PostScript Impact Report 2019-20

Annual activities & impact review April 2019- March 2020

PostScript360 formerly known as Battle Against Tranquillisers Registered Charity number 1056508 www.postscript360.org.uk

Our work

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Telephone Support Service.

We provide practical advice, counselling, tapering schedules, reassurance and support through a tailored recovery and support plan to tape off Benzodiazepines and other similar prescribed drugs safely. This service is for those who live outside or unable to attend our Therapy groups.

Therapy 300 This is a face to face service of counselling and group therapy for those who live close to Bristol, South Gloucestershire, Bath, North East Somerset. Therapy 300 is for people who want to withdraw safely off Benzodiazepines (Benzos) and other similar prescribed drugs and to improve their emotional and social wellbeing.

Advocacy Service Liaising on behalf of our clients to their GPs and other health care services to have a better understanding and outcome for the client’s wellbeing.

Training For health practitioners who come into direct contact with people who misuse prescribed drugs including benzodiazepines, Z drugs, sleeping pills, Pregabalin, Gabapentin and opiate-based painkillers.

Prevention Awareness Breaking down the barriers associated with prescribed drug dependence, understanding the harms and misuse .

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Our aims We are committed in supporting individuals to reduce the harms caused by prescribed drugs of dependence and withdrawal through a wrap-around service of one to one therapy, counselling, group therapy and a telephone support service. We train health professions, promote awareness and prevention, as well as supporting people through advocacy.

Our values are: Respectful of everyone we meet.

Responsive and person-centred approach.

Patience and understanding.

Sharing knowledge of best practice.

Creative and innovative approaches in solving issues.

Supporting people’s choices and their decisions.

Our beliefs are: Getting to know people as individuals, understanding their life stories, knowing how best we can support them.

Everyone has a right to dignity and respect as valuable individuals, no matter how they encountered prescribed drugs of dependence.

We aim never to turn anyone away through our services and by working with other organisations, ensuring individuals receive the correct services for their needs.

To challenge the health professionals and practitioners of the problems caused by benzodiazepines and other similar drugs, by promoting prevention awareness and sharing our knowledge.

To work with as many GP’s and health professionals in delivering a recovery and support plan for our clients.

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Why PostScript360 is needed Understanding the harms and social impact- it’s thought that as many as 3.9 million people in England that suffer from a dependency to benzodiazepines and other similar prescribed drugs (PHE was commissioned by the Department of Health & Social Care 2017 to assess the scale of prescription drug dependence in England). Benzodiazepines dependence is second to alcohol in the number of people who misuse or have a dependency to it. Given the epidemic portion of benzodiazepine dependence in the UK, you might reasonably ask why so many people’s lives have been devastated from a drug that is initially prescribed?

Dependence to benzodiazepine drugs is common. Many people who are prescribed these drugs for legitimate medical conditions will unintentionally abuse them and may then go on to develop a crippling dependency. Benzodiazepines are different from other addictive substances such as heroin or cocaine as they don’t give the user an intense rush or buzz. Instead, the effects generally come on more gradually, giving the user a sensation of calm and sedation that can last for many hours. Like any drug, the more you take, the stronger the sensations are.

However, Benzodiazepines are based on low-level, functioning dependence, where the user treats the drug as a pharmaceutical medication, keeping the levels constantly ‘topped up’.

Anyone who has struggled to stop using benzodiazepines will be aware of the serious affects they have on the mind and body. The drugs are designed to influence almost every part of the brain; that is why they are so effective as anti-anxiety medication. But it is also why they can be so difficult to stop.

Benzodiazepines work by literally slowing down the functioning of the brain. They do this by enhancing the actions of a chemical in the brain called GABA, (gamma-amino-butyric acid).

GABA is an important part of our brain’s natural sedating instrument; it sends messages from brain cell to brain cell telling them to slow down or stop firing completely. Normally, it is released in times of high stress and acts as a leveler, allowing us to continue what we are doing without being overcome by anxiety. However, when GABA levels are artificially increased by Benzodiazepines, it can lead to several effects, from slurring words, dizziness, sleepiness to total blackouts.

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One of the effects of GABA is the suppression of important natural ‘reward’ chemicals such as serotonin and norepinephrine. This causes the increased release of a chemical called dopamine, which causes feelings of calm and contentment. When benzodiazepines are used for a long period, the brain responds by reducing the amount of these neurotransmitters it naturally produces, leading to a reliance on the drugs just to feel ‘normal’. There is no single cause of benzodiazepine

dependence and abuse. There are, however, risk factors that

increase the likelihood of a person abusing his or her medication. Although family history and genetics tend to play a role, certain environmental factors contribute such as stressful jobs, bereavement, mental health issues and the majority of PostScript 360 client’s is anxiety and mental health (60%).

