Problems and Purpose

The aim of the Drugsfutures project was to engage the public in a national conversation on the issues raised by the current and future use of drugs that affect mental wellbeing. The specific objectives of the dialogue were to:  

• Provide opportunities for members of the public to discuss and explore their aspirations and concerns about current and future issues related to brain science, addiction and drugs  
• Identify areas of consensus, disagreement or uncertainty on a broad range of issues raised by current and possible future scientific developments, and explore initial views and changes in opinion
• Inform the final recommendations made by the Academy of Medical Sciences (AMS) Working Group for public policy and research needs. 
• Enable the AMS and the wider science community to increase their knowledge and understanding of public engagement and its potential for future application. [1]

Background History and Context

Following the publication in 2005 of the Drugs Futures 2025? Report, the Government wished to see further investigation of these issues and asked the AMS to take this process forward. In 2006, the Academy of Medical Sciences (AMS) was invited by the Government to undertake an independent review of the societal, health, safety and environmental issues raised by scientific advances in brain science, addiction and drugs (BSAD). The AMS convened an expert Working Group to take this study forward, in consultation with experts and the public. Therefore, a public engagement programme was an integral aspect of the Working Group’s core activities. 

The ‘Drugsfutures’ project was commissioned to design and deliver public dialogue on the issues as part of the evidence base for the Working Group as it came to its conclusions and recommendations. The Drugsfutures project focused on three specific drug categories: recreational drugs, drugs for mental health and cognition enhancers. [1]

Organizing, Supporting, and Funding Entities

Cost of project: £300, 000

The dialogue was commissioned by the Academy of Medical Science (AMS) and the Department of Health. The Academy of Medical Sciences (AMS) is the independent body in the UK representing the whole spectrum of medical science. The Department of Health (DH) is the government department responsible for public health issues, and was responsible for the commissioning of the project.

The project was funded by Sciencewise-ERC. Following an open call, the Office for Public Management were contracted to deliver the project. The project contractor, OPM is an independent centre for the development of public services and provides consultancy, research and leadership development. Diane Warburton of Shared Practice, an interdisciplinary practice, was the independent evaluator.

Sciencewise-ERC is a Department for Business, Innovation and Skills funded programme to bring scientists, government and the public together to explore the impact of science and technology in our lives. It helps Government departments and agencies commission and use public dialogue to inform policy making, involving science and technology issues. Its core aim is to develop the capacity of Government to carry out good dialogue, to gather and disseminate good practice, have successful two-way communications with the public and other stakeholders, and to embed the principles of good dialogue into internal Government processes.

Participant Recruitment and Selection

Overall, the Drugsfutures project involved 478 individual public participants over the three months of the public engagement activities, plus numerous expert speakers, observers, etc: 

• 61 public participants at the launch, plus 52 experts, policy makers, facilitators, etc.
• 146 public participants at the 19 outreach workshops (including a one-off event in London and 3 outreach events run by the BA); 59 then attended the regional workshops
• 121 specially recruited public participants at the 5 regional workshops (plus 59 as above)
• 25 public participants at the Brainbox events
• 125 participants in the online consultation (314 registered) [3]

Participants at the workshops were recruited by a professional recruitment agency to include a diverse cross section of the population and were provided with a modest financial incentive. For the ‘outreach’ workshops, participants were recruited on the basis of specific knowledge, experience or family situation, e.g. mental health service users, parents of children with attention deficit hyperactivity disorder (ADHD) and ex-drug users. Individual incentives were not given to participants in the outreach work, although a financial contribution was made to the several charitable, voluntary and public-sector organisations that provided assistance. [4] 

Methods and Tools Used

Face to face dialogue activities included the following:

• A public launch at the Science Museum’s Dana Centre, attracting 113 participants  
• The Brainbox – a deliberative workshop of 30 specially recruited public participants. The Brainbox met twice, for two days each time, with sessions at the start and end of the project
• Five regional one-day workshops on different topics: drugs and the law, young people, society, drugs for smarter brains, and drugs for mental health
• 19 short (2-hour) ‘outreach’ meetings with specific key groups (e.g. teachers, ex-users).
• Workshops with hard-to-reach groups involved in previous engagement projects 

The face-to-face events were supplemented by an initial literature review to summarise previous public engagement on the issues. An online consultation was structured according to the five themes used in the face-to-face events, which used blogs and questions to stimulate responses. 125 responses were submitted on-line. 

The public dialogue element of the project was integrated with separate stakeholder consultation and expert examination strands run by the AMS, so that all overall findings could be integrated in the final report. The dialogue activities became an integral element of the work. 

