A Conversation with… Mark Gilman (Part 2 of 2)

The second of a two-part conversation that Toby Seddon had with Mark Gilman. ‘In this part, we pick up the story in 1999, when Mark moved from Lifeline to the Home Office. The conversation ranges widely, covering treatment, recovery, social justice and crime, reflecting the unique breadth of Mark’s contributions to the field.’

In this conversation, Mark talks about the time he was a regional manager for the National Treatment Agency (NTA).

‘There was actually some public opinion research done in the NTA which reiterated the idea that the primary beneficiary of many of the interventions was not individual people with drug problems themselves, with substance use disorder themselves, but the wider community.

And that was kind of legitimate within the NTA, the National Treatment Agency. And obviously under the New Labour administration, Tony Blair and the subsequent home secretaries, … and for Paul Hayes, Head of the National Treatment Agency, was the ability to deliver crime reduction. Tough on crime, tough on the causes of crime. One of the causes of crime being heroin dependency, and the solution being treatment to reduce the crime even if the patient didn’t get better.

And that’s when I started to get uncomfortable, morally, ethically, with for example methadone maintenance, which I had always been a big supporter of—primary harm reduction—and still am now. But at that time then, this thing about dehumanising people seemed to be consolidated in particularly methadone maintenance treatment. The measure was how much crime was not committed and the language, ‘What is the crime reduction dividend?’ And I suppose being a contrarian, but ultimately knowing that the people they were talking about were the people I went to school with and in my own family, to hear them being talked about in this dispassionate way started to give me some issues around methadone maintenance…. The argument was, and to an extent still is, the intervention is successful if crime is reduced, even if the patient gets worse.’

The whole conversation is well worth a listen.