Aberdeenshire Alcohol and Drugs Partnership
Mini Public Report
Aberdeenshire Community Learning and Development
(CLD) Service
18th and 25th January 2020
Community Learning and Development Changing Lives Strengthening Communities
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Contents
Subject Page
Introduction 3
Key Findings 4
Participants 6
Delivery Process 7
Key Input 1 - The Human Rights Approach 8
Key Input 2 - Creating the conditions for Radical Kindness 11
Key Input 3 - The Draft Strategy 14
Deliberation Question 1 - Prevention and Support 17
Deliberation Question 2 - Individuals, communities and 20 services
Participant Evaluation 23
Carnegie Trust UK blog. 24
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Introduction
Background to the Engagement The Aberdeenshire Alcohol and Drugs Partnership have been developing a new strategy. The final draft has evolved from a wide range of community conversations alongside feedback from local forums and an online survey. The draft strategy frames a new approach which is built around the concepts of human rights and radical kindness. This is consistent with the new national strategy which is called ‘Rights, Respect and Recovery - Scotland’s strategy to improve health by preventing and reducing alcohol and drug use, harm and related deaths’. Governance for the plan sits with the ADP Partnership which reports to the Integrated Joint Board (IJB). The IJB agreed that the final draft would go out for further consultation with the key aspect being the delivery of a mini-public
Why the mini-public approach?
The CLD service in Aberdeenshire has been piloting the use of mini publics since 2017. Staff have been trained in Dialogue and Deliberation methodology which underpins this approach.
The mini-public concept is built on a belief in the ability of ordinary citizens to consider complex issues and make decisions based on an evaluation of the evidence. This is like the methodology of the jury system where randomly selected citizens listen to evidence, sometimes from experts, draw all the information together and then as a group discuss the findings and deliberate to make their considered judgment.
In small mini publics participants cannot be statistically representative of the wider population – but they are still demographically diverse enough to the extent that a wide range of demographic factors from the wider population are represented.
One early judgment-call in this process was whether to recruit directly from lived experience groups and services to ensure people directly affected by the issue were involved. The decision not to do this, but to select as randomly as possible from the general population in the belief that this would still reach people with lived experience was validated. It was clear that participants brought a range of relevant experiences with them and that there were many experience informed perspectives shared.
An incentive payment was offered to remove any barriers that people may have had to participating. Evidence from previous experience in Aberdeenshire has shown this was significant for a third of participants, particularly those who do not normally take part in consultations. In this process half of those participating agreed that the incentive had been a significant factor in their decision to participate.
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Summary of Findings 1. The draft ADP Strategy is underpinned by values including kindness and human rights. People were particularly struck by the rights-based approach and endorsed this – although they felt there was still a job to be done in making citizens aware of their rights and to ensure agencies and services recognised their obligations as right bearers.
2. This is one of the many aspects of cultural change that the strategy is driving towards. People want to see support for those with problematic drug or alcohol use as easy to access as smoking cessation is.
3. Education was identified as being of critical importance – particularly in developing sessions that involve both parents and children/young people.
4. Prevention is clearly the longer-term objective, but if people require support with alcohol or drugs it is important that they can access it easily and that once they do, they are signposted to all relevant services.
5. The concept of kindness was easily understood, and people could see how that could improve wellbeing and prevent problems developing and ensure that people who do need support can access services.
6. There was also a recognition that practicing kindness could also make individuals or services feel vulnerable. On an individual basis there is a fear that it may be misinterpreted, or the person being kind may be seen to have an ulterior motive.
7. In services, there needs to be an acceptance of the role of kindness as the building block - how people are engaged with is seen as being more important than meeting numerical targets as it improves the quality of the interaction.
8. The concept of radical kindness was harder for people to understand or even get a clear definition of - this is something that needs to be made clearer in the strategy.
9. The broad understanding that began to develop on day two was that radical kindness goes beyond doing what is in your own self-interest and in the context of agencies and services is about not giving up on people , even when they appear not to be responding positively.
10. The discussion around recovery which came up in day one resonated with many people who saw the importance of compassion. How services or support are delivered is crucial and impacts greatly on feelings of self-worth.
