Brand New Day

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Dr Ed Day has just been appointed as the government’s drug recovery champion. He talks to DDN about the challenges and opportunities of the new role.

Dr Ed Day Recovery Champion UK. DDN Profile
Read the full profile in DDN Magazine

‘If I was going to pick one thing, it’s still the stigma of drug use,’ says Dr Edward Day of the challenges that his new role as the government’s drug recovery champion will need to address (see news, page 4). ‘There’s a real job to do to break down the prejudice against people who’ve had a drug problem.’

A 20-year veteran of the field, Dr Ed Day started out at what was then the regional addiction unit in Birmingham while still a junior doctor training in psychiatry. ‘That really sparked my interest,’ he says.

‘It was a very different world back then – a 25-bed unit with an outpatient bit attached in the grounds of an old psychiatric hospital, and we had probably a couple of thousand patients who came from the whole of the West Midlands. You got a detox and relatively little else. But that patient group really spoke to me, and I decided that this was what I was going to do.’

After completing his PhD he became a consultant in an NHS drug service in Birmingham, and worked there until he started his current role as consultant psychiatrist at the Birmingham and Solihull Mental Health NHS Foundation Trust five years ago. He’s also clinical reader in addiction psychiatry at the University of Birmingham, and now drug recovery champion on top – isn’t that a lot to take on?

‘Well, I’ve always had a clinical/academic role, so I’ve always juggled those two things,’ says Dr Ed Day. ‘Half my week is spent doing hands-on clinical work and the research I do is all patient-centred, so the two feed off each other. It can be a challenge at times but the two sides of the job go hand in hand.’

He’s also been heavily involved in shaping national policy, including the NICE guidelines for methadone and serving on the two ‘orange book’ working groups, as well as a substantial amount of teaching and stints as a trustee of Action on Addiction and Changes UK.

'orange book’ on clinical drug guidence
Dr Ed Day served on the two ‘orange book’ working groups

While juggling all this can be difficult, it’s also advantageous, he says. ‘I’m quite often the only person in the room who can see both sides of the fence – academia and clinical services.’

‘Recovery is defined by the person –
I don’t think it’s my place to put a definition on it’

The word ‘recovery’ is something that people have argued over – how would he define it? ‘Recovery is defined by the person – I don’t think it’s my place to put a definition on it,’ he says. ‘But I’d go along with the various attempts that really focus on trying to achieve control over substance use, good mental and physical health and, for want of a better term, citizenship – something to get up for in the morning, friends, family, job.

‘I guess the contentious bit is whether the control over substance use means abstinence or not. If you want a straight answer then I do think the best outcomes I’ve seen are when people get abstinent, but to say recovery is only about abstinence is to dismiss all the other stages on the way to that, and I think that’s one of the difficulties.’

The field does seem to be less polarised, however, with some of those barriers breaking down. ‘Definitely, and I think perhaps the key task of this role is to try to move that forward. In those 20 years of my career, for the first ten years we went from a very low level of service – where people saw someone for maybe ten minutes every six months – to a lot of investment.

‘The professional services really developed, and there was a lot of very good evidence-based practice that went in. I think the British system stands up around the world as one of the most evidence-based.’

While recent years have meant less money, one positive has been the ‘shift in emphasis towards peer-led abstinence-based recovery’, he states, ‘which I think was an element missing in the system in those early years’.

He’s always held the view that ‘the professional part is the base that sorts out the basic needs, keeps people alive, links them into services’, but the real achievements come when people leave those professional services and become independent.

‘That’s where the peer-led recovery community comes in – the best system needs both of them talking together. They are two separate worlds, and they have to be, but we need to work together to get a recovery-orientated system where people can see the way out when they come in. That’s the key.’

In terms of people becoming independent, one part of the role is to support effective joint working between treatment, housing, criminal justice, local councils and other agencies. Has this been falling short? ‘I think it probably has – not through want of trying but it’s quite a difficult thing to do, and this role is very much set up to address that. I report to the home secretary’s drug strategy board which brings the ministers from the key agencies together, so I’ve got a platform to talk about what needs to be done to improve that.’

