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 Friend – since 2011 Antidote funded via Big Lottery Fund

Recent trends Issue GHB/GBL3.2%27% Crystal meth0%39% Mephedrone0%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

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

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 youre 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

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