Commissioning A Crack Service Megan Jones Lambeth DAT Manager

Lambeth  South-west inner London Borough  Brixton, Clapham, Streatham  Population ~270,000  62% white  26% Black  5% Asian  5% mixed  3,000 – 5,000 problem drug users  ~2000 drug users in treatment per year

Key providers in DAT/Borough  NHS Trust (SLAM)  Prescribing service – specialist and GP shared care  Psychology services  CDP  Arrest referral  Assessment for access to structured drug treatment  Day care  Mainliners  Open access  Harm reduction

Commissioning Lambeth Harbour  Needs assessment 2002  Current services – specialist and general  Users  Criminal justice agencies  Lambeth DIP positive testers 2005/6:  Cocaine 51%  Cocaine & opiates 42%  Opiates 7%  2005/6 Treatment data (primary and secondary drug use)  58% report heroin use  50% report crack/cocaine use 93% }

Crack-specific Service?  Funding available  Lambeth:  93% problem drug users use crack  ~70% budget funds “opiate" services  Diversify existing services?  Develop crack expertise?

Lambeth Harbour Tier 2/3 stimulant service  Partnership approach  Staff seconded from all key providers  Development of specialist expertise  Opportunities for learning to be absorbed back into host agencies

Partnership Approach CDP as Lead Provider  Premises  Operational management  Staffing of direct access services  Key working within tiers 2 and 3 provision  Group work SLAM as key provider  Psychological treatments  Dual diagnosis  Clinical practice Mainliners  Recruit, train and support volunteers  Support all project activities

Service Specification  Strong management  The “hook”  Crisis intervention  Complementary therapies  Shower/laundry provision  Food  Assessment, referral and care planning  Psychological interventions  Motivational interviewing  CBT  Relapse prevention  Life skills  Housing

Considerations  Staffing capacity  Location  Opening hours  Physical space – day service  User involvement  Methamphetamine

Where are we now  Up to 93% PDUs use crack  Two year review  Staff capacity issues  Re-think volunteering  More in-reach into other services  User involvement  Crack Needs Assessment

Wish List  Loads more money!  Safe house  Dual diagnosis