Services will not become equitable simply by writing more policies or asking people for their stories

By Shinasa Shahid

Today, we have enough policies or research about inequality in addiction services. But the people most affected have very little power to shape those services.

People from Black, South Asian, and other global majority communities often do not receive addiction treatment that fits their needs. There are governments reports that already state this and researchers and services already know this. Yet, very little changes. So here, the problem is not knowledge. It is power. There is a power gap. 

When a hospital wants to improve addiction services, they invite people from minority communities to a meeting to share their painful stories. Everyone thanks them and a report is written. But nothing changes. When someone shares their painful, traumatic experiences, it’s consultation, not co-production. Co-production is when the hospital approaches the communities to help them design the service, to help them make decisions to better serve those communities. Today, the communities are asked for opinions but are rarely given real decision-making authority. This is why many people from the Black, South Asian, and other global majority communities avoid treatment.

I have spoken to many services who think that people don’t engage because they don’t want help. Or there is not much need in those communities. I always disagree with them. The people who were suffering told me that they left because they did not feel understood, they did not feel respected, the services were not culturally safe for them, the services did not represent them. If you walk into a service and nobody understands your culture, religion, language, family expectations, intergenerational migration trauma, or experiences of racism, you may not feel safe enough to stay. So, the problem is never lack of motivation. It is lack of trust.

Let us understand another related term, decolonising recovery. We are talking about changing the assumptions behind treatment. Currently, most recovery systems are mainly based on Western approaches of psychology. This means, the systems focus on the individual, personal responsibility, therapy, and behaviour change. We also have to understand that for many communities recovery may involve family, faith, elders, cultural traditions, community rituals, spirituality, etc. It is important to reconnect the person to family, culture, and community.

Addiction is usually an attempt to cope with pain. And one of the correct way to see this is by asking what pain is the person trying to escape. That pain might come from childhood abuse, racism, migration trauma, family violence, discrimination, or historical trauma. Treatment often tries to stop drug use without treating the underlying pain.

I like the word ‘lived experience’ because it is powerful and stronger than any research. Services often ask people to repeatedly share their traumatic stories. Those stories are then used in reports, funding applications, conferences, and research. But unfortunately, nothing changes. Some call this trauma mining. When people repeatedly relive painful experiences but never gain influence or see change, the system is only benefiting from their trauma, isn’t it?

I always spoke against the term ‘hard-to-reach’. The communities are not hard to reach. Instead, the services are. The services are difficult to trust. Instead of blaming communities, services should reflect on what are they doing that makes people avoid those services. There are several practical changes that needs to be done. Instead of asking communities after decisions are made, we must involve the communities from the beginning. Instead of one-year grants, we must invest in long-term funding. Instead of mainstream organisations receiving most funding, we must directly fund community-led organisations. And instead of designing services for everyone in the same way, we must develop culturally adapted services.

Recovery is reconnection. Reconnection with oneself, with family, with culture, with community, and with spirituality. Unfortunately, these parts are missing from many current services.