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11. There is recognition that this is a whole community issue which affects all of us. Small acts of kindness which make people feel connected to and part of their community are on their own insignificant but if multiplied can have more impact
12. People with lived experience are particularly well placed to help in shaping how services are delivered and what works best for people at different stages of their recovery.
13. If funding is restricted, then we need to look at different ways to draw down or generate local funding to make things happen. Local recovery groups are good examples of services which don’t cost that much to run but which make a big difference.
14. Community and connections are important. People need safe and welcoming spaces where they can take part in activities and access services. Community can also be created online – virtual support should also be part of the solution.
15. Volunteering is another way to widen the range of services and to get people more connected in their communities. This should also include the criminal justice system where payback in the community should be part of an individual’s reintegration through contributing to their community.
16. There is an understanding that resources are limited but also a recognition that at times people need access to support outside of office hours. Squaring this circle to provide 24/7 online support is a challenge but people felt that more volunteers could be recruited to support this.
17. Existing telephone helplines and services may just require some more awareness about alcohol and drugs and the kindness agenda to fill this gap in a sustainable way.
18. If kindness and human rights are what underpin the strategy, then these must also be included in the monitoring of the strategy and the performance of key partners and services.
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Who was involved? How we recruited the panel?
CLD commissioned IBP to carry out the recruitment from 6th January 2020.The aim was to recruit 24 participants (4 from each administrative area in Aberdeenshire), none of whom should have previously taken part in a mini public or citizen jury.
The methodology agreed with IBP was that recruitment would be conducted primarily on a household and / or in-street basis.
Table 1: Participants by recruitment and attendance
24 participants were recruited (12 women and 12 men). There were four males who did not take part in session one (in brackets) and they were therefore automatically unable to take part in session two. It is positive that there was a higher than expected retention of participants in session two with only one person dropping out because of a family illness.
The main concern is the under-representation of the 18-25 demographic – of the three people recruited only one took any part in the process.
Session One Session Two Age Range Female Male Total Female Male Total 18-25 1 0 (2) 1 0 (1) 0 (2) 0 25-44 5 1 (1) 6 5 1 (1) 6 45-64 5 3 (1) 8 5 3 (1) 8 65 + 1 4 5 1 4 5 Total 12 8 20 11 8 19
Table 2 Participants by location
Administrative Area Actual Participants Home Location
Banff and Buchan Macduff (3), Fraserburgh
Buchan Peterhead (2), Stuartfield, New Pitsligo
Formartine Newburgh, Ellon,
Garioch Inverurie, Kintore,
Marr Torphins (2), Huntly, Insch,
Stonehaven (2), Portlethen (1) Cove Bay *(1) Kincardine and Mearns *Aberdeen City location – person was recruited in Portlethen
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Delivery of the mini public
The aim of the mini public is to create a welcoming space where people get the opportunity to hear from subject experts and are then given enough time talk about and understand the issue – this is known as the dialogue phase.
Time is spent making introductions and agreeing the ground rules for the process and in line with the theme one of these was ‘Be kind to each other and respect different opinions.’
On the first day of the mini public we had expert input from
Michaela Jones, National Lived Experience Development Officer for the Scottish Recovery Consortium who led an input on the Human Rights approach
Ben Thurman from Carnegie Trust UK who spoke about the work they have been doing nationally in relation to Kindness.
The dialogue continued with an introduction to the new Aberdeenshire strategy which is called ‘Being Human’. This was picked up on the second session on 25th January where …
Luan Grugeon Chair of the Aberdeenshire ADP led a discussion on how we as a community can stop problems developing and help people access support when they need it,
This led to the deliberation stage where participants began to apply their learning and considered two questions
1) How could an alcohol and drugs strategy that is built around the ideas of human rights and radical kindness help in …
o preventing these problems developing in the first place o helping people speak up and get support at an early stage?
2) If the radical kindness approach works what would things look like in your community for: o The person themselves who is affected by drugs and alcohol use. o Other people who are impacted as a result (partners, family, children, neighbours) o The agencies who provide services in the community.
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Key Input 1 – Human Rights Approach
Michaela Jones gave the first keynote input around the concept of Human Rights, particularly in relation to people who are in recovery from problematic alcohol and drug use. The presentation started with a quiz which helped people to explore how much they know about the Universal Declaration of Human Rights and understand that only some of these universal rights are directly protected under UK Law
The key point of the presentation was helping people recognise that they are Rights Holders and that services and agencies are Duty Bearers who have a responsibility to ensure that individuals can exercise these rights.
