Equality is never given. It is often taken away.

I saw ”The Iron Lady” last week. Aside from being a moving and appropriate portrayal of Alzheimer’s, it reminds you how remarkable Thatcher was. In 1981 she argued:

 “Equality and opportunity cannot exist alongside each other. What is opportunity if your only opportunity is to be equal?”

Typical of the woman but what a pity. She could truly have been remarkable if her own personal experiences hadn’t made her so blinkeredly individualistic. And mental illness is a great leveller.

Muriel Spark had an idea that babies are born knowing everything that goes on in the world but that from the moment they are born the socialisation process constricts them, narrowing their knowledge so that they can be social beings. The end point is where we are deemed to be successful, whether as academics or managers or parents or citizens. But actually we only demonstrate how successfully we have been robbed of our primal knowledge, so that we can conform with expected social behaviours.

Nobody gives equality but more powerful people can take it away from less powerful people.

The current debates in the UK about LGBT marriage are not about a wider, benevolent society granting equality to LGBT people who want to be married; rather, they’re a marker that LGBT people are reclaiming what was taken away from us. I was legally married to my partner Paulo in Brussels but returned to the UK to find that our marriage had been relegated in UK law to the status of ‘civil partners’. And the ignorance and conceit of some people is breathtaking. The Tories in particular have clearly been dragged into the 21st century by the weight of public opinion but they expect us gays to be grateful for their tolerance.  Take for example, the response that I received from David McCletchey MSP when I asked him to support gay marriage:

“I welcome the establishment of civil partnerships in Scotland which means that civil partners now have the same legal rights and responsibilities as married couples in terms of their relationship with one another.  Accordingly I do not see the need for further change.”

 Either he’s been forced to accept the step towards equality – civil partnerships – that he really doesn’t agree with. And he is convinced of his own benevolence in embracing diversity in this way. And LGBT people should be grateful. Sorry but this one isn’t.

In Thursday’s ‘Guardian’ Susanne Moore criticised the attitude of Louise Mensch, the conservative pseudo-feminist MP whom she typifies as “pulling away from victim and drab feminism in favour of being chic and individually entrepreneurial”.  As Susanne points out, contrary to the individualistic and neo-liberal Mensch, all women do not have the same opportunities. Class is still important and women are more likely to be victims of physical and mental abuse, workplace discrimination and patronising and chauvinistic attitudes, even in places where you’d least expect it. I’ve come across this recently in my work as a member of the European Union’s Civil Society Forum on Drugs where not one women was elected to its “managerial” board. I raised the issue of the importance of having women’s representation but I seemed to be one of the only people  that thought it was really important. Presumably in this, as in so many other contexts, women’s voices will be sought by men on issues which the latter deign to consider pertinent.

 But it’s my contention that all issues are women’s issues and it’s not for men to decide where and when and how they should be represented.  Men don’t give women a voice and power but they can take it away. Straight people don’t give gay people equal rights. White people didn’t give slaves their freedom. They took it away.

Protest

Earlier this month I went to an anti-poverty conference in North Edinburgh. It was great to see so many people from disadvantaged communities not giving up but, rather, challenging the status quo of ‘haves’ and ‘have nots’ which characterises our society.  

And I am inspired also by the protesters in St. Andrew’s Square, Edinburgh and across the UK and other countries who are bringing into mainstream discussion – at last! – the unacceptability of the increasing gap between rich and poor.

First among major UK politicians, Ed Miliband in his conference speech (which received fairly mixed reviews) raised this issue and he even linked it to the unrest that led to riots in England earlier this year. In government, however, New Labour advanced the neoliberal market agenda. Albeit that they introduced worthwhile schemes targeted at specific individuals and communities, they didn’t want to tinker with addressing structural economic inequalities. Indeed, politicians like Mandelson seemed to revel in encouraging greed and excess for people at the top. (And remember, I’m only talking here about our UK context; the situation becomes even more extreme when we consider the global situation.)

This week the High Pay Commission described the high salaries of UK executives as “corrosive” to the economy. Stating that the disparity between what top executives and average workers earn has been building for 30 years, it drew up a 12-point plan to stop “high pay creating inequalities last seen in the Victorian era”. Vince Cable, the Business Secretary, said he would be “looking seriously” at the proposals.

