Drug Rehabilitation
December – February 2009/10
Jonathon Drewhurst and Jennifer Drife, Drug Rehabilitation Psychiatrists, were placed around Male' for 3 months. During that time they liaised with, and held workshops with the Ministry of Health, the police, relevant NGOs and hospital staff. Some of the projects they worked on included investigating suicides and mental health problems amongst drug users, examining data relating to methadone clinics, surveying attitudes to needle sharing in injecting users and conducting a training programme for local drug rehabilitation counsellors.
They presented their findings to both the Vice President of the Maldives, who is taking an active lead in problematic drug-use issues, and the Drugs Council.
May 2010
Paul Harvey, GP with expertise in community based substance misuse management went to the Maldives as part of the Sheffield Collaborative.
Paul was based with the Drugs Prevention and Rehabilitation Service and visited a wide range of facilities and stakeholders involved with drug rehabilitation. He visited the detox unit in Villigilli, the residential rehabilitation facility at Himmafushi and the HIV control project.
He was also able to discuss the dreams of 2 key NGOs, Society for Women Against Drugs (SWAD) and Journey, who strive for a cognitive approach to rehab, rather than a therapeutic community, and for better collaborative working between the NGO's, and also between NGO's and statutory providers. Paul was impressed by the range of sports, arts and craft activities available, alongside counselling and family therapy.
During meetings with Mariya Ali, Deputy Health Minister, Paul was able to discuss links between substance misuse, mental health and child protection, and potential for establishing a national drugs telephone hotline, which could refer clients to community teams if appropriate.
To examine drug links with mental health and broader society, Paul met with psychiatrists and Family Protection staff at IGMH, aswell as 40 Hulhumale police officers and members of the Crime Prevention Group.
Paul also met with Mohamed Waheed, Vice President of the Maldives, who had previously expressed an interest, to Friends of Maldives, in meeting volunteers dealing with substance misuse issues, as one of the government's 5 key pledges. He was very enthusiastic about piloting a community team to address drug care, and keen to listen to Paul's suggestions:
- Joint drug protocols for all treatments to allow effective management by more professionals
- Community detox.
- Establishment of community drug care teams for each atoll, perhaps being part of larger community mental health or social work teams
- Rehabilitation of recovering drug misusers into employment and society
- Drug teams for prisons, including ways to address mental health issues
- Halfway house facilities for recovering addicts
- Examine the law which stops drug treatment in pending court cases
- Look at code of conduct for all drugs workers with agreed training and confidentiality.
- Consider needle exchange schemes as a means to reduce infection and improve safety.
Paul's reports on can be viewed at Substance Misuse 2010 and Current Model of Drug Care 2010.
Whilst Paul was collaborating with Andrew Lee, they were able to further explore ways to raise the profile of public health as a specialty in the atolls, to change the population's expectations regarding accessing care, and providing a good enough primary care service that patients do not self-refer to specialists.
