Not getting a grip

A rethink on prison drug treatment is desperately overdue, says Mike Trace.

When I launched the first prison drug treatment strategy more than 25 years ago we knew there was a big problem to address – but we weren’t particularly clear on what we were ultimately trying to achieve.

Over the years it has become clearer. From a health perspective, the objectives are to provide a humane healthcare and prescribing service to prisoners who use drugs, and to take public health measures to minimise the risk of infections and overdoses – both in prisons and in the high-risk period shortly after release.

Meanwhile, from a criminal justice perspective, the objectives are to reduce demand for drugs on the wings, and to cut reoffending rates by rehabilitating those whose crimes are driven by drug use or addiction. 

From 1999 to 2012, this balance between public health and rehabilitation activity was broadly maintained. True, substitute prescribing and general healthcare services were too often of low quality, and many of the 100 or so rehabilitation programmes consisted of little more than a few weeks of prison officers reading out classroom-style manuals to bored prisoners. But the ambition was there, and quality was gradually improving.

When the NHS took control of the budget for commissioning prison-based drug treatment in 2012, their priority was understandably to improve health service delivery and substitution treatment.

But unfortunately this was accompanied by a lack of interest in the criminal justice system objectives – funding for the activities that actually affected the prison drug market was cut, and the opportunities for prisoners to use their time inside to choose rehabilitation and recovery diminished.

Patterns of drug use in prison were changing before 2012, and have changed massively since – less than half of the people on treatment caseloads are now primary heroin users, and the dominant drug of choice inside is spice. This has meant that opiate substitution treatment in prison – though much improved in the last 15 years – has only a marginal impact on reducing demand.

Peer pressure on prisoners to be involved in a drug market now largely controlled by prison gangs and organised crime is greater than ever – 11 per cent of male prisoners and 18 per cent of females report developing a drug problem while inside (a remarkable figure considering that almost half of prisoners have a pre-existing problem on arrival).

Disastrously through this period, the range of structured and intensive drug and alcohol rehabilitation programmes in prisons was decimated. In 2012, there were more than 100 programmes – most managed internally by the prison service and of poor quality, although there were plenty of examples of great delivery.

Meanwhile, charities such as RAPt and Phoenix Futures delivered well designed and properly resourced intensive rehabilitation programmes – independently reviewed and researched, and demonstrating positive impacts on wing culture and post-release reoffending. Thousands of pris­on­ers used these program­mes as a springboard to a crime-free life and many now work in the sector.

The absence of meaningful rehabilitation and recovery options in most prisons over the last ten years means that the dominant culture on the landings is one of drug dealing, drug seeking, drug consumption, and the associated cycle of debt, violence and health crises. This also undermines efforts to reduce crime.

Most prisoners going in with a drug or alcohol problem come out with nothing changed – the main driver of the cycle of reoffending and rearrest that is making prisons overcrowded and unmanageable.

It doesn’t have to be like this. Most readers will know I’ve been banging on about this failure of strategy for at least ten years and more recently the chief inspector of prisons, the Justice Select Committee, the National Audit Office and numerous local independent monitoring boards have been saying the same thing. Even the prisons minister, James Timpson, acknowledges that prisons cannot function effectively with an uncontrolled drug market. 

The substance misuse services in prisons have to do more than simply manage the chaos – we need to be supported to deliver services that actually change the culture on the wings. This means much greater attention to creating safe places for those prisoners who want to get away from the cycle of drugs, debt and crime – dedicated locations where the mutual aid groups, therapeutic communities and structured recovery programmes can do their work to help prisoners turn their lives around.

Both the prison service and the NHS are now realising that current provision is not having enough impact on the drug market or related harms. But despite plenty of warm words, 18 months into a new administration I still see no concerted action to change the reality on the wings. And as the RAPt t-shirts used to say, ‘If nothing changes, nothing changes’.

Mike Trace is chief executive of Forward Trust