Prison to Rehab Protocol

Participating Residential Rehabilitation Providers

Background and context

The Scottish Government has a commitment to supporting and enabling people with drug related conditions to access residential rehabilitation. An important element of this is the development of a pathway for individuals in custody who will benefit from appropriate residential rehabilitation on immediate discharge from custody. An initial protocol had been written by the Residential and Recovery Providers Group and this is a revised version prepared one year after the introduction of the original protocol. This revised protocol reflects some of the learning gained from the initial cohort.

This protocol is designed to develop a clear route of continuing care for prisoners who have demonstrated a profound motivation to become substance free and manage their own recovery by moving directly to residential rehabilitation on liberation from custody.

Going direct to a residential rehabilitation service from custody is difficult and various psychological and personal barriers to treatment have been identified^[1]. Prisoners require to be motivated, to be able to demonstrate their commitment and to have an understanding of what to expect and what is expected of them. Residential rehabilitation providers have indicated that the suitability of referrals could be improved through a more joined-up approach, as some individuals are referred for inappropriate reasons, such as a lack of accommodation or to support a testimony in court.

Prison staff and prison healthcare staff need to be aware of the range of available residential provision and understand the vital role they have in the preparation of the prisoner for a direct transfer to residential rehabilitation. Referrals made at short notice or to other areas can impede this crucial preparatory work. This could be mitigated by improved communication between prison health workers and rehab providers, which would help to increase understanding of residential rehabilitation and the particular model offered by a provider^[1].

Prison health workers can be key to integration, through processes such as facilitating the reduction of Opioid Replacement Therapy (ORT) in prison. Residential rehabilitation staff require to understand the difficulties associated with coming directly from custody and to be involved in the assessment and preparation of the individual.

The success of this protocol requires all parties to demonstrate clear and accurate communication, be aware of the limits and range of their responsibilities and have an understanding of the scope and variation across the residential rehabilitation services.

It is evident to date that a key element is the early identification of candidates for the move from custody to residential rehabilitation. Those candidates who transfer at short notice tend to remain in residential rehabilitation for a shorter period.

It is the intention of this protocol to ensure that all partners involved in a complex and detailed process have a clear understanding of their role and how they can contribute to a positive move from custody to residential rehabilitation. All partners should understand that the wider care needs of each prisoner moving from a custodial setting to a residential rehabilitation setting will be different. The range of holistic needs of each individual may require the intervention of professional organisations which can include criminal justice social work, housing, DWP and other relevant organisations.

The role of family support can be crucial and positive family engagement is highly desirable.

The emphasis in this protocol is in the preparation of individuals for the transition from custody to residential rehabilitation. For prisoners there is a complexity to this process for a number of reasons:

Release from custody to residential rehabilitation is at odds with the conventional view of prison release. A prisoner who chooses this route is making an active decision which conflicts with the usual norms and expectations.

The prison system is not designed to prepare prisoners for release to residential rehabilitation. Prisoners who wish to take this course of action will require support from prison officers which may present the prison with resource demands.

Residential Rehabilitation providers have built up experience through practice since the introduction of the protocol and are well equipped to offer advice and support to prison and healthcare staff.

Prisoners may have previous experience of residential rehabilitation and this will influence their desire to pursue this as an option.

Prisoners are required to work with prison staff and residential rehabilitation staff as part of the assessment and preparation prior to admission to residential rehabilitation.

By Recovery and Residential Providers Group