Prison to Rehab Protocol

8. LEAP (Lothians & Edinburgh Abstinence Programme)

Location: Woodlands House, Astley Ainslie Hospital, Edinburgh

8.1 Ethos

LEAP is a treatment and rehabilitation programme for those dependent on alcohol and other drugs (including opiates, stimulants, cannabis, tranquillisers etc.) and usually lasts 3 months or longer. The treatment model is that of Therapeutic Community (TC). The programme is suitable for those who want to achieve a substance-free recovery.

LEAP is part of the services provided by the Addiction Treatment & Recovery Care Directorate (NHS Lothian) and is delivered in partnership with the City of Edinburgh Council, the Cyrenians, Encompass (Access to Industry) and the three Lothian Alcohol and Drug Partnerships. It is closely connected to the system of care in Lothian that provides drug and alcohol treatment to dependent patients, receiving most of its referrals from specialist treatment providers in the community.

Treatment

There are several elements in the LEAP programme to help people achieve recovery. These are:

• Therapeutic Community living
• Medical care (including detoxification)
• Therapeutic (group and one to one sessions)
• Mutual aid/recovery community resources
• Trauma-informed support
• Access to psychiatry and psychology care
• Access to Occupational Therapy
• Peer support – including an innovative peer bridging project
• Preparation for rehab rolling programme
• Complementary therapies
• Drama sessions
• Recreational activities and trips
• Support with housing
• Education, training and employability
• Long-term Aftercare – 2 years
• Family Programme

The staff team includes two specialist addiction doctors, a psychiatrist, a psychologist, four nurses, an OT, a pharmacist, a chef, eight therapists, five administrative staff, a peer support co-ordinator, a peer bridging manager and six employed peer workers (in recruitment) and more than 20 peer support volunteers.

The breadth of the multidisciplinary team allows us to support patients with complex needs who may need higher level medical, psychiatric and behavioural health care.

LEAP has two accommodation units, Randolph Crescent Hostel and the Firhill unit. The first is a sixteen bedded unit while the latter is an eight bedded unit, both with support from staff in the evenings, overnight and at weekends. A housing assessment forms a part of the overall assessment process and housing support staff will work with patients to ensure they maintain their own tenancy while on the LEAP programme. Patients attend for treatment at Woodlands House on the Astley Ainslie Hospital site in Edinburgh during the day. Housing support staff are available to give support with any housing issues.

Outcomes

The majority of patients who start treatment at LEAP complete treatment (annual completion rates are around 65-70%). A one year externally conducted and published study found significant improvements across a range of domains. Analysis of data to four years post-treatment found that over 60% of patients who completed treatment were reporting ongoing abstinence and continued improvements in measured outcomes.

Aftercare

LEAP offers aftercare support five days a week for up to two years after graduation from the programme. We recommend that graduates attend two of these sessions each week.

This takes the form of group therapy. LEAP offers the following aftercare groups:

• LEAP solutions (Relapse Prevention / Coping Skills)
• Mindfulness and Mindful Compassion
• Overcoming Anxiety
• Women's group
• Mixed groups

For our West Lothian graduates we offer weekly aftercare in Bathgate. This takes place on a Friday morning. Cognitive Behavioural Therapy (CBT) is also available from LEAP therapists for suitable aftercare patients with ongoing issues.

Recovery Community

LEAP practises assertive referral/connection to mutual aid groups in Lothian, both online and in person. Many groups have members who are ex-LEAP patients and firm connections are made to support ongoing recovery.

LEAP has close working relations with Edinburgh Recovery Activities, a LERO which promotes recovery through activity and connection to other recovering people.

Employability

Around 70% of LEAP graduates go on to join the Encompass Programme, part of Access to Industry's service focussed on training, education and employability

Volunteering

There are more than 20 trained and supervised peer volunteers supporting patients before, during and after treatment. LEAP graduates have the opportunity to volunteer once recovery is well under way.

Homeless men

The service supports a recovery house for homeless men which is accessible for suitable patients post-treatment. This runs on the Oxford House model.

8.2 Admission criteria and process

Criteria for suitability

We will normally only start an assessment when prospective patients are on

• Methadone 60mls or less
• Diazepam 20mg or less
• Suboxone/Subutex 20mg or less
• Espranor 18mg or less
• Budival weekly preparation 24mg or less
• Budival monthly preparation 96mg or less

Budival ideally converted from monthly to the weekly preparation shortly prior to admission.

Patients can be referred in on 60mls of methadone, but need to have reduced to 50mls by admission. Alcohol detoxification can also be provided although we sometimes have to arrange admissions to the Ritson Clinic for this to be done safely as an inpatient. Complex drug detoxes are also supported in the Ritson Clinic. Patients using crack or powder cocaine or other stimulants will also be medically supported through any withdrawals.

Exclusions

The service is commissioned for patients who have previously been Lothian residents. May be unsuitable depending on risk assessment outcome in relation to history of violence/ aggression/ sexual offending behaviour. This is done on a case by case basis and will normally involve input from several professionals. Our goal is to treat if at all possible, though we need to consider the risks to other patients and staff as well as the needs of the patient seeking treatment.

• Significant mental health problems – acute psychosis or acutely suicidal
• Chaotic drug use which cannot be managed safely.
• Cognitive impairment that precludes new learning and engagement
• Some severe mobility issues where a single site out of area rehab may be more appropriate.

Opening hours for admission

The programme at Woodlands House operates from 8.30am to 4.00pm every weekday and from 9.00am to 12.00 noon on a Saturday. Out of hours patients are supported by City of Edinburgh Council staff and Cyrenians staff in the two residences. Weekend activities are supported by peer supporters. Admissions generally happen Mondays to Thursdays and admissions must be completed by mid to late afternoon.

Assessment

This is done in person. Support prior to admission and after assessment would be by phone or video appointment weekly in the run up to admission.

Assessments are usually completed over two or three appointments by LEAP staff and include assessment of physical and mental health, review of past medical history and current prescriptions, social history, forensic history and addiction history. Risk assessments are made by LEAP staff and by housing staff. Where risks are identified that may be difficult to manage, a wider multidisciplinary team consensus is sought. Our psychologist and/or psychiatrist can be involved in assessment and risk management.

The service normally has a waiting list, which means that assessments for people in prison would need to start two or three months ahead of planned admission date.

Transport

Transport can be arranged by LEAP staff.

Contact details

Dr Ian Scott
0131 446 4400
Ian.scott@nhslothian.scot.nhs.uk