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.

The numbers in black and white: facing up to an uncomfortable truth

Editor’s note: in the November/December issue of Druglink, we published an article by Geoff Monaghan who offered a critique of the Release/LSE report on stop and search. Owing to time and space constraints, we were not able to offer the report’s authors a right of reply in that issue. They in turn were concerned at having to wait until the next Druglink in January. Therefore, we decided to publish their reply as a DrugScope blog. 

By Niamh Eastwood and Michael Shiner

Have you ever wondered why people are still complaining about the over-policing of black communities? If you have, Geoff Monaghan’s article in the November / December 2012 edition of Druglink provides some clues.

Geoff, a former detective sergeant in the Metropolitan Police, takes exception to our recent report – The Numbers in Black and White: Ethnic Disparities in the Policing and Prosecution of Drug Offences in England and Wales. The report shows that black people are stopped and searched for drugs at six times the rate of whites, even though they use drugs at a lower rate, and are more likely to be charged when found to be in possession. It also shows that ethnic disparities in drug policing have significant knock-on effects, with black people being taken to court and sentenced for drug offences at a higher rate than white people – often for possession offences. Our analysis is based on official data and the same technique that has been used by the Home Office and latterly the Ministry of Justice for well over a decade. The report has been described by The Voice as a ‘landmark study’[1].

Geoff Monahan is less complimentary, though he begins by acknowledging the legitimacy of our concerns and has ‘no hesitation in accepting the fact that members of black, Asian and minority ethnic (BAME) groups – black suspects in particular – appear to be treated differently from white suspects at a number of points between arrest and conviction.’ He says he knows ‘full well’ that people from such groups are over-represented in stop and search, acknowledging “that some (perhaps many) police officers don’t always conduct their search, arrest and other investigatory powers in strict accordance with the law and codes of practice”.  He also accepts that ‘there are documented cases that confirm ethnic bias in officer decision-making about who to stop and search and/or arrest.’ In a recent report on cannabis policing co-authored by Geoff, our report is cited to support the claim that there are ‘racial tensions’ between police services and people from ethnic minority communities, and that ‘these tensions are linked to the policing of drugs, particularly cannabis’[2]. What, then, is the problem?

Apparently our report’s overall conclusion, that drug law enforcement unfairly focuses on black and Asian communities, ‘is flawed, and so the recommendations are less than sound’. Having accepted the substance of our concerns, Geoff devotes the rest of his article to trying to pick holes in the analysis. His conflicted reaction is illustrative of the defensiveness that has characterised police responses to long-standing evidence of ethnic disparities in stop and search.

The inquiry into matters arising from the death of Stephen Lawrence, particularly the finding of institutional racism, has had a profound affect on the police psyche, but has not prompted the kind of organisational change that many hoped. A key reason for this is that the police service has engaged in an ongoing process of collective denial[3]. The extent to which stop and search is disproportionately targeted at black and minority ethnic communities has remained largely unchanged since the Lawrence inquiry, yet police representatives continue to trot out well-rehearsed arguments that seek to explain the disparities in ways that do not implicate police decision-making. The Lawrence inquiry was dismissive of such arguments, but this has not stopped the police from repeating them. Among the favourite defences are claims that black people are stopped and searched at a higher rate because they offend more and/or are more ‘available’ to the police. The first argument is unsupported by the evidence, and surveys have, as we noted in our report, repeatedly shown that people from black and minority ethnic groups use drugs at a lower rate than whites. With this avenue closed off, Monaghan focuses on the available population argument.

Geoff claims our report contains ‘factual errors’, but fails to identify any. Rather, he challenges the methodology – one that is used by the Government, the police, the Equality and Human Rights Commission and pretty much anyone working on the issue in the academic world. His main objection is that we fail to take account of previous research on the available population, citing that undertaken by MVA and Miller for the Home Office in 2000. A lot is made of the suggestion that the police might not be able to do much about ethnic disparities in stop and search because the composition of the available population is shaped by structural factors, such as unemployment, that are beyond their control.