The PANEL principles which underpins the Human Rights approach was explained.
Participation People should be involved in decisions that affect their rights.
Accountability There should be monitoring of how people’s rights are being affected as well as remedies when things go wrong.
Non –discrimination All forms of discrimination must be prohibited, prevented and eliminated. People who face the biggest barriers to realising their rights should be prioritised.
Empowerment Everyone should understand their rights, and be fully supported to take part in developing policy and practices which affect their lives
Legality Approaches should be grounded in the legal rights that are set out in domestic and international laws.
Questions, questions, questions.
After the presentation, people worked in small group to develop questions and discussion points which were then picked up in a Question and Answer discussion
Question Answer
Not all the UN Rights are Not a lawyer but think that we are only beginning the discussion about enshrined in British Law exercising rights. There is a power dynamic and we as citizens need – how do local laws to be more aware of our rights and agencies need to advocate more override universal for human rights. rights?
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Question Answer
Some people have experienced a negative Don’t give up. reaction when they have One of the key things is that we need to raise awareness of agencies tried to assert their and services being Duty Holders – they do not always seem to be human rights – what can aware of this and it is not optional. you do about that?
You have shared your Compassion is the most important thing – when people treated me as own journey with us a human being and not just a bunch of ‘issues’. today – what do you A human approach is what makes the difference – and seeing it as a think was the most important factor in your health issue. recovery?
The starting point is a conversation – people are often open once a How can we challenge discussion starts. discrimination? There are national bodies who can also help – such as the Scottish Human Rights Commission.
No easy answer – for me it has been 10 years – only last 2 years have been comfortable We have talked a lot The most important thing is to help improve awareness of health about recovery – how literacy – recognising the issue earlier. People became sick and tired long does recovery of being sick & tired and that is when they need kindness, compassion take? and support. Support is not constant – people may dip in and out as well which is normal.
Sadly, it is not. Addiction is a coping mechanism – a response to stresses and strains that people find overwhelming. Is addiction treated as a There needs to be better integration across different kinds of services mental health issue. – it is exhausting having to tell your story again and again. The best antidote is community and connection,
Recent reports have Not sure about the European reference – sometimes these things are identified Scotland as down to getting better at gathering the data and statistics. the drugs capital of Still worth noting that there are significantly more deaths caused by Europe. Is that the legal drug – alcohol. accurate? However, in relation to drugs maybe the approach needs to be more about reducing harm.
Is it about needing more Don’t think it is just about money – think it is about changing our focus funding? to concentrate on wellness.
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Key Input 2 – Creating the Conditions for Kindness
Ben Thurman from the Carnegie UK Trust spoke about some of the work they have been doing across the UK around the concept of kindness, He explained some of the theory around different types of kindness. Random kindness – Doing something like paying for an extra coffee for someone else. There is no actual interaction with the person who will benefit from the coffee but just a hope that they will enjoy the moment when they get a free coffee. Relational kindness – When we have a relationship with someone and do our best for them – the nurse who spends 5 minutes chatting with a patient at the end of a shift or the bus driver who helps an infirm person on and off the bus. The employer would also view this as good and positive behaviour. Radical Kindness – This can be seen more as being about institutional change and challenging current norms – so can be disruptive. Ben went on to discuss what radical kindness might look like in the context of an alcohol and drugs strategy.
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Questions, questions, questions.
Question Answer
People are still trying to work this one out. How can you put Carnegie have produced a number of reports on this including one something like called The Practice of Kindness ‘kindness’ into a policy? This kind of research is starting to produce evidence that shows that deliberate attempts to encourage kindness can make a difference.
Trust does take time to build up. The simple answer is to concentrate Trying to be kind could on what works - and be kind to yourself. be misinterpreted – how Society is different now and we don’t always have the same social and do we do this without family connections as we had before. In some ways we must create feeling vulnerable? the new spaces where people can meet and feel comfortable with each other.
