Rehabilitation Work

Supporting Desistance and Recovery

Hannah Graham

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9781138499454
• eBook ISBN: 9781317497387
• Edition: 1
• Topic: Social Sciences
• Subtopic: Criminology
• Index: Social Sciences

Conversations about rehabilitation and how to address the drugs-crime nexus have been dominated by academics and policymakers, without due recognition of the experience and knowledge of practitioners. Not enough is known about the cultures and conditions in which rehabilitation occurs. Why is it that significant numbers of practitioners are leaving the alcohol and other drugs field, while disproportionate numbers of criminal justice practitioners are on leave?

Rehabilitation Work provides a unique insight into what happens behind the closed doors of prisons, probation and parole offices, drug rehabs, and recovery support services drawing on research from Australia. This book is among the first to provide a dedicated empirical examination of the interface between the concurrent processes of desistance from crime and recovery from substance misuse, and the implications for rehabilitation work. Hannah Graham uses practitioner interviews, workforce data and researcher observations to reveal compelling differences between official accounts of rehabilitation work, and what practitioners actually do in practice. Practitioners express a desire to be the change rather than being subject to change, actively co-producing progressive reforms instead of passively coping with funding cutbacks and interagency politics.

Applied examples of how practitioners collaborate, lead and innovate in the midst of challenging work are complemented with evocative illustrations of insider humour and professional resilience. This book is a key resource for students, academics and practitioners across fields including criminology and criminal justice, social work, psychology, counselling and addiction treatment.

1
Introduction

It was the best of times, it was the worst of times …
It was the epoch of belief, it was the epoch of incredulity,
It was the season of light, it was the season of darkness,
It was the spring of hope, it was the winter of despair

(Charles Dickens, A Tale of Two Cities (1859))

Rehabilitation is changing. It is changing in ways that impact the people at the centre of rehabilitative services and systems, ways that also bear influence at the levels of institutions, workforces and sectors. Contemporary rehabilitation, and the lives of those in the process of it, has attracted an inordinate amount of scrutiny from academia, policymakers and the media over the last four decades. Rehabilitation has been attacked and problematised, dismissed as irrelevant, as well as ‘saved’ and reconfigured (Bauman, 2000; Cullen, 2005; Cullen and Gilbert, 2013). Its absence may render the corrective mission (be it punishment, treatment or both) inhumane. Yet its presence and use in criminal justice and health systems seems to invariably leave it open to challenge. The legitimacy, efficacy, and identity of contemporary rehabilitation have been contested and under threat for a while (see Ward and Maruna, 2007). Like Charles Dickens’ (1859) sentiments about the best of times and worst of times, there is an observable polarity in the seasons that have been weathered by those who do rehabilitation work, and this is partly dependent on whose voices and discourses dominate at any given time. Ironically, there have been countless calls for reform and culture change in rehabilitation sectors whose expertise and core mission is helping others reform and change. The dynamics and politics of fiscal, policy and social change mean that the focus and forms of rehabilitation may regularly change, but not always in line with the intentions of those seeking its reform. Nowhere is this more apparent than in the United Kingdom and United States, however, jurisdictions such as Australia and New Zealand have not remained immune.

Drugs and crime are lightning rods for public opinion. Wars on drugs and crime have been waged for years in the West. Considerable attention has been devoted to understanding the nexus between them, preoccupying policymakers and scholars across criminology, public policy, health sciences and social care (see Bean, 2014; Hammersley, 2008). At the heart of this lies an imperative to better understand the personal factors, institutional responses and policy levers which might effectively reduce rates of reoffending and relapse, and minimise associated harms and costs. In essence, most stakeholders have focused on the contributing circumstances and risk factors which may compel individual trajectories into criminal careers and habitual drug use. Until relatively recently, less attention has been given to understanding processes of desistance from crime and recovery from addiction and substance misuse, that is, the factors, circumstances and opportunities related to pathways out of drug use and crime.

Why research rehabilitation work?

