Drugs bussed

"In England and Wales you have areas that are black holes, where drug users can't access any support services," says Reverend Martin Blakebrough, chief executive of charity the Kaleidoscope Project. In rural areas, he adds, the NHS can't offer the degree of personal support that many users need to kick the habit for good.

Housing associations can help to plug these gaps. The Kaleidoscope Project, a sister programme to south London's Kaleidoscope (Kingston) Housing Association, has provided specialist drugs treatment since the 1960s. Last October – at the request of Gwent Crime and Disorder Partnership – it set up a centre in Newport with a mobile unit that visits clients in the South Wales valleys. The entire cost was met by £400,000 from the Welsh assembly via Gwent's community safety partnerships.

For anyone hoping to set up a similar rural support service, Blakebrough says the first thing you need is wheels. He considered a bus but chose a huge, American-style motor home. Bought second-hand for £30,000, its sitting and dining areas have been left intact, which means staff can offer clients tea and coffee in an informal atmosphere. "Hospitality is important to us," says Blakebrough.

The motor home goes out three days a week to market towns within about 30 miles of Newport, stopping for three hours at a time. The charity worked with other sectors to identify areas of need, particularly Gwent's substance misuse action teams, which are made up of council, police and health representatives and meet every six weeks.

It is important to keep appointments, says John Lipscomb, senior project worker for Kaleidoscope in Wales. In high-demand areas of Kaleidoscope's run, up to 12 people turn up at the appointed time and place every week. "It takes people time to come to trust the service and sticking to certain times helps build up trust," says Lipscomb.

The value of discretion
Publicity must be low-key in order to avoid attracting opposition from local residents. Kaleidoscope's leaflets are only distributed to places that deal directly with drug users – health surgeries and police stations, for instance, because professionals such as GPs and police drug workers are the people most likely to encourage addicts to use the service.

Discretion is important when the outreach work is going on, too. Kaleidoscope's motor home has no labels on it, and the charity works with local authorities to identify car park sites that will not be busy with local people. "We don't want it to be so obvious that the community could stigmatise people who access the service," says Lipscomb. Many clients are also concerned there should be no CCTV cameras around that could expose their problems to other residents.

The main thrusts of Kaleidoscope's mobile service are a needle exchange and advice. "We help people to recognise the risk factors – for example, injecting into arms is less of a risk than your neck or groin because of their proximity to arteries and nerves," Lipscomb says. It also provides boxes in which clients can return used needles, rather than leaving them in public areas.

Keeping staff safe
Kaleidoscope rotates different nursing and project worker staff from its Newport base and always sends out two people for safety. The staff needed for a mobile drug support unit will vary according to the service it is going to provide: for instance, if you are going to prescribe heroin substitutes, you will need a doctor. A decision must then be made as to whether or not people will pick up their prescriptions from the main centre.

If, like Kaleidoscope, you insist on people making daily visits and being supervised when they take the drugs, it is a long way for them to come. But if they go to their local chemist, you will have to fund the drugs and any supervision.

Dispensing drugs from a mobile unit is unlikely to be an option, though, because this would mean convincing the ODPM, which issues licences, and the local police that the unit is safe. "Because you're not static, you can't wire up an alarm to the bus; and if you rely on a particular mobile phone signal and the mast goes down, you have no cover," Lipscomb points out. Also, the police would want to organise an emergency response team for the time the unit is in the area, "but if you're in a place for three hours and only three people turn up, is that an appropriate targeting of police resources?"

Forming partnerships with other specialist support services is helpful. Kaleidoscope's mobile staff point people to Newport-based personal advisers for one-to-one counselling and the hostel and education support centre run by Newport Action for the Single Homeless. Secure housing in particular can kick-start the process of helping people deal with their drug problems. Lipscomb says: "Drug treatment can be the first step in treating people's other problems, but they might not feel able to tackle life-threatening issues like drug addiction if they don't have a stable place to live."