Our 40-year losing struggle with drugs is the latest intractable problem to be addressed by a so-called ‘public health’ model. It’s an attractive prospect, a system with a medico-scientific cachet that has proven successful not only in public health but in other areas.
Our Violence Reduction Unit cited the model as the basis for its campaign to reduce violence in the west of Scotland, and London has borrowed the bones of the Glasgow model to address the bloody gang violence that plagues their vast urban sprawl – good luck with that one. And now the public health model is to be rolled out again as the main plank of our latest drug strategy. It seems like a shrewd move, for while our struggle with alcohol has moved in a positive direction, the same cannot be said for drugs. It’s not that we havent had decent drug strategies before – we have. The 2008 ‘Road to Recovery’ was well thought through, but like previous plans it eventually died of neglect.
The truth is that in Scotland we are pretty good at developing strategies but very poor at delivery. Time after time, new strategies are launched to a fanfare only to eventually wither for lack of funding or performance management, so that they join that great scrapyard of good ideas from which they are periodically resurrected, rebadged and relaunched only to follow the same trajectory.
So why should a public health model be different? I suppose the first thing to be said is that the recognition the misuse of drugs is a health not a justice issue is a success in itself and long overdue. The second is that we know that properly applied, the system works.
A public health model is an all-systems approach which emphasises the overall effect on the target audience, rather than focusing on individuals. Such plans always have three prongs: tackling the agent (drugs), the host (drug users) and, most significantly, the environment in which the first two operate. The evidence is clear – fail in one, fail in all. Hard-edged delivery is the key.
Drug addiction is often titled a disease of despair and it’s a fair description. Addiction is a chronic recurring beast with a long tail of complex needs, mental and physical ill health, unemployment, crime, homelessness, social isolation ... need I go on? It’s a tough nut to crack. It’s also a diverse and fast-moving foe with local differences. Many of our services are focussed on opiates while psycho-stimulants grow and morph under our feet.
In all this confusion, there is one indisputable fact: we are failing. The drug death total of 900 a year and rising is the hardest of statistics. This bleak body count cannot be denied and, for that reason alone, a new approach is welcome.
But to succeed a public health model must be adequately resourced. This is where it gets difficult. Mental health services are generally considered to be in crisis, homelessness is at an all-time high, the budgets of councils, responsible for social care, have been cut to the bone and drug partnerships have suffered double-digit funding reductions over the last few years.
Let’s be clear, a public health model will not succeed in this climate anymore than previous drug strategies did. But Scotland’s public health minister must know this and presumably has a plan for funding delivery. We have admired this problem too long, but if our new approach fails we cannot blame a well-proven system – only our own resolve.
Tom Wood is a writer and former Deputy Chief Constable