Annex C

Development of Community-Based Services

Objective of Service

1 To contact drug misusers and help them to minimise the risk and damage to themselves and others as a result of their drug misuse. In particular, to provide advice and help in reducing the risk of acquiring and transmitting HIV by whichever means are most readily achievable by each individual concerned.

Service Base and Access

2 The service should be based in a location which is easily reached by the local drug misusing population. A town centre location will often be ideal though a side street will probably be preferable to a main street since it will be important that people using the service do not feel conspicuous. In some districts more than one base will be necessary to ensure that the service is accessible to the whole population.

3 In rural areas with poor public transport the use of a mobile unit may be one way of reaching the population. Similarly, in urban areas where particular estates or districts are known to have many drug misusers a mobile unit visiting each estate may be a worthwhile approach. It should be borne in mind, however, that if such units are unduly conspicuous they may be unattractive to many drug misusers who would prefer a discreet service. An alternative would be for the staff of the service to work from a number of static bases such as advice centres, health centres etc. In some cases, a flat (or house) in a `problem' estate may provide an ideal base. Where a mobile unit is used it will generally be preferable for it to be linked with a stationary base.

4 Opening hours should be tailored, as far as possible, to the needs and habits of drug misusers. This will often mean evening opening (perhaps in place of mornings), perhaps including weekends. This should fit in better with the daily pattern of many drug misusers' lives; it will also provide easier access for those who are working.

5 Immediate access is extremely important since drug misusers who are not highly motivated may not be willing to wait or return if they can not be seen straight away.

Staffing and Style of Service

6 The service should be perceived as practical, non-judgemental, informal and geared to the user's needs and problems. Former drug misusers may be particularly effective in this role. In the past, the voluntary sector has often been in the forefront of this type of service development. Its role will remain important but, as Community Drug Teams have demonstrated, it is possible to provide this type of service very well in the statutory sector. Either way, care must be taken to avoid over-identification with 'authority'.

7 Some professional input will be required on a 'consultancy' basis. This may be from sessional GPs (to provide primary health care and, where required, help with drug problems), and advisers to help with non-drug problems.

Service Provided

8 The service provided must be geared both to achieving the objectives in para 1 above and meeting the needs of drug misusers so they find it relevant and attractive. The provision of help and advice which is not directly related to drug misuse may be the 'carrot' which persuades many drug misusers to make and maintain contact. The service on offer should therefore include:

a. Practical advice and help
In particular, advice and help with the type of problems which drug misusers often suffer but are not directly related to their drug use. Examples include welfare benefit advice, housing and employment advice, help with child care and legal problems. The staff of the service should be able to provide some advice and help of this sort but will also need to call on others with more expertise. In some cases it may be useful for outside staff with expertise in one of these fields to do a periodic advice session at the service (staff from the LA housing emergency department, the Manpower Services Commission, a legal advice centre, are obvious examples). An alternative would be for the staff of the service to develop a network of contacts who could advise them (usually by telephone) on individual cases. At a still more practical level, the provision of facilities such as launderettes and creches may be effective in attracting clients. This kind of practical help not only meets clients' needs but may also enable them to attend the service without feeling stigmatised.

b. Advice or help on HIV and how to avoid it
The advice given must recognise that some drug misusers are not yet sufficiently motivated to consider abstinence and that others are not yet ready to stop injecting. All clients must be given non-judgemental practical advice about the different ways of avoiding acquiring or transmitting the virus. This is discussed in more detail in Chapter 5. The provision of condoms and syringe exchange will reinforce the health education and provide the means to put it into practice. This should normally be part of the service though provision of syringe exchange is not essential providing there are other outlets locally. Where this is the case, advice on where to obtain syringes should be readily available.

c. General medical care
Many drug misusers do not have general practitioners and are often in need of primary health care. A general practitioner or hospital doctor should normally be employed by the service on a sessional basis to provide treatment for problems such as abscesses and other illnesses together with family planning and cervical cytology. If this is not possible, the service should develop links with local GPs who are willing to deal with referrals. Advice and support in getting a GP should be available.

d. Help with drug problems
Help with drug problems should be available for those who want it. The permanent staff should be trained and equipped to provide advice and counselling. More specialist help, including the possibility of prescribing, may be provided in a variety of different ways e.g:
—    through the sessional GP, or in liaison with the client's own GP;
—    through specialist drug staff (e.g. community psychiatric nurses) attached full- or part-time to the service (again, in liaison with a GP or hospital-based specialist);
—    by referral to the local drug dependency unit.

Advertising and Outreach

9 The services should be extensively advertised. Advertising should spell out clearly what services are on offer rather than just publishing the existence of the service. It should make it clear to drug misusers that the services are for them but that they are not only about drug misuse. It must also be made clear that the services are not only for those who feel motivated to stop or reduce their drug misuse. The health and practical advice aspects of the services should be highlighted. Suitable sites for advertisements may include retail pharmacies, accident and emergency departments, GPs' surgeries, youth organisations, launderettes, 'takeaways'.

10 Some of these services, e.g. mobile units, will be a form of `outreach' in themselves. More generally, all the services should form a useful base for outreach work where this is considered appropriate.

Links with other services

11 Good links and easy two-way referral will be essential with:
—    other drug counselling/advice services;
—    local GPs;
—    drug dependency units (or other specialist psychiatric services where there is no DDU);
—    GUM clinics;
—    residential rehabilitation services;
—    social services;
—    other statutory services such as housing departments, social security offices, the Manpower Services Commission;
—    other (non-drug) advice agencies.