The way in which these benzodiazepine drugs can affect the brain is a tendency for a tolerance to develop. This basically means to ‘achieve the same level of relief from your medication that you did when you first started to take it, you need to up the dose to get that specific level of relief’. Addiction starts when physical dependence has developed, the person wants to avoid unpleasant withdrawal symptoms more than what society believes prescribed drug dependence is. The user feels depressed, their anxiety is out of control their GABA levels are no longer working correctly, they take the medication not for pleasure but purely to get some form of control, knowing at the same time they are damaging themselves even more.

Once a user is at this stage of their dependence, they will buy their medication online and from dealers on the street, not knowing what they are buying and entering into the Novel Benzodiazepine market.

If an individual has misused benzodiazepines and suddenly stops, they are at risk of many health issues such as drowsiness and confusion, dizziness and blurred vision, lack of coordination, difficulty breathing and many more associated health conditions; more seriously if mixed with alcohol and other drugs this can result in coma and death.

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Benzodiazepine-related deaths by year of death registration for England and Wales 410 [ONS, 2019], Northern Ireland 100 [NISRA, 2020] and Scotland 800 [NRS, 2019].

Toxicity arising from overdose or use in combination with other central nervous system depressants is a relatively frequent Emergency Department presentation [EMCDDA, 2018].

Death arising from the use of benzodiazepines is thought to be uncommon in otherwise healthy people, unless other drugs or alcohol have also been used. Data provided by the National Programme on Substance Abuse Deaths (NPSAD) showed that in England between 2006 and 2015 there were 5740 benzodiazepine related deaths. Of these 5740 deaths, 207 (3.6%) recorded benzodiazepines as the only compounds implicated in the cause of death.

Deaths and data from https://www.gov.uk/government/publications/novel-benzodiazepinesprevalence-and-harms-in-the-uk

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Moving forward In the first quarter (April – June 2019) PostScript360 formerly known as Battle Against Tranquillisers, focused on consolidating, testing, adapting and improving our services to meet the needs of our clients (service users). To build a robust organisation fit for future expansion, the Trustees appointed a CEO in June 2019 to create a stronger platform from which to launch the growth of the charity to: Reach more people through group therapy to have a better chance of overcoming prescription drug dependence.

Grow our therapy groups in our communities, empowering participants to make better choices around their well-being.

Reduce the number of people misusing and developing a dependency on prescription drugs.

The charity’s aims are to improve our existing services by innovating changes for a more person-centered approach. Our goals are to disseminate our new programme called Therapy 300 in the second quarter, that assists clients to make the necessary changes to improve their mental, emotional and physical health. Our holistic wellbeing package aids clients to make changes to their daily lives by using a mind mapping therapeutic tool which helps them address improving their connections to society, diets, health/fitness and social networks. The mapping techniques show how feelings, actions, thoughts, and facts are connected, to then address the underlying issues that may have caused clients to take benzodiazepines and other similar drugs in the first place. The data collected from our existing clients assisted us to give a realistic time frame for individuals to complete Therapy 300 of 18 to 24 months to withdraw from benzodiazepines and other similar drugs safely and successfully.

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Moving forward At the end of the first quarter of the year the charity relocated to a bigger office in the Kingswood Estate Bristol to accommodate a work force of five staff. It was a constructive move for the charity enabling better communication amongst staff and being around other charities, creating a more inclusive community at the Kingswood Estate.

In the second quarter, the charity CEO and management produced a three-year fundraising strategy, an income and expenditure budget and a business plan to focus on the specific steps necessary to achieve both the charity's short-term and long-term objectives.

Scaling up Our aim is to reach more people in need of support, we did this by promoting Therapy 300 through GPs, communicating through social media, marketing and networking with Clinical Commissioning Group, health professionals, similar organisations supporting people with drug dependency and addiction. The charity joined CVS South Gloucestershire Leaders Board with over 32 charitable organisations, presented an awareness prevention talk at the University of the West of England (UWE) for a joint multi-agency drugs group involving Bristol University, UWE, Avon and Somerset Police, other drug agencies and charities. We presented our new service to the staff at Developing Health and Independence. Throughout the year we attended networking events at the Care Forum, Recovery Festival and other charity events.