In discussions of responses, much of the extant empirical literature has been devoted to concentrated analysis of rehabilitation in terms of interventions and institutions. Ward and Maruna (2007: 29) aptly suggest that ‘every criminologist knows what rehabilitation is, but few of us have actually described how it is supposed to work’. Arguably, the same could be said of those studying drug rehabilitation. Critically, is it reasonable for academics and policy architects to conceptualise rehabilitation principally in ways that expect it to ‘work’? Are we talking of professional practices, or personal processes, or both? In seeking to address this knowledge gap, too often discussions of rehabilitation theories are de-contextualised. A critical lacuna remains: not enough is known about the cultures and conditions in which rehabilitation professional practices and personal processes occur. Where these things are examined, they tend to be understood and bounded in a segmented fashion. This includes, for example, studies which investigate a specific type of practice (risk assessments, pre-sentence reports, pharmacotherapies), a specific type of practitioner or occupational group (prison officer, forensic psychologist, social worker, alcohol and other drugs nurse), and in the context of a specific institution or setting (the prison, probation, drug court, mutual aid group, or therapeutic community). Studies that position their findings with consideration for more than one actor and more than one context are the exception, rather than the norm. Yet, individual processes of recovery and desistance, which include rehabilitative service provision and supports along the way, often show that people engage with more than one type of practitioner and service, in more than type of one setting over time.

To date, limited research has investigated the dynamic influences of concurrent desistance and recovery processes on rehabilitation in different settings, nor examined how diverse types of practitioners support individuals living with multiple complex needs through such processes. Incorporated throughout this book is a focused overview of desistance and recovery scholarship and practices. It is among the first texts to provide a dedicated examination of the interplay between the two.

Research focus and rationale

This research seeks to develop a more multi-faceted understanding of the cultures and practices involved in rehabilitative service provision. It is exploratory and explanatory in nature, delving into the normative and cultural dimensions of two fields – criminal justice and the alcohol and other drugs sector in a given jurisdiction in Australia. This book will seek to incorporate consideration of the dimensions and contexts of rehabilitation work, including reference to: historical, physical and material, psychological, social, emotional, moral and ethical, ideological and philosophical, procedural, temporal, spatial, technological, fiscal, political, legal, organisational/institutional, structural and societal contexts.

The word ‘rehabilitation’, as acknowledged at the outset of this book, is common parlance in criminal justice and alcohol and other drugs literature and practices. The title of this book raises the question: why call it ‘rehabilitation work’? To be clear, this phrase has not been devised out of a motivation to reject or counteract the language of other academics. It has not been chosen out of a desire to coin a shiny new term – the fields of interest do not need any more of those! It is employed here to deliberately distinguish the centrality of rehabilitation as a lived experience, as a personal process of human development which may (or may not!) be associated with processes of desistance from crime and recovery from substance misuse. Some people desist or recover for reasons other than professional intervention and service provision, and some people do so with no interaction with professionals. Nonetheless, where they are involved, which would likely be a vast number of cases, ‘rehabilitation work’ as a book title and term positions practitioners as helping professionals who work to support such processes.

‘Rehabilitation work’ is differentiated from ‘What Works’; the differences between the two become clear throughout this book, especially in discussions in Chapter 2. ‘What Works’ represents a movement towards evidence-based practices that, while having some utility, can be critiqued on the grounds of its ontological assumption that academics and practitioners, as experts, know best what ‘works’. In reality, the bulk of evidence-based practice discourses focus on risk and its reduction, which is not the same as capturing the fullness of what is involved in rehabilitation. Rehabilitation is not something that is done to a person in a way that ‘works’ to induce change. Practitioners are not the owners or producers of rehabilitation; they are (among others) the enablers and supporters of it. They have developed an expertise (body of knowledge) and skills from their experiences of working with people, supporting them to rehabilitate themselves. The other aspect of the book’s title is ‘supporting desistance and recovery’, both of which are defined and explained in Chapter 2. It is worth acknowledging that this reflects a conscious choice in how rehabilitation is understood in this book, reflecting my own research interests and orientations, as well as wider developments in the last decade of rehabilitation literature. Desistance and recovery scholarship chart progressive shifts in the orientations of professional cultures and practices towards people in such processes. It no longer legitimate to characterise support of desistance and recovery as a niche interest or marginalised edgework that practitioners do ‘off the side of their desks’.

