Mark Dempster, one of the UK’s top addiction experts and author of ‘Nothing to Declare’ and ‘The Ongoing Path’, takes on rogue detox and treatment facilities.
After over seventeen years of working with drug and alcohol addiction clients and helping them through detox, treatment and long term recovery, I am as passionate as ever about ensuring the services provided to clients with chemical dependency are the best possible. The standards expected for public sector services should be no different from those for private detox and treatment facilities. The majority of private detox and treatment facilities deliver high quality services and my experience of working with them has been excellent and provided successful recovery for my clients who use them.
Yet, I have worked with too many clients, more recently, who have had poor, substandard experiences with the few private and detox facilities which appear to be focused solely on money rather than the client’s interests and welfare. This is not good enough. There needs to be accountability, especially as this is a vulnerable client group.
One private organisation called Pathways House in Canterbury recently engaged a client in a ten-week detox and treatment contract. The client had a recent previous experience of being in a residential rehabilitation that was very positive. The client had slipped in his recovery and needed the intensity that an effective residential rehabilitation provides. He was desperate to get help, no matter how much it cost. He was not in the best state to sign a long-term contract. I believe he was not in any fully functional mental state to be able to consider the detail of such a contract.
Within six days of being in this treatment facility, he could see the residential weekly program was scant with no group therapy, or educational seminars on addiction. In fact, all it had was two diary groups per week, some massage and brief meditation practices facilitated by volunteers, with the rest of the weekly program fluffed out with NA or AA meetings at night in the town. He decided that what they were providing was not meeting his needs. He wanted to leave the facility and use a different recovery treatment rehab that had an adequate structure. He spoke to the manager who would not give him a clear answer on the Pathways refund policy. He was not told how much of the ten weeks treatment costs he would receive back; the manager and owner said it was at their discretion. He said he was manipulated and coerced by this manager to stay for a few extra days which took him over the seven-day contract time, which effectively means Pathways could keep all of his money. A deleterious behaviour, I have noticed all to often in the drug field, is the transference of blame to the client by the practitioner. i.e. the client is the problem, not the service, the client is aggressive and manipulative, not the service, who is effectively trying to seize ten thousand pounds of a vulnerable clients money for substandard treatment.
This was the case with Pathways, where the client was made to feel his addiction was making him illogical in his requests and approach. He was left with a bill of ten thousand pounds to pay, which included the remaining weeks of his treatment that he decided not to go ahead with. For weeks I represented my client, helping him to negotiate with the facility, who were bullish in their approach, continuing to demand full payment. Eventually, after much discussion, causing further stress for my client at a difficult time in his life where he should have been focused on recovery, they accepted a final payment of £5,400 (initially only willing to return £3200, which is almost £10,000 for 9 days) – for just nine days treatment, two of these days being a weekend without any structure or input.
This is an extortionate expense for accommodation in a semi- detached house in the middle of a suburban area. I was aghast, especially as I compared fees of some of the mid – top of the range residential facilities which only charge £700 per day. My client was paying the highest fee range whilst the quality of the treatment he received was ‘shoddy’ at best. If the client’s father and I had not stood our ground and threatened legal action they would have tried to keep almost ten thousand pounds. I assume many vulnerable clients and/or family members, without my expertise in representation, has been duped to pay the full amount in this way.
This is not the first time I have experienced this. There are a few other rogue facilities, who are not subject to the stringent regulations that Local Authority and Health Services are: they overcharge for treatment and get clients to sign up to long-term contracts when they are in desperation to do anything to get clean and sober. These services are not always the best available, despite their high cost. The client is not given the option to consider the contract after being detoxed and being saner of mind to be able to consider long-term treatment options. After further investigation, I have found that some detox and treatment facilities actually build in a number of client drop-outs to their business plans. These clients sign up to long term contracts, but do not complete their treatment beyond a week or more; sometimes staying only a few days. For these unscrupulous businesses it is a win/win situation, full compensation for only a small portion of actual costs. However, it reflects poorly for the treatment sector as the family members and clients are left footing an extortionate bill.
There are a number of issues with this that I am now formally asking the Government, the Care Quality Commission and the Public Health England to look into:
- More stringent regulation for private detox and treatment services, looking at both the quality and price of service, as well as contract arrangements.
- Consumer rights for clients who sign up to private detox and rehab contracts at a time when they are not fully functional of mind and in a state of desperation. My belief is that there should be a ‘cooling off’ period, with an initial stage of treatment paid for, but the remaining weeks of treatment to be reviewed once the client has experienced the level of service and is more clear in their mind as to their needs.
- An expectation for private detox and rehabs to make clients aware of the public health services available for free, including Twelve Step programs and other self-help groups, as well as what they can provide themselves (thereby making the client aware that help is available both privately and publicly). This is something I do for the clients who see me and information is freely available to visitors to my website.
- Independent mediation service for clients of private detox and rehabs, so that they have a public body they can raise a complaint with if they feel unfairly treated or have entered into contracts they were not fully aware of at the time.
I believe this issue is limited to a small number of private detox and treatment centres; but that the effect on the clients who are treated this way can lead to relapse, financial ruin and harm to their mental health. This needs to be looked at by the government and the health regulatory authorities to ensure we have a healthy mixed economy of detox and treatment services for clients with chemical dependency that help them to overcome addiction and lead a life of recovery, without having their consumer rights violated.
The press release I have sent out about this issue is available here and the letters sent to The Hounourable Jane Ellison MP, Parliamentary Under Secretary of State for Public Health, The Hounourable Norman Baker MP, Minister of State for Crime Prevention, the Care Quality Commission and the Public Health England. I will be keeping you up to date on their responses.
I would welcome emails from anybody else who has experienced similar problems – if you have a story to share please email me at firstname.lastname@example.org and I will include your example in my submission to the Care Quality Commission.
For further information about this issue or to book Mark for an interview, please contact email@example.com or 07710 629 873.