure groups and community voices – recovery groups as a power for change
4. JOB-SWAPS It was acknowledged that those working in the field as peers in recovery may not fully understand the challenges of professionals’ roles. ‘Job swaps’ offer a way of achieving the improved awareness.
5. INFLUENCE PUBLIC POLICY and petition for increased recognition and respect for the role of recovery
6. CHANGE CULTURE – using the tools of co-production to challenge discrimination and stigma in the local community
7. CHANGE PUBLIC OPINION to create opportunities for access and engagement

This plan included some weighty aspirations but these reflected the sense of duty and the passion for the wider recovery movement as it contributes to a new working culture in partnership with professionals. The first 4 are functions for the wider recovery community to fulfil and in doing so help to action points 5-7 from the bottom up. The overriding aspiration is that professionals will be attracted to engaging with the recovery movement.