Chamber and committees

It is fair to say that stigma about certain types of treatment exists in certain quarters. Some of the discourse that we read or hear about methadone, for example, is unhelpful. Time and time again, I have said that I am not interested in supporting harm reduction or medication-assisted treatment at the expense of residential rehab and abstinence. Neither am I interested in supporting abstinence over harm reduction. The only thing that I am interested in is supporting people, and they need to have informed choices and options.

There is a large international evidence base on different strands of medication-assisted treatment. However, medication should never be our only offer to people, hence the importance of implementing MAT standards that involve treating drug and alcohol issues on a par with other health conditions. If any of us sitting here were to trip up to our doctor with any other health condition, we would be given information and choices and we would have a bit of a discussion about what is best. The same ethos should apply here: people should always have choices, options and the space in which to engage and make informed choices about what is best for them.

I am not interested in false arguments around, for example, harm reduction versus abstinence. We have to dump our own ideological perspectives—my views on many things have changed over the years—and we must follow the evidence, but it is crucial that we listen to what each individual wants and needs.

The proposition could change depending on the feedback that we get from the Lord Advocate and the Crown Office in due course. Our work has centred on one service in one city, but there has been a broad range of work. The correspondence around that work is not all mine; the committee will appreciate that there is a central role for the independent Police Scotland and the integration joint board.

My approach in Government has been to facilitate and support that work, and to enable people to build from the ground up a proposition that is framed within the powers that we have. I will look at what it would be appropriate for me to share, because I appreciate the great interest in that aspect.

I also appreciate that there is strong parliamentary support for safe drug consumption facilities. Although I know that some Conservative members have reservations, I take them at their word that they are not looking to stand in the way of a pilot.

There is accountability at each and every level. I am stepping up accountability for local areas, but I stress that I am not asking other people to do anything that I am not prepared to do myself. Accountability and leadership are crucial not only at local level but at senior levels in IJBs, local authorities and Government. Accountability is needed at each and every level. We are accountable to ourselves and one another and we need to challenge ourselves and one another.

That is an important point and is reflected in our national drugs mission plan. You will see in our outcomes framework the importance of not only tackling poverty and inequality but focusing on equalities and different groups.

I have already spoken about women and young people. My concern is that we are not doing enough to reach into other communities. I am conscious that, sometimes, services can have stereotypes and misconceptions about other communities. I assure Mr Choudhury that my officials and I have begun to make better contacts with groups.

The visibility of the recovery community is a factor as well. That has encouraged other groups. I recently made contact with the lady from the Scottish women’s Muslim group, for example. I am conscious that, although drug and alcohol problems can be hidden across our society in general, they can be even more hidden in some communities. Some of that can be related to our false perceptions of other communities. We really need to think more sharply about how we reach out to other communities. If members, especially Mr Choudhury, wish to engage further on that, I would be delighted to do so.

I will give you one example. Yesterday, I was at a recovery-oriented systems of care event for women, where 200 women in Glasgow with lived and living experience were putting the world to rights and certainly holding my feet to the fire. It was a fabulous event with the Glasgow ADP lived and living experience reference group, which will also be one of the reference groups for the national collaborative.

I met a woman at the event who told me that, when she embarked on the early stages of her recovery journey, social work were involved with her and her children, and they were of the view that she could not take her child to a fellowship meeting—a recovery meeting. In my view, although I am not making judgments about such cases, that begs the question whether we understand enough about the recovery community and recovery opportunities. That meant that that lady was very constrained in the time that she could spend going to meetings and investing in herself and her recovery. Sometimes, quite simple things can be done in practice that involve taking a more personalised care approach by acknowledging the challenges that parents with caring responsibilities have.

Monday was a great day with the official opening of Harper house in Saltcoats. It has actually been open for a few weeks now, and the first families have begun to come in. It opened for referrals last month, and we are now beginning to see more referrals, with families entering the great facility. Harper house is a national specialist facility that is available to families from all over Scotland. It will be a leading therapeutic facility, and services across the country will be able to learn from it.

We are doing other work, such as our work with Aberlour. On child and mother houses, we are working with the River Garden Auchincruive in Ayrshire, which is increasing its facilities for women.

In relation to the whole-family approach, the families framework is a stream of work that is led by multidisciplinary experts in the area. They are, of course, working to support and share best practice, but they will also do an audit of how the framework is being implemented. Again, that is about gathering and publishing more information so that we can support, but also scrutinise, what is happening on the ground.

We have made a cross-Government commitment to keep the Promise, which is about keeping families together and preventing the unnecessary separation of children from their parents, because that is in everybody’s interest. Our work also speaks to the additional stigma that women and mothers experience if they have a problem with substances—I know that we will discuss stigma later today in the chamber. Many women fear coming forward to seek help so, as well as early intervention, cultural changes are needed to ensure that women feel safe in coming forward and can build trusted relationships.

That area has certainly not been forgotten. All the lived experience evidence tells us that, when we distil all this, what people need is a home, relationships and to feel valued and that they have a purpose in life. We can help with that by supporting people to take up volunteering opportunities or employment.

People have a basic, fundamental need for accommodation. I hope not to depersonalise the loss of life in any way by talking about statistics, but the information from the homelessness death statistics is crucial. Mr Briggs is absolutely correct to say that death rates among homeless people are too high and that more than half of those deaths are drug related—a very close association exists between homelessness and drug-related deaths. I am not one for overreading one set of statistics but, by way of information, I note that the number of drug-related deaths in that set of figures reduced from 151 to 127—in the homelessness death figures, there was a reduction in the number of drug-related fatalities. That figure is still too high, but the reduction points to some movement.

I am a big proponent of the housing first approach. Mr Briggs will be well aware of the Government’s ambitious record on building social housing. However, there cannot be housing without support, which is why Ms Robison and her team are taking forward the housing first approach—as well as other ones—to provide care for people as well as accommodation.

The Government and the residential rehabilitation development working group are very clear about what residential rehabilitation is and what it is not. The definition is very clear: residential rehabilitation is structured, residential and therapeutic programmes that support people towards an alcohol and drug-free lifestyle. There are other models of residential services, whether those focus on crisis care or stabilisation.

Those models are also important in ensuring that we have a wide spectrum of treatment opportunities and services to get the right people into the right treatment at the right time. I dispute the claim that we are investing in pretendy residential rehabilitation; that is unfair. What we are counting, if I can put it that way, and what we are funding is a traditional residential rehabilitation model that has been undervalued and underinvested in historically.

At the start of this week, I published—in part due to recommendations by the Auditor General—an annual report that details the spend and location of national mission moneys. I am determined to have as much transparency as possible about that.

I am determined to follow the money. I think that that is where I am on the same page as the Auditor General, because I want to ensure that the additional resource that the national mission has secured has the maximum effect. This Government has made a decision to allocate specific resources to residential rehabilitation and I want to ensure that that is used for pathways into residential rehabilitation, for residential rehabilitation beds and, of course, for the associated aftercare. I am accountable to Parliament and I want to satisfy myself that money is being spent on what it was destined for.

Yes, that is not a problem—we will have a look at that.