There is some evidence that black and minority ethnic groups are over-represented among people ‘who use public places where and when stops or searches are carried out’[4], potentially helping to explain why they are stopped and searched at a higher rate than we would expect given their numbers in the general (residential) population. This evidence is limited in several important respects, however. Only two published studies have sought to assess the ethnic composition of the available population in England and Wales and related it to those who are stopped and searched. Taken together they cover a handful of tightly defined localised areas with high rates of stop and search, which means the results cannot be generalised to the country as a whole with any degree of confidence. Leaving aside the methodological difficulties of determining the ethnicity of the available population in what may be busy thoroughfares, these studies were designed to assess the possible role of ethnic bias in street-level decision making. While such decisions are a potentially significant source of bias, they are not the only, or necessarily most important, consideration. The Lawrence inquiry identified ethnic disparities in stop and search as evidence of institutional racism, which recognises that discriminatory outcomes may occur in the absence of individually biased decision-making due to organisational policies and practices.

The emphasis on the ‘available population’ has been described as a ‘smokescreen’ by the Black Police Association[5]. Critics have pointed out that availability does not provide sufficient grounds for a stop-and-search because officers are ordinarily required to have an ‘objective basis’ for suspecting somebody before they proceed. The Equality and Human Rights Commission (2010: 52) has also noted that availability “doesn’t hold up to scrutiny as it is self-fulfilling”[6]  because the make-up of the available population is partly a function of police decisions about where and when to carry out stop and search. Ethnic profiling, in other words, can occur at the level of the neighbourhood as well the individual.

Geoff’s discussion of the available population is highly selective and illustrates the general defensiveness that characterises police responses. Like many police personnel, Geoff treats availability as the final word on disproportionality, with little consideration of the associated caveats and methodological limitations or contrary evidence. According to MVA and Miller, their study ‘did not give a clean bill of health to the police use of stops and searches’[7] , but provided clear examples where people from minority ethnic backgrounds were stopped and searched more often than would have been expected from the available population. MVA and Miller also found evidence that stops and searches were targeted at areas with disproportionate numbers of black and minority ethnic residents, but where local crime rates did not appear to justify such attention. Hence they concluded that their research should not be seen as an ‘excuse’ for the police to turn attention away from the potential role of discrimination.  Most notably, perhaps, MVA and Miller  endorsed the analytical approach we used in our report, recommending that police forces ‘should continue to compile measures of disproportionality based on residential figures’ because ‘these figures remain an important indicator of the actual experience of different ethnic groups within police force areas’, describing ‘the outcomes of stops and searches’[8].

Our research aimed to assess whether the degree to which people from black and minority ethnic communities are subject to drug law enforcement is reasonable given their levels of drug use and the answer to this question is a resounding ‘No – it is not’. We made no claims that ethnic disparities are driven by bias in street-level decision making, though we doubt very much that they can be wholly explained by the available population. Ethnic disparities are greater in relation to stop and search for drugs than other offences, suggesting a degree of targeting, particularly given the relatively low rates of drug use within minority communities. We would also note that the wide ranging discretion afforded to officers; the emphasis on colour blind policing; and difficulties in bringing cases of discrimination to court are crucial in sustaining existing disparities[9].

Geoff rejects the suggestion that cannabis policing is a priority for enforcement and disputes the notion that cannabis warnings have resulted in net widening – something he appears to accept in his co-authored piece on the policing of cannabis[10]. We don’t claim that cannabis has become a formal enforcement priority, but show how the introduction of the cannabis warning scheme alongside targets for offences brought to justice has inadvertently created a perverse incentive structure that rewards officers for going after ‘low hanging fruit’ . The result has been a marked increase in the amount of stop and search targeting drugs, mainly low level cannabis possession, at a time when rates of use have been falling. Cannabis warnings have been issued in their tens of thousands per year, more than doubling the number of criminal justice disposals for drug offences.