Similarly, the image on the cover of this book is intentionally evocative and provocative. Many practitioners and service users have said that it resonates with them as an illustration of recovery and desistance. They suggest that the tattoo-like imagery is realistic, with some pointing out the modern reality that a practitioner may have just as many or more tattoos than service users. Some practitioners and academics have reacted to the image, offering wonderfully fascinating and thought-provoking critiques. Perhaps the tattoo-like imagery shrewdly symbolises issues of social stigma? One sociologist saw the image as analogous to practitioners having a ‘helping arm’ reflecting Foucault’s (1982) notion of ‘pastoral power’, guiding individuals to change their conduct in an onwards and upwards progression. This sociologist said they saw the ‘helping arm’ as resembling the finger of God. This perception speaks to real and, at the same time, troubling pressures for practitioners to assume these types of roles, hybridising pastoral power and penal power focused on individuals against a neoliberal backdrop. My own response is to embrace the ambiguity of people’s interpretations and to ask, whose arm is it in the picture? Who is it that we perceive as supporting desistance and recovery? Surely practitioners are only one of a multitude to do so, and perhaps the best reading of such imagery is that the arm is that of the person desisting and recovering, and the view is that of practitioners and academics.

This research is compelled by an intrigue to know more about a few particular concerns. These are reflected in the research questions:

1. What are the perspectives, experiences and cultures of practitioners working in the Tasmanian criminal justice field and alcohol and other drugs field?
2. How and why do these shape rehabilitative processes of working with people with complex needs to support their desistance and recovery?

These questions and the research aims and sub-themes are explained in more detail in Chapter 4. The two fields of interest highlighted in these questions and have been chosen because both are tasked with supporting the rehabilitation of growing numbers of people who live with multiple complex needs, in part arising from the drugs-crime nexus. In drawing upon the work of Pierre Bourdieu and others, these ‘fields’ are also at times described as sectors, with the terms used somewhat interchangeably in this book as boundary markers to delineate them from other cognate fields or sectors, for example, mental health. Much attention has already been devoted to understanding and reducing the drugs-crime nexus (Uggen and Thompson, 2003; Bean, 2008; Hammersley, 2008). This book is not focused on macro-level analysis of how and why the social problems of substance misuse, crime and other issues co-occur. Instead, it is based on an acceptance that people in the process of rehabilitation often require support to change more than one behaviour or facet of their lives. Addiction is rarely a ‘stand-alone’ issue, and crime should not be divorced from understanding it in the context of other social issues and inequalities.

Ironically, this research has become a study of people working amid complexity and change in two senses. The first is the literal and obvious sense of practitioner perspectives on working with people with complex needs, people whose lives have formed a very personal interface of the drugs-crime nexus and have borne the collateral consequences. There are inherent complexities in supporting people who live with vulnerabilities, risks, rights, strengths and needs which manifest themselves in diverse forms and attract equally diverse labels and responses. The second is the more subtle sense of drawing out practitioner perspectives on working as people with complex needs, as people deserving their own support while they do difficult work in the midst of complexity, crisis and change. The research evokes practitioner reflection on their own beliefs, hopes, rights, needs, inequalities and responsibilities in the diverse work roles, workplaces and workforces that make up the two sectors of interest. This implicit invitation is one that several insightful individuals take up in the interview conversations, making the research findings and future applications all the richer. In light of these things, the research centres on understanding how and why practitioners and systems might change in order to better support people in this process of change.

The research context: Tasmania, Australia

The research in this book has been conducted in Tasmania, an island off the southern coast of the Australian mainland. The state of Tasmania is one of the eight jurisdictions (six states, two territories) that make up Australia. As an island, it is similar in land size to countries such as Portugal, Hungary, Scotland or Ireland. However, it has a considerably smaller population. In 2015, the population of the island state of Tasmania was estimated at around 516,000 people (Department of Treasury and Finance, 2015). The state has a strong tourism industry, with visitors drawn to its iconic landscapes, many beaches, and expansive wilderness. Despite its geographical size, the small population means that most people live in the small cities: Hobart, Launceston, Devonport and Burnie.

In comparison to other states and territories of Australia, Tasmania has some of the highest levels of socio-economic disadvantage and one of the highest unemployment rates in the nation (Australian Bureau of Statistics, 2012, 2015). Approximately a third of the Tasmanian population are Centrelink concession card holders, meaning they receive government benefits such as the aged pension, disability pension or unemployment benefits (Public Health Information Development Unit, 2013). Furthermore, around 10 per cent of the Tasmanian population live below the 50 per cent poverty line – that is, living on after-tax incomes of less than $370 per week (Tasmanian Department of Premier and Cabinet, 2011). As the research literature on the intersection of inequalities, substance use and criminalisation will show, the prevalence of social disadvantage in Tasmania is relevant to understanding it as a service provision context. Descriptions of the research context in terms of service provider landscapes are provided in Chapters 5 and 6 respectively.

