‘All I want is real help’
was many times higher than in the general population,
particularly in the first few weeks – yet naloxone was
not being provided routinely to guard against fatal
overdose. Furthermore, the opportunity to reduce drug
problems in custody was being squandered by the
subsequent failure to provide support on release.
In the last ten years a new challenge had also
emerged through widespread use of synthetic
cannabinoid receptor agonists such as ‘spice’ – adding
new health priorities to the continuing efforts to contain
blood-borne viruses, particularly HIV and hepatitis C.
So if progress has stalled, where does the failure
lie? The picture from the ACMD is of fragmented
responsibility and a lack of systematic follow-up.
Continuity of care appears to be missing throughout
the transition period – the latest PHE data shows that
only 32 per cent of people who were assessed as
needing treatment on release were having treatment
in the community within 21 days.
Many of the deaths resulted from overdose, yet the
community policy of maximising access to naloxone
(to reverse the effects of an opioid overdose) still
hasn’t reached English prisons. Only 12 per cent of
prisoners who were previously dependent on heroin
left prison with naloxone in 2017-18 because of
reluctance among NHS providers to fund it – a
situation that could be resolved by funding through
national NHS bodies, including NHS England.
W
ith much to tackle, the ACMD has
made key among its
recommendations the need for a
minister, nominated by the Drug
Strategy Board, to take over-arching
responsibility for improving custody-community
transitions for prisoners with complex health needs.
‘The fragmentation of responsibility for
implementing the previous reports and
recommendations in this area is one of the problems
we’ve identified,’ Alex Stevens, co-chair of the ACMD
told DDN. ‘This is why we’ve recommended that a
single minister be made responsible for implementing
these recommendations and previous ones, including
the Bradley review [2009] and the Patel report [2010].’
While realistic that there could be delays in
responding ‘because of all the turmoil politically’, he is
hopeful that interest shown last year by Robert
Buckland MP could prove useful in terms of continuity,
since he has been made minister for justice.
In the meantime, there is much that could and
should be done now. ‘Given that, from the spending
announcements we’ve been getting from Boris
Johnson, austerity seems to be officially over, there’s
no reason that money shouldn’t be spent on saving
people’s lives by distributing naloxone,’ he says.
Other recommendations have already been made
but need renewed attention – such as the
www.drinkanddrugsnews.com
I’ve spent a total of 28 years in custody and over three years in isolation. For years
I’ve searched out drugs to give me comfort. When I’m released I find myself
scoring and telling lies. I use and it fills that void and temporarily gives me the
power to be confident and feel I fit in better. Once it comes to light you’re using,
the powers that be recall you and I end up again in deeper discomfort, knocked
back again. My hope has gone. The jail’s chocka with drugs and I’m expected to
never pick up and use. My family is gone, my mother is in a care home. I’m full of
guilt and resentment and all I really want is real help and someone in my corner
encouraging me, but I’m falling short of finding good people who get me and
know how to help me. The truth is I contemplate suicide a lot.
Colin, in a letter to DDN editor
‘If progress has stalled,
where does the failure
lie? The picture from
the ACMD is of
fragmented
responsibility and a lack
of systematic follow-up.
Continuity of care
appears to be missing
throughout the
transition period.’
recommendation to change Friday release dates for
vulnerable prisoners, to give them a fair chance of
experiencing joined-up working between custody and
community. ‘This is an odd one,’ says Stevens. ‘NACRO
released a report last year arguing for reductions in
Friday afternoon releases and the pushback they got
from the Ministry of Justice was that if this was working
properly, it shouldn’t make a difference what day of the
week you’re released on. But all the reports from the
inspectorates of both prison and probation show that
we do not have a system that’s working properly.’
In some cases, the recommendations are an
extension of existing initiatives, such as making sure
people have access to universal credit or a chance of
employment, along with help to find somewhere to
live. ‘There are pilots going on and we’re arguing that
these should be accelerated,’ he says. The problem –
such as in the case of universal credit, where there is a
partnership between the Department for Work and
Pensions and the Prison Service – is that they are
competing with so many other priorities.
‘We’re arguing that more priority should be given
to this population because it’s so highly vulnerable to
health problems, but also problematic in terms of its
high level of reoffending,’ says Stevens. ‘And so there
would be wins for public health and crime reduction if
priority was put on meeting the needs and solving the
problems of this population.’
And while we wait for the processes of
government, what should the treatment community
be doing? The ACMD talks about the vital need for
effective community pathways and says the ‘main aim’
of the planned reforms to probation should be dealing
with offenders in the community – a conclusion built
on effectiveness, safety and ‘substantially cheaper’
cost. That surely points to a highly proactive role for
community drug and alcohol services?
Stevens recommends looking at the other recent
report, by the Ex-Prisoners Recovering from Addiction
Group, chaired by Lord Patel. ‘This has developed a
blueprint for pathways between custody and
community for people with various different types of
drug treatment need, including those who have
achieved abstinence in prison – a group that’s often let
down when they leave prison,’ he says. ‘There are
practical steps available in that report.’
Much is being pinned on hopes for a nominated
minister, and within that person’s mandate this
indicator of progress stands out: ‘reducing the
numbers of people who die within four weeks of
leaving custody and while under supervision of the
probation services.’ Could this be the opportunity to
join up the strands of research and recommendation
through a clearly defined brief? DDN
September 2019 | drinkanddrugsnews | 15