The nadir of Monaghan’s argument comes when he suggests arrest rates are low (7 per cent) because ‘all savvy drug users/traffickers need to do is hide their drugs in their underwear, or body orifices’ and the police are unable to detect the substances due to the legal constraints on strip searches and intimate searches. We hope Geoff isn’t advocating widespread invasive searches in order to boost arrest rates for low level drug possession offences. In any event, he is incorrect to state that officers require authorisation from a senior officer to conduct such a search. A strip search can be carried out before arrest if the officer deems it ‘necessary’ and the only safeguard is that the search is carried out in a police station or a designated area out of the public’s view. We have no idea how many such searches are being undertaken as the data is not being centrally collated, despite the humiliating and intrusive nature of the intervention. While few drug searches result in arrest, this is typical of stop and search as a whole, which has an overall arrest rate of around 10 per cent. Even when including cannabis warnings and on the spot fines the hit rate of 18%, which Geoff describes as ‘impressive’, still means that 4 out of 5 people stopped and searched are not found to be in possession of drugs. Such a low yield cannot be simply brushed aside with references to savvy offenders given the ‘alarming’ and ‘disturbing’ lack of professionalism highlighted by the recent HMIC report into the use of stop and search[11].

We welcome the opportunity to respond to Geoff’s concerns, but would rather be having a different conversation. The ethnic disparities we have highlighted are a problem, regardless of what is driving them, particularly given that they cannot be explained by what is known about patterns of offending. These disparities are part of a deeply entrenched pattern of injustice, perpetrated by the state against already marginalised and vulnerable communities in the name of drug control. Geoff says he recognises there is a problem but like so many others steeped in a police oriented worldview he is unwilling to face up to the uncomfortable truth about the fundamental failure of the police to find solutions to a decades’ old injustice.

[1] Elizabeth Pears (2013) ‘Black people have become victims of 'war on drugs’, The Voice, September 1, 2013; http://www.voice-online.co.uk/article/black-people-have-become-victims-war-drugs%E2%80%99
[2] Monaghan G & Bewley-Taylor D (2013), ‘Practical implications of policing alternatives to arrest and
prosecution for minor cannabis offences’, International Drug Policy Consortium, http://www.leahn.org/wp-content/uploads/2013/10/MDLE-report-4-_-Practical-Implications-of-Policing-Tolerated-Cannabis-Markets-1.pdf
[3] Shiner, M. (2010) ‘Post-Lawrence Policing in England and Wales: Guilt, Innocence and the Defence of Organisational Ego’, British Journal of Criminology, 50(5): 935-953.
[4] MVA and Miller, J. (2000) Profiling Populations Available for Stops and Searches, Home Office; page 9.
[5] Metropolitan Police Authority (MPA) (2004), Report of the MPA Scrutiny on MPS Stop and Search Practice, Metropolitan Police Authority.
[6] Equalities and Human Rights Commission (2010) Stop and Think: A Critical Review of the Use of Stop and Search Powers in England and Wales, EHRC; page 52.
[7] Ibid page 87.
[8] Ibid page 88.
[9] See also Alexander, M (2010) The New Jim Crow: Mass Incarceration in the Age of Colorblindness, New Press.
[10] Monaghan G & Bewley-Taylor D (2013), ‘Practical implications of policing alternatives to arrest and
prosecution for minor cannabis offences’, International Drug Policy Consortium, http://www.leahn.org/wp-content/uploads/2013/10/MDLE-report-4-_-Practical-Implications-of-Policing-Tolerated-Cannabis-Markets-1.pdf
[11] Her Majesty’s Inspectorate of Constabulary (2013) Stop and Search Powers: Are the Police Using them Effectively and Fairly?

Headspace: Not sorted for E’s or whizz

While the forensic information has yet to be made public, the tragic death of Nick Bonnie at the Warehouse Project in Manchester (28 September) appears to be the latest in a series of deaths linked either to strong ecstasy or the PMA-ecstasy combination. Up until 2011, PMA had only been implicated in two deaths in the previous 18 years. That figure leapt to 20 in 2012, while the BBC File on Four programme (29 October, listen here) claimed that figure had already been exceeded for 2013.

