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Services, pathways and integrated care systems

Gay men needing chemsex or chems support often require specialist help and advice with multiple services working together, such as the NHS, drug treatment, mental health, legal, housing, and debt. The reasons why you may not receive the support and care you need, when you need it,
is complicated but factors include:

Heteronormative services
Many services are conceived and delivered along the lines that clients and patients are heterosexual (straight). This is referred to as heteronormative. This means a service may have little understanding or knowledge of gay men and the wider LGBT+ community, which can impact negatively on the quality of support and care given. Some services are trying to be more inclusive but we hear numerous stories from gay men who say they have to explain who they are, talk about deeply personal issues to heteronormative professionals, and describe gay sex, hook-up culture, and chemsex, which can be both challenging and embarrassing.

Integrated Care Systems (ICS)
Legally established in 2022 (England), Integrated Care Systems (ICS) aim to improve outcomes in health and healthcare, tackle inequalities, enhance productivity and value for money. This should mean improved coordination as you move seamlessly between services. However, within our (chemsex) experience, ICSs are not working as they could and should.

The EU, austerity, and cost of living crisis
Leaving the EU has impacted recruitment and, after years of austerity, many services have been cut to the bone or disappeared altogether—with tight budgets across remaining statutory and NHS services the foreseeable future. The cost-of-living crisis continues to affect many, and we have yet to fully recover from the COVID pandemic. Combined, this will likely affect the support you need, when you need it.

Chemsex is not new
Before it was named as such, chemsex has existed since the 1990s. However, government departments, public health, and statutory services have been slow to acknowledge and address the issue, though this is starting to change. Subject matter expertise Some services lack “subject matter expertise” (SME) which refers to knowledge, skills, and/ or experience in a specific field or topic, such as chems, sex, and the lives of LGBT+ people. This can often affect the quality of support and care you can reasonably expect. Some services are starting to address these issues which is long overdue.

Even if you know where to look
Finding and accessing support remains both challenging and time-consuming. It can be especially draining if you’re on your own, experiencing GHB withdrawal, or crystal meth psychosis.