Residential Treatment at a crossroads: A response to Collective Voice's landmark guide on improving access and outcomes in residential treatment

There are moments in a field when someone puts into writing what practitioners have known, and felt, for years. Collective Voice's newly published guide, Improving Access and Outcomes in Residential Treatment, is one of those moments. Reading it, I felt something that I imagine many colleagues in this sector will recognise: a mixture of relief that it exists, frustration that it needed to, and, beneath both, a quiet and persistent hope.

This is a cause close to my heart, and it has been for most of my professional life. I have worked in and around residential addiction treatment across roles in direct practice, service development, and now academic research. It is the world that shaped my understanding of what recovery truly means, and it is the world that my doctoral research is actively trying to better understand and serve. So, when I say that this guide matters, I am not speaking as a detached observer. I am speaking as someone who has sat with the people this system was built for, and who has watched, too often, as the system has failed them.

This guide is designed to offer clear, realistic and practical support to commissioners, team leaders and all those involved in designing and delivering treatment and recovery services. What I value most about it is that it doesn’t romanticise rehab. It treats it as a serious, evidence-informed intervention that belongs inside a coherent treatment and recovery system and it focuses on the practical mechanics that decide whether someone actually gets there.

In this article, I unpack why this guide lands arrives at the right moment, what are its ten key recommendations, and the evidence gaps it’s inviting us to reflect upon.

Why this guide arrives at the right moment

The Collective Voice Tier 4 Forum has done something important here. They have assembled evidence, case studies, and sector knowledge into a practical, readable document that any commissioner or community provider can act on. That is not a small achievement. The residential treatment landscape in England has been starved of this kind of clarity. A field where funding arrangements vary wildly across local authorities, where referral processes have become inadvertent gatekeeping mechanisms, and where providers operate under chronic financial uncertainty despite delivering interventions that work.

The guide's core message is the need to ensure that residential provision is an accessible option at the heart of local treatment systems. Its central argument is both simple and compelling: residential rehabilitation is evidence-based, cost-effective and flexible, and yet too few people can access it. The data cited is striking in its implications: those who received residential treatment, particularly those who arrived with the most complex needs, achieved positive outcomes at roughly three times the rate of those on community-only pathways. Against this backdrop, the report's ten practical recommendations are a blueprint for a system operating far below its capacity to help.

"It is illogical and unfair to penalise people for displaying the symptoms of the condition they are actively seeking support to address."

Collective Voice, Improving Access and Outcomes in Residential Treatment, 2026

This line, on repeat access to treatment, captures something fundamental about how addiction has been misunderstood and, at times, stigmatised, even within services designed to address it. Recovery from addiction is rarely linear. It is, as both the research literature and the people living it consistently show, a dynamic, non-linear, deeply personal process. Penalising a second or third attempt at treatment is not a rational resource-allocation decision, but rather a moral stance dressed up as administrative policy.

Ten recommendations that offer a practical framework for commissioners and providers

• 01 Fund rehab places without asking for client financial contributions

• 02 Avoid panel processes that create unnecessary barriers or delays

• 03 Stop requiring clients to prove motivation before accessing treatment

• 04 Ensure people can access residential treatment multiple times if required

• 05 Make rehab a visible, ongoing option throughout a treatment journey

• 06 Reflect the true cost of cancellations in commissioner agreements

• 07 Create clear, uninterrupted pathways from detox into rehabilitation

• 08 Ensure length of stay is aligned with evidence, not just budget

• 09 Integrate residential providers into local workforce development

• 10 Develop tailored pathways for people leaving prison, those who are rough sleeping, and people in hospital

  
  

Source: Collective Voice, Improving Access and Outcomes in Residential Treatment, 2026

Although each recommendation is worth exploring and understanding in depth, recommendation eight deserves particular attention: ensuring that length of stay is driven by evidence and individual need rather than financial pressure. The guide rightly notes that the 12-week placement common across many funded pathways in England may be better understood as a minimum threshold than a standard. Research consistently shows that longer residential stays, ideally approaching or exceeding 90 days, are associated with significantly better outcomes. Yet funding pressure has been quietly compressing stays at exactly the moment when client complexity has been increasing.

The Staffordshire model, highlighted in the guide, deserves replication. Block-booking beds with residential providers rather than spot-purchasing by the night is a structural commitment to the sector's sustainability and, by extension, to the people it serves.

The evidence gaps this guide invites us to fill

Reading the guide through the lens of my ongoing doctoral research, I am struck by how precisely it maps onto the questions that have driven my own academic work over recent years. The case being made, that residential treatment is effective, that its effectiveness is contingent on adequate duration and post-discharge support, and that current measurement approaches do not adequately capture what recovery actually means for the people going through it, is a case I have been building, across the different research papers of my PhD.