One early goal is to speak to as many people as possible and get a view of where this is working well. ‘Obviously you’ve got areas where it does and others where it doesn’t, for a variety of reasons, but I think if we can develop a series of models that work then different areas can choose from those. That’s perhaps a more effective way of doing it.’ One crucial element is the interface between substance treatment and mental health services, he says. ‘We definitely need a more joined-up approach there.’

‘There was a lot of energy five or six years ago,
so maybe it’s my job to go in and make some noise
and bring it up the agenda again’

When it comes to working closely with ministers, there’s a fair amount of political upheaval at the moment, to say the least. There’s going to be a new prime minister, possibly a general election, and there’s Brexit. How is all this going to affect the role? ‘Who knows? It’s all been so unpredictable, so I’ve had the same thoughts.

‘But in my early interface with the Home Office I’m quite impressed. There is a drug strategy, and it has some really good stuff in it – it’s still committed to evidence-based treatment and trying to integrate these different parts, and to helping people recover in their communities. I think all we can do is take that and keep plugging away.’

It could be that now is the time that this role is really needed, he says. ‘There wasn’t a voice in the government, and if there isn’t a voice then other issues will happily take over. There was a lot of energy five or six years ago, so maybe it’s my job to go in and make some noise and bring it up the agenda again.’

The service user voice is also something that hasn’t been heard enough, he believes. ‘I don’t think it ever is. One of the problems in our field is that if you say “service user”, it depends what you mean by the service. With users of professional services, particularly drug users, I think there’s always been a slight fear of, “if I speak out, I’ll lose the service”, which is a problem.

‘The abstinence-based recovery group is very articulate, and that voice definitely needs to be heard more, but we need both. The user voice needs to be there in policy, but it also needs to be there in treatment services. I do think service users need more say in what treatment they’re getting, and the types of treatments available to them.’

While stigma remains the ‘overarching’ challenge, there are clearly a host of others facing the sector, not least funding. ‘I think one of the worries is the public health grant and the potential loss of the ring-fenced money,’ he says.

‘A lot of money’s gone out of the sector in recent years and we have to make sure that doesn’t continue. Going hand in hand with that is the loss of skill and experience and I’d be quite keen to look at that. My particular area is psychological/ psychosocial treatments, and I think that’s the bit that’s suffered and needs a voice to articulate.’

Training pathways to becoming an addition specialist via medical schools are also under threat, which could mean ‘no one articulating that this is an issue and that we can help people move on’ he says. ‘That’s all part of that stigma question – if you aren’t taught about it as a doctor or nurse or in social worker training then you form certain views which perhaps aren’t the most helpful.

‘There’s a lot to do, but there’s also a lot of positive things going on. In some ways that’s the quick win – to put a bit of wind behind the sails of some of the really good projects, look at what we can learn and try to make sure that’s available across the country, rather than just in certain areas.’

So when it comes to the thorny issue of stigma, what’s the answer – is it simply about raising awareness and setting out to educate people like employers and housing providers? ‘Very much – that’s one part of it,’ he says.

‘I’m very impressed when you get people in recovery who can demonstrate that, despite those barriers, they’ve got to where they are. I never cease to be amazed by how often people in HR departments in big companies or wherever have never even considered that. They just automatically assume that if you’ve had a drug problem you must be bad.’

When instead they could be thinking, ‘this is exactly the sort of person we should be looking for – someone with that sort of determination and commitment’? ‘Precisely. You’ve been through this incredible struggle and you’ve come through the other side.

‘Going to AA or NA meetings and hearing
people talk, you can’t fail to be impressed
by the power of those stories’

You can appreciate what you’ve got in finding recovery, but also you’ve seen a lot of life and the difficulties people face. Going to AA or NA meetings and hearing people talk, you can’t fail to be impressed by the power of those stories. The trouble is they’re still too few and far between.

‘We need to get that message out there, because it does change people’s minds. Many of the people we’ve cast to one side would make fantastic employees and could achieve great things. We need to keep articulating that.’

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