The wide range of engagement events allowed for sensitive development across the programme and different levels of participation. Doing small group work and outreach groups helped to build trust and engage some of the more ‘hard-to-reach’ groups. 

What Went On: Process, Interaction, and Participation

Brainbox

The main elements of the first Brainbox event were as follows: 

Friday 2 February 2007, 6.30pm to 9pm 

• Introductions and welcome, including overview of the event and the main questions to be addressed and the history of the Drugsfutures project from the Foresight research.  
• Introductions among participants to each other in pairs and then feeding back to the whole group, covering their family and work background, what they feel about taking part in this project, and why they decided to get involved.  
• Split into four small groups, two to discuss why people take drugs and two to discuss what influences what people think about drugs; with points raised in the groups recorded on flip charts (20 minutes).  
• Report back to the main group in plenary of findings from small groups and discussion of issues arising (25 minutes), followed by short break  
• Working in 3 small groups, brainstorm harms to the individual, family and society from use of drugs and put up on wall; then refer to pre-printed cards to prompt any issues missed (20 minutes)  
• Feedback to the main group in plenary of findings from small groups and discussion of issues arising (15 minutes)  
• Distribution of information packs to all participants, covering issues from all five of the Drugsfutures themes  
• Introduction to agenda for following day, questions and distribution of pre-event questionnaire for people to complete and bring back the following day 

Saturday 3 February 2007, 9.45am (for 10am start) to 4.30pm 

• Introductions and overview of day, and introduction of AMS representative (and restatement of purpose of project)  
• Presentation by Professor Phil Cowen to introduce current state of knowledge about the brain and mental health (10 minutes), followed by questions and open discussion (35 minutes)
• 3 small groups (with expert moving around) to consider scenario and identify positive and negative issues, and additional information the groups need (1 hour)  
• Plenary feedback to the main group of findings from small groups (45 minutes)  
• After lunch, plenary session to revisit earlier discussion, with initial consideration in groups of 2-3 people, to consider attitudes towards mental health and drugs and wider implications (20 minutes)  
• 3 small groups, each looking at specific questions on a scenario on a different topic: drugs and young people, drugs for a smarter brain, and drugs and the law. Groups left to discuss without facilitation but with member of group nominated to keep flip chart notes and feedback to the main group (55 minutes)  
• Plenary feedback to the main group of findings from small groups (30 minutes)  
• Each group to go around and look at notes from the other groups and mark with a green dot those they agree with, and a red dot those they do not, and consider which issues were difficult and why, in order to identify where there were agreements, differences and questions (30 minutes)
• Plenary session to summarise next stages; distribution of information logs for people to use to keep notes of the process; request for participants to keep diaries of interesting issues, press coverage etc that they see; any outstanding questions; mention website; give dates, etc. of the next session  

Second brainbox event 

Friday 30 March 2007, 9.45am (for 10am start) to 4.15pm: 

• Welcome and introductions, including by AMS to nature of the project and importance of public engagement to their work on the issues, followed by questions.  
• Introductions to experts, observers (including the evaluator) and media, and overview of the agenda for the 2 days, followed by questions  
• Film of Drugsfutures launch shown  
• Small group discussions on the main themes from the previous session to see what is missing, what is agreed with and where disagreement, followed by plenary to allow each group to report back to the whole group (45 minutes in total)  
• Preparation for presentations: participants work in groups of 3-4 people to develop questions related to tasks in their packs (10 minutes), followed by presentation on cognition enhancers by Dr Danielle Turner, University of Cambridge, and Dr Rebecca Roache, Future of Humanity Institute, on the ethical issues of cognition enhancement, followed by questions and answers, and review of main points of learning (50 minutes)  
• After lunch, preparation and presentations on recreational drugs by Daren Garratt from the UK Harm Reduction Alliance, on harm reduction, and Keri Tozer and Sue Garnett from the Relay Project, Merseyside, on the future of recreational drugs and how they can be controlled, from an ex-user's perspective, followed by questions and answers, and review of main points of learning (60 minutes)  
• Preparation and presentations on drugs for mental health by Robin Felton, Alzheimers Society Birmingham and Solihull branch on dementia care, and Rebecca Swift from Birmingham and Solihull Mental Health Trust on promoting positive awareness of mental health issues, followed by questions and answers, and review of main points of learning (60 minutes)
• Panel session with the experts who had spoken so far, to review the main issues that arose and discuss further including through questions and answers with the panel (30 minutes)
• Closing session, to take any outstanding questions and review agenda for following day.  

