reducing reoffending ; a drug and alcohol perspective
TRANSCRIPT
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Reducing re-offending:A drug and alcohol perspective
Prof Jim McManus,
Association of Directors of Public Health
Director of Public Health, Hertfordshire County Council
13th October 2017
Policing and Crime Seminar
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About ADPH
• This is a personal view and don’t claim this to be ADPH policy, we are currently revising and reviewing our policy on drugs and alcohol
• ADPH represents Directors of Public Health in the UK in their role as local system leaders and works to support them in protecting and improving the health of the population
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Some fundamentals. Shared view?
• Addiction is chronic and relapsing condition. People don’t just stop taking substances, or change their lives overnight, and that includes offending behaviour.
• CJ system isn’t necessarily best regime for delivering effective behaviour change interventions. CJ sanctions (DRR/ATRs) have their place, but need to be done with a therapeutic approach rather than a punitive one.
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Big current issues (we’d need a whole event on these)
• Chemsex and its harm, health and legal consequences
• NPS
• Prison and custodial settings issues
• Conceptualising harm as harm to self, others, families, relationships, people and property. (A multidimensional view)
• Natural areas of overlap and distinction for us all to work together
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The three domains model
• Treatment, Care and Support
• Enforcement and Control
• Prevention and Education
• In use by 11 local areas to conceptualise how best to work together
• In a number of local strategies
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Policy Landscape• 2012 Shift to Local Authorities Public Health
• Government shift to recovery
• Evidence of effective interventions
• Naloxone
• Ageing cohort of opiate users dying
• NPS
• Review of commissioning Landscape
• Retrenchment of Residential Rehab
• New Drugs Strategy (VERY mixed bag)
• Lack of coherent alcohol strategy
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Pushback and broken bits
Need to listen carefully• Some aspects of provider
sector lobbying through FOI and reports on reduction in residential rehab (UKAT report for example) and recent ACMD report
Some genuine issues• Research
• Specialist clinical training places
• Paucity of evidence on recovery for some drugs
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Strategic Challenges• Changing epidemiology and burden of disease
• Health problem and crime problem
• Different cohorts, different substances
• Drug related deaths
• The utility of compliance testing (limited)
• Getting sentencing and sanctioning right for people in the criminal justice system which incentivises reduction of harm from drugs to people and communities
• S136
• Dual diagnosis
• More focus on drugs than alcohol in many places
• Reducing funding
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Systems thinking
The wider determinants of Health and Local Government functions (Must adopt a Lifecourse approach!)
The Lives people lead and whether LA functions help or hinder healthy lifestyles (policy, service quality, access, behavioural economics, behavioural sciences)
The services people access such as primary care (high quality, easy access, good follow up, behavioural and lifestyle pathways wrap around)
•Our health and our offending occurs in a system•Criminology and public health/epidemiology share some concerns in the literature
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3 Domains: Working out who does whatLead Enforcement and
ControlPrevention Support,
Treatment and Care
Drugs ? Multi agency Probation, NHS, Public Health
Alcohol ? Multi agency Probation, NHS, Public Health
Alcohol related violence
? Multi agency NHS Acute Trusts
Employment and housing
? Multi agency LD Partnership
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Some intervention issues• Earlier intervention is better, but needs to be a therapeutic approach to a
long-term condition
• Early access to D&A treatment is essential if treatment is to be effective. So
– we need to find ways of identifying potential problematic drug and/or alcohol use.
– Not just test on arrest, but also more subtle approaches – domestic abuse situations, Public Order, ASB are all areas where there is direct and continuous police intervention.
– Should be identifying individuals earlier, but LA’s need to make sure appropriate responses are in place when/where needed.
• Out of custody disposals are worth developing – opportunities for early intervention/engagement, deals with things outside the formal CJ system, and might support a shift towards a therapeutic approach.
• Testing in and of itself is unhelpful. Ok for treatment, not a good tool for monitoring compliance.
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Measuring Success at system level
• Police stats re drug offences are often based on possession or possession with intent to supply.
– Not a good indicator as more associated with proactive policing activity and stop/search.
