10,000 fewer people in treatment
The Office for Health Improvement & Disparities just (28 January 2022) published its annual “Alcohol and drug treatment in secure settings” report, covering the financial year 2020/21. The report contains information on both adults and young people in contact with treatment services in prisons, youth custody and immigration removal centre settings. This blog post covers the headline findings and main trends.
The principal finding is the way that the pandemic has reduced the availability of drug and alcohol treatment in prison. There were 43,255 adults in alcohol and drug treatment in prisons and secure settings between 1 April 2020 and 31 March 2021. Although numbers in treatment have been decreasing year on year, this was a drop of almost 10,000 (18%) from 2019 to 2020.
Treatment numbers and substance use
Around 60% (25,830) of the people in treatment, started treatment during this year. Of these people, half (49%) said they had a problem with opiate use, which was similar to the previous year. Of the people starting treatment with opiate problems, 69% also had a problem with crack cocaine, a 9% decrease from the previous year. You can see a more detailed breakdown of problem substances for adults in prison treatment in the graphic below.
Continuity of care
The proportion of adults released from prison and successfully starting community treatment within 3 weeks of release was 38.1% in 2020 to 2021. This has increased by 3.6% from the proportion in 2019 to 2020 (34.5%) and is 7.8% higher than when this was first reported in 2015 to 2016 (30.3%). It is of course, still well short of the government’s target of 75%.
Deaths in treatment
There were 55 people who died while they were in treatment in 2020 to 2021. This is a 45% increase compared to the previous year when 38 people died, particularly worrying when you factor in that there were 10,000 fewer people in treatment. People with opiate problems accounted for 56% of the deaths in 2020 to 2021, which is less than in adult community treatment where people with opiate problems accounted for 65% of deaths. Tragically the average (median) age of these 55 people who lost their lives was just 42 years old.
Mental health
Over a third (39%) of people starting treatment were identified as having a mental health need. The highest proportion was seen in the opiate group (42%), compared to 32% in the non-opiate only group. The mental health needs recorded in NDTMS should reflect the needs identified by prison healthcare staff or identified in the community before the person was in the secure setting.
Treatment outcomes
A total of 25,494 people left treatment in secure settings between 1 April 2020 and 31 March 2021. A third (32%) of those were discharged after completing their treatment free of dependence, compared to 26% last year, an increase of 6%.
The non-opiate only group (49%) and non-opiate and alcohol group (48%) had the highest rates of successfully completing their treatment. Last year both of these groups had a rate of 40%. The proportion of people successfully completing treatment in the alcohol only group increased to 44% from 41% last year. The opiate group had the lowest rate of successfully completing treatment (17%), but this was still a substantial rise from 12% in the previous year.
Almost two-thirds (58%) of adults leaving treatment were transferred for further treatment, either in the community (45%) or in another secure setting (14%).
The remaining 9% of adults left treatment without completing it, mainly by dropping out of treatment (4%) or being discharged due to being released from court (2%).
Young people
There were 727 young people receiving treatment for drug and alcohol problems in secure settings in 2020 to 2021. Most (64%) of these were in young offender institutions, with a further 23% in secure children’s homes, 8% in secure training centres and 6% in welfare-only homes. Unsurprisingly, the two most common problem substances were cannabis followed by alcohol.
Of the young people starting treatment in secure settings in 2020 to 2021:
- 92% said they had a problem with cannabis
- 38% said they had a problem with alcohol
- 27% said they had a problem with nicotine
- 15% said they had a problem with cocaine powder
- 8% said they had a problem with opiates
- 4% said they had a problem with ecstasy
Conclusion
It is likely that the impact of COVID-19 on prison and drug treatment is much worse than the substantial reduction in numbers revealed in these statistics. I am currently undertaking a study of the prison treatment experiences of people who use opiates and have received many replies from people who said the main form of treatment (apart from prescribing) was work books to be completed in the cell. Many who had made progress in tackling their dependency, said they had mainly been supported by other prisoners.
Thanks to Andy Aitchison for kind permission to use the header image in this post. You can see Andy’s work here.
