SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Responding to patients' needs during pregnancy (Feb 2008)

On returning after my wonderful 3 month sabbatical in Latin America, almost the first person I saw in the surgery was Rachel, aged 26 years who had been a patient of mine for 3 years. She was receiving methadone maintenance and had been working as a classroom assistant in a primary school all of that time. She had come to tell me she was pregnant (and ask me if I had a good time). She was excited and wanted the baby but she was obviously scared and had a list of questions.

She was now 20 weeks, had engaged well with the local specialist midwife and was attending all her appointments. She had been offered to transfer her drug treatment to the specialist services, but had declined stating that she could get care for herself and her baby in the surgery. She then asked me why Social Services would not help her. I asked her to explain and she described how the midwife had referred her to Social Services, at her own request. They informed the midwife that she was not priority and that they could not do anything until the baby was born. The midwife went on to explain that she was homeless having left her sister's flat when she found out she was pregnant because her sister and partner used daily. This information had not changed her priority status.

I was shocked and "almost" didn't believe Rachel, even knowing our social services well - could they not support a vulnerable 26 year old single pregnant woman who used drugs, or see her as a priority? I set out to investigate starting with the midwife who confirmed Rachel's story and agreed that this was a terrible situation. I then rang Social Services and spoke to the duty social worker, who had no record of her and when I told the history they restated that she wouldn't be a priority. I asked if they were familiar with Hidden Harm and/or the New Clinical Guidelines. The social worker had not heard of either.

I then spoke to the head of the department who "sort of" understood my concern and went off to investigate. Unlike her staff, she was also pleased that Rachel was asking for help now, before the baby was born and agreed to set up a pre-birth meeting and invite all parties. She had no suggestions about her lack of housing. Fortunately we have a housing outreach team in the area working with people who have substance and housing problems and I have referred Rachel urgently to them.

Services that cannot understand, interpret and respond to the bigger picture of genuine client need for vulnerable groups are setting up clients to fail, failing in terms of their professional and service duty, and disregarding important national guidance. Drug users have a right to good services and this includes a receptive, caring and professional response by service staff willing to find ways of offering help. Why should a pre-birth meeting be so difficult to offer to a pregnant, homeless woman who uses drugs? Housing is vital to us all and even more so to Rachel, and a referral to an appropriate local agency seems like a basic service response.

The Clinical Guidelines clearly state that for service users like Rachel, good communication and coordination is imperative between parties, care needs to be multidisciplinary and planned. For me, pre-birth meetings with the parent/s in the driving seat are really helpful in achieving this. Rachel knows she will struggle without good support - let's hear her.

If you aren't totally familiar with your local Maternity and Social Services policies around pregnant drug users then check them out and challenge them if they aren't up to the standard advised in Hidden Harm and the New Clinical Guidelines.

- Dr Chris Ford