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Providing substance misuse support to LGB & T people
New trends, challenges and developing a strategic approach through commissioning
Monty Moncrieff
Overview
• Recent trends• Meeting new needs• Club Drug Clinic – NHS partnership• Commissioning for LGB & T users
Who are we?
• London Friend – since 1972• Antidote – since 2002• Antidote @ Friend – since 2011• Antidote funded via Big Lottery Fund 2011-15
Recent trendsIssue 2005 2011
GHB/GBL 3.2% 27%
Crystal meth 0% 39%
Mephedrone 0% 14%
Referrals from GUM, A&E, statutory drug services
8% 63%
Recent trends in MSM
Of G and crystal users:• 95% using to facilitate sex• 80% injecting (70% shared equipment)• Prefer to use ‘bareback’ sites to find sex• Average 5 partners per episode• 75% HIV+• 90% attribute diagnosis to drugs and alcohol• 60% non-adherence to ARVs whilst ‘high’• >50% of HIV negative men had at least one course of
PEP in past year
More worrying trends
Recent trends
• Dependent use of G (requiring medical detoxification)
• Unable to prescribe substitute• Acute psychosis• A & E presentations with acute intoxication or
withdrawal• Game-changer for drugs services and the LGB
&T population
Meeting new need
• Different interventions• Different awareness• Educating mainstream providers• Satellite & partner provision – especially GUM
– Code Clinic• Awareness in sexual health settings• Informing policy makers
Club Drug Clinic
Club Drug Clinic
• Central & North West London NHS Foundation Trust
• Drug Treatment Centre at Chelsea & Westminster Hospital
• Response to number of men presenting via GUM with substance misuse needs
• Innovation funding from CNWL - £200k/year for two years (Apr 2011 – Mar 2013)
Club Drug Clinic
• Open to all – not LGBT specific• Not restricted by local authority• Multi-disciplinary team• Antidote – LGB & T expertise, structured
psychosocial interventions and recovery support
• For service users = seamless ‘one-stop’ service responsive to need and aware of LGB & T issues
Club Drug Clinic
• > 250 clients• High level of LGB & T clients (84%, mostly MSM)• 68% new to treatment• Distinctive divide in patterns of use LGBT/non-
LGBT• 60 G detoxes (58% of G users)• 87% feel made progress with drug problem
(10% uncertain, 3% no progress)
Commissioning
• Central government funding (Pooled Treatment Budget)
• Via DAATs according to local need• Traditional focus on opiate and crack cocaine
users• Strong criminal justice focus• Poor focus on LGB & T diversity
Scoping Study
• Department of Health IESD funded• Reports in 2014• Explore options for commissioning for LGB & T
need – strategic inclusion• Offer additional training and support• Share learning to national commissioners
Challenges
• Lack of data – clients outside of PTB-funded services being ‘missed’ centrally
• Comparable data – mirroring NDTMS• NDTMS existing data – poor LGB, no T• Challenging commissioners’ performance
Opportunities for commissioners
• High level of new-to-treatment clients• High level of drug-free discharges• Low rates of offending• Payment by results potential• Synergies with sexual and mental health
providers
LGB & T Audit Tools
LGB & T Audit Tools
• Organisation policies• Needs assessment• Commissioning intentions• Outcomes for LGB & T clients• Workforce competence & development• Meeting Public Sector Equality Duties• Creating a welcoming environment• Interventions and referral pathways
Questions for Commissioning
• Are LGB & T populations analysed in your JSNA or DAAT business plan?
• Does LGB & T need feature in your joint health & well-being strategies?
• Are you setting objectives that are LGB & T inclusive?
• Are you utilising LGB & T health research in your planning?
• What goals are you setting to fill any gaps in evidence for the next strategic review?
Questions for Commissioners
• Are you asking your providers to monitor sexual orientation and gender identity?
• Are you asking your providers (and potential providers) to demonstrate how they will achieve outcomes for your LGB & T populations in tender documents?
• Are you monitoring outcomes for LGB & T people with your providers?
Questions for Commissioners
• What engagement have you carried out with local LGB & T people and organisations?
• How are you ensuring your providers are LGB & T competent?
• How can you demonstrate you’re meeting your Public Sector Equality Duty in regards to sexual orientation and gender reassignment?
Invitation to Join
• Commissioners• Providers• Carry out audits• Work to develop local action plans• Work cross-boundary in London• Share knowledge nationally
Contact details
• www.londonfriend.org.uk • www.londonfriend.org.uk/antidote • [email protected]• 020 7833 1674