The catalysts for this research

Two catalysts have unequivocally shaped this research. One of them accounts for how and why this research started. The other represents a watershed moment two years later which crystallised a depth of conviction and lucidity as to what matters and why.

The initial catalyst for commencing this research in the form of a PhD study was a series of events in 2008. Concurrent to my doctoral candidature, I was employed full-time by the University to work with a residential alcohol and other drugs rehabilitation service on a three-year capacity building project, in collaboration with other organisations in the sector. In 2008, I was struck by the chronic season of staff turnover in the local field, with experienced practitioners leaving – none of whom were retiring. Those of us who were avid cooks were willingly commandeered to cater for the series of morning teas to farewell one staff member and welcome another in their place. This became a pattern. It struck me that the only consistent form of social capital and informal staff interpersonal support for those who chose to stay was the collegiality and mirth arising from the many morning teas. The tally count of the workforce exodus across many of the local alcohol and other drugs services become so acute that there were jokes about those of us ‘still standing’ being ‘veterans’ of the field (a curious term, given I was aged in my early twenties at the time!). Change was also occurring in the governance of the alcohol and other drugs sector. In the space of the following two and a half years, the small Tasmanian peak body (an ‘umbrella organisation’) representing the sector had a turnover of three chief executive officers (CEOs) and four project officers, and the federal government agency funding body saw the movement or resignation of four managers and nine project officers. I wanted to better understand the sense of ‘Ground Hog Day’ and the loss of organisational memory and practice wisdom that I observed. This compelled the beginning of research exploring practitioners and their work, with an interest in why so many, under the same conditions and with the same complex caseloads, chose to stay and thrive. Seven years later, at the point of this research being converted and published as a book, few of the practitioners involved in these morning teas, or working for the peak body, still work for that organisation, such has been the extent of the workforce turnover.

An unexpected event in 2010 provided the second catalyst which changed my perspective and understanding of the issues and, in doing so, implicitly changed the focus of this research. The members of my household had a first-hand encounter with a textbook example of drug-related crime – a home burglary. A young man entered our home at night, knowing we were present and stole a large number of items. He entered and stole from several other households that night. The dealing of the case through law enforcement and the courts revealed that he may have been under the influence of both prescribed mental health drugs and illicit drugs at the time. At the time, part of my job was to plan and host a state-wide conference on ‘Mental Health and Drug Use in the Criminal Justice System’ in addition to my PhD research on these topics. Included in the stolen items which were never recovered were technological devices and a USB containing materials for the conference, part of my PhD thesis, literature review and a copy of a book manuscript on Working with Offenders (White and Graham, 2010). The scenario became even more ironic when the police and courts asked for the input of our household as ‘victims’ in understanding the appropriateness of how to respond to this man. Members of our household had conducted research with or were currently working in each of the major criminal justice institutions and an alcohol and other drugs service to which he could be sent while on bail or under sentence, including the Mental Health Diversion List with the Magistrates Court, the Court-Mandated Drug Diversion initiative for drug-related offenders with Community Corrections, the only local residential drug rehabilitation facility, and the prison.

This event was a watershed moment, at a personal and professional level. My perspective of rehabilitation transformed from a largely academic exercise to a deep-seated examination of my personal convictions. Did I believe the things I had been reading about desistance and recovery? My values and ideology, and what these look like in practice, featured prominently in how I thought and felt. Furthermore, my deep-seated convictions about the importance of desistance and recovery scholarship were not derived from the (unfair and unhelpful) stereotypical caricature of a rehabilitation proponent with naïve bleeding heart who is ‘soft’ on ‘criminals’. Despite feeling mixed raw emotions about the invasion of privacy and sense of safety, we chose to forgive the ‘offender’ for the harm done and to affirm opportunities fo...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• List of tables
• About the author
• Acknowledgements
• Abbreviations
• Foreword
• 1 Introduction
• 2 Rehabilitation: from paradigms to processes
• 3 Tools and approaches in rehabilitation work
• 4 Navigating the research process
• 5 Alcohol and other drugs rehabilitation work
• 6 Criminal justice and working with offenders
• 7 Allies and adversaries: complexity and the dynamics of collaboration
• 8 Theorising rehabilitation work and the helping professions
• 9 Changing rehabilitation cultures
• References
• Index