In Cardiff and Vale University Health Board, a team of clinicians and people with lived experience are transforming the way we support people recovering from opioid addiction. The Buvidal Psychological Support Service (BPSS), developed by Consultant Psychiatrist Dr Jan Melichar and Clinical Psychologist Dr Lucie James, combines the stabilising effects of long-acting opioid substitution therapy with trauma-informed psychological care.
A New Model for Recovery
Buvidal, a monthly injectable medication for opiate dependence, offers individuals physical and psychological stability, creating space for deeper recovery. Recognising that medication alone is not enough, the BPSS was created to provide wraparound therapy for those on Buvidal, helping them process trauma, rebuild relationships and reconnect with their lives. The service offers up to 32 extended therapy sessions and operates with a flexible attendance policy, understanding that real life is unpredictable and recovery is rarely linear.
One client put it powerfully:
“I’ve truly changed on a fundamental level. Like I’m free, I’m free. I’m free to control myself and my emotions and my actions. I’ve got my freedom back. I’m not a prisoner in my own body anymore.”
Scaling What Works
In 2023, the team brought the BPSS to the Spread & Scale Academy: an intensive three-day programme run by the Dragon’s Heart Institute to support teams with bold, proven ideas to grow their impact. There, they worked alongside peers from across NHS Wales and beyond, exploring how to clarify their purpose, communicate their impact, and spread their approach across the system.
“The Spread & Scale Academy was invaluable,” said Dr Lucie James. “It helped us bring our ideas together and think strategically about where we wanted to go. Since then, we’ve built new relationships with the Shaping Change and Value in Health teams, and interest in the model is growing across Wales.”
Tangible Impact
The outcomes speak for themselves. A recent evaluation showed that 75% of individuals who started treatment with the BPSS remained engaged, and 50% of those completing the first tier of therapy felt ready to address their mental health and trauma. Clients have reported reductions in psychological distress and improvements in quality of life, reconnecting with family, finding stable housing, and moving into volunteering or paid work.
The impact extends beyond individual recovery. In the first group of 20 BPSS clients, the number of inpatient mental health bed days dropped from 40 in the six months prior to starting treatment to zero in the following six to twelve months.
Now, there are 67 clients using this service and this equates to a reduction of 137 Mental Health Bed Days, which represents a cost reduction of over £70,000.
Joe Brown, Cardiff and Vale UHB’s Value in Health Business Partner said, “For every 100 BPSS clients, we would expect a reduction in inpatient mental health bed days of 205 days. Using Patient Level Costing, this would equate to £105,000 opportunity cost saving. So, for every 100 clients seen under BPSS, we would expect a £105,000 opportunity cost saving.”
This not only reflects a profound personal transformation but also a significant efficiency saving for NHS Wales. Many individuals have also re-engaged with their physical health, including attending long-postponed appointments and treatment for serious conditions such as cancer.
Looking Ahead
The BPSS began as a two-year pilot and has now secured a further year of funding from Welsh Government, with strong support from the Cardiff and Vale Mental Health Clinical Board and the Area Planning Board. The team is committed to working with partners across Wales to support the adoption of similar models in other areas.
Their ambition is clear: to embed trauma-informed psychological support as a standard part of opioid treatment services across the country.
Huw Griffiths, Head of the Dragon’s Heart Institute, said, “Buvidal provides stability. The BPSS provides hope. Together, they offer a path to healing for people navigating the complex terrain of addiction and trauma. With the support of the Spread & Scale Academy, this team is not only changing lives, they are helping to change the system.”
Read more about the Spread & Scale Programme at the Dragon’s Heart Institute.
