Stabilisation, detoxification and other crisis support in Scotland: Service mapping and capacity survey 2022/23

Key Findings

Main Survey

The mapping exercise identified a total of 38 providers offering a form of stabilisation based on their reporting offering opioid substitution therapy (OST) and/or benzodiazepines and/or OST optimisation.

The majority of stabilisation providers (71%) are statutory organisations (either NHS hospitals or other statutory organisations). The remaining were residential rehabilitation providers (16%), third sector organisations (8%), a general practice and a private hospital (6%).

Around half (53%) of services operated in a community-based or outpatient model and the other half (47%) in a residential or in-patient setting.

Glasgow City has the highest concentration of both residential and community-based stabilisation services (34%). The other 25 services were spread across 20 local authority areas in Scotland.

Of the 29 stabilisation providers that gave an estimate, there was a total of 1,875 people receiving treatment. This included 272 people attending residential or in-patient services and 1,603 people attending community or out-patient.

There is a wide range in the types of substances for which treatment and support is offered, the range of treatment and support offered, and the length of the treatment. Most stabilisation services also offered some form of detoxification (95%) and behavioural or psychological interventions (92%).

Most stabilisation providers (68%) do not operate a waiting list for their services. Those that did describes waits of between two weeks and up to 12 weeks, with a few noting that this varies depending either on capacity or clinical need.

Most stabilisation providers (63%) stated that there are no criteria for exclusion from their service. Exclusion criteria, where adopted, included the profile of substance use (11%), the existence of a criminal record (8%) or of a specific mental health concern (5%) although some reported that people are assessed on a case-by-case basis and may not result in automatic exclusion from the service.

Referrals come from the local ADP or Health Board areas (53%), hospitals (50%), general practices (47%) or through social work (45%). It is also quite common for people to self-refer.

All stabilisation services operate within one or more regulatory frameworks, including the National Health Service (NHS), Health Improvement Scotland (HIS) and the Care Commission.

The most common source of funding is through the NHS or local ADPs. Self-funding for stabilisation is uncommon.

Providers reported that people commonly return home following discharge from residential stabilisation services as opposed to entering residential rehabilitation. Almost two thirds of residential providers (65%) and three quarters (75%) of community-based providers responding that service users 'rarely' or 'never' move on to this following discharge from their service.

A further five providers were identified as providing some form of detoxification, which did not include stabilisation. They came from a range of organisations, and all also offered behavioural or psychological interventions an active connection to community recovery resources.

A further 24 providers were identified as offering another form of crisis support, which did not include stabilisation and/or detoxification. They are primarily third sector or homelessness services principally operating in community-based settings, offering a range of other treatment and support.

Prison survey

All responding prisons (12 out of 15) offer some form of stabilisation for a range of substance use profiles alongside a range of other treatment and support. These include detoxification, behavioural and psychological interventions, wound care and blood-borne virus testing.

Responding prisons reported a patient-centred approach being taken and that there is no maximum capacity. Instead, treatment and support are delivered based on an assessment of need upon arrival.

Conclusions

Services operating in Scotland aimed at supporting people at a point of crisis with regard to their substance use have noted commonalities. However, the findings of this survey suggest an operational definition of "stabilisation" and how this differs from other forms of crisis support is currently lacking. Based on the results of the survey, a possible broad definition is suggested: "Stabilisation aims to support people to manage their substance use through medication prescription in combination with detoxification and/or psychosocial support as required". This suggested definition will need to be further considered the SCCWG and would benefit from engagement with various stakeholder groups, including people with lived and living experience.

The report highlights considerations for further research. These include further research on providers of stabilisation and detoxification; on other crisis support providers; and into the lived and living experience of current service users, people seeking referral and those supporting them.