• For the effectiveness of reducing re-offending, perhaps better to look at the types of offences committed by drug users – often burglary and theft – and then whether offending is reduced over a period.
• This can be a good measure for PH commissioners to use as an outcome for treatment effectiveness.
• Need to also to measure how far people have progressed, not just whether they are there or not. This needs to be built into thinking.
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Wider system provision
Wider family support is crucial.
– Third sector are often better at this, but tensions with pull back to NHS from some quarters
•housing and employment as part of the package
•Housing is crucial to engaging in effective treatment
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Where are we in comparison to other areas? – One cluster view to illustrate point
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Where are we in comparison to other areas? (Continued)
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Where are we in comparison to other areas? (Continued)
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Where are we in comparison to other areas? (Continued)
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Strategic Opportunities together
• Join up strategy across three domains
• Join up commissioning
– Education & prevention
– Treatment & support
– Control & enforcement
• Focus on harm to both people and place
• Focus on prevention
• Focus on recovery for many, maintenance for some
• Early into testing, early into treatment
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Drug Testing on Arrest• In several places now. We learned from Leics. • Looking locally• When: started 4th April 2016 at Stevenage & Hatfield police
stations• Who:
– all detainees that are arrested or charged for a ‘trigger’ offence for the second time in a 12-month period, or
– authorised by the duty inspector• What: required to undertake an oral swab test for heroin
and/or crack cocaine• 851 detainees have been tested. 77% were positive for heroin
and/or crack cocaine
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Drug Testing on Arrest (Herts)
• Key Findings as at June 2017 • Performance reporting for the cohort of 140 individuals with
previous offending rates shows:
• 17% reduction in offences in the first year following initial assessment (962 offences in baseline year; 796 in year 1)*
• 9% reduction in arrests in the first year following initial assessment (678 arrests in baseline year; 615 in year 1)
– 30 individuals have no known offences recorded against them since their initial assessment
– 20 of these individuals have not come to police attention at all in the year following initial assessment (no known offences and no arrests)
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Drug Testing on Arrest (Herts)
– 37 individuals are new to treatment and this section of the cohort commit proportionately less offences (26% of the cohort; 18% of offences in the baseline year and 20% in the year following initial assessment)
– 38 individuals were transferred to specialist treatment; 28 committed a total of 159 offences (20% of all offences) in the year following IA and a further 10 committed no known offences
– 39 individuals 39 individuals were transferred to another DAAT/prison; 35 committed a total of 387 offences (49% of all offences) in the year following IA. Just 4 committed no known offences.
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Drug Testing on Arrest (2016)
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DToA: what do we know?• 200 offenders selected for baseline data collection measuring
offending behaviour 1 year prior to being arrested and drug tested in custody to show:
Reoffending rates of those who attend treatmentReoffending rates of those who do not attend treatmentSuccessful treatment outcome of those who attend treatment
• effective at identifying Class A drug using offenders, who are a difficult client group, both locally & nationally, to engage in treatment
• majority of offenders are aged between 30-39 and are mainly committing theft/shoplifting/ whilst those arrested for burglary has dropped
• Other areas where Drug Test on arrest is used have showed significant reduction in crime & reoffending as well as cost savings in dealing with the associated crime
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Some ways forward
• Re-designing treatment services
• Looking at needs of ageing population
• Focus on young people & families
• Focus on those with complex needs/in crisis
• Safer places to recover from alcohol use
• Housing needs (short & long term)
• Supporting all agencies to address the issue
• continuing to treat those with entrenched use
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Key Opportunities
• Whole system approach
• Earlier the better
• Focus on recovery and reducing harm
• Mainstreaming ethos
• Redesign of sentences and sanctions
• Building prosocial behaviour into interventions
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The mainstreaming duty – imagine if we put this to heart….
“Without prejudice to any other obligation imposed on it, it shall be the duty of each authority to which this section applies to exercise its various functions with due regard to the likely effect of the exercise of those functions on, and the need to do all that it reasonably can to prevent, crime and disorder in its area.”
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Thank you
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