Download Presentation by Tabor Lodge Group

Submission
from
Tabor Lodge Addiction and Housing Services Limited
to
Oireachtas Joint Committee on Health and Children
Tuesday October 25th 2011
1. Introduction
I would like to thank the Chairman of the Committee and the Committee for the invitation to address
you today on behalf of Tabor Lodge Addiction & Housing Services Limited in Cork.
My name is Mick Devine and I am the Clinical Director of Tabor Lodge Addiction & Housing Services
Ltd and the Clinical Manager of Tabor Lodge Addiction Treatment Centre.
I am accompanied today by Finbarr Cassidy, who is the Treatment Manager of Fellowship House, a
facility for extended addiction treatment for men in Togher, Cork and Eileen Crosbie who is Treatment
Manager of our equivalent facility for women, Renewal, in Shanakiel, Cork.
Each of us is a member of the Irish Association of Alcohol and Addiction Counsellors.
In addition to being the Clinical Director of our Company, I also represent the wider voluntary sector for
addiction services on the National Drug Rehabilitation Implementation Committee (NDRIC). This
committee was set up by the HSE following issuing of the Rehabilitation Report and NDRIC’s function
is to implement the recommendations of this report. Briefly, the main recommendations of this report
are that
- comprehensive rehabilitation services need to be established in the country, which should be
- properly co-ordinated,
- properly funded and
- there needs to be a partnership approach to rehabilitation service delivery.
I am also the Secretary of the Addiction Treatment Centres of Ireland (ATCI). This is a group of
treatment centres who are of similar function to Tabor Lodge. The Rutland Centre, Dublin and Aislinn
Centre, Ballyragget, Co Kilkenny are also members of this group and they have both addressed the
committee already. In addition there is Hope House, Foxford, Co Mayo, Bushypark, Ennis, Co Clare,
Talbot Grove, Castleisland, Co Kerry and Aiseiri, Cahir, Co Tipperary & Co Wexford, and Whiteoaks,
Co Donegal. Collectively, these treatment centres have been delivering treatment in Ireland for over 25
years, working in collaboration on treatment issues of importance. The group is currently developing its
own strategy for service delivery into the future.
Since the inception of the Southern Regional Drugs Task Force in Cork in 2003 I have represented both
Tabor Lodge and the voluntary sector on this task force.
In addition to Finbarr Cassidy being the Treatment Manager of Fellowship House he also represents the
voluntary sector and Fellowship House on the Cork Local Drugs Task Force and he has recently become
the Chairperson of a cluster of voluntary treatment, education and community organisations.
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2. Tabor Lodge Addiction and Housing Services Limited - Organisation and Services
(i) Tabor Loge
Our mission is to care for people with addictions and to care for their families and we have been
providing this service since 1989. The service was established by the Sisters of Mercy and the
Company has charitable status. President McAleese visited us last year to join us in our celebration of
our 21st Birthday.
We provide treatment services to persons addicted to alcohol, drugs, gambling, eating and spending
disorders.
The core piece of service that we deliver is a 28 day residential Tier 4 service for up to 18 people. We
admit over 230 people annually. All of our clients are over 18 years and we currently have a resident
who is 79 years old. We treat male and female clients and traditionally the ratio of males to females has
been 2 to 1 but is now nearer 1 to 1 with an increase in the number of women presenting for chemical
dependency issues. Approximately 50% of our admissions are individuals in the 18 to 35 age group.
Approximately half of our clients pay the cost of treatment themselves. This may be through their own
or the family’s resources or private health care or work place schemes.
(ii) Fellowship House and Renewal
In the last 10 – 15 years we have seen it necessary to develop step down facilities such as Fellowship
House and Renewal. It became clear that people aged between 18 and 35 in particular who are
unemployed, addicted to more than one substance and come from a family or community background
that is disadvantaged face such challenges in their home or community that 28 days treatment is not
enough and that there needs to be an extended care in a residential setting. A 12-week programme is
delivered and up to 10 men can be accommodated at Fellowship House and 9 women in Renewal.
These services are unique and we therefore take referrals from treatment centres all over the country.
At these facilities, treatment continues and the skills for rehabilitation and reintegration into the
community are learned. There is partnership with FÁS to provide ongoing education and training for
employment. We also provide what we call “Sober Houses” which is secure, independent
accommodation where those who still have housing needs or cannot return to the home environment can
stay for a further period of up to three months.
This addresses one of the most difficult issues for people in early recovery from Cork, and from many
other parts of the country, in getting themselves established in secure accommodation.
We find that up to half of the men and women who attend Tabor Lodge for treatment will need the
extended service offered by Fellowship House and Renewal. The other half will be able to establish
their rehabilitation by engaging with the 28 day residential services and then moving on to our
Continuing Care and Family Services. Our experience is that these people have their own supports and
resources and those of their family and community as well as supports offered by employment.
(iii) Family Services
Thanks to funding received through the Cork Local Drugs Task Force we are able to employ a full-time
Family Addiction Counsellor. This has helped us to develop Community Based Family Support
Services and last year we had over 5,000 attendances.
