
Highly vulnerable people too often fall through cracks in healthcare provision which don’t address the full complexity of an individual’s overall health needs.
In October the Office for National Statistics published the latest statistics for drug-related deaths in 2019, showing – yet again – a record year in almost a decade of increasing deaths and an appalling picture of human loss and suffering.
People who have drug or alcohol problems face disproportionate health inequalities, frailty, and premature morbidity in general. Highly vulnerable people too often fall through cracks in healthcare provision which don’t address the full complexity of an individual’s overall health needs.
And when someone does die, are the systems of care around that person sufficiently able to review and learn from the circumstances around the death or give the necessary time and space for the people connected to the individuals – friends, family and workers – to process what has happened?
Looking beyond the statistics
This week we hosted our first ever online event to consider these issues with a range of speakers from the worlds of substance misuse, inclusion health and multiple disadvantage.
Data and context
Steve Taylor, Programme Manager at Public Health England – Alcohol, Drugs, Tobacco & Justice, gave an overview of the latest statistics on drug-related deaths and the wider context of vulnerability. Steve noted the strong correlation between drug-related deaths and areas of deprivation, but also that drug poisoning are just a subset of drug-related deaths – in 2017, 60% of drug-related deaths among opiate users in treatment were for reasons other than drug misuse poisoning. His presentation also noted that deaths of opiate and alcohol users in treatment during Covid-19 appear to have increased.
Other relevant resources
April Wareham, Director at Working with Everyone, spoke powerfully about the lived experience of people in marginalised communities who face stark health inequalities and underlined the importance of remembering that behind every statistic is a personal story. She advocated for a system that “sees people as whole people, and as part of communities… and lets them set their own priorities.”
Other relevant resources
- Working with Everyone – various reports
- Friends Families and Travellers – Reducing Health Inequalities for People Living with Frailty
Dee Menezes, Data Scientist at the UCL Insititute of Health Infomatics, presented from an Inclusion Health perspective, drawing on findings from her research into deaths among homeless people. Her research found a median age of death of 52 among homeless people, with 30% of deaths from conditions amenable to healthcare.
Other relevant resources
- Aldridge RW, Menezes D and others – Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England
- Michael Marmot – Inclusion health: addressing the causes of the causes
- The Health Foundation – Health Equity in England: The Marmot Review 10 Years On
System responses
Mike Ward, Senior Consultant at Alcohol Change UK, presented analysis of alcohol-related Safeguarding Adult Reviews as well as the various legal frameworks around alcohol use, mental capacity and care. Shockingly, analysis of SARs by Michael Preston-Shoot showed a quarter of Reviews had as their principal focus a person with alcohol-related concerns.
Other relevant resources
- Alcohol Change UK – Learning from tragedies: an analysis of alcohol-related Safeguarding Adult Reviews published in 20172017 SAR analysis
- Alcohol Concern and the AVA Stella Project – Domestic abuse and change resistant drinkers: preventing and reducing the harm
Finally, Steve Moffatt, Senior Policy Manager at the Make Every Adult Matter Coalition, presented MEAM’s forthcoming report on mortality and substance misuse, calling for local processes that are supplementary to Safeguarding Adult Reviews that improve system learning when someone dies.
Other relevant resources
- Make Every Adult Matter – forthcoming report on mortality and multiple disadvantage (to be added)
- Fulfilling Lives Newcastle and Gateshead – Understanding high mortality rates among people with multiple and complex needs: exploring underlying factors and opportunities for prevention in Newcastle and Gateshead
Resource bank
Improving our responses
- Collective Voice and NHS Substance Misuse Providers Alliance – Improving clinical responses to drug-related deaths: A summary of best practice and innovations from drug treatment providers
- Public Health England –Understanding and preventing drug-related deaths: The report of a national expert working group to investigate drug-related deaths in England
- Local Government Association – Preventing drug related deaths
System learning
- Drugscope – Drug-related deaths summit 2015
- Graham Parsons – Drug-related deaths: practical responses to a growing problem
- Office for National Statistics – Drug-related deaths “deep dive” into coroners’ records
- Fulfilling Lives – Understanding high mortality rates among people with multiple and complex needs: exploring underlying factors and opportunities for prevention in Newcastle and Gateshead
Impacts on families
- University of Bath, Centre for Death and Society – Understanding and responding to those bereaved through their family members’ substance misuse
- Peter Cartwright – Supporting People Bereaved through a Drug- or Alcohol-Related Death
- Lorna Templeton – Supporting adults bereaved through substance use with the 5-Step method: an exploratory study
Adfam and Cruse Bereavement Care – BEAD (Bereaved through Alcohol and Drugs) Project
We hope that this can be a developing resource bank for the field. If you have any suggestions for new resources or how we can improve this page then please get in touch with peter@collectivevoice.org.uk.
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