Case dismissed

Why are recommendations to improve custody-community transitions being routinely ignored when so many lives are at stake? DDN reports.

Click here to read the full article in DDN Magazine

As drug-related death rates continue to rise there is one fact we can be sure of: that newly released prisoners make up a significant number of those who lose their lives – there were 955 deaths of offenders in the community in England and Wales in 2017-18. The few weeks after release pose a particularly high risk.

The reasons for this can be complicated and overlapping – tolerance to drugs has been compromised while chaos is reintroduced. Those who find themselves in custody frequently have mental and physical health problems, all kinds of background trauma, and problems relating to their housing and basic wellbeing – all mixed in with their problem drug use. Leaving prison can mean confusion, uncertainty and overwhelming difficulties with families, accommodation and day-to-day living.

These issues have been well documented over the years, with clear recommendations resulting from reviews such as The Patel report: reducing drug-related crime and Rehabilitating offenders: recovery and rehabilitation for drug users in prison and on release: recommendations for action, published by the government in 2010.

But according to the Advisory Council on the Misuse of Drugs (ACMD), the extent to which these recommendations have been implemented is unclear, with little evidence to suggest that they have led to safer practice. In their report, Custody-community transitions, released in June, they examined the existing recommendations and, with input from government departments, service providers and charities in the sector, looked at what must change (DDN, July/August, page 5).

Only 12 per cent of prisoners who were previously dependent on heroin left prison with naloxone in 2017-18

A look at the ‘substantial harms’ that contribute to the unacceptable death rate showed that many prisoners were still being released without the certainty of accommodation, increasing their risk of relapse and reoffending. The risk of death post-release was many times higher than in the general population, particularly in the first few weeks – yet naloxone was not being provided routinely to guard against fatal overdose.

Furthermore, the opportunity to reduce drug problems in custody was being squandered by the subsequent failure to provide support on release.

In the last ten years a new challenge had also emerged through widespread use of synthetic cannabinoid receptor agonists such as ‘spice’ – adding new health priorities to the continuing efforts to contain blood-borne viruses, particularly HIV and hepatitis C.

So if progress has stalled, where does the failure lie? The picture from the ACMD is of fragmented responsibility and a lack of systematic follow-up. Continuity of care appears to be missing throughout the transition period – the latest PHE data shows that only 32 per cent of people who were assessed as needing treatment on release were having treatment in the community within 21 days.

Many of the deaths resulted from overdose, yet the community policy of maximising access to naloxone (to reverse the effects of an opioid overdose) still hasn’t reached English prisons. Only 12 per cent of prisoners who were previously dependent on heroin left prison with naloxone in 2017-18 because of reluctance among NHS providers to fund it – a situation that could be resolved by funding through national NHS bodies, including NHS England.

With much to tackle, the ACMD has made key among its recommendations the need for a minister, nominated by the Drug Strategy Board, to take over-arching responsibility for improving custody-community transitions for prisoners with complex health needs.

Alex Stevens, co-chair of the ACMD
Alex Stevens, co-chair of the ACMD

‘The fragmentation of responsibility for implementing the previous reports and recommendations in this area is one of the problems we’ve identified,’ Alex Stevens, co-chair of the ACMD told DDN.

‘This is why we’ve recommended that a single minister be made responsible for implementing these recommendations and previous ones, including the Bradley review [2009] and the Patel report [2010].’

While realistic that there could be delays in responding ‘because of all the turmoil politically’, he is hopeful that interest shown last year by Robert Buckland MP could prove useful in terms of continuity, since he has been made minister for justice.

In the meantime, there is much that could and should be done now. ‘Given that, from the spending announcements we’ve been getting from Boris Johnson, austerity seems to be officially over, there’s no reason that money shouldn’t be spent on saving people’s lives by distributing naloxone,’ he says.

Other recommendations have already been made but need renewed attention – such as the recommendation to change Friday release dates for vulnerable prisoners, to give them a fair chance of experiencing joined-up working between custody and community. ‘This is an odd one,’ says Stevens. ‘NACRO released a report last year arguing for reductions in Friday afternoon releases and the pushback they got from the Ministry of Justice was that if this was working properly, it shouldn’t make a difference what day of the week you’re released on. But all the reports from the inspectorates of both prison and probation show that we do not have a system that’s working properly.’

In some cases, the recommendations are an extension of existing initiatives, such as making sure people have access to universal credit or a chance of employment, along with help to find somewhere to live. ‘There are pilots going on and we’re arguing that these should be accelerated,’ he says. The problem – such as in the case of universal credit, where there is a partnership between the Department for Work and Pensions and the Prison Service – is that they are competing with so many other priorities.

‘We’re arguing that more priority should be given to this population because it’s so highly vulnerable to health problems, but also problematic in terms of its high level of reoffending,’ says Stevens. ‘And so there would be wins for public health and crime reduction if priority was put on meeting the needs and solving the problems of this population.’

And while we wait for the processes of government, what should the treatment community be doing? The ACMD talks about the vital need for effective community pathways and says the ‘main aim’ of the planned reforms to probation should be dealing with offenders in the community – a conclusion built on effectiveness, safety and ‘substantially cheaper’ cost.

That surely points to a highly proactive role for community drug and alcohol services?

Stevens recommends looking at the other recent report, by the Ex-Prisoners Recovering from Addiction Group, chaired by Lord Patel. ‘This has developed a blueprint for pathways between custody and community for people with various different types of drug treatment need, including those who have achieved abstinence in prison – a group that’s often let down when they leave prison,’ he says. ‘There are practical steps available in that report.’

Much is being pinned on hopes for a nominated minister, and within that person’s mandate this indicator of progress stands out: ‘reducing the numbers of people who die within four weeks of leaving custody and while under supervision of the probation services.’ Could this be the opportunity to join up the strands of research and recommendation through a clearly defined brief?

‘All I want is real help’

I’ve spent a total of 28 years in custody and over three years in isolation. For years I’ve searched out drugs to give me comfort. When I’m released I find myself scoring and telling lies. I use and it fills that void and temporarily gives me the power to be confident and feel I fit in better. Once it comes to light you’re using, the powers that be recall you and I end up again in deeper discomfort, knocked back again. My hope has gone. The jail’s chocka with drugs and I’m expected to never pick up and use. My family is gone, my mother is in a care home. I’m full of guilt and resentment and all I really want is real help and someone in my corner encouraging me, but I’m falling short of finding good people who get me and know how to help me. The truth is I contemplate suicide a lot.

Colin, in a letter to DDN editor

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