Saturday 31 March 2007, 9.45am (for 10am start) to 4pm: 

• Welcome and outline of tasks for the day  
• 3 small groups to develop priorities on the benefits and hopes, concerns, research needed and control and regulation on cognition enhancers (25 minutes)  
• Feedback of findings from small groups to plenary session (20 minutes)  
• 3 small groups to develop priorities on the research needed, services and resources, education and information and control and regulation on recreational drugs (25 minutes)  
• Feedback of findings from small groups to plenary session (20 minutes)  
• After lunch, initial polling (using hand held electronic voting pads) to vote on priorities and trade-offs, based on priorities identified earlier (45 minutes)  
• 4 task groups, each to prepare a presentation on one of the themes: cognition enhancers, mental health drugs, recreational drugs, and control and regulation (30 minutes)  
• Presentation (to AMS, and to whole group) of findings from small groups (30 minutes)  
• Reflection on the process, completion of evaluation forms.

Regional workshop process 

The regional workshops ran for a whole day, on a Saturday, from 9.30am arrival (for 9.45am start) to close at 4.30pm. As with the outreach workshops, the workshops varied slightly depending on the topic, but the main elements were: 

• Initially, people were able to sit where they wanted  
• Welcome and introductions by organisers to explain the theme and the agenda (plus housekeeping details)  
• Introduction by AMS representative on the project background and how the outputs from the public engagement process would be used by the AMS  
• Electronic voting to gauge initial views on the subject: warm-up to get people used to the equipment, then approximately 6 questions  
• Groups were reorganised to ensure a demographic mix in each small group, so people moved around to form 4 small groups.
• Initial discussions on the issues (30 minutes), in small groups each with facilitator, using background information provided on sheets for each person, in order to identify a group view of key issues and key questions  
• Introduction of scenario and briefing notes by facilitator to enable the groups to relate the general issues to a specific situation (30 minutes), followed by feedback from each group (45 minutes)  
• After lunch, there was an information gathering session to answer a set of questions given to each group by facilitator and the groups are asked to answer the questions and present the outputs from their discussions, drawing on what people already know about the subject from external sources, using the information provided, and asking the experts available at each event (30 minutes).  
• In the workshops on Drugs for a Smarter Brain and Drugs and Young People, there was a 30-minute session with questions and answers to an expert panel, before groups were asked to come up with their own responses and recommendations. In the Drugs and Mental Health workshop, the experts were asked to introduce themselves and their work to the whole group (about 5 minutes each), and they were then available to answer questions from any of the groups. In the Drugs for a Smarter Brain workshop, the experts joined the table discussions to provide further information if needed.
• Then, taking each question in turn, the groups agreed on a collective view and identified key questions. A group member took responsibility to record key questions. The facilitator helped each group to prepare a presentation back to the whole group, and decide which group member(s) would present back (60 minutes).  
• Presentation by each group back to main group (30 minutes)  
• Questions and discussion (30 minutes)  
• Electronic voting to gauge views at the end of the session on the subject (same 6 questions); and these results compared with earlier results of electronic voting.  

Outreach Groups

The outreach workshops ran for a couple of hours. They varied slightly depending on the topic but the main process was as follows: 

• Introduction from the organisers, followed by introductions among participants (pairs introduced each other)  
• Introduction to the focus of the discussion (the topic of the event)  
• Exploration of changing attitudes to the topic including how people think attitudes to drugs will change in future, what they think about motivations, wider implications, rights and regulation, different perspectives, etc  
• Wrap-up including review of key points of discussion to check those there agreed with the points being taken forward [3]. 

Key messages from the public 

On recreational drugs 

Questions were raised about the limits on the right to use these drugs, with the focus on minimising harms, education and prevention, and implications for mental health problems.

Future priorities focused on effective drugs education that starts at an early age, involves ex-users, and provides targeted information that is honest, open and clear about the benefits as well as the disadvantages of recreational drugs, and covers the effects of drug abuse on home, work and society.

Most participants supported continued prohibition, but favoured a more health- based approach with imprisonment only for dealers, a reduction of legal sanctions against drug users, acknowledging that it is impossible to eradicate the use of recreational drugs and exercise control over the quality of drugs.

On drugs for mental health 

Participants felt that decisions about the appropriate use of medicinal drugs for mental health should involve doctor and patient. Drugs should only be used if they have been successful and other approaches have been exhausted, and on-going support should be available to help people come off medication as early as possible.

Future priorities focused on a better understanding of the causes of mental illness, giving priority to research into dementia, depression, relationships between mental health problems and recreational drug use, whether any particular groups of people are prone to mental illness, and focusing on drugs that are effective and have minimal side effects. Drugs that will prevent the emergence or progression of Alzheimer’s disease were seen as crucial, given our ageing population. 

On cognition enhancers 

Participants identified two distinctions: treatment (for medical problems) versus enhancement (of a ‘normal’ state), and ‘natural’ enhancement (e.g. vitamin supplements as a good diet) versus ‘unnatural’ enhancement (e.g. pills to improve cognitive ability).

