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

Standard 8 Independent Advocacy and Social Support

All people have access to independent advocacy and support for housing, welfare and income needs.

People have the right to ask for a worker who will support them with any help they need with housing, welfare or income. This worker will support people when using services, make sure they get what best suits them and that they are treated fairly.

Rationale

The single biggest structural driver of problematic drug use is poverty and deprivation. Problematic drug use is more prevalent among people from more deprived areas and from less advantaged backgrounds.

Studies have consistently shown a high prevalence of co-morbidity of mental disorders in people experiencing problematic drug use and a clear association with experiences of homelessness and the criminal justice system. People who use drugs are more likely to face poverty and deprivation. They are also more likely to face stigma in society and from the services they use as well as self-stigma (RRR, p13). As a result they may find it much harder to have their voice heard by others, to stay engaged with services, to exercise their rights, or to know where to turn to resolve issues. Giving this group the right of access to independent advocacy is an important tool to redress this power imbalance, challenge stigma and assist people who use drugs to have their views heard; and thus to participate more fully in processes that affect them.

The Scottish Independent Advocacy Alliance defines independent advocacy as follows: "independent advocacy is about speaking up for, and standing alongside individuals or groups, and not being influenced by the views of others. Fundamentally it is about everyone having the right to a voice: addressing barriers and imbalances of power, and ensuring that an individual's rights are recognised, respected and secured. Independent advocacy supports people to navigate systems and acts as a catalyst for change in a situation. Independent advocacy can have a preventative role and stop situations from escalating, and it can help individuals and groups being supported to develop the skills, confidence and understanding to advocate for themselves. Independent advocacy is especially important when individuals or groups are not heard, are vulnerable or are discriminated against. This can happen where support networks are limited or if there are barriers to communication. Independent advocacy also enables people to stay engaged with services that are struggling to meet their needs."

'Independence' means that an independent advocacy organisation does not provide any other service except independent advocacy. Independence is fundamental in building trust, particularly those who may have had ambivalent relationships with other services in the past.

The 'Housing First' model provides rapid housing that is not conditional on abstinence from drug use. A systematic review and meta-analysis of randomised controlled trials of the housing first approach conducted in 2019 showed improved housing stability and health, reductions in homelessness and use of non-routine health services, and no increases in problematic drug use.

Criteria

8.1 All people should be informed of independent advocacy services should they wish support in their journey through services. This should not just be raised once at the start of someone accessing services but should be offered as an option and discussed when relevant throughout.

8.2 People should have expert advice at any point of need throughout their treatment journey with regards to:

a) benefits and welfare advice;

b) housing.

8.3 People should be confident that the advocacy services have a good understanding of problematic drug use and recognised treatments.

8.4 Staff should raise the issue of independent advocacy with all people accessing services.

8.5 Staff should have clear pathways to support people with issues relating to benefit advice and with issues relating to welfare advice.

8.6 Staff should have training to understand the role of independent rights-based advocacy and have access to rights-based and health inequalities training.

8.7 Staff and management should connect with Collective Advocacy groups to ensure that the voices of people with lived and living experience are embedded in service change and development.

8.8 ADPs, planners and service managers should monitor referrals to independent advocacy e.g. require staff to record whether advocacy has been discussed with someone and if not why not.

8.9 Services should have established housing, welfare and independent advocacy referral pathways for all people.