Transcript Clinical Management of Substance Misusers in Prison

Integrated Drug Treatment System
lessons learned from implementation
Background
IDTS is a joint venture between criminal
justice (Min of Justice) and Health (DH)
In recent years there has been growing
evidence that integrated drug treatment,
including methadone maintenance, is
effective in reducing crime and preserving
life (NICE, 2007)
Rule one
Be sure of your timing
Rule two
Make sure your partners support you
Rule three
Be sure of why you are doing this
One half of all prison suicides happen in the first
28 days of custody
62% of those who died were problematic drug users
(HMP Safer Custody Internal Report 2002)
Timing of 172 suicides by period of time in custody (DH 2003)
Under 24 hours
11%
24 hrs - 7 days
21%
1 wk - 1 mth 19%
Over 1 mth 49%
Someone received into a prison is twice as likely to commit suicide in the
first week of imprisonment if they are drug dependent
In the week following release, prisoners are 37 times more likely to die of overdose
than other members of the public. Women are 69 times more likely to do so.
Opiates were involved in 97% of drug related deaths that occurred in the first two
weeks of release from prison. (Home Office 2005)
Death rates of drug users leaving prison
(Dolan et al 2005)
Rate of survival
1
0.99
Left prison on
methadone
0.98
0.97
0.96
0.95
Left prison not
on methadone
0 3 6 9 12 15 18 21 24 27 30 33 36
months
Rule 4
Fight to keep control
Rule 5
Construct a local, regional and national
structure
IDTS Central Project Team
CSIP
H&SCCJ
Programme
Director
(Kieron
Murphy)
IDTS Regional Steering
Groups (9)
Regional HSCCJ CSIP Lead
NTA IDTS
Programme
Manager
(Fintan
Hayes)
NTA Regional
IDTS Lead
(The Regional
IDTS Lead
may be either)
ROM
Representative
Central Project
Team
Representative
CARAT Area
Support Manager
Area Drug
Coordinator
NDPDU
SHA/ CARATs
PCT
Support
Representative
Managers
DIP Regional
Representative
Prison Health Clinical Lead
… plus others as agreed locally
IDTS Regional
Development
Manager (CSIP/
NTA)
Establishment IDTS Implementation Group (for each First Wave prison)
Rule 6
Make sure all policy components and
funding are in place
Rule 7
Invest heavily in training
Rule 8
Enlist senior support
Rule 9
Support the people in the middle
Rule 10
Work with the people who want to make a
difference
Rule 11
Make for the mainstream
Rule 12
Invest heavily in Big Research
Rule 13
Do not complicate the complicated
‘None of us is as good
as all of us’……
Rule 14
…..Chose a slogan that more than 5% of
the audience can understand