Substance Misuse - Improving Services and Supporting Offenders Nino Maddalena CJ lead Alcohol & Drugs, Public Health England
Overview Recovery agenda looking at the drug and alcohol problems of the offender population in the context of wider health and social care needs The transformation of substance misuse provision in prisons and how this was achieved Work in progress Looking to the future: challenges and opportunities 2 substance misuse -improving services and supporting offenders
Complex problems - no simple solutions Easy to get lured into simple equation i.e. Drug misuse = drug related crime stop drug misuse = stop offending Link between drugs and crime clearly established but relationship complex 3 substance misuse -improving services and supporting offenders
The (poor) health of the prison population Compared to the general population, prisoners are more likely to: misuse drugs and/or alcohol smoke test positive for hep C and HIV infections suffer mental health problems report having a disability self-harm and attempt suicide die prematurely 4 substance misuse -improving services and supporting offenders
Substance misuse problems in prison population Alcohol (Home Office 2004) 32% of men were assessed as hazardous drinkers (AUDIT score of 8 or more). Twice as high as the general population For women the proportion was 15% which is more than double the general population Drugs (NOMS SPCR 2013) study showed 81% of adult prisoners said they had used illicit drugs at some point prior to entering prison almost two-thirds (64%) within the month before entering prison Rates of using heroin and crack cocaine were higher among women compared to men (49% and 44% respectively) Smoking Over 80% of prisoners smoke (4x national rate) 5 substance misuse -improving services and supporting offenders
Mental health Mental health More than 70% of the prison population has two or mental health disorders Male prisoners are 14 times more likely to have two or more disorders than men in general, and female prisoners are 35 times more likely than women in general Personality disorders are particularly prevalent among people in prison. 62% of male and 57% of female sentenced prisoners have a personality disorder. 49% of women and 23% of male prisoners in a Ministry of Justice study were assessed as suffering from anxiety and depression Suicide rates The suicide rate in prisons is almost 15 times higher than in the general population 6 substance misuse -improving services and supporting offenders
Mortality and BBV Mortality rates In the week following release, prisoners in the sample were about 40 times more likely to die than the general population HIV and Hep C 9% of men and 11% of women in prison have hepatitis C (twenty times higher than the rate of 0.4% in the general public). The HIV rate in prison for men is 15 times higher than the rate outside at 0.3 per cent 7 substance misuse -improving services and supporting offenders
Recovery wider issue than substance misuse Housing 30% of people released from prison will have nowhere to live. 18% of clients in an average homelessness project are prison leavers. Employment One-third (32%) of prisoners reported being in paid employment in the four weeks before custody. However, 13% of SPCR prisoners reported never having had a job. Education 47% of the prisoner sample held no academic qualifications. In 2003, the proportion of the population of working age in the UK holding no qualifications was 15%. Abusive backgrounds 29% of prisoners had experienced emotional, physical or sexual abuse as a child. With women (53%) more likely to have experienced such abuse than men (27%). 8 substance misuse -improving services and supporting offenders
Transformation of prison based substance misuse services since 2006 Where we were.. Inconsistent, variable quality, postcode lottery Where we are now... Consistent delivery of clinical treatment across adult prisons in England Out of step with the evidence base and lagging behind community based provision. Class actions. High incidence of self harm and suicide amongst drug misusing prisoner Under funded Introduction of IDTS between 2006-20I0 underpinned by NICE guidance and in line with community based services Dramatic reduction in suicides amongst this client group since IDTS NHS England inherit 115m budget for prison based substance misuse services 9 substance misuse -improving services and supporting offenders
How we got there - key milestones Introduction of phased implementation of Integrated Drug Treatment System (IDTS) between 2006-2010 2007 PriceWaterhouseCoopers report on prison funding emphasis on cost effective and evidence based approach 2010 - Patel Review recovery orientated, outcomes focused and local commissioning 2011 DH assume responsibility for funding all substance misuse services including psychosocial interventions 2011-2013 programme of re-commissioning integrated, recovery focused drug and alcohol services across the prison estate April 2013 NHS England take on responsibility for commissioning all healthcare provision in all custodial settings 2013-14 implementation of NDTMS in prisons 10 substance misuse -improving services and supporting offenders
A shared endeavour at national and local level At a national level there is a National Partnership Agreement between NHS England, NOMS and Public Health England in relation to the adult and Young Peoples estate identifying respective roles and responsibilities NHS England have developed and are refining a national delivery framework and local operating model that sets out how national, regional and local operational and governance arrangements Health and Justice Area Teams are being supported by PHE centre based alcohol and drug teams and dedicated Health and Justice posts. 11 substance misuse -improving services and supporting offenders
Work in progress Development of Health and Justice Indicators of Performance (HJIPs) joint NHS England, PHE and NOMS initiative to develop and more robust performance management framework to assess effectiveness of healthcare interventions Focus on strengthening through the gate interventions e.g. alcohol brief interventions. New Public Health Outcome Framework (PHOF) indicator focussed on successful through the gate referrals into community based treatment. Treatment Outcome Profile (TOP) for prison NDTMS New psychoactive substances (NPS) toolkit published and national training programme initiated 12 substance misuse -improving services and supporting offenders
Looking to the future challenges ahead Transforming Rehabilitation responding to the new world of resettlement prisons, release on licence for all sentenced prisoners and offender management delivered by Community Rehabilitation Companies (CRCs) Smoke free prisons roll-out commencing in the South West with a view to national roll out Integrated care pathways for offenders with mental health and substance misuse problems How do we ensure that the split commissioning arrangements for custody (NHS England) and community (Local Authority based public health) work together to ensure effective continuity of care? Information technology developing a new Health and Justice Information System (HJIS) that will operate across all custodial settings that supports an integrated health and social care pathway system for detainees into and out of places of detention in England 13 substance misuse -improving services and supporting offenders