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Long, Jean (2007) Residential services for alcohol and drug users. Drugnet Ireland , Issue 24, Winter 2007 , pp. 8-9.

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The National Drugs Strategy (NDS) 2001–2008 provides the strategic framework for drug services in Ireland. The strategy is based on four pillars, supply reduction, prevention, treatment and research, and is underpinned by 100 actions which are the responsibility of various government departments and agencies. Through the NDS, the Health Service Executive (HSE) (formerly the 10 health boards), is mandated to provide a range of treatment options, including residential components, to drug users experiencing problems.

 
In 2005, a mid-term review of the NDS recommended that rehabilitation be adopted as a fifth pillar of the Strategy. Arising from this recommendation, the HSE appointed an expert working group in 2006 to describe residential treatment services for problem drug and alcohol users in Ireland, to calculate their current capacity and to estimate future requirements. The report of that group has now been published.1
 
The working group mapped existing inpatient detoxification, rehabilitation and aftercare  services, and reviewed the international literature. The literature examined four specific areas: models of care, the evidence base for opiate and alcohol detoxification, methods employed to calculate the number of places required for detoxification, and the standards for measuring quality of care. Available data from existing reporting systems, such as the Hospital In-Patient Enquiry scheme, the National Drug Treatment Reporting System and the National Psychiatric In-Patient Reporting System, were analysed. A number of submissions were made to the group. A population-based approach was adopted to estimate the level of residential services required. The availability of and requirements for residential treatment beds are shown in the table below.
 
Bed type
Current provision
Total beds required
Shortfall
Medical detoxification and stabilisation
23
127, of which:
50% for alcohol (64), and
50% for drugs (63)
104
Community-based residential detoxification
15
Assessment not completed
 
Residential rehabilitation
634.5, of which 31% are reserved for use by people with problem alcohol use only
887, of which:
 between 14 and 37 for a specific adolescent service;
205 for illicit drug users transferring from inpatient detoxification services;
382 for problem alcohol users transferring from inpatient detoxification services; and
300 to address the needs of drug or alcohol users who have attended outpatient detoxification services
252.5
Step-down/halfway house
155, of which 76% are for use by men only
296 (required by 30% of service users)
141
 
The key recommendations of the working group are:
  •  The four-tier model of service delivery, which offers clients the least intensive intervention appropriate to their need, should be adopted as the framework for the future delivery of alcohol and drug services in Ireland. It was acknowledged that the all four tiers need to be fully resourced for this model to be effective.
  •  A standardised assessment protocol which allows for the systematic identification of each client’s needs is required.
  • Inpatient detoxification should, as a rule, be provided in dedicated units. The transition from a detoxification programme to rehabilitation should be seamless so as to avoid waiting lists, relapse and (in the case of opiates) overdose. Detoxification must be followed up by rehabilitation and aftercare interventions.
  • The number of inpatient detoxification and residential rehabilitation beds needs to be increased (see table above).
  • Where there is unused capacity at present in a service or unit because of staffing, such capacity needs to be brought on stream immediately
  •  In highlighting a deficit of 356.5 beds (104 inpatient detoxification and 252.5 rehabilitation), the working group noted the estimated 66 beds in psychiatric units and hospitals that are currently used for alcohol and drug problems and which will no longer be available as a result of the restructuring proposed in the report of the expert group on mental health policy.2
  • Of the estimated 63 beds required for inpatient detoxification for drug users, one 50-bedded unit should be provided between the Dublin Mid-Leinster and Dublin North East HSE regions where, the data indicate, the majority of opiate and benzodiazepine users live. The remaining 13 beds should be divided between the HSE Southern and HSE Western Regions.
  • In the case of services focusing primarily on the treatment of alcohol problems (detoxification and residential), the beds need to be evenly spread over the four HSE regions (16 per region) since the data suggest a more even distribution of alcohol-related problems throughout the country.
  • Clients with co-morbidity issues who are in residential drug and alcohol services should be provided with adequate support by the mental health services, with clear pathways into residential mental health services when required.
  •  There is a need to review community-based or outpatient detoxification services, including the possible role of Level 2 GPs in their provision.
  •  The Prison Service needs to extend its detoxification and rehabilitation programme in Mountjoy Prison, and establish similar programmes in all other prisons within the State.
  •  The provision of step-down or halfway-house accommodation for newly released prisoners and homeless people who have been detoxified or who have started rehabilitation programmes is particularly important.
  •  A unique identifier and mechanism to track progression from treatment services to rehabilitation is required.
  •  A directory of current residential services needs to be developed and undated annually.
  •   Families of drug and alcohol users could be more involved in the overall careplans of recovering users. Innovative approaches to care for the children of drug users while in treatment are required.
  •  The Quality in Alcohol and Drugs Services (QuADS)3 suite of organisational standards and the Drug and Alcohol National Occupational Standards (DANOS),4 developed in the UK by Alcohol Concern and Drugscope and Skills for Health, should be adapted for use by drug and alcohol services in Ireland.
  • There must be quality standards for the residential facilities themselves, and the HSE should discuss with the Health Information and Quality Authority (HIQA) the possibility of bringing such facilities under the regulation of HIQA’s social services inspectorate. This would help avoid duplication of effort when quality audits are undertaken.
  •   It is particularly important that relevant stakeholders ensure that all detoxification procedures meet the highest standards of clinical governance, care and patient safety.
  •  The level of provision set out in this report should be reviewed in March 2010.
 1. O’Gorman A and Corrigan D (2007) Report of the HSE working group on residential treatment and rehabilitation (substance users). Dublin: HSE
2. Expert Group on Mental Health Policy (2006) A vision for change: report of the expert group on mental health policy. Dublin: Stationery Office.
3. Alcohol Concern and DrugScope (1999) Quality in Alcohol and Drug Services (QuADS): Organisational Standards. London.
4. For more information about DANOS, see the Skills for Health website at www.skillsforhealth.org.uk.

 

Item Type
Article
Issue Title
Date
October 2007
Page Range
pp. 8-9
Publisher
Health Research Board
Volume
Issue 24, Winter 2007
EndNote
Accession Number
HRB (Available)

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