Introduction
In the last few weeks, I have been asked twice to reflect on accessing and generating community capital in the context of residential treatment. The first time was for the European Federation of Therapeutic Communities (EFTC) conference in Glasgow and the second time was for a partnership project on REC-CAP with a residential treatment facility in the southwest of England called the Nelson Trust. I am also honoured to be a part of the Scottish Government Residential Rehabilitation Working Group, chaired by the fabulous Dr David McCartney of the Lothians and Edinburgh Abstinence Project (LEAP). More about the Nelson Trust shortly, but I wanted to start with a couple of basic premises about residential treatment:
- In spite of growing scepticism among some academics and commissioners, the evidence would suggest a clear role for residential treatment and that it is an essential option in any comprehensive recovery-oriented system of care
- However, residential rehabs have often not maximised the gains they could achieve by not focusing enough on the concept of throughcare, in particular, what happens to people after they leave rehab
- Linked to this, there is a problem that often arises in the third and final residential stage of ‘emergence’ in residential programmes where there is some level of community engagement but it is not always linked to what comes next
Social capital and recovery capital
There is a wonderful book on social capital by Robert Putnam called ‘Bowling Alone’ which differentiates between bonding capital (the strength of associations in established and equal groups) and bridging and linking capital (which is about connections to new and different groups, that are both equivalent and different.
In my own work on recovery capital ‘ ‘Desistance and recovery capital: The role of the social contagion of hope’ , published in 2019, I argued that the way to build personal recovery capital (over the course of the recovery journey) is to generate social and community capital that creates the space for people to belong to new groups, learn new roles and rules and access the resources and activities that can generate hope and the belief that recovery is possible and realistic.
What I would now add to that, based on a paper called ‘Ice Cream and Ink Spots’ that I wrote with Jo-Hanna Ivers in 2021, is that the process starts with access to community capital (i.e. new groups in the community) that can generate (directly or indirectly) social networks and supports (social capital) that then allows the individual the time and space to build their own resilience, coping skills and the resulting self-esteem and self-efficacy that are at the heart of sustainable personal recovery capital.
So the conceptual starting point in creating a framework for recovery to happen is to build bridges to pro-social groups and activities. There are three types of community recovery capital:
1. Professional resources – for some people this will mean counselling and psychotherapy to address trauma, for others access to the dentist or primary care physician, as well as to mental health, housing and employment services
2. Recovery resources – this includes mutual aid groups like Alcoholics Anonymous, Narcotics Anonymous and SMART Recovery (both face to face and online) as well as what are referred to in the US as RCOs (Recovery Community Organisations) and in the UK as LEROs (Lived Experience Recovery Organisations). This category will also include accessible, attractive and visible recovery champions and leaders
3. General community resources – which includes things like libraries, colleges and community centres, as well as the more local specific resources like clubs and associations (yoga classes, football teams, churches, environmental groups and so on).
Different people will need different combinations of these things and each person will need different combinations at different stages of their journeys, so diversity and richness in all three categories are essential.
What they do is to provide the two central pillars of recovery – meaningful activities and positive social networks. Each one affords the opportunity for positive human connection, new senses of belonging and identity and a sense of empowerment and purpose.
Nelson Trust: So what does this have to do with residential treatment?
Like many residential services, the Nelson Trust, who have a wonderful mission of helping residents to build recovery capital in a trauma-informed way, have developed a third stage of residential treatment that is built around their Recovery Hub, an activity centre that supports residents to engage in volunteering, community engagement and to give residents the resources they need for the next stage of their recovery journey.
The staff (the vast majority of whom are in their own recovery journey) have made huge endeavours to build diverse and interwoven connections into the local community that provides a wonderful continuity and set of supports for people who resettle into one of the recovery houses that are linked to the residential treatment facility. Their locations in Gloucestershire, Stroud and Gloucester, have become strongholds of recovery and there are vibrant recovery community capital resources and links to both the professional community and the local lived communities.
Furthermore, the Nelson Trust has also committed to implementing the REC-CAP as a commitment to the science of recovery and continuing to monitor their residents even after they have left the residences and returned to the community.
This is a crucial transition for a recovery residence moving from being a ‘house on the hill’ to a contributing and positive force and resource in the local community, challenging stigma and building bridges and links to the local community. These bridges provide the basis for building sustainable community recovery capital, and making it easier for each subsequent generation of residents to access community resources, supported by graduates of the programme already engaged and by community groups who acknowledge that the relationship is mutually beneficial.
What is the flaw in this plan?
But here is the rub for the Nelson Trust and for every other residential treatment provider. This is a great system for residents who are able and willing to permanently relocate to Gloucestershire, but not so good for those who, as a result of family commitments, and other personal reasons, have to return to other parts of the country, where the Nelson Trust (and all of the other rehabs) have limited ability to generate or even to corral recovery resources.
As the world of LEROs (and RCOs) grows in the UK and US, there may be growing opportunities for partnerships where residential treatments link to the LERO in the area that the resident returns to, but at present this is patchy.
Similarly, for some people, online resources may provide at least a partial solution to this challenge as would recovery management check-ups provided by the residential facility.
However, the challenge remains that for many people the departure from a residential rehab, is one from high social recovery capital (within the rehab) to low or negative social capital (particularly if returning to areas where most of the available network involves people who are still using). This is a problem not only for the providers of residential treatment but especially for those commissioners who allocate funding for distal placements.
Regardless of the effectiveness of the particular rehab, the impact on recovery capital will be contingent on a continuity of access to community recovery capital.
In conclusion, there are three (measurable) conditions for testing the likely benefits of referring people to residential treatment away from their home areas:
1. Only commissioning residential treatment providers who have a strategy for engaging community capital in their later stages of treatment
2. Building effective bridges from the recovery residence to local community recovery resources for those returning
3. Having an adequate set of recovery resources available and accessible in your area to sustain and further build the recovery capital gains achieved in residential treatment