Prison population: substance use and wider support needs

Chapter 6: Service mapping

• Reporting of ADPs on partnership working and interventions within prisons is patchy and inconsistent, with wide variations in the depth, breadth and quality of reporting being provided.

This element of the study focused on addressing research objective 3:

• Map current models of substance use care/interventions within Scotland's prisons, how they interface with other healthcare interventions within prisons, and how they interface with community care models and services, including assessing aspects of treatment continuity, finding examples of best practice, and throughcare pathways during transition from custody to the community.

In undertaking our review, we were mindful of two other mapping exercises that were either currently in progress or planned, and have had meetings with the relevant stakeholders involved in these pieces of work to share findings and join up critical conversations:

• The MAT Standards Implementation Support Team [MIST] at PHS have been commissioned by the Scottish Government to undertake an assessment of readiness to deliver MAT in prisons. Healthcare Improvement Scotland have also been commissioned by the Scottish Government to develop a learning system to support the implementation of MAT Standards, including a specific learning system for their implementation in prisons.
• The National Prison Care Network, through its Mental Health and Substance Use Group, has committed to undertaking a mapping exercise to look at integrated and shared patient pathways for Mental Health and Substance Use where feasible and appropriate.

We have also taken cognisance of the recent study undertaken by the Scottish Centre for Crime and Justice Research titled, 'Mapping Drug Use, Interventions and Treatment Needs in Scottish Prisons: A Literature Review' (Toomey, 2022). The key findings of this piece of work, which resonate in their entirety with our findings, are summarised as follows:

• High numbers of those who enter Scottish prisons have drugs in their system and high numbers identify as having a drug problem.
• Nearly 40% report using illegal drugs whilst in prison.
• 83% of people^[33] change their drug use whilst in prison.
• Benzodiazepines, opiates and cannabis are the most commonly used drugs in Scottish prisons.
• Opiate and alcohol only users tend on average to be older than non-alcohol and opiate users.
• Women are overrepresented in drug using populations in Scottish prisons.
• Between one-fifth and one-quarter of the Scottish prison population has an OST prescription. These rates vary greatly between estates though.
• Naloxone kits are available upon release to those leaving a Scottish prison. Generally women have higher uptake of these.
• Use of drugs often arises from boredom, limited regimes, and isolation.
• Buvidal was made available to all prisons during the Covid-19 pandemic.

Methodology and activities

This mapping exercise was based on data gathered for the Scottish Government's ADP Annual Review 2019/20 process. The purpose of an ADP annual report is to provide each ADP Board^[34] and their partners with an overview of the wide range of services and activities undertaken in the previous financial year to help improve the lives of the people who have had or are experiencing substance use problems. They set out to measure progress against the Scottish Government's national drug and alcohol strategy Rights, Respect, Recovery^[35], the DDTF emergency response paper^[36], and the Alcohol Framework 2018^[37].

Through the development and delivery of the local strategy, the ADP should identify where there are shared outcomes and priorities with other local strategic partnerships. In these cases they should develop shared arrangements to support delivery. As a result, minimum agreement to the strategic plan and arrangements for delivering should come from Community Justice Partnership; Children's Partnership; and Integration Authority.^[38]

Information provided by each ADP was scrutinised to identify information pertaining to criminal/community justice pathways and partnerships, covering the whole journey for individuals entering prison, serving their sentence, and then returning to the community. The following headings, taken from the ADP Annual Review template, has been used to structure this mapping exercise.

• Representation at the ADP.
• Prison arrangements in place for naloxone.
• ADPs working with community justice partners.
• ADP contributions toward community justice strategic plans.
• Procedures for individuals with treatment needs in the criminal justice pathway (upon arrest).
• Procedures for individuals with treatment needs in the criminal justice pathway (upon release from prison).

Data was available for 29 out of the 30 ADPs^[39]. A summary of our findings and key messages is provided below, with a full analysis provided in Appendix E.

Results

28 out of 29 ADPs report strategic partnerships in the form of Community Justice Partnership representation and 18 of these ADPs report SPS representation (where there is a prison within their geographical area).

14 ADPs (who have a prison in their area) provided details of the arrangements currently in place for naloxone (see Appendix E for details of these arrangements). There is a variety of different arrangements in place, however, implementation is not seamless, and there is little consistency across the country.

All 29 ADPs reported having worked with community justice partners in regard to information sharing during 2019/20. A total of 27 ADPs noted that they had worked with community justice partners with providing advice/guidance. Just over half (16) ADPs reported that they had worked with community justice partners with coordinating activities and the joint funding of activities.

27 ADPs reported that they have locally agreed procedures in place for individuals with treatment needs upon arrest. Further scrutiny of responses indicates wide variation and little consistency across the country in this regard.

The same 27 ADPs also report that they have locally agreed procedures for individuals with treatment needs upon release from prison. Similarly, there are a wide variety of arrangements in place, however, there is no uniformity.

Summary

In undertaking our review, we were mindful of various other mapping exercises that are currently in progress. Once complete, they should be combined with the findings from this study to form a comprehensive picture of current activity. More importantly, the various exercises should be assessed to identify how improvements to continuity of treatment/support can be achieved consistently across Scotland to ensure that people who live in Scottish prisons and who experience problems with substances are afforded the same choices and quality of care.