Bean Counters and Harsh Winds
Monday/25/Aug 2008 Filed in:
Social and Economic
Issues
Today the
new Deputy Governor of the Bank of England, Charles Bean speaking
to a conference of bankers in Jackson Hole (I kid you not) brought
us some economic news that matched the bank holiday weather.
The slump (recession, credit crunch, economic implosion)
was going to drag on for some time. Maybe another year.
In the meantime he said:
"It's going to be a tricky period. Household real income is very low. That will make it difficult for households and there are difficult social issues that will arise,"
My bet would be that it'll be trickier for some households than others. While one is naturally sympathetic to anyone who loses out at times like these - well, almost anyone - its the people who are at the bottom of the economic pile who I've got the greatest concerns for. Inflation coupled with pay restraint and increasing unemployment tends to be much harder on people for whom a £5.00 increase in the weekly shop simply can't be managed. I have to resist the temptation to buck at an economic orthodoxy that tells us that pay restraint and unemployment are the defacto responses to the crisis of inflation or I'll start fondling my davy lamp again and thinking about Keynes ( a whippet I briefly owned in 1984) . I would however like to say it does seem a shame that for the likes of Charles Bean the social issues that arise appear to merit a brief sideways - and if regretful, then fleetingly regretful, glance.
Drugs in a Future Recession
About 18 months ago as part of the national consultation I delivered for DrugScope I facilitated a small group of drug experts looking at where drugs issues might move over the next 5 years or so. One of the issues we looked at was what would a recession mean for drugs in the UK.. Curiously while there has been a fair amount of research into the inter-relationship of problematic drug use and poverty, there has been little if any work undertaken on modelling the response of vulnerable communities, illicit drug markets and drug users to recession. (There was a great piece of work done by the Scottish Drugs Forum for the Scottish Association of Alcohol and Drug Action Teams last year that reviewed the literature around the links between poverty and drug. You can find it here. )
We looked at a few key questions. First of all, what impact does decreasing personal disposable income have on people's individual drug use? There was a broad consensus across the group that at times of economic strain people tended to shift away from stimulants towards depressants. One participant said he would expect people to use fewer drugs that you did things with and so that had additional assumed costs - so like taking coke and going out drinking, or popping an E and going clubbing and shifted to drugs that helped you do nothing - like cannabis and heroin. Much of the eighties heroin boom was stimulated by the influx onto the market of cheap smokable gear but it was fed by high levels of unemployment and poverty across the UK.
Another person also suggested that for people bang into the heavy end of cocaine or crack use methamphetamine may seem a better bet. This of course is dependant on supply - and if seizures are anything to go by, methamphetamine use in this country is still pretty rare. However, there have been some more significant finds lately I understand and also more reports of use outside the gay club scene.
When money gets tight in an already disadvantaged area, the grey economy often booms - with more people wanting to buy things for less. Alongside this increase in demand, petty acquisitive crime and low level fraud become more attractive propositions for people struggling to keep their heads above water. This might bring more people into DIP schemes -but increased engagement in borderline criminal activity may also increase people's vulnerability to developing problems with drugs. There's a debate about whether poverty leads to crime and drug use or crime leads to drug use and poverty. I think the relationships are complex and difficult to map with any certainty. What I do know is that living in poverty, engaged in crime or selling sex are anxiety provoking difficult ways to live. For some people taking drugs becomes a rational coping mechanism.
We know its the people at the margins of society - the unemployed, people in unstable housing, people who've grown up in local authority care etc who suffer disproportionately from problems related to substance use. This is not necessarily because people in these situations use more drugs, but because they lack the protective factors - like having a job, a decent home and a supportive family - that can help someone else keep experimentation with drug use under control and non problematic. At a time of economic downturn or recession, the margins of society get wider. More people lose their jobs, homes - under the strain families break up. Unemployment - pretty much certain to follow the current stagnation usually lags behind the first wave of a recession. Some commentators argue that we won't see the real increases in unemployment for another 12 - 18 months, but that when we do, they could be with us for another 5 years.