From a public health perspective, why this is happening now is almost beside the point; the question is ‘what more can be done to warn club goers of the dangers of using ecstasy?’ And then you have to throw into the mix the numerous anecdotal reports of serious outcomes for users of some of the new compounds, especially synthetic cannabinoids. There are no official statistics on the prevalence of use of substances like Black Mamba, Annihilation and Exodus Damnation – and nobody should be helping the more scurrilous end of the media, by unduly ramping up concerns. But even if the names are just a marketing ploy to encourage sales, the percussive effects of these drugs are all too real.

We could do worse than reinvigorate some of the harm reduction initiatives from the 1990s, when rave culture was at its height. Not that this was exactly free from controversy. The first materials on safer dancing appeared in Liverpool in 1992 published by the Merseyside Regional Drug Training Unit (now HIT). After hearing about the rising tide of MDMA-related A&E admissions to local hospitals, they produced the ‘Chill Out’ leaflet, setting out what has now become standard information about not getting overheated, staying hydrated and so on.

The tabloid response was swift and brutal, with one paper going so far as to suggest that parents go round to the unit’s offices and chuck the director Pat O’Hare in the River Mersey.  It didn’t take too long for that information to appear in medical articles, in materials from organisations like DrugScope (then ISDD) and Release and, significantly, in government literature. The government also backed the London Safer Dancing Campaign; ISDD launched the London Study Safely Campaign aimed at students and there were other similar initiatives around the country. The more responsible venues began supplying free water, chill out areas and allowing drugs workers onto the premises to offer advice and support. Did people still die from taking drugs? Sadly they did, but few club goers could have said that they had no idea about the possible ways they could reduce potential risks.

It is true that for a decade now, most drug use, be it problematic or recreational has been in decline. And we don’t know how much of a health problem we really have with the new drugs – except there seems to be a lot of them about. But there is sufficient anecdotal evidence coupled with the jump in MDMA-related deaths to warrant a step change in thinking about information provision – not least because, as well as traditional indoor venues, the last decade has seen an explosion in outdoor festivals where drug-related fatalities and casualties have also occurred.

Unfortunately, proactive information underlining risk reduction is looking pretty scarce right now. The government would point to the FRANK website as a reliable source of information – which it is. But, as reported in this issue, a survey of school students in Nottingham showed that while FRANK has high brand recognition, virtually none of the students would use it a source of information. This will sound quite Luddite, but whatever new technology can deliver, I would argue there is still a significant role for shoving a leaflet in somebody’s hand, putting up posters and providing other tangible objects of social marketing.

DrugScope continues to get regular calls from a whole range of professionals looking for just this – and we can’t help, because there are no funds for free print distribution these days. And due to financial cutbacks, government funds for similar communications activities have also dried up.

It is impossible to say if more readily available information would have saved those who have recently died; but it has to be worth making sure people are properly informed. After all, when Leah Betts died in 1995, one of the most widely publicised drug deaths of all time, few of the current casualties would even have been born.

Harry Shapiro

The state we’re in

Paul Anders, Senior Policy Officer, DrugScope

Everybody is aware of the pressure that the voluntary and public sector have been under for the last few years. Most areas of public spending have been squeezed to a greater or lesser extent, and some sectors have seen provision and capacity substantially affected. While the drug and alcohol treatment sector has not got off scot-free, the presence of the NTA and the somewhat protected funding structure provided for in the Pooled Treatment Budget (PTB) had sheltered the sector to some extent from the pressures elsewhere.

In April 2013, all that changed. Commissioning responsibilities moved to local authorities accompanied by funding previously indicated for drug and alcohol services, which now forms a substantial part of the local public health allocations. What should be noted here is that while the amount of funding nominally allocated to drug and alcohol services hasn’t gone down, there is (currently) no sign of effective protection or ring-fence for the sector and its clients.

Turning to the Public Health Outcomes Framework, which local authorities will be measured against, we can see that relatively few indicators relate directly to the work of the sector – arguably three out of a total of 66 outcome indicators. While well-prepared providers are already working to demonstrate the way their work supports improvement of other key indicators, there is the risk that local authorities under increasing financial pressure may think that a third of the money delivering a twentieth of the outcomes is not a great deal. Public Health England has a role to play in all of this, although it’s not yet entirely clear what that role may comprise of.

