Home > Involving service users: the Irish experience.

Pike, Brigid (2011) Involving service users: the Irish experience. Drugnet Ireland , Issue 37, Spring 2011 , pp. 5-6.

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Action 42 of the National Drugs Strategy 2009–2016 identifies the need to further involve the users of drug treatment services, ‘both as an essential part of clinical governance procedures and service planning’ (para. 4.79). The issues to be considered when involving service users are highlighted in a recent qualitative study of service user involvement in a Dublin-based methadone maintenance service.1 

Completed in mid-2008, this study was based on in-depth semi-structured interviews with eight providers from the service, three drugs task force co-ordinators and the co-ordinator of the drug-user group, and eight service users attending different clinics across the broad geographical area in which the service operated. The author, Aoibhínn King, in the School of Social Work and Social Policy, Trinity College, Dublin, identified issues around five themes:
 
1.     Purpose of the service: There were conflicting views about the purpose. Service users were clear that the purpose was to contribute to a reduction in the difficulties they experienced through drug use and to the stabilisation and normalisation of their lives. Service providers were more ambivalent: while many saw abstinence as the final goal, they claimed that harm reduction and improved quality of life were the actual outcomes.
2.     Understanding of user involvement: While there was overall consensus that user involvement was both progressive and desirable, and increased the effectiveness of the service, in reality, service users’ experience was that the system did not engage with them: ‘I’m not involved at all, like they haven’t asked me to do anything, just come up and get me methadone.’ 
3.     Determining own care: Respondents generally endorsed the principle that service users have valuable knowledge and experience that can help in planning and delivering their care programme, but they were almost unanimous in stating that, in practice, service users played little or no part in determining their own treatment. Moreover, there was a prevailing view that both service users and service providers gave higher priority to issues around methadone maintenance than to addressing the issues which impacted on the individual’s life and influenced their drug use.
4.     Involvement in service evaluation, planning and development: Involvement was perceived as largely symbolic. Several obstacles were identified, including resource constraints, organisational and national protocols and procedures, unrealistic expectations on the part of service users, disillusionment and fear of criticism on the part of service providers. The author also noted, ‘the culture within services served as the most significant barrier to meaningful collaboration’.
5.     Operational system and interactions between service users and service providers: The author found that the staff attitudes common under the ‘old system’ of treatment still pervaded the culture in treatment services and was the main impediment to the active engagement of service users. Staff tended to define service users in negative stereotypical terms, and service users, in turn, characterised their relationship with treatment systems primarily in terms of fear, rather than terms of equality or mutuality.
 
King described the explicit acknowledgement of the imbalance of knowledge and power between provider and user as ‘remarkably stark’. While the service studied was nominally imbued with the harm reduction ethos, the author found that the underlying philosophy of the old drug treatment system had not shifted to any great extent.
 
To bring the treatment service into line with harm reduction philosophy, King concluded that much more was needed than simply including abstract statements of principle in official policy documents: ’It may be that what is needed is a more explicit and committed approach which incorporates the education and training of all involved in the delivery of treatment services for illicit drug users, if the situation identified here is not to persist.’
 
1.  King A (2011) Service user involvement in methadone maintenance programmes: the ‘philosophy, the ideal and the reality’. Drugs: education, prevention and policy. [Early online PDF, 7 Sep 2010]. https://www.drugsandalcohol.ie/14472/ 
Item Type:Article
Issue Title:Issue 37, Spring 2011
Date:2011
Page Range:pp. 5-6
Publisher:Health Research Board
Volume:Issue 37, Spring 2011
EndNote:View
Accession Number:HRB (Available)
Subjects:VA Geographic area > Europe > Ireland
L Social psychology and related concepts > Inclusion and exclusion
J Health care, prevention and rehabilitation > Treatment and maintenance > Patient attitude toward treatment
T Demographic characteristics > Person who uses substances (user)

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