National Mission on Drugs: annual report

6. Outcome 5: Quality of Life is improved for people who experience multiple disadvantages

6.1 Overview

Many people with problem drug use experience multiple disadvantages, and therefore require support from a wide range of services to ensure these are addressed in a joined up and person-centred way.

The MAT Standards emphasise the importance of taking a person-centred approach. This includes access to independent advocacy and support for housing, welfare, and income needs.

Summary of MAT Standards 8 to 10:

8. All people have access to independent advocacy and support for housing, welfare, and income needs.

9. All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery.

10. All people receive trauma-informed care.

6.2 Progress in 2023-24

6.2.1 Whole Government Approach: Housing

We have continued to upscale Housing First across Scotland, which provides settled, mainstream accommodation for those with problem substance use and other complex needs. The latest Housing First monitoring report noted that there were 26 local authorities with Housing First programmes at March 2024, and it is estimated that over 1,800 Housing First tenancies have started across Scotland.

The National Mission has supported the actions in the Ending Homelessness Together action plan through the Dual Housing Support Fund, which provides support to individuals who want to keep their tenancies whilst in rehabilitation services. Funding has been made available to ensure that when an individual accesses rehabilitation, their housing payments on their core residence do not stop for the time that they are in treatment.

We know that people facing issues with homelessness and problem substance use often engage with various services before reaching out to homelessness organisations, often at the point of crisis. The prevention of homelessness will be most effective when it is recognised as a priority across all public services, and this is why we have included new homelessness prevention duties as part of the Housing (Scotland) Bill, which was introduced in March 2024.

This Bill includes new duties on relevant bodies, which are listed in the Bill, to ‘ask and act’ about housing circumstances, alongside changes to existing legislation to ensure local authorities act sooner, to prevent homelessness.

6.2.2 Mental Health

We have continued to support people with co-occurring substance use and mental health conditions through the Healthcare Improvement Scotland (HIS) Pathfinder project. The project has laid the foundations for further improvement to care, better integrated working between services and better health outcomes for people. This work is due to end in Summer 2024 and a closure report is due in Autumn 2024.

Building on this work, a gold standard protocol for joint working is currently in development by HIS and implementation is due to begin in 2024-25.

We also continue to engage with NHS, Local Government, and Health and Social Care Partnerships on a plan to deliver the recommendations from the rapid review of care for people with co-occurring mental health and substance use conditions, and those from the Mental Welfare Commission’s report ‘Ending the Exclusion: Care, treatment and support for people with mental ill health and problem substance use in Scotland’. This will be underpinned by clear lines of accountability, reporting mechanisms and milestones. A total of £2.39 million will be invested in the implementation of these recommendations over three years.

The Scottish Government published core mental health standards and the psychological therapies specification in September 2023. These documents aim to support services to deliver psychological therapies and interventions and provide mental health care, treatment and support that is person-centred and free from discrimination or stigma, that will meet the needs of all individuals, including those that use substances. In 2024-25 we will continue to support health and social care partners to implement the mental health core standards and psychological therapies specification.

6.2.3 Whole Government Approach: Justice

The Vision for Justice in Scotland and our cross-government approach acknowledges the frequent interactions with criminal justice by people who use drugs. We also know that there is a relationship between people having a drug- related death and prior contact with the criminal justice system.^[10] That is why it is important to address the underlying causes of crime and support people to live full and healthy lives.

Bail and Release from Custody (Scotland) Bill

The Bail and Release from Custody (Scotland) Act 2023 was passed by the Scottish Parliament in June 2023 and received Royal Assent in August the same year. It introduces a number of reforms designed to deliver on the Scottish Government’s commitment to refocus how imprisonment is used. These reforms are intended to ensure that, as much as possible, the use of custody for remand is a last resort for the court, and that a greater focus is given to the rehabilitation and reintegration of individuals leaving prison custody.

The Act is in two parts. Part 1 focuses on the use of bail and remand in recognition of the negative impact that short periods of imprisonment can have. It amends the legal framework, which is used to make bail decisions, so that people are only remanded in cases where someone poses a risk to public safety, which includes victim safety, or poses a risk to the delivery of justice.

Part 2 focuses on arrangements around release from prison custody, introducing provisions to improve release planning processes and support available to people leaving prison. This includes a release planning duty on named public bodies and a requirement for the Scottish Government to publish national statutory standards of throughcare support for prison leavers. The Act will also end release on a Friday, or the day before a public holiday. This recognises the difficulties people experience accessing the community-based services they need when released on those days.

Planning for implementation of the Act is underway, with commencement expected to take place over 2024.

National Strategy for Community Justice

The aims and priority actions of the National Strategy for Community Justice support a shift towards greater use of community sentences and other community- based interventions. This includes a trauma-informed and person-centred approach to the provision of support for substance use issues. The Strategy’s accompanying Delivery plan, which was published in June 2023 and is updated twice annually, details actions being undertaken by community justice partners to drive improvement nationally.

Diversion from Prosecution: Joint Review

A joint review of diversion from prosecution was published on the 21 February 2023 by HM Inspectorate of Prosecution in Scotland, HM Inspectorate of Constabulary in Scotland, HM Inspectorate of Prisons for Scotland, and the Care Inspectorate. This assessed the operation and impact of diversion from prosecution in Scotland and made a number of recommendations in relation to communication, processes and consistency of practice. The Scottish Government now chairs a working group, comprising of diversion partner agencies, which is coordinating implementation of the recommendations from the review.

Review of Community Sentencing

The Scottish Government published a review of the two main community orders specifically aimed at people with substance use problems. Summary findings were published in August 2023, and updated in December 2023 with the complete analysis annexed.

This review assessed how Drug Treatment and Testing Orders and Community Payback Orders (DTTOs) with drug treatment requirements have been used, their outcomes and whether they are the most effective mechanism to support an individual’s recovery and reduce recidivism rates. It found that at the very highest level, the evidence suggests that court-ordered treatment is less effective than voluntary treatment but is still likely to produce more positive outcomes for people than custody.

Beyond that, the evidence on how best to maximise the potential benefits, and minimise the potential harms, of court-ordered drug treatment in response to offending behaviour remains uncertain, although consensus around good practice is emerging in some areas.

The review identified an obvious need to update the practice guidance on DTTOs, which are significantly out of date and do not reflect current practice. It also identified a number of trends in the Scottish data that may warrant further investigation, and several areas of law and practice that would benefit from more detailed consideration with stakeholders, including people with lived experience of court-ordered drug treatment.

Prison and Healthcare Recovery

In 2023-24, the Scottish Recovery Consortium continued to deliver the Prison Recovery Project. The project aims to create and embed an integrated and consistent approach to drug and alcohol recovery support and activities of care within the prison estate across Scotland. This increases the opportunities for people to access recovery support, mutual aid and peer support within the prison and creates robust and recovery pathways when people leave prison and return to their community. The delivery is based on the Connectedness, Hope, Identity, Meaning and Empowerment (CHIME) framework for recovery which supports people, including staff, to develop knowledge and understanding of addictive behaviours and recovery. It focuses on developing and enhancing both individual and systematic recovery capital and provides a range of tools to develop those skills, knowledge, and experience.

In 2023-2024, the Scottish Recovery Consortium has increased its reach and worked directly with all 17 prisons across Scotland. They have developed a network of small, grassroot, lived experience organisations that support people. This work continues to be carried out through a collaborative approach with the Scottish Prison Service, the third sector and statutory partners. It creates robust and strong links with recovery communities and lived experience recovery organisations across Scotland to ensure connections are embedded in the community for those leaving prison.