Renfrewshire Council

Renfrewshire is similar to many other areas in Scotland and the UK in that it has continued to experience a range of issues across communities in relation to alcohol and drugs. Local partners have been very concerned about the levels of harm being experienced by local people and established an independent Commission in order to assess the true impact of alcohol and drugs in Renfrewshire.

Many leading experts at a local and national level agreed to join the Renfrewshire Alcohol and Drugs Commission as it was different to others - it focused on both drugs and alcohol and represented a significant opportunity for all partners to come together to support real change across communities.

In Renfrewshire, local drug and alcohol services had recently been subject to an independent review and there was clear direction of travel to move to a new service model which better supported recovery.

This however is only one piece of the jigsaw, and the Commission undertook an extensive programme of engagement and evidence gathering to ensure that the impact of alcohol and drug use was considered as broadly as possible, rather than focusing solely on services which support treatment. It is important to stress that this was a Listening Commission where lived and living experience and the views of families and frontline staff were fundamental to the approach taken.

The Commission's findings are:

High levels of harm exist in Renfrewshire

Levels of harm in relation to alcohol and drug use are increasing and the nature of this harm is changing. The availability of drugs in particular is changing and street drugs like Etizolam have significantly increased risk of harm and the number of drug related deaths. People told us that it had never been as easy or as cheap to access these types of drugs. The profile of people using drugs has also changed with people tending to consume a range of different drugs, as well as increasing numbers of people using drugs over many years and consequently suffering very serious ongoing health conditions.

Research and engagement indicated high levels of hidden harm in Renfrewshire with many people reporting significant levels of consumption of alcohol and drugs. This is something that partners need to get a handle on quickly, to better understand how to support people, many of whom will never come into contact with a formal alcohol or drug service.

The country's relationship with alcohol is not a positive one, and the Commission explored the link between availability and promotion of alcohol in Renfrewshire and the strong link that this has to the very high levels of alcohol related harm in Renfrewshire. However, data on alcohol related harm was limited and needs to improve.

Supporting people with complex needs

Alcohol and drug services are moving towards a recovery orientated model of care, but this needs to move faster and should involve people with lived experience and their families.

Frontline staff across a range of different services were committed to the people that they were supporting, and we saw examples of positive practice and relationships, particularly in relation to young people with complex needs. Staff were positive about moving towards a recovery orientated model and saw the benefits of moving to a more holistic model of care and support with all partners and working together in a trauma-informed way.

The reach of alcohol and drugs services locally is potentially lower than it is in other areas - meaning that people who need support are not always in contact with a formal services or through other community and voluntary sector organisations. Support needs to be available to support the full range or continuum of needs that people have - through engagement we heard of specific gaps in terms of the availability 24/7 crisis service and rehabilitation services.

Through the engagement undertaken, the Commission came to the view that building based services were not fit for purpose. The location and physical structure of these buildings did not always provide a safe, welcoming or trauma informed environment for either staff or service users. Service users and families also had to go to multiple buildings to get support with different issues.

Support for mental health issues is perceived as being difficult to access or not there at all

One of the clear findings of the Commission, is that there was a significant disconnect between people using services and services themselves on the support that was available in Renfrewshire in terms of mental health. People who used alcohol and drugs services told us they didn't know where to turn to get the help they needed to deal with the trauma they were trying to deal with and felt they waited long times to see mental health professionals. We heard that people often just wanted to speak to someone who knew what they were experiencing and needed a positive peer relationship to support their recovery. Services felt that a comprehensive range of services and supports were in place and were keen to understand why this disconnect had developed.

Commission members were particularly concerned about the impact of poor mental health on young people. Whilst high quality services like the RADAR service for young people with issues relating to alcohol and drug use, it was clear that mental health services for young people need to be made available to support people with all different levels of needs. There was evidence of counselling and peer support in schools, but it was clear that a whole systems approach is required to ensure that young people do not fall through the cracks and experience poor outcomes.

Impact on families

The impact that alcohol and drugs have on families and relationships is stark. This is true at all stages of life, from children and young people affected by parental drug or alcohol use, to siblings and elderly parents trying to support adult relatives with their drug or alcohol use. The Commission heard evidence about the stressful situations that families found themselves in, often feeling like they had nowhere to turn. This included situations where families felt there was a risk to a person's life.

Alcohol and drug use is a significant factor in many children in Renfrewshire requiring care and protection. The trauma that children, young people and wider families experience as a result is life changing - this is reflected strongly in findings of The Promise national care review and there was significant evidence of this in Renfrewshire.

Alcohol and drugs surround people whether they want them to or not

The impact of alcohol and drug use on young people was a particular focus of the Commission's work and engagement programme. Young people made a short film about their experiences, and about how easy it was to get access to alcohol and drugs and the negative impact it had on themselves, their families, friends and communities.

For young people experiencing more complex needs, it was disturbing to hear that most young people felt that nothing could have prevented their drug or alcohol use, and that they were always destined to be this way. The value and strength of their relationships with support workers however shone through and there was real hope for the future.

Over and above the impact on young people, it was clear that the availability and presence of drugs and alcohol was an issue for people across all age groups.

There is strength in local communities to support recovery 

Lived experience can be the bridge between services and supporting people with their recovery. The recovery community in Renfrewshire has been gaining momentum with groups like the Sunshine Recovery Café building many positive relationships and opportunities to support recovery at a community level.

The Commission heard about the importance of social relationships and social connection to support recovery. It was clear that there needed to be more opportunities for social connection in Renfrewshire, and that there was as significant opportunity for all partners to value lived experience more fully through the development of peer support models.

Recovery needs to be supported by all partners in Renfrewshire - from the recruitment of staff with lived experience, to tackling stigma and language around alcohol and drug use, to the training staff about trauma and the way in which services are delivered.

It was clear all partners in Renfrewshire were ambitious for its people and its place, and that frontline staff were committed and focused on building positive relationships with people using services and their families. The Commission found a positive basis on which to improve outcomes in Renfrewshire. Whilst COVID has created many new challenges, there remains a strong commitment to working together to support people impacted by alcohol and drug use.

Commission's recommendations for change are set out in section nine of this report and include priority actions on:

• urgently addressing issues in relation to mental health service provision, including provision for young people
• considering trauma as part of everything that partners do in Renfrewshire - this is fundamental to reducing or preventing problems with alcohol and drug use and supporting recovery
• introducing a whole system approach to supporting people with their alcohol and drug use
• increasing the reach and capacity across the whole system of support for people using alcohol and drugs 
• making urgent changes to the buildings from which services are provided
• reviewing the support that is available to families impacted by drug and alcohol use - at all stages of life
• partners providing leadership around alcohol supply, promotion and availability
• valuing lived experience as part of the approach to recover in Renfrewshire - developing meaningful relationships with recovery organisations and building strong partnership peer support models
• tackling stigma around alcohol and drug use and supporting opportunities for social connection across Renfrewshire to support recovery.