Full to bursting

DDN article on prison healthcare

At the end of February, the Ministry of Justice (MoJ) published its updated projections for the prison population in England and Wales.

The number of prisoners is set to increase to ‘between 94,600 and 114,800 by March 2028, with a central estimate of 105,800’, it says – last year it was less than 84,000. 

This huge increase is ‘predicated on several factors’, says MoJ, including changes in sentencing policy and courts working through their case backlogs. The projections may seem surprising given lord chancellor Alex Chalk’s announcement last October that the government intended to legislate for a ‘presumption against prison sentences of less than 12 months’ – to be replaced by community sentences, alongside better access to drug treatment and mental health services. 

However the government also intends to ‘put the worst offenders away for longer’ – as part of an overall strategy to make the best use of prisons and give lower-risk offenders the ‘greatest chance’ to turn their lives around. The adult female prison population, meanwhile, stood at 3,611 in November 2023 and is projected to have reached 4,200 by November 2027, although the MoJ stresses this doesn’t include ‘any future impact’ of the government’s female offender strategy, which aims to treat custody as a last resort.

Human cost

Alex Chalk
The projections may seem surprising given lord chancellor Alex Chalk’s announcement last October that the government intended to legislate for a ‘presumption against prison sentences of less than 12 months’ – to be replaced by community sentences, alongside better access to drug treatment and mental health services.

Many commentators have pointed out that the prison system can barely cope with the current numbers, and while criminal justice charity organisation Clinks welcomed the presumption against short sentences and consequent reduction in the ‘financial and human cost’ of this revolving door, it warned that with MoJ anticipating an increase in anything up to 6,800 in community caseloads there were also real concerns over the additional  pressure on ‘probation services, commissioned rehabilitative service providers, and the wider voluntary sector working with people in the community’. These would all need to be adequately resourced to meet the increased demand, it stressed. 

The move away from short prison sentences is undoubtedly a welcome one, however. As Professor Dame Carol Black pointed out in the first part of her Independent review of drugs, more than a third of the-then 82,000 people in prison were there for – mostly acquisitive – crimes related to their drug use. Most were serving short sentences, which obviously gave little time for any kind of effective treatment and created a situation where drug users were ‘cycling in and out of our prisons, at great expense but very rarely achieving recovery or finding meaningful work’. There were also ‘significant problems with the transition of prisoners to community treatment on release’, she added, with most people highly likely to reoffend. While the overall reoffending rate is 25 per cent, the rate for those serving sentences of under 12 months is more than 50 per cent, rising to 58 per cent for sentences of six months or less.  

Custodial alternatives

Alex Stevens
Alex Stevens is professor in criminal justice at the University of Kent. He was a member of the UK Advisory Council on the Misuse of Drugs from 2014 to 2019, and president of the International Society for the Study of Drug Policy from 2015 to 2019. Prof Stevens is currently leading the national diversion evaluation for the Cabinet Office, which will hopefully result in a recommended model next year that should inform and encourage police forces.

So what are the best alternatives to short sentences? Last year’s report from the House of Commons Home Affairs Committee (DDN, September 2023, page 4) recommended improved use of diversion schemes – where the police don’t involve the courts in cases of low-level offending – as an ‘important tool’ in reducing drug-related crime as part of a wider shift to ‘public-health based interventions’, but added that provision was at present a postcode lottery. 

‘It definitely is, but there’s work underway to correct that,’ Jason Kew, senior innovative practice officer at the Centre for Justice Innovation and combating drugs partnership lead for Berkshire, tells DDN. ‘Professor Alex Stevens is leading the national diversion evaluation for the Cabinet Office, so next year we should see a recommended model from that learning and that should encourage all forces.’

Until 2021 Kew was detective chief inspector at Thames Valley Police, and it was there that he helped to develop that force’s successful diversion scheme (see box, page 8). Several organisations are currently involved in making the evidence-based case for a move to a diversion model, he says, adding that most forces probably already operate some kind of diversion scheme, even if only on a de facto basis. 

And in February this year MoJ reported on the progress of its ‘intensive supervision courts’ which have been piloted with almost 60 offenders in Birmingham, Liverpool and Teesside since last summer. As well as engaging with treatment, offenders meet regularly with the same judge and are also subject to random drug testing by probation officers. A study into the effectiveness of the courts is currently being undertaken by Revolving Doors in partnership with CFE Research and the University of Greenwich. 