Let’s hope he does but I wouldn’t hold my breath.

Because the political establishment has presided over and even encouraged a situation where, for example, the pay of top executives at a number of FTSE companies had risen by more than 4,000% on average in the last 30 years.

In the companies’ defence, Richard Evans, president of PepsiCo in the UK and Irish Republic, told the BBC:

“If we want great people to come and work in the UK, given it’s a global talent pool, we’ve got to be prepared to pay the amount of money that those executives can get elsewhere in the world”.

To which I say, follow the St. Andrew’s Square protesters’ example. Don’t buy any of Pepsico UK’s brands. These include: Walker’s Crisps, Doritos, red Sky, Sunbites, Quaker Oats, Scott’s Porage Oats, Tropicana, Pepsi MAX, 7UP, Gatorade, Planet Lunch, Copella, SoBe V-Water. (I have to admit that it won’t be a big sacrifice for me not to purchase anything from this unhealthy list!)

Protest loudly. Lobby politicians. Don’t let David Cameron say that we’re ‘in it together’ while pay for directors of the UK’s top businesses has risen by 50% over the past year, to an average of around £2.7m.  If you’re working in the much maligned public sector, strike on 30th November.

And snap out of complacency.

To return to the North Edinburgh Poverty conference that I mentioned at the beginning of this blog, one of the things that most moved me was when an old woman, describing her experience in her ‘ice box’ flat, suggested to others, as a way of managing their fuel bills, that they follow her example and make up a flask of tea or coffee first thing in the morning so that they won’t have to boil the kettle more than once a day. I met a few days later with a friend and expressed my disgust at the unacceptability of such a situation. His response was that there was no ‘real reason’ for anyone to be worried about being able to afford to boil a kettle.

But they are.

And that’s ‘real’.

Riots

Noone can fail to have been shocked by the events that we’ve seen in London and elsewhere this week. And it goes without saying that the actions of those involved are inexcusable. Also, that demoralised, under-resourced police officers are having to struggle to re-establish the public order and safety that all people in our communities deserve. 

David Cameron was wrong however to describe the situation as “plain and simple”; it’s anything but. I hope that when this is done we can reflect and reprioritise prevention and early intervention activities with communities and individuals who have become increasingly disengaged. Yes, wrongdoers should  certainly be punished but we need to look at how to rehabilitate young people who have done wrong. We also need to recognise that disinvestment  in youth and community services may save money in the short term but it can, at least indirectly, lead to exactly the kinds of circumstances we’ve had this week.

I lived in Lambeth for a long time and until recently I was working with the Lambeth Crime Prevention Trust in Brixton, one of the ‘hot spots’. This agency engaged many young people in meaningful leisure and community activities and provided education about being a citizen, avoiding knife crime, resisting peer pressure etc. However, it wasn’t deemed to be a priority service and consequently it lost its funding and closed down in March this year.

Closer to my current home, in Edinburgh the ‘North Edinburgh News’, a community charity based in Pilton which promoted positive views about the disadvantaged areas it covered and was able to provide a whole range of community information and to support networking  also lost its funding and closed in March this year. It would have needed £30K per year to continue.

In no way should we condone the violence and looting. However, we do need to try to understand and consider how we are running our society and what priorities we have within it. As a final point on this really sad blog,  when I saw the scenes from Clapham Junction on Tuesday night I was reminded of Polly Toynbee’s description when she undertook an experiment, flawed of course because she always had the option to go back to her ‘real’ life, of trying to live on the minimum wage in Clapham Park estate. Her overwhelming experience was of feeling excluded from an individualistic, materialistic society where we and others assess our worth based on what we own; the Arding & Hobbs store she described in the following extract subsequently became the Debenham’s store that was ransacked on Monday.  