One of the conclusions we reached was that a recession would change patterns of drug use and drug markets. If the recession does bite then over the next year or two we're going to be seeing more communities and more individuals becoming vulnerable to developing problems related to substance use. The reductions we've seen in drug use may not be stable. Use of depressants might increase. More people currently using drugs by their own definition non problematically may start to experience greater difficulty. We could be seeing greater demand for treatment, for brief interventions and for social support. This is all without considering how our alcohol culture might shift and change during the years ahead. We need a plan to shore up our most vulnerable communities, and ensure support is available for individuals.
What Support - and for Whom?
Certainly we need to try to maintain the capacity of treatment services - but we may need to improve their penetration into our most deprived communities through easy access low threshold services - so we get people earlier in their drug using career. We need to develop better primary care services so that we can treat the majority of people in the community rather than using the expensive and unneccesary approach of pulling people in right up at the most specialist and most expensive tier of treatment. We also need to see greater targeted investment in communities - enabling them to put in place the types of measures that protect people from drug use. And here I am not talking about enforcement, but investment in social housing, intermediate labour market projects, training, community schools and family support. We know that there are things we can do to increase community and individual resilience to problematic drug use. Surely now would be a good time to put some of those things in place?
The new national drug strategy - and indeed the employment green paper - tell us some key things this government understands about poverty and drug use.
The danger as we face a recession that by all accounts is going to get worse before it gets better, is that if we don't spend on getting some of those protective factors in place for the most vulnerable individuals and communities, we're may see treatment services with diminishing pro rata budgets jammed to the rafters with increasing numbers of people whose problems have become intractable and desperate. Waiting times could increase and we could end up with a larger out of treatment population than we had in 1998. With unemployment growing and social housing under pressure drug users will be way down the list for mainstream support or jobs. And the problems will deepen.
Someone once asked me "if you could immunise people against drug use would you"? My answer to that is a pretty resounding no - insofar as we're talking about injecting them with some serum or other. But if I could immunise people against problematic drug use through tackling the roots causes of the problems - like economic disadvantage, health exclusion, poor family support and endemic generational low wage employment or unemployment (and I don't mean by just creating a 'dip lite' oriented to the job centre) would I? Too bloody right I would.
Of course DATs aren't allowed to spend the Pooled Treatment Budget on anything but treatment and there's not much inducement for local authorities to spend any of the Area Base Grants or mainstream monies on drug users or drugs projects, so in terms of getting extra local resources, most areas are probably a bit stuffed. However there are some opportunities to build in a bit of support for the most vulnerable communities. The Working Neighbourhoods Fund is a source of support to remove barriers to employment in some of the most disadvantaged areas - by working with the people responsible for it locally to target resources on areas most vulnerable to widespread problematic drug use, DATs might make some real headway . Mainstream programmes - like SureStart - could be encouraged to include people vulnerable to problems related to drug use - including people who are or who have been in treatment - with progress measured in terms of numbers not developing problems rather than our constant focus on only tackling people's social or "recovery capital" after they've become desperate enough to need treatment.
Where's the Money Coming From?
The government's plan to enable areas to spend on the social inclusion and anti poverty agenda through efficiencies elsewhere begins to look a little hollow given what's effectively a reinforced ringfence on the PTB (predicating it on the completion of NDTMS returns and the treatment plan for the first time last year), but maybe they could lead the way by enabling people to begin to deploy some of their other budgets more imaginatively - and with greater sensitivity to local need.