In terms of partnerships with the criminal justice sector, another change has taken place. From April 2013, elected Police and Crime Commissioners (and their staff) have replaced Police Authorities. While they, in effect, take control over their budgets in two stages (in April 2013 itself and then 2014), they will be key players – for example through commissioning Drug Interventions Programme (DIP) successors, or through commissioning outreach or – ultimately – whatever sort of provision they feel would work best locally, which could include none at all, at a time when core police budgets are also under pressure.

Clearly, 2013 could turn out to be a crucial year for the sector –a year zero for two hugely important funding and commissioning reforms. However, it was always unlikely to be a ‘big bang’ year – there are contracts with time remaining, and there was a reasonable assumption that at least some of these new structures would take time to familiarise themselves with their new responsibilities and bed themselves in. However, with around 150 local authorities making decisions about spending on public health, and over 40 Police and Crime Commissioners (PCCs) in charge of community safety and crime reduction, understanding the sector has suddenly become more difficult.

The State of the Sector research, conducted for the Recovery Partnership, is an attempt to address that, and will also provide a useful resource for DrugScope in other activities. The research comprised a large online questionnaire, interviews with services in 9 areas that had been identified as particularly interesting, interviews with a number of chief executives and through Freedom of Information Act requests to every PCC in England and Wales. In London, DrugScope, along with the London Drug and Alcohol Policy Forum, contacted every local authority to learn more about their commissioning structures.

The results so far have, to an extent, been in line with expectations – for the reasons above, it always seemed unlikely that there would have been rapid and significant changes by the end of October 2013 but knowing where the sector has come from will help us to identify the direction of travel more accurately. DrugScope and the Recovery Partnership will be publishing a full State of the Sector report later this year, but produced an interim report for its annual conference in November, focussing on key parts only of the responses to the online questionnaire.

These included:

• 36% of services reported a decrease in funding, of which around a third was due to losing services as a result of recommissioning.
•  41% had been through a retendering or recommissioning exercise in the last 12 months, with 64% expecting to in the coming 12 months.
•  44% reported a decrease in front-line staff numbers, and 63% an increase in the use of volunteers.
•  43% said they were not engaged with their Health and Wellbeing Board, including no involvement in any Joint Strategic Needs Assessment Consultation.
• Around 4 in 10 had had involvement with their Police and Crime Commissioner, but only around 1 in 10 was involved via the Police and Crime Plan consultation.
• 9 out of 10 respondents reported that welfare reform had had a negative impact on their clients.
• No respondents were receiving funding from Jobcentre Plus’s Flexible Support Fund.
• Most respondents identified funding and recommissioning as the biggest single challenges facing their own service.
• The most significant gaps in local provision were (in order) access to housing, partnership / support for clients with complex needs, and education, training and employment opportunities.

The responses to the survey and the interviews carried out with service managers and chief executives paint a nuanced picture of a sector that clearly faces challenges, but is innovating and showing resilience. There are several causes for concern, not least in the external environment, but the outlook is far from bleak – for now.

If you would like to discuss the State of the Sector research, please contact Paul Anders – paul.anders@drugscope.org.uk or 020 7234 9799

Who benefits

Who Benefits? is a broad partnership of charities who want to reframe the terms of the debate about social security. Too often, the portrayal of welfare benefits and benefit claimants in the media and elsewhere is misleading – that benefits are generous, easily obtained, and often a lifestyle choice. We know that that just isn’t the case – work with our members and directly with clients shows only too clearly that people are facing increasing hardship due to a range of factors, including the Work Capability Assessment and the on-going process of welfare reform. Coming from a drug and alcohol perspective, we’re also acutely conscious of the impact of stigma; one of the most insidious and harmful effects of the way that the media talks about social security is to increase the stigma felt by all people who have to rely on benefits to get by.

Who Benefits? aims to provide balance to this largely negative narrative by highlighting the vital role that social security and welfare benefits have in supporting people who would otherwise be at risk – the young, the old, the unwell and those experiencing other forms of disadvantage. Who Benefits? believes that no one should go hungry because they lose their job or become homeless because they get ill, and will give a voice to the millions of people who have been helped and supported through at least one point in their lives by social security benefits.