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The Family Affair programme held in Croke Park last Tuesday highlighted the need for a review of the
literature and the need to support families where there is addiction. The present Drugs Strategy
recognises family members as service users in their own right. This is a very welcome development and
Tabor Lodge has been playing a leading role in caring for families and helping families to realise that
that they need to be cared for themselves where there is addiction and encouraging them and challenging
them to look to their own needs and to develop their own quality of life.
(iv) Continuing Care Services
An integral part of Tabor Lodge’s services over the 22 years has been Continuing Care Support. The
initial 28 day treatment is a beginning only, giving people an insight into their addiction and helping
them to see that addiction is really the problem. Our experience is that while approximately 50% of our
service users need the supports of Fellowship House and Renewal, all of our clients will need the
support of a weekly Continuing Care Support Group where they follow an aftercare plan and check in
with our services on a regular basis to review progress.
Our model of care is therefore similar to the model of care for treatment of any chronic condition. It is
not confined to just the initial residential stay to treat the addiction but encompasses the aftercare plan
which deals with how the person rehabilitates and adjusts to normal life without the use of alcohol,
drugs, gambling or a disordered relationship with food.
As an organisation, we are accredited by CHKS which are a British based accrediting body who are
recognised by the VHI. In our partnering with public sector bodies and with the private health insurers
there is an emphasis on the need for transparency, for value for money and quality service delivery and
our CHKS accreditation assures that all these are in place.
3. Alcohol
(i) Main Drug of Choice in Patients Attending Tabor Lodge
The most important point that we would take the opportunity to make today is that the main drug of
choice of the addicted population attending our services is alcohol, as Table 1 illustrates.
Table 1 – Profile of people treated at Tabor Lodge Addiction Treatment Centre, 2010
Alcohol
Cannabis
Opiates
Benzodiazepines
Prescription Painkillers
Cocaine
Others
Other stimulants
Total
181
21
16
10
4
3
3
1
239
It is easy to be misled by the impression that the main drug of choice in the country is heroin, and
indeed services and strategies have evolved in response to the heroin problem, but it is important to
point out that the principle of substitution in these strategies is limited when it comes to working with
other drugs like alcohol, where substitution onto a different substance is not viable.
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Table 1 shows the number of people who are presenting with illicit drug problems, but also and more
interestingly, the growing number of people presenting with prescription medication problems and over
the counter (OTC) painkilling medications.
(ii) Minimum Pricing
In inviting us to address the committee, we were asked to address the issue of minimum pricing for
alcohol. On this issue, we would like to take the opportunity to make the point that of the 181 people
admitted to our services last year who said their drug of choice was alcohol, they were categorised as
chemically dependent to alcohol according to the diagnostic tool we use which is the DSMIV. This is
the diagnostic and statistical manual of Mental Health Disorders of the American Psychiatric
Association Fourth Edition and this diagnostic tool is generally in line with the World Health
Organisation’s diagnostic tool of chemical dependency.
We are clearly saying therefore that the people that we treat are chemically dependent on alcohol, that
they are addicted, that their alcohol use is out of control, that they use more alcohol than they should.
For us, pricing is not the issue for the addict and alcohol will obtained by fair means or foul, regardless
of the price.
(iii) Roscommon Child Care Case
We would like to take the opportunity to mention the Roscommon Childcare Case, as reported by the
HSE enquiry team on 27th October 2010, which we are sure the Committee were interested to read. In
paragraph 9 of this document there is a section on alcohol and drug dependency wherein it is stated
“there was evidence to suggest that both parents had a considerable dependence on alcohol, upon
which much of the family income was spent. This preoccupation with alcohol clearly affected their
parenting capacity. It was manifested by the children often being left alone when the parents were in
the pub and the older children having to fulfil adult roles, such as minding and feeding their siblings.
The purchase of alcohol was also tolerated by the Home Management Staff when the mother was
brought shopping”. This paragraph gives an insight into of the plight of addicted people and the impact
their alcoholism and chemical dependency has on themselves and on their families, especially their
dependents.
This abysmal scenario is reported daily in our services, whether it is the parent who is the chemically
dependent person, this scenario or similar scenario is reported by all patients. This gives an insight into
the impact of addiction on a person’s life and on their families, and how degrading and dehumanising it
is.
(iii) Referrals to Tabor Lodge from Social Services
We would like to draw your attention to the referral sources to Tabor Lodge over the past 5 years, per
Table 2.
Table 2 – Referral Sources to Tabor Lodge
2006
75
71
27
18
16
SELF
FAMILY/FRIEND
COURT/PROBATION SERVICES
G.P.
