Prison population: substance use and wider support needs

Chapter 9: Recommendations

Given the systemic complexities and challenges of partnership working that our review has highlighted, we have chosen to present our recommendations in two distinct groupings:

• Firstly, a small set (4) of high-level key recommendations (which are explicit in terms of the action required by the named organisations within the recommendations); and
• Secondly, a larger set (22) of outcome-based recommendations, grouped around a series of themes reflecting the findings of the needs assessment. These recommendations describe a 'preferred future' which will only be achieved by all relevant stakeholders and partners working together in close collaboration.

High-level key recommendations

Key recommendation 1: Better consistency and continuity of care should be achieved through the negotiation and agreement of a detailed partnership agreement between all the key partners involved in the commissioning and delivery of substance use services and supports across prisons (and wider criminal justice pathways)^[40]. This new (substance use) partnership agreement should detail a core set of principles for working better together and will have the core aim of implementing improved and consistent practice as well as improving experiences for those individuals receiving support.

Key recommendation 2: A multi-agency, multiple and complex needs, working group should be convened by Scottish Government to operationalise the learning from this needs assessment (and should be combined with learning from the concurrent Mental Health needs assessment study). The group should include lived/living experience and family representation.

Key recommendation 3: There should be coherent, national oversight and governance of progress towards achieving all of the outcome-based recommendations (detailed below), through the instigation of an independent National Oversight and Assurance Group. The group will need to pay particular attention to the need for urgent action to address the significant data deficiencies highlighted in this report.

Key recommendation 4: By building upon the successful coordination and planning work adopted that led to Scotland's prisons becoming smoke-free, SPS, private prisons, and Integration Authorities should consistently and fully implement the MAT Standards across all of Scotland's prisons. This should include being evidenced through detailed consultation work with all key sub-groups of Scotland's prison population (i.e. male/female/young people and sentenced/remand populations).

Outcome-based recommendations

Outcome theme 1: The wrong starting place

• Outcome-based recommendation 1.1: The needs of all those who experience problems with substances are effectively supported in the community, reflected by Sheriffs and Courts utilising greater and broader use of diversionary measures to prevent individuals unnecessarily being sent to prison.
• Outcome-based recommendation 1.2: All stakeholder strategies and delivery plans reflect an understanding of a starting premise that substance use in Scottish prisons is an integral part of a coping mechanism to a range of complex issues (not withstanding that it causes a range of problems) and requires both psychosocial and medical intervention.

Outcome theme 2: Continuity of treatment and support

• Outcome-based recommendation 2.1: As part of the full implementation of MAT Standards there will be greater continuity of treatment for individuals between prisons (transfer) and between community and prison (into and out of custody).
• Outcome-based recommendation 2.2: For those moving through the criminal justice system, including into and out of prison, critical through-care support (in relation to family contact, housing, casework, legal issues, and managing benefits) is experienced continuously from arrest through to community reintegration.

Outcome theme 3: Policy perspectives

• Outcome-based recommendation 3.1: Substance use policy across Scotland's prisons and the wider criminal justice system have adopted a prevention-first approach, and fully co-ordinate and integrate with all relevant disciplines supporting multiple and complex needs. This should be evidenced across all levels of national, regional, and local planning frameworks.

Outcome theme 4: Systemic complexities

• Outcome-based recommendation 4.1: Prisons will be actively incorporated into all relevant local, regional, and national planning structures (especially ADPs, Community Planning Partnerships, and Community Justice Partnerships).
• Outcome-based recommendation 4.2: Integration Authorities are fully inclusive of Community Justice and prison partners, with the active involvement of all agencies in joint commissioning and leading to a visible use of pooled treatment budgets.
• Outcome-based recommendation 4.3: Whilst not disregarding the multiplicity of complex needs, there is a fully functional and integrated approach to address the consistent overlap between substance use and mental health.

Outcome theme 5: Non-substance use specific needs

• Outcome-based recommendation 5.1: Those entering and leaving prison do so with greater support for the maintenance of existing housing or provision of suitable housing upon leaving prison (to avoid them re-entering the negative cycle of substance use that is often associated with homelessness, temporary or unsuitable housing provision).

Outcome theme 6: Substances and substance use

• Outcome-based recommendation 6.1: Drug screening in Scotland's prisons is used to gain intelligence about, and understand the patterns of, substance use among the prison population, and to indicate opportunities to deliver health and psychological interventions.
• Outcome-based recommendation 6.2: Individuals who enter prison with a primary dependency (physical and psychological) on alcohol should have access to appropriate psychological interventions (as well as pharmacological).

Outcome theme 7: Substance use specific needs – in-prison

• Outcome-based recommendation 7.1: All individuals entering Scotland's prisons receive sufficient information and support to enable them to make informed choices about their prison-based care and treatment, including early conversations about support for abstinence and recovery, where appropriate. Those living in prison feel confident that disclosing substance use will lead to support and help as needed.

Outcome theme 8: Throughcare and liberation

• Outcome-based recommendation 8.1: Continuity of care is experienced before, during and after custody (through stronger and continuous case management, earlier planning for release, avoidance of Friday or Bank Holiday release, increased provision by statutory and third sector community-based services to engage with the needs of individuals throughout this process, working in co-operation with prison services and other justice services), such that individuals experience less pressure to use substances or to relapse following liberation.
• Outcome-based recommendation 8.2: The Prison2Rehab pathway is consistently available to people leaving all of Scotland's prisons, with good accessibility for all of those who require it.

Outcome theme 9: Specific populations

• Outcome-based recommendation 9.1: Young people's location of incarceration is close enough to their home to support continuity of care and their familial networks, reflecting the learning from the recent diversification of the female prison estate in Scotland, and contributing to the prevention of problematic alcohol and drug use.
• Outcome-based recommendation 9.2: People on remand have greater access to the range of substance use interventions and support that are already made available to the sentenced prison population.
• Outcome-based recommendation 9.3: The female population receive enhanced trauma-informed interventions to mitigate the need to use substances to cope with consistent underlying and existing traumas.
• Outcome-based recommendation 9.4: Individuals withacute co-occurring psychiatric and substance use needs are not remanded or sentenced to a prison environment, but rather are supported in specialist psychiatric or community provision.

Outcome theme 10: Workforce

• Outcome-based recommendation 10.1: There is a fully resourced, trained, and confident workforce, across sectors, who all consider working with substance use to be a legitimate part of their role.

Outcome theme 11: Recovery

• Outcome-based recommendation 11.1: Recovery and substance-free interventions are comprehensively developed across all of Scotland's prisons, with access available to all those who request them.

Outcome theme 12: Data

• Outcome-based recommendation 12.1: Data collection and monitoring arrangements are consistently supported and evidenced by a fulfilment of HMIPS Standard 9 (Health and Wellbeing) at all of Scotland's prisons and are reflected in a successful delivery of the Prisons Digital Health & Care Systems Provisioning Programme.
• Outcome-based recommendation 12.2: In moving towards a fulfilment of HMIPS Standard 9 (see 12.1 above), and in response to the high levels of risk carried within the prison system, the key health, social care, local authority, and justice partners routinely share common health and substance related data.