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Providing substance misuse support to LGB & T people

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?.

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Providing substance misuse support to LGB & T people

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  1. Providing substance misuse support to LGB & T people New trends, challenges and developing a strategic approach through commissioning Monty Moncrieff

  2. Overview • Recent trends • Meeting new needs • Club Drug Clinic – NHS partnership • Commissioning for LGB & T users

  3. Who are we? • London Friend – since 1972 • Antidote – since 2002 • Antidote @ Friend – since 2011 • Antidote funded via Big Lottery Fund 2011-15

  4. Recent trends

  5. 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

  6. More worrying trends

  7. 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

  8. 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

  9. Club Drug Clinic

  10. 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)

  11. 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

  12. 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)

  13. 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

  14. 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

  15. 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

  16. 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

  17. LGB & T Audit Tools

  18. 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

  19. 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?

  20. 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?

  21. 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 you’re meeting your Public Sector Equality Duty in regards to sexual orientation and gender reassignment?

  22. Invitation to Join • Commissioners • Providers • Carry out audits • Work to develop local action plans • Work cross-boundary in London • Share knowledge nationally

  23. Contact details • www.londonfriend.org.uk • www.londonfriend.org.uk/antidote • monty@londonfriend.org.uk • 020 7833 1674

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