“Well-worn and familiar tracts of the city devoted to pleasure, art, eating, clothes and shopping disappeared of my map. Why wander down the King’s Road when everything there is denied to you? Oxford Street and Regent Street vanished from my route. So did Clapham Junction and Arding and Hobbs. So did Shaftesbury Avenue, the National Theatre, the Albert Hall and the Barbican. Wherever I walked, everything I passed was out of bounds, things belonging to other people but not to me. No Starbucks sofas beckoned any more, no Borders bookshop, no restaurants, not even the most humble cafe. This is what ‘exclusion’ means, if you ever wondered at this modern wider definition of poverty. It is a large No Entry sign on every modern pleasure. No Entry to the consumer society where the rest of us live. It is a harsh apartheid. Exclusion makes the urban landscape a forbidding place where every brightly lit shop doorway designed to welcome you in to buy, buy, buy is slammed shut to one-third of the population. Shopping for the meanest food staples under rigorous cost-controls is no fun, and it becomes less so every time.”

Toynbee, Polly (2003) Hard Work: Life in Low-Pay Britain London: Bloomsbury Publishing

Decriminalising personal drug use

I am frustrated by the lack of clarity which politicians, journalists and other commentators demonstrate when talking about legal options in relation to drug use, often confusing arguments for decriminalisation of penalties with legalisation. Although people have different perspectives about the way forward, any claims of certainty about outcomes which relate to drug policy must be treated with a huge degree of scepticism. Without the possibility of having a control group to compare against, causality is impossible to measure. However, it is clear that decriminalisation of penalties for personal drug use is consistent with UN Conventions and guidance:

“Serious offences, such as trafficking in illicit drugs, must be dealt with more severely and extensively than offences such as possession of drugs for personal use. In this respect, it is clear that the use of non-custodial measures and treatment programmes for offences involving possession for personal use of drugs offer a more proportionate response and the more effective administration of justice” (Costa, A.M. 2010, p.7).

The official Commentary to the 1988 UN Convention states: “It will be noted that, as with the 1961 and 1971 Conventions, paragraph 2 does not require drug consumption as such to be established as a punishable offence”. The Commentary suggests establishing a strategy regarding the range of offences relating to personal use, similar to that practised by many states, in which such offences are distinguished from those of a more serious nature by a threshold in terms, for example, of weight. However, different countries, while embracing the concept of separating out less serious from more serious offences, have established national arrangements specific to their own setting. Some countries have opted to decriminalise personal drug use, shifting to administrative rather than criminal sanctions. Others instead have opted for a policy of depenalisation, whereby they cease to apply criminal or administrative sanctions, though the laws still exist to prohibit activities. Legalisation has not been adopted by any country and would be a clear breach of UN Conventions. Thus, for example, in Portugal possession of a small quantity of drugs for personal use has been completely decriminalised, whereas in other countries the approach has been not to decriminalise but simply to treat the offence as a low priority for law enforcement. For example, in the Netherlands, Germany and the Czech Republic, possession for personal use remains unlawful, but guidelines are established for police, public prosecutors and courts to avoid imposing any punishment, including fines, if the amount is considered to be insignificant or for personal consumption. Very few EU countries (Sweden, Latvia, Cyprus) exercise the option to impose prison sentences for possession of small amounts.

Antonio Costa, former UNODC Executive Director has argued eloquently against the criminalising and incarceration of people with drug problems (Costa, A.M. 2010). According to Costa, incarceration in prison and confinement in compulsory drug treatment centres often worsens the already problematic lives of drug users and drug dependent individuals, particularly the youngest and most vulnerable. Exposure to the prison environment facilitates affiliation with older criminals and criminal gangs and organizations. It also increases stigma and helps to form a criminal identity. It often increases social exclusion, worsens health conditions and reduces social skills.

Hughes and Stevens (2010) have argued that most studies have found there are no significant increases in use as a result of decriminalisation. They have also suggested that it is difficult to make any certain judgment on the effects of decriminalisation on drug use, given the absence of adequate comparators. However, the financial and other costs associated with a focus on law enforcement and incarceration can be high and reducing the cost of arresting and punishing drug users would enable resources to be focused on maximising the other factors that protect against drug abuse, such as prevention and treatment. It has been argued that one of the biggest impacts of changes in the law has been the reduction of pressure on overburdened penal systems and prison overcrowding (Jelsma, M. 2009).  A study which considered data from the Netherlands, United States, Australia and Italy concluded that the removal of criminal penalties appeared to produce positive but slight impacts. The primary impact was reducing the burden and cost in the criminal justice system. This also reduced the intrusiveness of criminal justice responses to users (Hughes, C.A. & Stevens, A. 2010, P.  1000).

