Treatment service users (TSU) project: phase two

5.3 Summary

Page last updated: March 2011

Levels of awareness and understanding of consumer participation exhibited among service users across all five sites remained universally low throughout the project. A clear exception was apparent in those instances where consumer representative positions had been created as part of the demonstration project and the consumers fulfilling these roles were able to be interviewed. Importantly, the data suggests that most consumers did value the concept in principle once it had been adequately explained. Staff were generally more likely than consumers to be familiar with the term 'consumer participation' (albeit most without any professional experience) and broadly supportive of it. Aside from a minority of staff that remained consistently disinterested, opposition among staff appeared most vociferous when higher forms of consumer participation (such as staff recruitment or appraisals) were mooted.

The terms 'stability', 'ex-users', and even 'consumers', prompted a number of important conceptual and practical questions. The notion of 'stability', initially considered a 'positive' attribution of individuals, became a means to assess the suitability of services. The readiness of individuals to take on the responsibilities of consumer participation became a concern about the fitness of services to run the project. Not unlike 'stability', the terms 'ex-user' and 'consumer' have become normalised within the taxonomy of drug and alcohol practice and policy. However, like 'stability', these terms are neither neutral nor fixed: their meaning and application varied across treatment settings and between speakers, from senior staff to consumers. The fluidity (and power) of these terms need to be recognised in the context of this project where each carried considerable currency.

Expectations of the project remained low to non-existent among consumers due to universally poor levels of awareness. The exception, as noted above, was among those consumers interviewed who had been recruited as representatives. Staff were mixed in their aspirations for the long-term benefits of consumer participation. In the service where consumer representatives and staff had been the most vociferous in their initial expectations there was the most dejection, frustration and cynicism reported at evaluation (for reasons of project discontinuity, failed consumer representative remuneration etc). This 'failure' merely highlights the institutional vulnerability of consumer participation in its nascent stages and, most particularly, of those consumers who were drawn into the process in good faith only to be 'let down' by the very service which encouraged their involvement.

By way of explanation for the lack of progress with the demonstration project, several senior staff made explicit mention of their over-stretched, under-resourced service. It is also important to emphasise how services also consistently acknowledged they had underestimated the amount of work involved in implementing the demonstration projects. Here a parallel could be drawn between staff's baseline belief (in evidence across most services) that they did not require any specific training or education vis-a-vis consumer participation and services as a whole, being somewhat underprepared in their approach to the demonstration project. Careful consideration and planning needs to take place in future before services take on the complexities incumbent in consumer participation in this context.