The administration of DIP - as I discovered during a number of consultation events last year - is cumbersome, expensive, ineffective and verging on the fetishistic in some places. Repeated Required Assessment, unneccesary and hugely expensive testing and obsessive data collection have not improved outcomes - but they have kept a lot of people busy. As Rod Morgan pointed out in his Kings College report last week, our efforts to formalise informal disposals almost always end with outcomes that have been both more expensive to reach and are less effective for the individual and society. While we know DIP can be effective, it has most impact on the small group of very prolific offenders rather than the wide group it currently somewhat inexpertly "grips". DIP was initially posited as a way of preventing crime, preventing reoffending. There is little or no evidence to suggest any substantial success on these terms. What DIP has instead become is an inflexible and in many cases inappropriately intensive offender management programme with costs that I'd lay money outstrip those of comparable properly targeted mainstream programmes. Disinvesting in DIP programmes wholesale is probably inadvisable for a number of reasons. But as contracts for DIP projects end, enabling local partnerships to tackle the issues that underlie crime and problematic drug use by shifting their resources and planning and establishing initiatives like intermediate labour market schemes, like P2W, like self management housing projects - and bringing in some of the best DIP practice around rent deposits and intensive family support could make a real difference.
However we do it, now surely is the time to address the problems that may be coming our way - with providers and workers playing a key role in identifying partnerships outside the drugs field and with the wider community to prevent the numbers experiencing real problems with drugs increasing by reinforcing the protective factors we know make such a difference. The recession may not happen. Unemployment may stabilise. Child poverty may after all decrease and we may all be able to go on as normal. But if the recession moves the way its predicted and drug use increases and changes as some have predicted, if we've done nothing to protect the most vulnerable communities, we'll be a long time trying to dig ourselves out of it. But we must have learned a lot from the last recession - there's a chance we can make a better go of it this time around.
I came into the drugs field in Liverpool in the 80's as a detached needle exchange outreach worker. I worked on three large North Liverpool Housing Estates. The links between poverty and drug use were undeniable. But it wasn't just financial poverty but poverty of expectation, experience, ambition, opportunity. At its peak on one particular estate prevalence estimates were suggesting that over 85% of the 18 - 25 year old age group were using gear. It was exceptional not to be on heroin. Much as I loved my work and felt privileged that people would let me in (usually only to be fair if I was carrying a nice big box of clean works and some condoms) I would not want to go back there and I wouldn't wish those problems on any community. Not even one of bankers.
"It's going to be a tricky period. Household real income is very low. That will make it difficult for households and there are difficult social issues that will arise,"
My bet would be that it'll be trickier for some households than others. While one is naturally sympathetic to anyone who loses out at times like these - well, almost anyone - its the people who are at the bottom of the economic pile who I've got the greatest concerns for. Inflation coupled with pay restraint and increasing unemployment tends to be much harder on people for whom a £5.00 increase in the weekly shop simply can't be managed. I have to resist the temptation to buck at an economic orthodoxy that tells us that pay restraint and unemployment are the defacto responses to the crisis of inflation or I'll start fondling my davy lamp again and thinking about Keynes ( a whippet I briefly owned in 1984) . I would however like to say it does seem a shame that for the likes of Charles Bean the social issues that arise appear to merit a brief sideways - and if regretful, then fleetingly regretful, glance.
Drugs in a Future Recession
About 18 months ago as part of the national consultation I delivered for DrugScope I facilitated a small group of drug experts looking at where drugs issues might move over the next 5 years or so. One of the issues we looked at was what would a recession mean for drugs in the UK.. Curiously while there has been a fair amount of research into the inter-relationship of problematic drug use and poverty, there has been little if any work undertaken on modelling the response of vulnerable communities, illicit drug markets and drug users to recession. (There was a great piece of work done by the Scottish Drugs Forum for the Scottish Association of Alcohol and Drug Action Teams last year that reviewed the literature around the links between poverty and drug. You can find it here. )
We looked at a few key questions. First of all, what impact does decreasing personal disposable income have on people's individual drug use? There was a broad consensus across the group that at times of economic strain people tended to shift away from stimulants towards depressants. One participant said he would expect people to use fewer drugs that you did things with and so that had additional assumed costs - so like taking coke and going out drinking, or popping an E and going clubbing and shifted to drugs that helped you do nothing - like cannabis and heroin. Much of the eighties heroin boom was stimulated by the influx onto the market of cheap smokable gear but it was fed by high levels of unemployment and poverty across the UK.