It is important to note, however, that there is little evidence that the removal of criminal penalties on its own will be likely to lead to significant increases or decreases in the overall prevalence of drug use or drug-related health harms (Hughes, C.A. & Stevens, A. 2010, P.  1000). The Portuguese experience has been arguably the most studied example of drug policy review. Portugal is the only country which has fully decriminalised personal drug use (in 2001) and it has reported outcomes which include reductions in drug use among young people and reductions in use of opiates, the most problematic type of usage. It has also noted the lack of negative outcomes, such as increased street drug use or drug tourism. However, the Portuguese legislative changes cannot be considered in isolation from the country’s corresponding investment in a range of social and health support services, intended to offer support to drug users where it is needed, while retaining the intention to deter drug use. The Portuguese evidence suggests that combining the removal of criminal penalties with the use of alternative therapeutic responses to dependent drug users offers several advantages. It can reduce the burden of drug law enforcement on the criminal justice system, while also reducing problematic drug use. Outcomes that have been reported include:

  • small increases in reported illicit drug use amongst adults;
  • reduced illicit drug use among problematic drug users and adolescents, at least since
  • 2003;
  • reduced burden of drug offenders on the criminal justice system;
  • increased uptake of drug treatment;
  • reduction in opiate-related deaths and infectious diseases;
  • increases in the amounts of drugs seized by the authorities;
  • reductions in the retail prices of drugs (Hughes, C.A. & Stevens, A. 2010, P.  1017).

Opponents of the legal change had expressed concerns that decriminalisation would lead to mass expansion of the drug market in Portugal. This did not happen and, in contrast with market expansions in neighbouring Spain, the numbers of problematic drug users and the burden on the criminal justice system in Portugal have reduced. It is not possible to state that any of these changes were the direct result of the decriminalisation policy. However, it is clear from the Portuguese experience that decriminalisation does not necessarily lead to increases in the most harmful forms of drug use. While small increases in drug use were reported by Portuguese adults, this was arguably less important than the major reductions in opiate-related deaths and infections, as well as reductions in young people’s drug use.  Other countries, such as Sweden and Switzerland, though adopting different legislative approaches, have also claimed successful outcomes from their drug policies but, as with Portugal, these countries’ substantial investments in health and social care services must be considered as at least as important as the legal framework.

Costa, A.M., 2010. Drug control, crime prevention and criminal justice: A Human Rights perspective: Note by the Executive Director UNODC, Vienna: Commission on Narcotic Drugs, 53rd session.

Hughes, C.A. & Stevens, A., 2010. What can we learn from the Portuguese decriminalization of illicit drugs? British Journal of Criminology, 50, Pp. 999-1022.

Jelsma, M., 2009. Legislative Innovation in Drug Policy:Latin American Initiative on Drugs and Democracy, Amsterdam: Transnational Institute.

Recovering communities

I was really excited and honoured recently to chair a side event on Recovery at this year’s Commission on Narcotic Drugs in Vienna. I’ve been learning a lot in the past few months through my involvement as a volunteer with Wired In. I’ve had opportunities to listen to the experiences and challenges of people who are recovering not only from addiction problems but from many difficult life experiences. They want and are planning to manage their recovery, not passive recipients of drug treatment, rather, mapping out positive life futures. Drug treatment and other social services and stronger communities can support this, they can’t deliver it. It seems fundamental but it is revolutionary and it’s about hope not hopelessness. It requires a systemic rethink, based on listening to and trusting communities and learning from people in recovery.

The Wired In website – www.wiredin.co.uk – supports an increasingly empowered community of people in recovery, supporting each other, exchanging ideas, challenging the traditional way drug and alcohol treatment services have been provided, emphasising that people with drug and alcohol problems are the experts who are best placed to map out and manage their recovery. Many people in recovery are talking about how drugs and alcohol had always been the focus of their lives and how that’s changing so that their focus is becoming not just about what treatment they get; rather, it’s about how they become integrated into their communities, how their communities change to support that and how they contribute as full members of their communities. And this movement is growing within communities and across countries.

