Providing substance misuse support to LGB & T people New trends, challenges and developing a strategic approach through commissioning Monty Moncrieff.

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