Compassion is critical – people are professionals and have power but as experts they need to be compassionate. What difference would Services tend to measure the amount of time spent or people seen – kindness and not the quality of the interaction. That needs to change. compassion make to services? We also need to support people in our communities who provide peer support – they can easily become burnt out.
People can be afraid to be kind – but that is maybe what is radical about it.
This is an important point – it must be a whole organisation approach How do we create a where it becomes part of the culture and ethos of the organisation. culture of kindness in The strategy is going wider than this and asking a wider partnership organisations? to endorse the kindness approach.
It is easier to be kind to those closest to you – It is much easier to be kind to ‘people like us’; but radical kindness how do you get over the asks us to be kind indiscriminately. fear of being kind or on the other side feeling We need to do more to reach across differences – both as people and embarrassed at as ‘professionals’ receiving kindness?
Eval
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Key Input Three – The Draft Strategy
Luan Grugeon is the Independent Chair of the Aberdeenshire Alcohol and Drugs Partnership and explained the background to the strategy and how it has been developed through consultation and discussion with people across Aberdeenshire. The overall vision is for a community which is healthy and resilient, where fewer people and families experience harms from alcohol or other drugs.
Luan noted some specific Aberdeenshire data 1 in 5 residents drink more than the recommended 14 units of alcohol per week. An estimated 5% of the population (around 10,000 people) drink alcohol in a harmful or dependant manner. Special services are working at full capacity at present and have regular challenges to meet waiting times. Alcohol and drug deaths are increasing. People who live in poorer socio-economic areas suffer more alcohol and drug harms. There will not be lots more money to deliver on the strategy.
Luan then went on to relate that data to real people she has known and worked with over the years. Theses were presented as anonymous personas – but they told the story of real people and families affected by alcohol and drugs in Aberdeenshire.
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Questions, questions, questions.
Question Answer
I think radical means ‘the root’ – so I see kindness as the root of this What does Radical strategy – the thing that underpins everything else. I know there are Kindness mean to you? some different interpretations of what this means but fundamentally everyone knows what kindness is and what it feels like.
There is lots of evidence in the importance of community connections How can communities for health and well-being. If we are in groups, we should think about help in reducing the how inclusive and welcoming they are. amount of harm caused by alcohol and drugs? We need to challenge stereotypes about each other and need to get over our fear of engaging with others in the first place.
Has alcohol pricing had I think it is too early to measure the impact of this yet. an impact yet?
It is a culture where we drink to celebrate and to commiserate. Is there something However, there are encouraging trends such as young people who are different about Scotland drinking less than previous generations. and our relationship The demographic group which has emerged as having problems with alcohol? related to alcohol are those in their forties and fifties. We have to remember that problematic drinking is often a symptom of something else
In my experience there is often something underneath it – some form Is that an issue – drugs of sadness. There is lots of evidence now about the impact of what and alcohol as a way to are called Adverse Childhood Experiences. This is not saying it is escape from everyday automatic that kids who experience these things will develop problems problems? as adults – but that there is a link between the two.
I spoke to someone who had taken part in a training programme which looked at coping strategies. It was not about drugs and alcohol What role does training specifically, but about how to deal with situations and develop and awareness raising resilience. One of those taking part – who was in recovery – said “I have in preventing wish I had this training when I was 12”. problems arising. We talk about the evidence base – things that we know have worked –
and there is a lot around the importance of developing resilience and decision-making skills from an early age.
How can we support Again, helping kids develop coping skills is crucial – programmes like children who have ‘Bounce Back’ which is delivered in primary schools.is a good parents who have example. alcohol issues?
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Question Answer
People have said that the discussion last week helped them How can a strategy understand the strong link with mental health and how that needs to make different services be linked better. I think we are starting to see examples of where work better together? services are becoming more integrated and working better together.
No – it is more of a process in which services should fade in and out Does recovery mean just depending on the person. People can be in both recovery and stopping? treatment at the same time. Recovery is a journey and an ongoing process.
Is drug use more I think it is more helpful to think about what is known as ‘poly’ use of stigmatised than alcohol drugs – which means that people may be using a range of different use? substances at different times.