My scoping review of psychometric outcome tools used in residential treatment settings, found that 154 distinct instruments have been used to assess recovery outcomes in this context, and yet the great majority remain narrowly focused on abstinence and symptom severity. The richer, multidimensional realities of recovery, such as identity reconstruction, the rebuilding of social connections, the slow accumulation of what we call Recovery Capital, are consistently underrepresented.

We are, in many cases, measuring what is easy to measure, not what matters most.

The guide rightly calls for better outcomes measurement that reflects lived experience and long-term trajectories. This is exactly the territory my current qualitative study is designed to map. My Architecture of Recovery qualitative study asks a question that the sector has been circling for years but rarely investigated with sufficient depth: what actually sustains recovery in the 12 months, 2 years, 5 years after leaving residential treatment?

The study is exploring sustained recovery after residential treatment through the voices of people who have lived it, at least a year beyond discharge. Not “did they complete?” Not “did they relapse?” But how recovery actually unfolds over time: what holds, what fractures, what quietly saves someone when life starts again outside the protected bubble of treatment. The early gains matter, of course. But the long game is where systems either prove their integrity… or expose their gaps.

By engaging people with lived experience of residential treatment in conversation, not at the point of discharge, but well into their recovery journeys, the study aims to capture what existing frameworks and outcome measures still miss: the temporal dynamics of recovery, the role of identity transformation, and the interaction between personal agency and structural context over time.

The Collective Voice guide calls for services and commissioning to be shaped by lived experience and long-term thinking. Architecture of Recovery is designed to generate exactly the kind of evidence that could support that ambition, translating narratives of sustained recovery into insights for practice, policy, and the refinement of measurement tools that actually reflect how recovery unfolds.

What residential treatment does that cannot be replicated elsewhere

One of the quiet strengths of the Collective Voice guide is the way it refuses to frame residential treatment as a last resort. This framing has done enormous damage. It positions residential care as something people earn through failure; a concession made when everything else has been tried, rather than as what the evidence suggests it actually is: a uniquely intensive, immersive intervention that creates conditions for change that community services, however excellent, cannot fully replicate.

Residential settings do something specific. They temporarily remove people from the environments, relationships, and cues that sustain addictive behaviour while providing a structured, socially embedded context in which new identities, routines, and connections can be rehearsed in real time. This is not a higher dose of outpatient therapy, it is a qualitatively different intervention. The therapeutic milieu, the peer community, the physical separation from risk environments: these are active ingredients, not neutral backdrop.

My research keeps returning to this. In the literature, and in the voices of people who have been through residential treatment, there is a consistent thread: the residential experience was not just where they stopped using, it was where they gain hope and began to imagine a different kind of life. That is a remarkable thing for a service to offer. And it is a thing we are at serious risk of losing if the commissioning and funding picture does not change.

A personal word on sustainability

The guide is frank about the fragility of the current landscape. Residential providers are operating without reliable income streams, capital investment, or workforce pipelines. The 2021 Dame Carol Black review described the sector as being "on its knees," and while the injection of new treatment investment that followed was welcome, relatively little reached residential services. The Government's stated ambition, that 2% of the drug and alcohol treatment population should be accessing residential treatment, remains a long way from being met.

This is not abstract. Each of the providers I have worked alongside, and many that have contributed to my research, faces difficult financial decisions on a regular basis. The decision to continue is often a values-driven one, made in the face of precarity that would not be tolerated in other parts of the health system. We owe it to them, and to the people they serve, to build something more durable.

The guide is right to call for regional commissioning, national coverage planning, and a shift away from transactional spot-purchasing. But it is also right to note that we cannot only wait for national change. Commissioners, community providers, and residential services can act now. The Staffordshire examples in the guide are not exceptional; they are what the sector looks like when local will and practical coordination are present. They should be the norm.

What we are building towards

I am deeply grateful to Collective Voice for producing this guide. If you’re a commissioner, a funder, or a system leader, this guide is an invitation to a different standard of responsibility.

But guides and reports can only do so much. What will matter, in the end, is whether the people who can act on these recommendations do so, and whether the research community, including those of us working at the intersection of lived experience and academic inquiry, can generate the evidence that makes the case unanswerable. That is the work I am committed to. And it feels, reading this guide, like the field is finally moving in a direction where that evidence will find a home.

Residential treatment works. And it is not a luxury. It is not a last resort. It is, for many people with complex and chronic addiction, the intervention that changes everything, if we let it. The question is whether we’re willing to make it accessible, connected, and outcome-literate enough to let it work for the people who need it most.

"Systems should understand and appreciate local rehabs as assets. Collectively, we need to view residential treatment less in terms of a negotiated business transaction for a placement, and more as an option and opportunity within a wider commitment to provide high-quality care and support." Collective Voice, 2026

That is a paragraph worth printing, framing and placing in every commissioning office in England.