We expanded our Telephone Support Service as soon as the CEO was in post in June 2019 from 12 hours a week, to 30 hours a week, opening the Telephone Support Service from 10.00 am to 4.00 pm, 5 days a week, with a new range of practical and emotional support based on Therapy 300.

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Therapy 300 was introduced to new and existing clients in the third quarter after the programme had been endorsed by a member of the South Gloucestershire Crisis and Primary Health Care Team. Once the clients have completed the programme, they will receive a certificate of completion and will be invited to join the 360 Club for additional support if needed. The 360 Clubs will be a peer to peer support groups (an alumni type service) ran by volunteers, especially by former clients that wish to help others, and hopefully the Clubs will take on challenges together to fundraise for the charity.

As the service grows, we aim to host two more groups at Southmead hospital by 2020 and expand our locations in Bristol, BANES and South Gloucestershire by 2021.We will approach other hospitals for rooms to run our Therapy 300. Going forward we will invite new clients to Gloucester House, Southmead Hospital for their assessment and recovery support plan, conducted by the charity staff and to offer one to one counselling before entering group therapy. This will reassure the client, bringing a more professional approach rather than meeting clients in cafes and safeguard our staff of lone working, giving them added security of conducting assessments and counselling within the hospital environment.

We will train volunteers for our peer to peer support groups (360 Clubs) as part of our growth.

We aim to attract volunteers that have had experience of withdrawal from prescribed drugs and have been free from dependency for 12 months, people who may have had a family member/friend affected by drugs, or individuals who wish to have a career in supporting people in this field.

For our Telephone Support Service and counselling we aim to train volunteers to answer our telephone support service, our objective is to attract student placements who are studying counselling in their third year at university, or counsellors who wish to gain experience to return to work.

By 2022, we aim to introduce a new programme for young people from the ages of 16 to 25 years, promoting prevention awareness and a package of support to schools, colleagues and universities.

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Communications To move the organisation forward the charity changed its name in January 2020 to PostScript360. The word ‘Tranquillisers’ is rarely used, to those who are not familiar with prescription drugs believe that tranquillisers are administered to put a person or animal to sleep. Using the word ‘Battle’ in our name was also not suitable because we work together with the clients, the medical profession and partner with other organisations.

‘PostScript360’ is a positive name, moving the client forward from benzodiazepines and other similar drugs, 360’s means to ‘turn a life around’. Therapy 300 is part of a recovery plan (300 is 83% of 360) to meet the needs of a client’s journey to be free or to significantly reduce their dependence from benzodiazepines and other similar drugs, by empowering individuals to live a more fulfilling life.

Turning your life around

To maintain the client’s recovery and to avoid lapses or relapses, we will introduced peer to peer support groups called the 360 Clubs. The name of the clubs gives our clients dignity and respect especially when hosting meetings in cafes or other public places, no one will know the significance of the name, only to those who are participate in the Club.

360 Club

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Communications The new name PostScript360 has opened doors to reengage with existing organisations, giving the charity opportunities to market our new services, as well as highlighting the charity is under new management, creating a greater interest in our services and our people.

The charity produced new service leaflets that clearly explain our services to potential new clients, GP’s and other health care services. In December 2019 we contacted 90 GP Practices by direct mail in Bristol and the Greater Bristol area, providing them with our service leaflets, asking practice managers to display our leaflets in their waiting areas, or for GPS to hand them to their patients. Within a week of posting we received six new referrals from GP’s.

We updated and refreshed our existing website with the name change and photos, rewrote content about our new services, about the charity and its trustees. We introduced a donate button, a fundraising tab and added a useful guide on how to fundraise for the charity. This will continue to evolve with the charity.

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Income generation and fundraising To make our services economically viable, we introduced a culture of asking for suggested donations by the staff, which at the beginning was uncomfortable for some, however once we hosted presentations to other similar organisations it quickly became apparent to the staff that this was part of other charities ethos too.

Areas of income generation are: Training health practitioners and organisations for a fee.

Individuals who are working and can contribute a donation towards our services.

Individuals living outside the South West area who require our Telephone Support Service that are working to contribute a donation towards our capacity and delivery of the telephone service.

Presentations to companies for a fee or to fundraise for our charity Prevention, awareness and support programmes to schools, colleges and universities, through a fee or fundraise for the charity.

Asking for support from our clients once they join the 360 Club (peer to peer support clubs) through fundraising activities or monthly donations.