Who Benefits? is coordinated by The Children’s Society, Crisis, Gingerbread, McMillan Cancer Support and Mind, and supported by dozens of other charities and community groups from a range of sectors, including DrugScope. If you’re interested in supporting or joining the campaign, you can find out how here.

Paul Anders
DrugScope Senior Policy Officer

Turning lives around? Drugs, alcohol and the Offender Rehabilitation Bill

As summer comes to an end and politicians return from recess, the Offender Rehabilitation Bill is about to continue its path through Parliament. The Bill – which was published in May, alongside the Government’s response to the ‘Transforming Rehabilitation’ consultation – is comparatively short, but nevertheless important, and contains a number of provisions that are likely to have an impact on those with drug and alcohol problems in contact with the criminal justice system.

Most significantly, perhaps, the Bill introduces a post-custodial licence period for short-term prisoners (those sentenced to up to 12 months), as well as a period of “additional supervision for the purpose of rehabilitation” in the community for anyone sentenced to up to two years’ custody; the licence period and the new supervision period will, together, last 12 months. So, someone sentenced to six months’ custody – who, under the current regime, would be released after three months in prison, with no supervision – will, under the new legislation, serve three months in custody, three months on licence in the community, followed by nine months of supervision.

The Government has set out clear reasons for these provisions: reoffending rates for those released from short prison sentences are high, and post-release supervision will address this through tailored support to help people ‘turn their lives around’. The lack of support for short-term prisoners has been a concern for DrugScope and others for a long time, and the principle of post-release support is an important one. But there are risks, too: it’s possible that the new licence and supervision periods will mean an increased numbers of breaches. This is a real risk for those with drug and/or alcohol problems, who may lead ‘chaotic’ lives, and find complying with the conditions imposed on them difficult. Apart from the cost attached to this (which the updated impact assessment for the Bill puts at somewhere between £6 million and £42 million annually), there’s also the question of the impact of  additional sanctioning as a result of a breach – which could include a return to prison – on ‘recovery capital’ and the pursuit of ‘rehabilitation’. 

There’s an issue, too, around proportionality of sanctioning, and the implications of the new supervision period for this. Someone given a two-week prison sentence, for instance, will in practice be ‘in the system’ for 53 weeks: one week in prison, followed by one week on licence and 51 weeks of supervision in the community.

The Bill also introduces a ‘drug appointment requirement’, which can be imposed as a licence condition, or during the new supervision period. Under this, you would be required to attend appointments with a view to addressing your “dependency on, or propensity to misuse, a controlled drug”. The requirement has to set out who the individual subject to the condition has to meet with (who must have “the necessary qualifications or experience”), where and when the appointments will take place, and the duration of appointments.

Under the Bill’s provisions, there is no “requirement to submit to treatment”. However, there are unanswered questions about what “treatment” means in this context, and how it may be interpreted in practice. It could, for instance, be interpreted to mean only medical treatment, meaning that some individuals might be required, for example, to participate in some forms of psychosocial interventions; further clarification is needed in this area. There are also potential problems as a result of a lack of specialist provision in some areas: this could result in some people being mandated to attend appointments at services that are not able to meet their particular needs effectively, or, in some cases, where their safety could be compromised – for instance, women who are in intimate relationships that are abusive.

Finally, as some DrugScope members have highlighted, the evidence for the effectiveness of mandating people to attend appointments as a way of ensuring engagement with treatment is mixed – for instance,  the required assessment process in the Drug Interventions Programme (DIP). DIP has been very successful in some respects; the National Audit Office (2010) cites Home Office research that crimes committed by those receiving DIP support and in drug treatment fell by 26% compared to their frequency of offending on entering the programme. However, it’s also significant that of those who were assessed under DIP in 2010-11, only 29% went voluntarily from assessment into treatment, with 6% successfully completing this treatment.

