Favourite public services: mental health: The last chance court

The Family Drug and Alcohol Court (FDAC) is a service for families in danger of having their children taken into care because of their substance addiction problems. It's a collaboration between Coram and The Tavistock & Portman NHS Foundation Trust, commissioned by Camden, Islington and Westminster councils, with funding from central government.

Why it’s on the list

Research shows that two-thirds of all care proceedings in England and Wales are related to parental substance and/or alcohol misuse. Judge Nick Chrichton, pioneer of FDAC, thinks in inner London it’s closer to 80%. The social and financial costs of this traumatic process, for parents and children are catastrophic. This court is a truly innovative approach that deals with this issue. It’s a collaboration between an NHS provider, a third sector provider, local authorities and central government – all working together to solve this problem.

What is so different about it?

Whenever I explain to someone how this service works, they always have the same response. “Isn’t this how these care proceedings work already?” The model seems to make so much sense to people that they assume all services must operate in the same way. But in reality it’s far from the norm. There are a number of key differences.

The first is related to culture change. The FDAC team welcome the families who enter the court – often families who have had children taken into care before and are considered the most complex and troubled – with the positive assumption that they can and will succeed. This may seem like a minor detail but it has a huge impact – they have usually become used to the assumption that they will fail.

Often, when parents enter court proceedings of this kind they are told to get clean but they aren’t supported to get clean. It’s obvious to most people I speak to that they are unlikely to do this for themselves. Many have been involved with drugs for most of their adult life, and often there are complex emotional problems that have led to them using drugs in the first place and these need to be worked on if they have any chance of success. With FDAC, once parents commit to getting clean they are immediately supported. A highly-skilled, multi-disciplinary team steps in – and they draw on peer volunteers in the form of parent mentors who have had similar problems to supplement this with authentic ‘people like us’ relationships. There are drug and alcohol treatment specialists, nurses and social workers, adult and child therapists. And they work holistically – they address the full range of parents' problems - addiction, debt, housing, relationships, mental health and domestic violence.

Another powerful difference is the court itself. It gets rid of lawyers. This may seem scary but it actually creates a more intimate, more positive environment. It also meets families more regularly, and there is a continuity of relationship between them and the judge – they see the same judge each time. One of the explicit roles of the judge is to encourage and motivate parents as they progress through the programme.

Why is it better for service users?

FDAC has two success criteria:

1. That parents are supported to get clean, stay clean and remain with their children
2. If this cannot happen – and let’s face it many of these parents are often facing incredibly difficult journeys to get there – the child is removed into a stable placement around a schedule that is right for them

And it works. The service was independently evaluated by Brunel University. It showed that more parents are supported to remain with their child. Parents graduating from the programme have successfully engaged with treatment, stayed clean and have remained with their children. And overall the service is much faster.  The team can do an assessment in two weeks that could take social services four months. They work around the needs of the child, in that they assess a deadline for parents on the basis of what is right for the individual child involved – children of parents unable to consistently stay clean have been removed from dangerous and damaging environments quickly and moved to stable placements. And when this happens parents usually remain in positive interaction with the service even when they place their child up for adoption. This makes it much less likely they will return to care proceedings at a later date. This may seem miraculous when you think of the mistrust these families often have of all professional interventions, never mind those that result in their child being taken away from them. And to back this up FDAC has already won a number of prestigious awards, including the Guardian Public Service Awards.

Is it cost effective?

The cost of a case at around £12,000-13,000 is not expensive, but this is not the cheapest solution out there. Due to extra court time and specialist intervention this service is more expensive than some, per case. However, there are likely to be long term cost savings. Parents are less likely to re-enter the system with identical problems. Children enter stable placements more quickly and are less likely to suffer trauma as a result due to high risk of emotional neglect and abuse. Although it’s too early to gather data on the children involved, it is predicted that these children’s life chances will be improved, they’ll do better at school and be less likely to need mental health services later, with a likely reduction in youth offending. These children would be disproportionately likely to become drug addicts themselves - entering into the same cycle as their parents – so this service helps to break this expensive generational cycle.

Unfortunately, as this was a pilot project central government funding runs out this month. The team are worried that FDAC is at risk as they are concerned that local authorities tasked with finding significant cuts in the current economic climate, will not be able to cover the full costs.  If this happens it will be a real shame as I’d like to see this model being replicated elsewhere.