Silkworth Lodge - Director

Scrutiny Review: Responding to Drug Use

Notes on Panel visit to Silkworth Lodge, 4th June 2004 Meeting with Ian Rodger, Programme Director, and Frank Laine, Trustee

In attendance: Constable M. de la Haye, Deputy G. Southern , Deputy M. Dubras, Mike Haden (Scrutiny Officer)

Silkworth has a capacity for 12 residents. It has taken approximately 40 residents through its programme since registered by the States in May 2003, of which 80% have remained clean and sober to date.

In the view of the Ian Rodger, Programme Director, all the necessary services for addicts exist in Jersey but there is a lack of co-ordination and a lack of understanding of what is being done by different agencies. In his view, neither GPs or Alcohol and Drugs Service (ADS) are sufficiently proactive in directing addicts towards the right forms of treatment -

• In 2003 a seminar was organised in the Island by the Jersey Addiction Group, aimed to assist GPs to help substance misusers more effectively in their surgeries and to develop awareness of the availability of JAG's treatment programme. Only 18 GPs signed up for the occasion and of them only 8 turned up on the day. Recent media reports have highlighted the small amount of time given over to drug awareness during medical training programmes.
• The Drug Dependency Advisory Group offers fine words but not enough effective intervention.
• 600+ clients go through Gloucester Lodge every year and are offered harm reduction and detoxification programmes but the rehabilitation/abstinence programme offered at Silkworth does not appear to be offered as an option, despite ADS paying lip service to co-operation and collaboration between agencies and professional groups' (quoted from Annual report 2002). In practice, there appears to be a fear of competition.
• For many ADS clients, harm reduction may be the appropriate approach; many have no immediate intention of ceasing their drug habit and have not reached a crisis point in their lives. They may well move forward into problem-free lives. For some, however, an alternative therapeutic approach should be offered to seize the window of opportunity' when addicts seek abstinence and recognize a need to change. This generally needs a rapid response - a long waiting period for detox is likely to lead to a wasted opportunity, sometimes with fatal consequences.
• It is not enough to deal with the physical effects of addiction through detox without addressing associated issues and having in place effective resources for after care and support. Otherwise the result is likely to be a merry-go-round' of repeated detoxes and relapses.

To address these problems, Ian has developed, in collaboration with Ian Dyer, Manager of Adult Mental Health, a draft proposal for a Substance Misuse Service Specification (included with his written submission in the Evidence File), setting out an integrated care pathway to deal with all forms of addiction. Addiction must be recognised as a multi-faceted problem, affecting personal health, family relationships, work etc.

Silkworth Lodge can offer assessment and consultation within 24 hours to substance misusers. Sometimes addicts themselves refuse to recognise the depth of their problems but they may be brought along concerned family members, friends or referred by GPs. Motivational and Cognitive Behaviour therapies along with 12 step recovery principles are a part of the eclectic programme of treatment delivered at Silkworth Lodge.

Detox is a requirement for admission to Silkworth. A simple detox may be sufficient to get an addict into the therapy programme and co-operation has now been established with Pat Devine at ADS for this to be undertaken on the premises on the same basis as home detoxes. Silkworth Lodge has recently offered a home detox' for appropriate residents who access their service with the agreement and support of clients' GPs and Silkworth's retained medical officer. The legality of doing this is currently being investigated by the registering authority. Although Ian has offered his services to ADS to conduct the detox programme himself this has not been taken up.

Silkworth is a charitable service. Treatment costs £600 per week, a fraction of the cost of treatment at similar facilities in the United Kingdom and cheaper than the costs of keeping an inmate at La Moye (£900 per week). Silkworth receives some funding from the States in the sum of £30,000 for 2003 and £15,000 in 2004. the latter sum is enough to treat three clients. In addition, through the efforts of Anton Skinner, in his role as Acting Chief Executive Health and Social Services, a grant of £90,000 has been received from the Confiscated Assets Fund for rehabilitation treatment of drug addicts for 2004, which is not being used exclusively for accessing clients to Silkworth Lodge, but if it was would support a further 18 clients. This funding allows the JAG to subsidise costs of treatment for those unable to afford the full amount. Clients who access this subsidy have to be assessed and funding approved by ADS.

Ian also welcomed the scrutiny process as an opportunity to seek wider political awareness and support for Silkworth Lodge's treatment and rehabilitation programme.