Future priorities included the need for further research into the effects of cognition enhancers before policy decisions are made to allow or prohibit their use. The greatest concern was around use by young people whose brains are still developing. The priorities for research were seen to be the benefits of cognition enhancers for people with mental health, the effects on healthy people of use, the effects of abusive use, and the social and financial impact of widespread use. 

Influence, Outcomes, and Effects

Policy influence

One of the public priorities, on the need for research into addiction as a disease, was picked up by the AMS and new funding of £8 million has been made available from the Medical Research Council to do that research. The dialogue directly influenced and improved the final AMS Brain Science, Addiction and Drugs (BSAD) report to Government. Public participants could trace their contribution in the final report. The dialogue increased available intelligence on why some legal interventions on drug use do not work.

In July 2009, the Advisory Council on the Misuse of Drugs (Home Office) launched a detailed review of the safety and regulation of cognition enhancers, which was raised as a research priority by public participants in its project.

Influence on policy makers 

Drugsfutures was the first major public engagement the AMS had been involved in. Its strategic plan now includes a principle that public engagement should be integral to all new policy studies.

Furthermore, the project helped AMS to make recommendations to Government on a contentious topic with a stronger evidence base. The dialogue achieved inclusiveness with the participation of ‘hard-to-reach groups’, achieved a good range of views, and enhanced AMS’s reputation as a result.  

Impacts on public participants  

Participants reported that they had learnt a great deal, clarified their thinking and that taking part affected their views on the issues. Public participants also stated they had learnt new skills and gained confidence through their involvement.

Almost all interviewees said they had talked about the issues from the workshops with friends and family, thus making a wider audience aware of the issues. The dialogue stimulated significant interest among participants about the content of the events. Almost all said they would like to know more about the project and future work in this area.

The dialogue raised awareness and understanding among public participants of policy making and the role of experts to help create a culture of trust in the public institutions. Additionally, the process resulted in high levels of trust that those who commissioned the process would take notice of what the public said. Participants felt their views were important and listened to.  

Analysis and Lessons Learned

Summary of good practice and innovation 

The dialogue had a clear framework and expectations for working with the public. The AMS was not seeking consensus or expecting all conflicts to be resolved. Instead, it sought to understand where there could be consensus and where conflict remained. The wide range of engagement events and methods was successful, and enabled sensitive issues to be discussed in depth.

The public dialogue element was integrated with separate stakeholder consultation and expert examination strands, so the findings from all strands of work could be integrated into the final report. The final AMS report included reference to public participants’ input and participants were able to trace their contribution in that final report.

AMS Working Group members were fully involved in the public dialogue activities throughout, which resulted in greater trust in, and ownership of, the results, and also allowed the group members to hear public views first-hand. The AMS attended all workshops/sessions and explained the process and how the results would be used. This approach demonstrated commitment to the process and helped generate trust among participants.  

A dedicated cross-Government advisory group, including representatives from the devolved administrations, Home Office and Department of Health, was convened to follow the progress and allow for policy implications to be identified throughout  

The very broad range of scientific and other experts engaging with the public (including ex-drug users as well as academics and neuroscientists) provided a rich mix of views and knowledge to inform the public discussions. Furthermore, scientific knowledge and technical expertise became more accessible and valued by public participants.

The credibility of the results with the AMS was enhanced by recruiting participants for representation of the general public, and of relevant ‘hard-to-reach’ groups  

Lessons for future practice  

• It is important to go back to participants to explain how their input has influenced the final conclusions. This needs to be built into the planning for the dialogue so that specific input can be traced.
• All those involved need to be clear that the process includes a responsibility for commissioning bodies to listen to, and take account of, the public views given, and for that to be made clear to public participants.
• The public may sometimes find it easier to discuss existing issues than asking questions about the future.
• It is vital to consider early on how to increase traffic to any online engagement. [1]

See Also

Sciencewise

References

[1] Sciencewise (2008) “Case Study: Drugsfutures- A Public dialogue on brain science, addiction and drugs”, Sciencewise

[2] Sciencewise (2017) “Drugsfutures” [online] Available at:https://webarchive.nationalarchives.gov.uk/20170110132722/http://www.sciencewise-erc.org.uk/cms/drugsfutures-2/

[3] Warburton, D (2008) “Science’s Drugfutures Public Engagement Programme”, Shared Practice, July 2008

[4] Academy of Medical Sciences (2008) “Drugsfutures Final Report: Brain Science, Addiction and Drugs”, Academy of Medical Sciences Working Group, May 2008

External Links

https://sciencewise.org.uk/ 

Notes