Applying to grant giving charitable trusts, parish councils and statutory funders such as the Lottery.

w Ne ces ur o res

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Our objectives Through Therapy 300, Telephone Support Service, Advocacy and Training we aim to empower and enhance our client’s recovery, knowledge and inspire self-esteem. By improving our expertise, and sharing our learning, we advocate for best practice amongst our partners, collaborators and peers. The Impact we want to make is: to support 320 people to withdraw safely from prescription drug dependency to be free or to significantly reduce their dependence to be able to cope with everyday activities in 2021; to have six support groups held at hospitals in the surrounding areas by the end of 2021; to grow our 360 Clubs, peer to peer support to other areas in the UK within the next three years; to enable 200 individuals who are recovering from dependency, to be active and empowered in their community through our Therapy 300 programme in 2020/1; to provide six volunteering opportunities through student placements and those who want to come back to the professional to have a greater understanding of the harm prescription drugs have on people’s wellbeing; to provide a bespoke support service to students at universities, colleges and younger people in the wider community who want to be dependence free from benzodiazepines and other similar drugs by 2022/3; to promote awareness of the harm of buying benzodiazepines and other similar drugs from the internet with short information videos via social media, presentations and events; to be the ‘go-to’ organisation for training and expert knowledge of the effects of benzodiazepines and other similar drugs by the health professionals and practitioners; to reach more people in need of our support, we will offer online counselling throughout the UK by 2023.

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Our impacts

Direct impact on more than 3,500 people of the harms and misuse

Provided advocacy for 60 people

Answered 4,100 telephone calls of help and support

Provided 100 days of one to one counselling

7,500 people engaged with us

Supported 103 people with complex cases

Our total successful exits – 90%. This contrasts to Public Health England overall successful exits of 49% in 2016-17.

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Meet our CEO PostScript360 is pleased to welcome our new CEO, Terri McDonald who took up the position in June 2019. She joined us with an impressive CV, having enjoyed a long career in the charity sector which includes overseas development, mobility disability, medical research and degenerative health conditions. Terri has a breadth of experience in several disciplines, which include senior management of operations, communications, finance, sales & marketing, corporate partnerships, fundraising and events, change management and business development in sustainability.

Prior to the charity sector, Terri had a career in marketing and sales in a newspaper group, and previously to that ran her own business in fashion, comprising of several retail outlets.

“I am delighted to join and lead the PostScript360 team, I have a passion and drive to make society fairer, more caring and more inclusive. I am commitment in caring for the welfare of people, to increase prevention awareness of dependence, and to tackle the stigma often associated with it. With a great team, together we will enrich the social, mental and emotional wellbeing of individuals overcoming prescription drug dependence.

There are simply not enough provisions to access support from our health care services to taper from prescribed drugs associated with dependence and withdrawal. It can take months and sometimes years to be dependence free. This is a significant public health issue that needs to be addressed. People are often referred to general drugs services, which do not have the resource, training or skills to manage prescription dependence. To overcome the inconsistent provision of support across the UK, a national approach should be adopted to understand the time related to tapering from prescription drugs. For GP’s to be able to work in partnership with local organisations that specialise in withdrawal and tapering management.

My attention is ensuring we are fit for future expansion to reach more people in our community who need support, using innovation to improve our service delivery, technology to improve communications and finding new opportunities to generate more fundraising income and ultimately for the charity to become sustainable. I am also ardent about being able to demonstrate the difference we make as an organisation in our communities and to build partnerships with other organisation and primary health care. My focus is to grow our services and volunteer groups to showcase the impact we deliver both internally and externally”.

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Meet our newest trustees Ian Smith has extensive knowledge and experience as a business growth consultant in both the private and public sectors having worked with several high-profile names such as AXA, Prudential, NHS and a host of Fintech Start-ups. Ian is a great asset to the charity bringing business skills and financial expertise to the team.

Sophie Knight’s background is in service delivery, working for the CAB, a housing association and various charities providing support, advice and representation to members of vulnerable groups. These have included domestic abuse survivors, people with learning disabilities and food bank clients. She was a founding trustee of ‘Fair Frome’ With a combination these skills and with her own determination to survive a chronic illness. When she was not well enough to work, she studied, earning a MRes in Politics and Sociology from the University of Bristol. Sophie has gained a unique perspective as both a professional and a service user.

Michelle Wynne has extensive career in management, first in the private sector as a Corporate Claims and Insurance Manager and more recently as Business Support Manager in the voluntary sector, my specific interest are the implementation of processes and procedures to ensure the smooth implementation and management of processes to manage performance and efficiency.

Alex Wingrove has a wealth of experience working within youth services offering opportunities and support to young people, particularly those from disadvantaged backgrounds. He also brings to the charity ICT skills in business support.