When we think about the problems that people have with drugs and alcohol, we know that problematic drug and alcohol use almost always comes with a whole lot of accompaniments – family breakdowns, abuse, violence, housing difficulties, involvement with criminals and the criminal justice system, financial problems and poverty, social exclusion. We all need support in recovering from that. We all need to recover from the challenges we experience as we go through life. I was in Glasgow last week. I always visit this city with somewhat mixed emotions; I haven’t been there very often recently. I grew up there and have very fond memories of visits to the Kelvin Hall at Christmas and to the Citizens Theatre where I remember a memorable Hamlet set in a mental hospital. However, I also remember when I was very young being frightened of a very drunk man slavering up against our car window. I also remember the sectarianism, which sadly continues to this day – bombs to Celtic supporters! – so that it wouldn’t be unusual for me, even at the age of 48, to be asked which school I went to. (St. Patrick’s it was – no hiding one’s religion and cultural background with that one.)  I can appreciate Glasgow’s incredible architecture and history and the great wit and culture of its people. However, we’re never just professionals or academics or just private individuals, nor are we ever only addicts; as individuals, we’re part of communities and as individuals and as communities we need to and can recover together from all the difficulties we encounter. I guess Glasgow makes me reflect and reframe; thus my ambivalence towards the place.

Following on from this, there seems to me to be a huge and continuing gap between how we frame the context within which drug and alcohol addictions and other social problems occur and the policy responses to it. The UK Employment Minister, Chris Grayling, was on the Today programme on Radio 4 this morning talking about the government’s plans to introduce a payment by results scheme for services delivered for people with drug and alcohol problems. Regardless of whether the government’s motivation is essentially ideological and about cost-cutting, it’s undoubtedly correct that there needs to be more emphasis on delivery of outcomes from treatment. However, recovery communities need to be trusted and supported to grow and they need to be engaged fully in a process to define what successful outcomes look like and to plan how people can be supported to achieve them. Within a new framework, clinicians need to be less arrogant and politicians less ideological and simplistic to recognise that addiction is a chronic long term health condition and that treatment can only ever contribute to delivering recovery, it can’t deliver it – individuals supported within and working as part of communities do that. Just as the law on its own can’t prevent drug problems – for example, drug use patterns in San Francisco and Amsterdam, with strikingly different legal arrangements, are remarkably similar, indicating perhaps the irrelevance of drug laws to people’s behaviours – neither can treatment on its own. And moreover, just as a treatment service which opts to work with complex drug or alcohol users rather than “cherry picking” more likely “successes”, should not be automatically deemed as failing, coming off drugs and alcohol on its own should not be deemed to be a success. Nor indeed should being employed. You can be employed and still be poor, unfulfilled, unloved and unappreciated, lonely and isolated.

I believe that there’s a very positive debate currently going on in the general public about how we re-build our communities and develop community solutions across all areas of our lives, rather than simply pathologising and blaming individuals for problems such as drug and alcohol misuse (or indeed unemployment) and penalising them. Wired In is one example of a network that is demonstrating the high aspirations of people in recovery, celebrating achievements and showing the way forward. But our politicians still have a long way to go to appreciate and embrace the full meaning of recovery, rather than just using the word as a rhetorical tool.

LGBT Pride and Prejudice

I greatly respect and usually agree with Evan Harris and I know that he has actively championed measures to make LGBT (lesbian, gay, bisexual and transgender) people less unequal.  However, I’m afraid that he (http://www.guardian.co.uk/science/political-science/2011/jan/25/political-science-evan-harris-advisory-committees)  and other “liberal” commentators are wrong when they take issue with the appointment of Hans-Christian Raabe to the Advisory Council on the Misuse of Drugs (ACMD) on the basis of his not being clinically qualified (which I find odd, as a practising GP he must bring useful perspectives), but don’t consider that his and his colleagues’ odious and highly unscientific views about LGBT people are relevant.

Evan and others are colluding with a position where it is acceptable to hold and express repellent views about the LGBT minority which they would find unacceptable, were they to be expressed about other groups, such as women (even at Sky, ask Andy Gray) or black people (ask any non-Daily Mail reader).

Previously, when discussing drug classification, the ACMD considered at length its role in giving out public signals, especially to young people, about harms of different drugs and usually concluded that it was important to take this into consideration. Well, with this appointment and many of the arguments being voiced about it LGBT young people and others are being sent a clear signal. Imagine, if you can, an argument being made that it didn’t matter whether a fellow committee member had linked black people with paedophiles, it’s the committee member’s professional experience that counts, anything else is irrelevant. It simply wouldn’t happen if suggested links with paedophilia had informed prejudiced public discourses about black people, as they have done for many years in relation to gay men.

