Drop in referrals into treatment from CJS
This is the latest in a series of blog posts I’m writing covering the detail of Dame Carol Black’s second part of her independent Review of Drugs which sets out a way forward on drug treatment and recovery for the government and which was published last month (8 July 2021). There is consensus across the field that the Review is the most important drugs report of the century so far. This week’s post looks at Dame Carol’s recommendations on how to divert more drug users in contact with the justice system into treatment and recovery. You can read the full series of posts summarising both Part 1 and Part 2 of the Review of Drugs here.
The scale of the problem
Part 1 of Dame Carol’s review showed that a cohort of around 300,000 heroin and crack users drive nearly half of all acquisitive crime and homicides. Spending an average of £40 to £50 per day on drugs, these users cycle in and out of prison. Initiating treatment for this group has a rapid effect on reducing offending and alleviating some of the pressure on our prison system. Yet referrals from the criminal justice system into drug treatment have fallen sharply over the last decade, particularly for crack users.
Dame Carol praises police-led out of court disposal and drug diversion schemes, like Checkpoint in Durham, Turning Point in the West Midlands, and DEP in Avon and Somerset, which focus on early interventions that divert individuals away from the criminal justice system and into drug education, support, and treatment. She recommends the expansion of these diversion schemes.
The Review highlights the fact that the use of community sentences with drug rehabilitation requirements (DRR) and alcohol treatment requirements (ATR) has decreased significantly, even though they offer a more cost-effective therapeutic alternative to short prison sentences for drug-related offending. She attributes this drop to same-day sentencing with no time for full pre-sentence reports and “ineffective” probation supervision, saying that there is often neither the time nor the expertise available to help arrange a community sentence with treatment requirements. In these circumstances, the judiciary inclines towards custodial sentences, particularly when the availability and quality of local treatment and recovery services are in question.
It will be interesting to read what the probation inspectors have to say in their forthcoming thematic inspection into work with drug users due to be published later this month.
Dame Carol commends NHS England’s pilot programme to rebuild community treatment sentences although it still only covers 20% of the country. The programme covers Mental Health Treatment Requirements (MHTRs), Drug Rehabilitation Requirements (DRRs), Alcohol Treatment Requirements (ATRs) and combined orders, in recognition of the fact that many people have multiple problems at the same time.
Funding has been committed in the NHS Long Term Plan to expand coverage of CSTRs to 50% of England by 2023. Like many in the field, Dame Carol would like to see much faster progress to get to national coverage.
Drug and alcohol services in prison
Treatment services in prison were outside the scope of Dame Carol’s review. Nevertheless, she points out failings in this area, criticising NHS England’s “often arm’s-length approach” to commissioning substance misuse services in prisons. She highlights a theme that has been a concern of many criminal justice substance misuse specialists over recent years: that contracts are often placed with a large prime provider of general healthcare, which is then left to sub-contract specialist substance misuse services. Dame Carol reports a decline in the range of provision in prison, particularly of recovery-orientated services.
Continuity of care
Dame Carol also shines a light on the fact that only one third of people who engage in drug treatment in prison go on to engage with community services on release. She expresses the hope that the new NHS RECONNECT programme for care after custody will help address this failing. The Review also brings attention to the concerns about the large number of prisoners released on Fridays with consequent adverse impact on their resettlement.