Medication Assisted Treatment (MAT) standards: access, choice, support

Standard 6 Psychological Support

The system that provides MAT is psychologically informed (tier 1); routinely delivers evidence-based low intensity psychosocial interventions (tier 2); and supports individuals to grow social networks.

This standard focuses on the key role that positive relationships and social connection have to play in people's recovery. Services recognise that for many people, substances have been used as a way to cope with difficult emotions and issues from the past. Services will aim to support people to develop positive relationships and new ways of coping as these are just as important as having the right medication.

Rationale

The Lead Psychologists in Addiction Services Scotland (LPASS) Report and the Orange Guidelines indicate that to be fully effective, substance use services, including MAT, need to be psychologically informed in everything they do. Also that high quality, evidence-based psychosocial interventions should be routinely offered by staff with the appropriate level of training, coaching and supervision.

Scottish guidance proposes that the foundation for all service delivery within a substance use service should be psychologically informed care (Tier 1). Psychologically informed care places an understanding of people's emotional and psychological needs at the heart of service delivery, and uses psychological principles and skills such as motivational interviewing to support people on their recovery journey (see LPASS report for further information on psychologically informed skills). All staff working across MAT services have a role in delivering psychologically informed care.

Structured psychosocial interventions (Tier 2) are used to support people's recovery from substance use, or mild to moderate co-morbid mental health problems, and are delivered by practitioners trained in specific evidence-base interventions. Structured psychosocial interventions can be woven into the fabric of MAT service delivery to support people's engagement and to increase the effectiveness of the treatment people receive (See LPASS report for definitions of tier 2 interventions and recommendations for delivery).

Criteria

Each service delivering MAT should:

6.1 have an explicit service plan in place for delivering psychologically-informed care and structured psychosocial interventions. Plans will include:

a) a baseline assessment of current service delivery from which to plan and build progress, and an in-built process for service evaluation and improvement;

b) an explicit workforce development policy that ensures all staff receive appropriate training to deliver psychologically-informed care and structured psychosocial interventions;

c) policies and procedures that support the translation of skills acquired through training into practice. These include:

• access for staff to regular coaching, reflective practice, and supervision to support the delivery of psychologically-informed care and structured psychosocial interventions;
• clearly defined roles for delivering structured psychosocial interventions within staff job plans, and protected time to do this;
• caseload sizes that allow staff to routinely deliver structured psychosocial interventions;
• identification and use of supportive tools, protocols, manuals and safety and stabilisation strategies to support staff in their delivery of psychological interventions;
  

6.2 establish a steering group to oversee the development and implementation of the above delivery plans. Steering groups will be led by addiction psychology and membership should include people with lived and living experience;

6.3 ensure the service culture and environment is psychologically-informed. This includes:

a) a culture that has compassion at its centre, where staff are encouraged to talk openly about how their work is making them feel, and where supporting staff wellbeing is a clear priority;

b) a clear understanding of people's emotional and psychological needs at the heart of all MAT recovery plans;

c) physical environments that are psychologically informed;

6.4 have a process in place to document experiences of people who engage with services. This would be evidenced through care planning that demonstrates the persons views have been sought, documented and acted on;

6.5 have clear pathways in place to ensure that people can access higher intensity Tier 3 & 4 psychological therapies if and when required (See LPASS Report for definitions of tier 3 & 4 interventions and recommendations for delivery).

6.6 support the development of social networks by:

a) actively promoting and linking people to services that place an emphasis on support from mutual aid and other recovery networks. There should be a clear and realistic recovery plan that outlines the network of support available to the person, including key people in their life;

b) providing support to build social capital through the promotion of connections with people in mutual aid or other pro-recovery networks;

c) providing social bonding and social bridging interventions, specifically designed to modify a person's social networks, including work with families or nominated persons.