Another person also suggested that for people bang into the heavy end of cocaine or crack use methamphetamine may seem a better bet. This of course is dependant on supply - and if seizures are anything to go by, methamphetamine use in this country is still pretty rare. However, there have been some more significant finds lately I understand and also more reports of use outside the gay club scene.
When money gets tight in an already disadvantaged area, the grey economy often booms - with more people wanting to buy things for less. Alongside this increase in demand, petty acquisitive crime and low level fraud become more attractive propositions for people struggling to keep their heads above water. This might bring more people into DIP schemes -but increased engagement in borderline criminal activity may also increase people's vulnerability to developing problems with drugs. There's a debate about whether poverty leads to crime and drug use or crime leads to drug use and poverty. I think the relationships are complex and difficult to map with any certainty. What I do know is that living in poverty, engaged in crime or selling sex are anxiety provoking difficult ways to live. For some people taking drugs becomes a rational coping mechanism.
We know its the people at the margins of society - the unemployed, people in unstable housing, people who've grown up in local authority care etc who suffer disproportionately from problems related to substance use. This is not necessarily because people in these situations use more drugs, but because they lack the protective factors - like having a job, a decent home and a supportive family - that can help someone else keep experimentation with drug use under control and non problematic. At a time of economic downturn or recession, the margins of society get wider. More people lose their jobs, homes - under the strain families break up. Unemployment - pretty much certain to follow the current stagnation usually lags behind the first wave of a recession. Some commentators argue that we won't see the real increases in unemployment for another 12 - 18 months, but that when we do, they could be with us for another 5 years.
One of the conclusions we reached was that a recession would change patterns of drug use and drug markets. If the recession does bite then over the next year or two we're going to be seeing more communities and more individuals becoming vulnerable to developing problems related to substance use. The reductions we've seen in drug use may not be stable. Use of depressants might increase. More people currently using drugs by their own definition non problematically may start to experience greater difficulty. We could be seeing greater demand for treatment, for brief interventions and for social support. This is all without considering how our alcohol culture might shift and change during the years ahead. We need a plan to shore up our most vulnerable communities, and ensure support is available for individuals.
What Support - and for Whom?
Certainly we need to try to maintain the capacity of treatment services - but we may need to improve their penetration into our most deprived communities through easy access low threshold services - so we get people earlier in their drug using career. We need to develop better primary care services so that we can treat the majority of people in the community rather than using the expensive and unneccesary approach of pulling people in right up at the most specialist and most expensive tier of treatment. We also need to see greater targeted investment in communities - enabling them to put in place the types of measures that protect people from drug use. And here I am not talking about enforcement, but investment in social housing, intermediate labour market projects, training, community schools and family support. We know that there are things we can do to increase community and individual resilience to problematic drug use. Surely now would be a good time to put some of those things in place?
The new national drug strategy - and indeed the employment green paper - tell us some key things this government understands about poverty and drug use.
- That the relationship between poverty and drug use is complex, but that helping someone out of poverty saves money in terms of expenditure on drug treatment and crime and healthcare (you know I think it might just be something like "every £3.50 we spend on poverty helps us save ..... " ah no, we've been somewhere like this before haven't we?)
- That treatment on its own doesn't in fact "work" in terms of helping people out of poverty, but that its just the first step. And that poverty itself can undermine the gains and the stability that people get from treatment.
- That employment and housing and support for families and communities are all critical - but that they cost money and no one anywhere is putting their hands in their pockets to fund it. New initiatives will be funded by efficiencies elsewhere in the system.
The danger as we face a recession that by all accounts is going to get worse before it gets better, is that if we don't spend on getting some of those protective factors in place for the most vulnerable individuals and communities, we're may see treatment services with diminishing pro rata budgets jammed to the rafters with increasing numbers of people whose problems have become intractable and desperate. Waiting times could increase and we could end up with a larger out of treatment population than we had in 1998. With unemployment growing and social housing under pressure drug users will be way down the list for mainstream support or jobs. And the problems will deepen.