Government is now moving towards seeing dependency as a health Is criminalising drugs issue. Some cities are looking at safe injecting rooms for drug users – part of the problem? this may be politically controversial but there have been no drugs deaths in any of these facilities elsewhere,
So, Laura is a working mum, living in the country with young kids and husband working offshore and caring for elderly parents. Her coping mechanism is drinking a bottle of wine at night – which she feels How can we help ashamed about but can’t stop. someone like Laura from In this example there is maybe a role for digital support services – if your case study she is at home alone with kids at night this might be the only example? accessible option. The likelihood is that it would be services such as Samaritans or Breathing Space in the first instance.
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Deliberation – Question One
How could an alcohol and drugs strategy that is built around the ideas of human rights and radical kindness help in: o preventing these problems developing in the first place o helping people speak up and get support at an early stage?
There were four small groups who worked together to discuss and respond to the question with suggestions captured on insight cards. Each group reported back their thoughts and added their insight cards to a sticky wall. People then discussed the collective suggestions and clustered them under theme headings. The group then used sticky dots to prioritise both the themes and the individual suggestions. Each person had three sticky dots so there was a total of 57 eligible votes to be cast. 47 were cast for the headings and 49 for the individual suggestion as per the table below shows.
Education (14 priority votes) Workshops in schools which bring together parents and young people. (6) Educating parents how to grow confident and resilient children. (4) Teachers to be more educated and involved around alcohol and drugs education. (1) Educate people about the impact of alcohol on them and others. (1) Education with a human face – importance of sharing and learning from people with lived experience. Education, Education, Education. Getting message to parents about good practice – e.g. not drinking or smoking in front of children. Life skills training for people before they go into secondary school. Better support for parents when they need it.
Services (10 priority votes) Reduce service waiting times for people asking for help. (6) Reduce GP waiting times. (3) Need to help people understand the role of all the different support services. (3) More government intervention and monitoring of the right not to be exploited. (1) Could there be a 24/7 helpline service like Childline? (1) No more money but reallocate resources. Mentoring – one person you trust who you can build up a relationship with.
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Community Spaces (9 priority votes) Need safe spaces where people can speak about issues that affect them. (2) We need more alcohol-free meeting spaces and events and places to socialise. (1) Volunteering is a good way to make a difference – e.g. Youth Clubs. (1) Need to create community spaces if they don’t exist.
Culture Change (7 priority votes) Need to change how we think about it in the same way as happened for mental health which has now lost a lot of its stigma. (3) Help people to change their lifestyles – long term prevention. (2) Challenge if some people don’t respond to kindness. (1) Change culture of peer pressure to drink – self-worth to say no and turn that into a positive choice. (1)
Information/Awareness Raising (5 priority votes) Need to increase awareness and information on help (3). Any evidence that some people are more susceptible to addiction than others? (2) How to help people recognise if they may have or be developing a problem. (2) People need to know where to go for support. (1) More understanding in the public that using drugs or drinking too much are a symptom and not a cause. Need to use social media more – awareness and support. We need to speak more about drugs and alcohol in our community campaigning. Need to raise awareness around human rights and what they are exactly (for services too).
Peer Support (2 priority votes) People with lived experience are best to speak to people who are struggling. (3) Mentoring – one person you trust who you can build up a relationship with. Kindness builds your confidence – more conversations. Need to make peer support groups more visible. Peer groups help to build personal responsibility into recovery.
Workplace Support The kindness agenda is also needed by employing organisations. (1) Need better workplace support for people.
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Participants looking at all the insight cards and selecting their personal priorities.
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Deliberation – Question Two
2) If the radical kindness approach works what would things look like in your community for o The person themselves who is affected by drugs and alcohol use. o Other people who are impacted as a result (partners, family, children, neighbours). o The agencies who provide services in the community.
The format for this deliberation was slightly different. There were three groups one for the individual; one for communities; and one for services. People elected which topic they wanted to discuss first and recorded their findings as before. People then moved to another topic and discussed what the previous group had come up with and added to this. The process was repeated a final time on the remaining topic.
Each group then clustered their collective results under themes as before and these were added to another sticky wall. People then had one sticky dot to allocate to their top priority in relation to the individual, community or services.
