Using human rights and advocacy to promote quality of life in dual diagnosis populations.

Reach Advocacy Scotland is to our knowledge the only dedicated addiction and dual diagnosis (addiction & mental health illness) advocacy service in Scotland. We came in to existence a few years ago as the Lanarkshire Recovery Consortium (LaRC) on the back end of the Hope and Recovery Conference held in October 2009.

Reach is the Advocacy based project where we deliver our SQA developed award in Advocacy Practice and deliver an advocacy service to people with addiction and comorbid mental health problems.

The inspiration for developing the award, the service and obtaining SQA Accredited Training Centre arose from our collective experiences of living with substance use disorders and mental health illness or both.

You may be asking yourself why we are appearing in the CYJC blog section. A good question; during our deliberations on recovery there was a recognition many of the recovery and health issues had root in childhood and adolescent experiences.

When we look at some of the narratives, news stories and journal articles on the transition from youth to adulthood we see the legacy effects in adulthood from adverse childhood experiences. Of the many people we meet, a high percentage report difficult times in childhood and the impact this has had across their lifespan. This is no more apparent than in the adult prison system and in HMP Barlinnie where we are putting the guys in the recovery group through the Advocacy Practice award.

The recently published blog by Nina Vaswani entitled An ACE up your sleeve? about the work being carried out in HMP Polmont highlighted similar issues. These issues were highlighted in the Telegraph article Care system ‘failing the most vulnerable and damaged children’ by Wesley Johnson, citing Juliet Lyon, director of the Prison Reform Trust: “Too often the state proves to be a poor parent as the tiny minority of children in care become the substantial number behind bars.”

When we examined our collective experiences of recovery and plotted what activities helped and supported this process, early recovery for some meant coming to terms with historical issues through a therapeutic process, for others this process was nurtured in fellowships such as Alcoholics Anonymous and Narcotics Anonymous.

Maintaining recovery required participation in meaningful social activities, with education being high on the list of good stuff. For some of us it was the first time we were involved in structured and accredited education offering a gateway to new life opportunities. What we needed now was a framework to guide our activities.

A New Approach

We had long considered the role of human rights and the right to health, but we had never thought what this meant when applied to addictions and co-occurring mental illness. A quick re-read of the preamble of the Universal Declaration on Human Rights (1948) gave us the inspiration and hope that we were on the right path.

This helped us to see it was possible to work with a person across a range of behavioural and developmental issues, without having to engage a silo based system. Having to deal with multiple agencies was endemic of our collective recovery experiences. Making your way through these was likened to navigating a ‘jungle of public institutions’ by Professor James Mitchell in his Orphan Problem blog, on the challenges facing us as an organisation.

The adoption of the human rights led to the inclusion of the World Health Organisation’s (WHO) definition of Quality of Life (QoL). This provided us with a working model that was aspirational and measurable, meaning we could quantify and evidence the efficacy of advocacy and education.

We were surprised to hear from the WHO that they do not have QoL data for dual diagnosed populations. This makes our endeavours rather unique, and as people who fall under this rubric it was very exciting to be amongst the first to consider quality of life for people with dual diagnosis.

We use the survey in our work with clients in the advocacy relationship and with people in recovery undertaking the SQA Accredited Advocacy Practice Award. This allows to build on the QoL research on the benefits of participating in education and meaningful activities.

We are working with Dr Iain McPhee at the University of West of Scotland who has been incredibly supportive in aiding us to further our approach. This has led to the development of an ethics proposal developed with Dr McPhee to explore the advocacy education programme on promoting the right to health and improving quality of life in dual diagnosed populations in Lanarkshire and Glasgow

Adopting this approach of right to health and quality of life, we find ourselves in a unique position particularly in the field of addictions and by doing so we revitalise the commitments set out in the preamble of the Universal Declaration on Human Rights.

We would like to thank the Centre for this opportunity and look forward to developing a positive working partnership.