Of course, Melanie Phillips has waded in to express her concern about the ‘demonised’ Christian community, echoing previously voiced concerns by Dr. Raabe himself (http://www.dailymail.co.uk/debate/article-1349951/Gayness-mandatory-schools-Gay-victims-prejudice-new-McCarthyites.html).  This woman has the uncanny ability to articulate the polar opposite of what I usually believe, despite her alleged concern about many of the same issues which worry me, issues that affect young people and communities, including drugs and alcohol, violence, bullying, anti-social behaviour, community engagement and responsibility.

Many of my family and friends would consider themselves to be Christians but they would hold no truck with the homophobic bigots who have colonised Christian public discourse. Melanie, however, trades on being extreme and controversial; it sells papers. But promotion of such views also damages people’s lives and leads to bullying and in still too many cases, depression, self harm and suicide.  However, though unacceptable, in a way it’s easier to deal with than the acceptance and normalisation by usually unprejudiced people of the bigoted positions of others.

I was in a seminar last week where someone was sounding off about what she perceived as the unacceptability of discussion of religion in social situations nowadays. Without any irony, she suggested that religion had become “The love that dare not speak its name”. I wish Oscar Wilde were here to respond to such rubbish. Every day LGBT people and women are treated to bigoted argumentations based on asserted religious beliefs about how we should conduct our lives and what rights we should or shouldn’t have.

And to get back to the ACMD, ideally, it should be a committee with the best representation of scientists, researchers and professionals for it to give good advice about drugs, with a public health focus. Dr Raabe has co-authored a vile paper that asserted:  

“Any attempts to legalise gay marriage should be aware of the link between homosexuality and paedophilia. While the majority of homosexuals are not involved in paedophilia, it is of grave concern that there is a disproportionately greater number of homosexuals among paedophiles and an overlap between the gay movement and the movement to  make paedophilia acceptable.” http://www.catholiceducation.org/articles/homosexuality/ho0095.html

Being a member of the Advisory Council on the Misuse of Drugs is an important public office. It should not be acceptable to hold such an office and to express and publish offensive statements against LGBT people or any other minority group.

New Police Reform and Social Responsibility Bill

Like many others, I’m very worried about the proposals to remove the  requirement  in the Police Reform and Social Responsibility Bill for the ACMD members to include a doctor, a dentist, a vet, a pharmacist, a drugs industry expert and a scientist from another branch of chemistry.

The Coalition government may be taking a more honest position than that of the last Government, though that does not make it less mistaken or more damaging for any hopes that we might move towards sensible, evidence-based drug policy.

When I resigned from the ACMD over the Mephedrone debacle, it was because I felt that rather than giving balanced, research-based advice, the committee had bowed to inappropriate media and political pressure to make recommendations which were incomplete in themselves and based on inadequate research evidence or consideration of important issues, such as how the drug was being used and what the likely consequences of a ban would be. So my problems were with the Government in putting undue pressure on the ACMD and also with the ACMD itself for neglecting its statutory and moral responsibilities by bowing to that pressure.

Fast forward to the current situation: I think that there are at least two important issues here:
 
1. The ‘scientific’ advice – I think for the ACMD to function at all, this needs to be absolutely the best and the statutory positions are required for that. From what I can see, I think the ACMD members have been naive and mistaken in ceding this position.

2. In addition to this, I believe that the ACMD needs also to be advised by experts who know about education, prevention and harm reduction practice and research, about how people behave and how to influence that – therefore, educationalists, social scientists and practitioners with substantial experience are also required.
 
Rather than removing the no. 1 requirement, the ACMD would have been strengthened by adding new statutory requirements re no. 2.

As it is, the public perception now is that the scientific credibility of ACMD members is of no importance to political decision makers, and the latter are now not even trying to hide that fact. Moreover, there are even suggestions being circulated on the internet that the change  has been prompted not just because politicians want to avoid science-based deliberations on drug policy but also because scientists worth their salt might not wish to tarnish their reputations by joining the ACMD.