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Evaluation
Participants took part in a range of individual and group evaluation and feedback exercises throughout both days.
a. Half of the group agreed that the incentive payment had been an important factor in Participant Comments their initial decision to take part. Our previous experience in Aberdeenshire has been that this is normally a factor for a third The whole strategy fascinated of participants, Given that this is the first me. Listening to other people’s views helped me Aberdeenshire wide process we have realise my own views are delivered it is likely that the additional often very black and white so travel required to participate may have to speak - made me think and been a factor in the increased importance change my mind… of the incentive.
b. At the planning stage it was decided to I enjoyed the discussions recruit as randomly as possible and not with so many different people target any of it through existing services. who make you think about The expectation was that in a random other opinions and views. group of this size there would be people with relevant lived experience - this proved to be an accurate assumption with a wide I feel I understand the situation better…. range of experiences represented.
The talk about human rights - c. 90% of people felt better informed about I have never considered my human rights and radical kindness after the own human rights before. presentations and discussions. This rose to 95% for the input on the draft strategy on day two. There is a lack of understanding for addiction d. All participants felt that they and others had problems and the mental been able to express their feelings and to health impact. contribute fully to the discussions. This is significant as 20% had expressed some nervousness at the start of the first It was more relaxed than I session. expected it to be and more interesting.
e. 95% of participants felt that the information captured in the deliberation stage reflected I liked the way that we pulled what had been discussed and agreed. One together our findings. person partly agreed with this and nobody disagreed.
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Notes from a mini-public
January 23, 2020
Share this story https://www.carnegieuktrust.org.uk/blog/notes-from-a-mini-public/
by Ben Thurman, Policy and Development Officer, Carnegie UK Trust
One of the key themes in a decade of working on societal wellbeing has been the need to open up opportunities for participatory democracy – to shift “from representation to participation”. We know that wellbeing is profoundly affected by our sense of agency and control – we know how important it is that people have a say in the decisions that are made around them. So there was a broader interest in participating in a ‘mini-public’ on Aberdeenshire’s Alcohol and Drugs Strategy than simply its focus on radical kindness.
Without shouting about it – indeed, by their own admission, somewhat ‘under the radar’ – Aberdeenshire Council has begun to integrate deliberative and participatory processes into the way they do things. Having sought out training on ‘Dialogue and Deliberation’ from Oliver Escobar and Wendy Faulkner at the University of Edinburgh, they have run mini-publics on issues like housing allocation, free school meals uptake, local social capital indicators, and, here, alcohol and drugs.
A first reflection on the process, was that it thoroughly challenged the idea that people don’t want to participate in decision-making. Twenty-odd people, giving up consecutive Saturdays, travelling from across Aberdeenshire to learn about and contribute to the Alcohol and Drug Partnership’s approach suggests otherwise – as did the level of engagement in wide-ranging discussions on human rights, kindness, public services and communities.
A second was on the value of a ‘jury approach’ that brought such a range of experiences and perspectives to the issue (as well as the skill of facilitators in creating a safe and inclusive space for all voices to be heard). In a sector where we sometimes risk working from assumptions that certain things are unquestionably right, the mini-public allowed expert witnesses to pause, take a step back, and really interrogate why we believe certain things – kindness, a human rights approach – are important.
This feels significant in a wider environment characterised by falling levels of trust in institutions and media hostility towards public services. Beyond the opportunity to influence decision-making in itself, creating spaces for a conversation about why public sector organisations might work in a particular way, and what the challenges and limitations might be, is surely an important part of rebuilding public confidence.
Similarly, facilitators noted the way that attitudes can change as mini-publics engage more deeply with issues. Providing space for twenty people to consider the lives and experiences of people affected by alcohol and drugs, might not seem significant. But if it builds understanding among
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people who then take this back to their communities, it might create a ripple that begins to challenge the stigma faced by some of the most vulnerable people in society.
A final thought was on the language and values that underpinned the strategy: that of kindness and human rights. One of the benefits of kindness is that it is universally understood: talking about kindness in social policy breaks down some of the barriers between ‘professional’ and ‘citizen’. It may be a coincidence that Aberdeenshire (and others) are moving away from more ‘professionalised’ terms at the same time as actively thinking about citizen participation. But if one of the parallel effects is to cede a more simple, accessible language, one that everyone can understand and relate to, that must surely be a good thing – for those affected by alcohol and drugs, for those working with them, and for the wider community.