OTHER TREATMENT CENTRE
4
2007
80
63
32
20
16
2008
87
47
32
25
18
2009
74
50
24
20
21
2010
96
47
11
21
17
5
4
9
4
SOCIAL SERVICES
HOSPITAL
EMPLOYER
COUNSELLOR
A & E LIASON WORKERS
OUTREACH WORKER
MENTAL HEALTH INCLUDNIG PSYHICATRIST
TOTAL
6
11
8
15
8
7
19
6
7
18
5
8
233
2
10
4
239
2
229
236
241
We would like to draw particular attention to the Social Services referrals over the last five years which
show that referrals in 2006 were 5, 2007 were 6 and then in 2008 and 2009 this number is considerably
higher and it could be that this is partly due to the Roscommon Case and also the very welcome
Children First guidelines operated by the HSE.
This highlights the importance of educating professionals in the field of child care to the dangers that
vulnerable children are being exposed to as a result of chemical dependency in the family.
In the cases referred to us by Social Services, the women were mothers whose parenting capacity was
severely compromised by their chemical dependency to alcohol. They had reached the point where the
State had to intervene out of a duty of care to the children and to make arrangements such as foster care,
to allow the opportunity for the mother to get help. In the majority of these cases the 28 day treatment
that we deliver is not enough for them to firmly establish their rehabilitation and they will need the
support of the services delivered at Renewal.
4. Funding
In addition to taking the opportunity to highlight to the Committee the primacy of alcohol as the drug of
choice, the other point we wish to make is that if we are going to have a comprehensive service then it is
going to have to be properly funded. We completely endorse Action 32 of the current National Drug
Interim Strategy 2009-2016. This Action aims to develop a comprehensive integrated national treatment
service using a 4 Tier model approach. We are a Tier 4 treatment agency and we are experiencing
extremely challenging funding issues where our funding streams are not secure and are in fact
deteriorating.
The former Minister with responsibility for the Drug Strategy, Mr John Curran, in the course of his time
in office, invited the HSE and the voluntary sector to sit down together to agree criteria by which Tier 4
residential treatment provided by the voluntary sector could be properly funded by the HSE.
In the course of their deliberations, they engaged a consultant, MTC, to review Tier 4 residential
rehabilitation services funded by the HSE to provide a report and make recommendations.
The report recommends that, where services are required within approved centres, funding should be
provided based on agreed outcomes at a level which would ensure that the organisation can remain
viable. Access and referral to residential services should be based upon best practice standards and
aftercare and relapse prevention should form an essential element of an individual’s treatment.
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The key recommendations from this report are that
- there needs to be one agency nominated to provide funding for residential treatment to agencies
who have reached mandatory standards of care and
- there are criteria agreed to assess the suitability of a person for residential treatment.
The CHKS accreditation awarded to Tabor Lodge confirms that we have reached mandatory standards
of care and the NDRIC is currently working on agreeing criteria to determine the suitability of a person
for residential treatment.
5. Recommendations
Based on our experience over many years in delivering addiction treatment services we would like to
make the following recommendations to the joint committee
1) Tackle Irelands National Alcohol problem. We believe that minimum pricing would not do this
but rather would increase the market share of the more established brands.
2) Cultivate nationally a more responsible relationship with alcohol, thereby supporting those
chemically dependent on alcohol in their efforts to establish a sober lifestyle. We were dismayed
with the profile of “the pint of Guinness” during the state visits of the Queen Elizabeth II and
President Obama and believe that this type of coverage is not conducive to a responsible national
relationship with alcohol.
3) We recommend that appropriate means to deal with the problem of alcohol are higher taxation
and controls on advertising.
4) Services such as ours who provide comprehensive treatment and rehabilitation to the chemically
dependent must be funded properly. They are not currently being funded properly as the funding
is not secure, it is not extensive enough and it is actually in decline. Over and above the
cutbacks that all caring services are enduring, we have recently learned that a crucial source of
funding for our service, which we have received for a long number of years from the HSE, is
potentially being withdrawn as a result of the transfer of Supplementary Welfare to the
Department of Social Protection.
5) Prioritise the implementation of Action 32 of the National Substance Misuse Strategy.
6) Implement the recommendations of the MTC review of HSE funded Tier 4 residential treatment
rehabilitation services.
7) Endorse Minister Shorthall’s ambition to progress beyond harm reduction strategies to
abstinences solutions.
6. Conclusion
To conclude, the main drug of choice in Ireland is alcohol. Addiction to alcohol has a devastating
impact on those involved and their family.
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The chemically dependent population should pursue an abstinence based solution in preference to a
harm reduction solution.
To achieve this comprehensive treatment and rehabilitation patient services must be securely established
by the state.
Tabor Lodge Addition & Housing Services Limited is a model of excellence in treatment provision.
We strongly endorse what Minister Roisinn Shorthall, Minister of State at the Dept of Health said in her
opening address to the NACD seminar “A Family Affair”, last Tuesday. Specifically, she said “I am
very focused on ensuring that there is an increased emphasis on moving people on from drug treatment
to a drug free lifestyle where that is achievable. It is my belief that there has been insufficient focus on
this ambitious goal in the past”
We very much welcome Ministers Shorthall’s statement and are also glad to greet this thinking as part
of our National Drugs Substance Misuse Strategy. We too agreed that there has been insufficient focus
on this ambitious goal in the past and that it should for the centre of our strategy going forward.
Thank you.
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