Significant impact

A move away from short sentences should also help to address the not inconsiderable issue of people developing a drug problem while actually in prison. A 2020 report from Reform stated that almost 15 per cent of prisoners said they’d developed a drug problem while in prison – double the rate from a decade ago – with a ‘significant’ impact on violence levels. Reducing the use of short custodial sentences to ease overcrowding was one of its recommendations at the time, with Forward chief executive Mike Trace commenting that more and more prisoners were getting ‘pulled in to the prison drug market’ with ‘fewer opportunities for them to use their time in prison to turn away from drugs and crime,’ (DDN, February 2020, page 4). 

The scale of the problem was recently illustrated in the alarming March 2024 report from HM Inspectorate of Prisons on HMP Hindley near Wigan, which found a ‘near tsunami ‘of illegal drugs, with a positive test rate of more than 52 per cent – ‘meaning that well over half the population were active drug users while we were inspecting’, it stated. 

One encouraging development, however, is the growth of drug-free wings in prisons – as of a year ago there were drug-free wings operating in 45 establishments in England and Wales (DDN, March 2023, page 5). But while the latest OHID figures show more than 46,500 adults in drug and alcohol treatment in prisons and secure settings in 2022-23, with 3 per cent year-on-year increases for the last two years, links with community treatment post-release can still leave a lot to be desired. 

Mental health

The same goes for prison-based mental health treatment. A 2021 report from the UK Parliament’s Justice Committee pointed out that while up to 70 per cent of the prison population were estimated to be suffering from mental health issues, only 10 per cent were receiving any treatment. Poor data collection meant that the true scale of the problem was unknown, but only likely to get worse, it said.  

A huge number of those mental health problems will of course be trauma-related, with people turning to drugs to self-medicate. ‘Someone in recovery told me, “You can’t recover unless you know what you’re recovering from”,’ says Kew. ‘And that trauma might take years of counselling. It’s not just a quick fix.’

A widespread shift to a more public health-based approach will of course mean fundamentally challenging parts of the wider culture in law enforcement, something that reflects his own journey. 

‘I joined the navy at 16 because I didn’t have any qualifications – the relevance of that is I had no critical thinking,’ he says. ‘I was just taught what I was taught and I joined the police with that mentality. In training I digested the law book, and I came out of training school like RoboCop – I was arresting so many people, and at first I didn’t really care too much about the impact of that. I was doing what I was employed to do. 

‘But then you see the harm that criminal justice can cause, the labelling, the stigma, the punitive approach in every part of the system. It was only when I got to know some of the people that I began to really understand trauma and addiction, that people are often self-managing serious trauma. 

So it’s about treating human beings as human beings. It doesn’t matter about the past, it’s the future that counts. It’s about preparing and enhancing all the skills, social capital and recovery and everything else to help that individual into the community. Why do we have this fixation on prison? Public health approaches work.’  DDN 

Prison population projections: 2023 to 2028 

The Thames Valley Police Diversion Programme

Jason Kew, senior innovative practice officer at the Centre for Justice Innovation and combating drugs partnership lead for Berkshire
Jason Kew, senior innovative practice officer at the Centre for Justice Innovation and combating drugs partnership lead for Berkshire

We looked at evidence for diversion schemes and decriminalisation around the world, as well as more local examples like Operation Turning Point in the West Midlands, which had a really good evidence base, Checkpoint in County Durham, and others, and we cherry-picked the learning, says Jason Kew. We needed to reduce deaths and reduce stigma, but we also needed to have an effective model – personally, I’d decriminalise overnight, but we had to be careful about what we were going to implement. 

Not all my colleagues were keen so we had to go back to basics with the reasons why. Reducing deaths was simple – everybody got that – and people understood a public health approach to drugs. It was actually the process that was the most challenging, because we needed to make it as easy as possible for cops. When you’re a police officer you can be dealing with road traffic one minute, domestics the next, then missing kids, shoplifting – the demands are wide, so it was vital that we make it effective for the police.

So what we were able to do was find a mechanism within the law which enabled that, and that’s the community resolution. That precludes the need for an arrest, and we were able to then get the drug services to take over from the police on the street – so it’s the drug services that the person hears from next. And for many people it’s the first contact they’ve ever had with services, so it’s a game changer, it really is. 

What we wanted to try to do was to give everybody who came into contact with the police an opportunity for some form of education or awareness, but that’s not one size fits all. You could have someone living on cardboard using spice who might not benefit too much from any kind of education around drug use at that point, but they might benefit from assertive outreach or connection with housing or benefits professionals, or some other kind of social capital. 

So it was principally about education and awareness, but also an open door to harm reduction according to that person’s needs, and the drug services were really keen. We had a working group – as well as our partner Druglink we had our local commissioned services like CGL, Turning Point, Cranstoun. We had big national charities with lots of experience, which meant we were able to bring lots of people around the table, including people with lived experience who helped to shape it all. And that’s how we ended up with our scheme.

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