Known unknowns and unknown unknowns: minding the gaps in young people’s treatment statistics

The release of the figures on young people's treatment for 2012-13 by Public Health England would seem to show a continuing decline in demand and further improvements in performance. The numbers of young people under 18 accessing treatment fell from a peak of 24,053 in 2008-09 to 20,032 in 2012-13, with Public Health England observing that “this reflects the overall decline in alcohol and drug use by young people over recent years”. That said, it is stressed that alcohol and cannabis continue to cause problems for some young people, while new problems are being created by club drugs and new psychoactive substances. The numbers of young people receiving help with club drugs rose from 2,007 in 2011-12 to 2,834 in 2012-13. Problems with heroin continue to affect only a very small minority: 175 in 2012-13.

The performance of the system is also encouraging. The statistics record an improvement in waiting times, with 99 per cent of young people waiting fewer than three weeks for treatment and an average wait of two days. Around four fifths of young people coming into specialist treatment services left having 'successfully completed' in 2012-13.

The figures are particularly striking in a period when local authorities have been managing cuts to their budgets. Young people's services have historically been more dependent on local funding sources than adult treatment and therefore should be more vulnerable to cuts when local budgets are squeezed.

In addition, there has been less drive and leadership from national government on young people's drug and alcohol services, compared to the strong interest at senior ministerial level in adult treatment and the challenge of 'building recovery in communities'. Indeed there is a general feeling that the Department for Education - in contrast to the former Department for Children, Schools and Families - has stepped back from drug policy. That service provision appears to be holding up in such circumstances is encouraging.

It does, however, raise the question of whether these statistics tell the whole story. When I was at Nacro, the crime reduction charity, we were constantly warning journalists and others of the perils of using statistics on offences recorded by the police as a guide to crime rates (incidentally, police figures are still being used for local crime mapping). For example, when the police improved procedures for reporting and recording racist crime following the Macpherson Report on the murder of Stephen Lawrence, this resulted in an increase in recorded racist crime. This was a good thing, reflecting a greater willingness to report, record and follow up on these offences.

Somewhat similarly, the numbers of young people accessing and being referred to treatment and the availability of treatment are not wholly independent variables - put crudely, you can only refer someone into a treatment service if there is one to refer them to.

Nor is there a direct and unmediated relationship between the overall numbers of young people using drugs and alcohol and the need for specialist treatment, so that a fall in one will necessarily explain a fall in the other.

Only a tiny proportion of under-18s using substances will ever require specialist support and a whole range of other factors tend to come into play where they do - such as experience of trauma and abuse, problems in education, offending, mental health and social exclusion. I'd treat the claim that a fall in the numbers accessing treatment is necessarily explained by overall decline in the much larger numbers who are using drugs and/or alcohol with some caution - which is not, of course, to deny that the decline is relevant and may well be significant too.

Nor, of course, and as Public Health England recognise, do figures on the availability of specialist drug and alcohol services for young people tell the full story about the need for and availability of interventions. Most young people experiencing problems where substance  misuse is a factor are unlikely to ever come into contact with specialist services, but may seek support (or fail to do so) from GPs and other primary care services, mental health services, mainstream children and young people’s service and through other routes.  Less is known about the quality and availability of this support.

I’ve just attended the launch of the Young Mind’s report Same old, about young offenders and mental health, and the problems in accessing services – so it’s also relevant to note that the PHE figures exclude the young people’s secure estate.

All in all, the figures provide grounds for cautious optimism, but it will be important to keep a close eye on interventions for young people during a period of change and transition for local authorities, and with new drug trends too.

The PHE report Substance misuse among young people in England 2012-13 is at  http://www.nta.nhs.uk/uploads/ypstats2012-13commentary[0].pdf

The Young Minds report Same old – the experiences of young offenders with mental health needs is at http://www.youngminds.org.uk/assets/0000/9472/Barrow_Cadbury_Report.pdf

DrugScope’s website for 11-14 year olds – D world - is at  http://www.drugscope-dworld.org.uk/

December’s policy blog was written by DrugScope’s Director of Policy and Membership, Marcus Roberts.