Someone once asked me "if you could immunise people against drug use would you"? My answer to that is a pretty resounding no - insofar as we're talking about injecting them with some serum or other. But if I could immunise people against problematic drug use through tackling the roots causes of the problems - like economic disadvantage, health exclusion, poor family support and endemic generational low wage employment or unemployment (and I don't mean by just creating a 'dip lite' oriented to the job centre) would I? Too bloody right I would.
Of course DATs aren't allowed to spend the Pooled Treatment Budget on anything but treatment and there's not much inducement for local authorities to spend any of the Area Base Grants or mainstream monies on drug users or drugs projects, so in terms of getting extra local resources, most areas are probably a bit stuffed. However there are some opportunities to build in a bit of support for the most vulnerable communities. The Working Neighbourhoods Fund is a source of support to remove barriers to employment in some of the most disadvantaged areas - by working with the people responsible for it locally to target resources on areas most vulnerable to widespread problematic drug use, DATs might make some real headway . Mainstream programmes - like SureStart - could be encouraged to include people vulnerable to problems related to drug use - including people who are or who have been in treatment - with progress measured in terms of numbers not developing problems rather than our constant focus on only tackling people's social or "recovery capital" after they've become desperate enough to need treatment.
Where's the Money Coming From?
The government's plan to enable areas to spend on the social inclusion and anti poverty agenda through efficiencies elsewhere begins to look a little hollow given what's effectively a reinforced ringfence on the PTB (predicating it on the completion of NDTMS returns and the treatment plan for the first time last year), but maybe they could lead the way by enabling people to begin to deploy some of their other budgets more imaginatively - and with greater sensitivity to local need.
The administration of DIP - as I discovered during a number of consultation events last year - is cumbersome, expensive, ineffective and verging on the fetishistic in some places. Repeated Required Assessment, unneccesary and hugely expensive testing and obsessive data collection have not improved outcomes - but they have kept a lot of people busy. As Rod Morgan pointed out in his Kings College report last week, our efforts to formalise informal disposals almost always end with outcomes that have been both more expensive to reach and are less effective for the individual and society. While we know DIP can be effective, it has most impact on the small group of very prolific offenders rather than the wide group it currently somewhat inexpertly "grips". DIP was initially posited as a way of preventing crime, preventing reoffending. There is little or no evidence to suggest any substantial success on these terms. What DIP has instead become is an inflexible and in many cases inappropriately intensive offender management programme with costs that I'd lay money outstrip those of comparable properly targeted mainstream programmes. Disinvesting in DIP programmes wholesale is probably inadvisable for a number of reasons. But as contracts for DIP projects end, enabling local partnerships to tackle the issues that underlie crime and problematic drug use by shifting their resources and planning and establishing initiatives like intermediate labour market schemes, like P2W, like self management housing projects - and bringing in some of the best DIP practice around rent deposits and intensive family support could make a real difference.
However we do it, now surely is the time to address the problems that may be coming our way - with providers and workers playing a key role in identifying partnerships outside the drugs field and with the wider community to prevent the numbers experiencing real problems with drugs increasing by reinforcing the protective factors we know make such a difference. The recession may not happen. Unemployment may stabilise. Child poverty may after all decrease and we may all be able to go on as normal. But if the recession moves the way its predicted and drug use increases and changes as some have predicted, if we've done nothing to protect the most vulnerable communities, we'll be a long time trying to dig ourselves out of it. But we must have learned a lot from the last recession - there's a chance we can make a better go of it this time around.
I came into the drugs field in Liverpool in the 80's as a detached needle exchange outreach worker. I worked on three large North Liverpool Housing Estates. The links between poverty and drug use were undeniable. But it wasn't just financial poverty but poverty of expectation, experience, ambition, opportunity. At its peak on one particular estate prevalence estimates were suggesting that over 85% of the 18 - 25 year old age group were using gear. It was exceptional not to be on heroin. Much as I loved my work and felt privileged that people would let me in (usually only to be fair if I was carrying a nice big box of clean works and some condoms) I would not want to go back there and I wouldn't wish those problems on any community. Not even one of bankers.