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2019 Annual Review

Meet George After a long talk with my partner who was about to leave me, my real recovery began. I spent a few months trying to cut my use again, but with no success, I searched online for local drug support organisations and found Bristol Drugs Project. I spent hours anxiously going over in my head what I would say, whoever I spoke to on the phone was very helpful and understanding. They told me they don’t have services to help with benzodiazepine use directly and signposted me to PostScript360 who have been helping me ever since.

They drew up a reduction plan for me to give to my GP and liaised with them on my behalf, the counsellor made it clear that I shouldn’t feel pressured to make any cuts to my dose until I am ready, that I was the one in control of my medication. I’ve been attending all my group sessions with PostScript360 every week, confronting my demons. One day in late January, I’m on a bus to the PostScript360 group having just told my partner to “get lost” while storming out of the flat, seething from the withdrawal. Some days, I just feel blank and empty inside, other days it’s like having a head full of bees. Why did I say that to her? but now I know it’s just the withdrawal talking.

With the support group therapy, it’s always very liberating to let it out, simply knowing that I have a safe space with other people going through the same, makes the process easier. I have learnt so much about myself, removing triggers and making positive choices. I have nothing but infinite gratitude towards PostScript360. They give me strength, and strength is a rare resource to find in the depths of withdrawal. I’ve kept reducing my use with the help of PostScript360, unbelievably my girlfriend is still by myside and I’ve even come clean to my friends and family.

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Chair Trustee Rob Farrow I am grateful to everyone who has supported us with our new improved services, we have a real opportunity to revolutionise the way we meet the needs of people overcoming prescription drug of dependence.

PostScript360’s wealth of dedicated staff, volunteers and expertise means that we are uniquely placed to make a real difference to people’s lives and to eradicate the stigma associated to dependency through sharing our knowledge, prevention awareness, being kind and supportive to those that need us the most.

Our new strategy focuses on ensuring that our charity’s integrity underpins everything we do.

This means challenging ourselves to ensure that we strive for the biggest impact for all our beneficiaries, and every organisation that works with us.

This year will test us all, never have we had to face the onslaught of Covid-19. The after mass of this pandemic will have huge implications to everyone’s well-being, the economic downturn will be felt across the world, and will take a long time to recover. The ripple effect will be immense with a greater number of people having post-traumatic stress disorder, anxiety, depression, substance use, loneliness, and domestic violence. Ultimately, as a charity we must function for the public benefit in our society and adapting to meet the changing environment.

We know once the restrictions have been lifted, there will be an even greater demand for PostScript360 services, as well as our fellow colleagues in other charities and other organisations. This is the reality we face and recognise collaboration is essential to enable us to share and develop our expertise, improve our reach and increase our capacity, so we can effectively meet the needs of those who need our services. This coming year will be a journey and a half, making us stronger and creating more opportunities.

Rob Farrow Chair Trustee

2019 Annual Review

In memory of our Founder Una Corbett who sadly died on 16th February 2020

Una was a crusader against tranquillisers from personal experience and taking up the fight for thousands of people whose lives has been devastated through dependence of benzodiazepines and other similar drugs. After retiring from teaching, Una set up a weekly self-help group in January 1986, at St James Church in the Centre of Bristol. During that year the Bristol Drugs Project opened, offering Una a room to hold support groups as well as the Susan Britton Wills Unit at The General hospital. Una was recognised for her services and won the regional gold medal in ‘Medical Community Award’ in 1991 by the Association of British Insurers. This continued and in March 1996 Battle Against Tranquillisers (now PostScript360) became a registered charity.

By this time Una had gained a reputation of expertise in the field of withdrawing from Benzodiazephines and other prescribed drugs, she was invited to worked with the Bristol Mental Health Trust and others to develop an Integrated Care Plan approach for Bristol, this was the beginning of a real structure for clients in mental health services. That year the Pompidou Report (United Nations Economic and Social Commission on Narcotic Drugs) produced a report which recommended that for every new benzodiazepine prescription issued, should include an exit strategy.

Una continued in her crusade writing reports, guidance information, improving policy framework for the prevention, identification and management of involuntary dependence to prescription medications. She never gave up the fight, it was never in her nature; three weeks before her death Una continued supporting former service users.

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PostScript360 1st Floor, East Wing, The Kingswood Estate, Britannia Road, Kingswood, Bristol BS15 8DB Tel 0117 966 3629 Email info@postscript360.org.uk www.postscript360.org.uk

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Registered Charity No. 1056508