It’s positive to see the Government paying attention to those with drug and alcohol problems in the criminal justice system, and improving resettlement support for short-term prisoners. But there are a number of issues with the approach it is taking, which DrugScope has raised with the Ministry of Justice and will continue to pursue.


Gemma Lousely,
Policy Officer

Only connect

I was recently sent a classic cartoon strip from Scott Adam’s Dilbert series, which documents the indignities and inanities of office life. This strip is set at a meeting where an intern has been invited to introduce himself to new colleagues. ‘I am Asok the intern’, he begins, ‘I report to you. But I also report to Alice on a dotted line. And I report to Carol on a fuzzy thin line. I have a blinking irregular line to Wally, and a wavy brown line to Dilbert’, at which point Alice buries her head in her hands and says ‘please make this stop’.

This strip may strike a chord with DrugScope members who are adapting to a wide range of new structures, which relate to each other in a variety of ways. These include Directors of Public Health, Clinical Commissioning Groups, Health and Wellbeing Boards, Healthwatch (both nationally and through its 152 local centres), Public Health England (nationally and through 15 regional centres), NHS England and elected Police and Crime Commissioners.

There is clear potential in so much simultaneous system change for a proliferation of dotted, fuzzy, blinking, irregular and wavy lines – particularly as different initiatives have been developed by different government departments, and may not always have been exhaustively choreographed.

Take, for example, Public Health England (PHE). At national level, strategic leadership for substance misuse sits with the PHE’s Directorate for Health Improvement and Population Health. But there is no direct line from this directorate to the 15 PHE regional centres (and their substance misuse teams), which are overseen by PHE’s Operations Directorate. The ‘line’ from PHE to local public health budget holders is also of the dotted variety. The recent PHE document ‘Our priorities for 2014-15’ explains that ‘PHE will not performance manage local authorities’, with public health ‘led locally by elected members’. (It was reported at a recent meeting attended by DrugScope that PHE Regional Directors may have autonomy to set their own local priorities independently of PHE nationally – raising intriguing questions, if true, about the scope and force of PHE’s national priorities and strategy within the wider organisation.)

To take another example, DrugScope recently met with the drug and alcohol team within the London Mayor’s Office for Policing and Crime (MOPAC). MOPAC is responsible for discharging the Police and Crime Commissioner role in London, and has identified ‘developing smarter solutions to drug and alcohol crime’ as a strategic priority in the London Police and Crime Plan, but it has limited say in the design and development of treatment services for offenders. The MOPAC team is therefore busy forging connections with decision-makers in the 33 London Boroughs – for example, Health and Wellbeing Boards. They are also working with the PHE London regional team, and thinking about how their work might eventually link up with the Ministry of Justice’s Transforming Rehabilitation reforms.

It was in Howard’s End, that the novelist E M Forster wrote ‘Only connect! That was the whole of her sermon. Only connect the prose and the passion, and both will be exalted, and human love will be seen at its height.’ That might somewhat overstate the benefit for us, but certainly ‘connecting’ will be critical for the future of drug and alcohol services. On a positive note the ‘fuzziness’ and ‘waviness’ of some of the lines could be viewed as a welcome indication of ‘flex’ and fluidity and an opportunity for creative inter-agency work. A lot will then depend on pro-active local work to ‘join the dots’ and ‘build recovery in communities’.

On a practical level, creating robust local forums and getting the right people to attend them is critical (think, for example, of the history of Drug Action Teams). It’s also important that busy people are supported to prioritise the activity that is needed to build relationships and effectively link up with others (for example, at a basic level, in job descriptions and work plans). Organisations like DrugScope have an important role to play in catalysing these processes and supporting members to engage effectively. In the autumn, for example, we are hosting a series of regional events on ‘building recovery’ in this new environment on behalf of the Recovery Partnership, and will be in touch as this – and other related work – develops.

DrugScope is currently monitoring, for the Recovery Partnership, developments for drug and alcohol services in light of the significant changes for the sector and related services. Find out more and tell us about any concerns in your local area at http://www.drugscope.org.uk/partnersandprojects/RecoveryWatch

Marcus Roberts
Director of Policy