Britain's last remaining residential detox unit blames dwindling referrals on council spending squeeze
The UK's only remaining residential detox and rehabilitation unit for young people with serious alcohol and drug problems is facing closure this week amid concerns that local councils are withholding referrals because of cost.
Middlegate — a specialist service based in Lincolnshire that caters for 12- to 17-year-olds in need of intensive detox and rehabilitation, often because other forms of treatment for substance misuse have failed — could close within days, its management claims.
The unit's five beds cost £3,600 each per week for a 12-week residential programme. Youngsters, mainly aged between 15 and 17, are referred by a range of agencies including local council children's services departments across the UK. Middlegate's owners and staff claim the unit could shut its doors in a matter of days because of mounting financial constraints on local authorities, with commissioners increasingly reluctant to pay the service's high fees. Chris Robertson, Middlegate's chairman, said he is worried that "belt-tightening" by commissioners means young people who might otherwise have been offered residential care are not being given it as an option.
Middlegate's closure would come at a time when, according to recent figures released by the National Treatment Agency (NTA), the NHS body responsible for overseeing treatment for drug misuse in England, there has been a sharp rise in the number of young people seeking help with a drug problem. The number of 12- to 24-year olds seeing drug and alcohol counsellors in England has gone up by 12% to just over 52,000 in the past two years.
The NTA data shows a decline in the number of young people using heroin and crack but a marked shift toward the use of others including ecstasy and cocaine powder. Drug use in combination with alcohol is also an increasing problem.
Robertson says the wider availability of community-based services for young people is to be welcomed, but warns that the future of access to residential treatment for those with more complex substance-use problems is in jeopardy. "This is the only under-18s residential centre left in Britain that does this kind of intensive work for both drugs and alcohol," he said. "The situation has never been as serious. We are surviving week by week."
Referrals have been dropping off for around 18 months, Robertson said. For a 10-day period earlier this month none of Middlegate's beds were occupied.
"We are hanging by a thread," he said. "We are here for those young people for whom removal from their communities, away from the dealers etc, is necessary. There is currently one resident. I just cannot believe that there are suddenly no children in the whole of Britain who need this kind of help. I can only conclude that it is because commissioners are worried about money."
Campaigners have been offering support to Middlegate, stressing its role within the context of wider service provision. Martin Barnes, chief executive of the charity DrugScope, said there had been "significant improvements" in the quality and availability of young people's substance-misuse services but that provision in some areas is still "far from" adequate.
"As yet, we still do not have a full picture of the extent to which the provision of services reflects the needs of young people," he said. "While only a small minority of young people with substance-misuse problems will require access to residential rehabilitation services, it is important that a full range of interventions and support are available.
"An issue for specialist residential services is that referrals and funding will often have to cross local authority and commissioning boundaries.
He added: "While we should be cautious about applying the experience of adult residential rehab providers to young people's services, time and again our members tell us that the problem is one of funding and commissioning rather than a lack of demand. To suggest that cost is not a factor in the provision and availability of young people's substance misuse services, including residential rehab, would be extremely naive."
The drug and alcohol charity Addaction said: "For some young people, residentials may well be the better option — some families are extremely chaotic, unhappy and damaging environments. So, in some extreme cases; removing them from the family home would be the right thing to do."
He added that services at the more costly end of the treatment spectrum will come under growing pressure as budgets are squeezed to "prove effectiveness watertightly".
The NTA said Middlegate may have run into problems as a result of substance misuse services for young people "being dramatically transformed" over the past few years.
"Middlegate has done some good work down the years but since Every Child Matters [the government programme to join up children's services] services for children have changed," it said. "It has become a more holistic approach based on dealing with the complex needs they might have, not just their substance misuse" "A residential unit that deals only with one aspect of a child's life may not be seen by commissioners as the best option when others are now available."
guardian.co.uk, Monday 15 June 2009 08.44 BST
Source - http://www.guardian.co.uk/society/2009/jun/15/health-drugs