Transcript Breaking the link

Rosanna O’Connor
Director of Delivery
National Treatment Agency
The National Treatment Agency for Substance Misuse
Special Health Authority established in 2001 to improve the
availability, capacity and effectiveness of drug treatment in England
NTA works in partnership with national, regional and local agencies
to:
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

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Ensure efficient use of public funds
Promote evidence based practice
Improve performance
Monitor and develop treatment effectiveness
NTA has led the successful delivery of DH targets to
Double the number in treatment
Increase percentage successfully completing treatment
Overview
The problem
Link between drugs and crime
The evidence
How do we know that drug treatment can make a difference?
What’s been achieved?
Community based treatment
Where do prisons fit in?
Prison based drug treatment finally comes in from the cold
Where do we go from here?
What threats and opportunities does the future hold
Percentage of different crimes motivated by drug use
Theft of
motor
vehicle
Fraud
Robbery
Theft from
motor
vehicle
Domestic
burglary
Shoplifting
90
80
70
60
50
40
30
20
10
0
Nondomestic
burglary
While shoplifting is the most common drug
motivated crime it accounts for a relatively small
share of the total cost of drug related crime
Drug motivated crime accounts for around half of all crime
Drug use is responsible for the great majority of some types of crime - but tends to be
skewed towards property crime rather than high victim trauma crimes
Source: The economic and social costs of Class A drug use in England and Wales, 2003/4 in Measuring different
aspects of problem drug use: methodological developments, Home Office Online Report 16/06; BCS 2007
Drug motivated crime accounts for around half of all crime
Drug users are estimated to commit between a third to a half of all acquisitive crime
Some users will have been offenders before taking high harm drugs but once addicted,
funding a serious habit is expensive and can increase offending
Source: The economic and social costs of Class A drug use in England and Wales, 2003/4 in Measuring different
aspects of problem drug use: methodological developments, Home Office Online Report 16/06; BCS 2007
Why it’s everybody’s problem?
If you are a taxpayer you will pick up part of the annual £15.4bn
bill for the crime and health costs generated by people buying and
using Class A drugs such as heroin and crack
If you are a victim of crime there is a strong chance it will be
drug-related. Estimates suggest that between a third and a half of
all acquisitive crime (shoplifting, burglary, vehicle crime, robbery,
etc) is drug-related. Around three-quarters of heroin and crack
users say they commit crime to fund their habit
The community you live in can be badly affected in a number of
ways, from the antisocial behaviour associated with drug dealing, the
activities of those under the influence of drugs (including discarded
needles), the violence associated with organised crime, and
prostitution.
Treatment effectiveness
The National Treatment Outcome Research Study (NTORS)
followed more than 1,000 problem drug users through treatment
It recorded significant reductions in offending, with rates of
acquisitive crime falling by half at the one-year point. These
improvements were maintained at various follow-up points.
National Institute for Health and Clinical Excellence (NICE)
suggests the health and crime cost of each injecting drug user is
£480,000 over a lifetime.
DTORS estimated a cost benefit ratio for all drug treatment of
around 2.5:1 as the mean benefit per drug user in treatment
Source: Drug Treatment Outcomes Research Study: December 2009
http://www.homeoffice.gov.uk/rds/pdfs09/horr23.pdf
Evidence of effectiveness of CJ interventions
Arrest Referral Schemes 1 and the Drug Treatment and Testing
Orders (DTTO)2 which showed that the average amount pent on
drugs fell from £400 per week at the start of the intervention to
£25 per week at the follow up stage
Acquisitive crime – to which drug-related crime makes a
substantial contribution - has fallen by almost a third since the
Drug Interventions Programme started in 2003
More than1 in 4 of those starting a new episode of treatment in
England are referred by staff working in the criminal justice
system.
1 http://www.kcl.ac.uk/depsta/law/research/icpr/publications/Doing%20Justice%20to%20Treatment.%20DPAS2.pdf
2 http://www.homeoffice.gov.uk/rds/pdfs/hors212.pdf
Stop press……
http://www.homeoffice.gov.uk/rds/pdfs06/r275.pdf
This study matches data
from the Police National
Computer (PNC) with the
NTA’s National Drug
Treatment Monitoring
System (NDTMS)
database on a sample of
opiate and crack users
who had recently offended
but had not been jailed
and had started treatment
in the community. The
number of offences
committed almost halved
following the start of
treatment and the results
were very much in line
with the studies that had
been based on self report
information
What’s been achieved in the community?
Drug Interventions Programme
(DIP)
Criminal Justice Integrated Teams
(CJITs)
Testing on arrest
Required assessments
Restrictions on bail
Rapid access to treatment
Drug Rehabilitation
Requirements (DRRs)
Every week, over 1,000 drugmisusing offenders are engaged in
treatment via DIP
HO research followed group of 7,727
DIP clients and found that half
showed a 79% reduction in
offending over a 6 month period
Overall volume of offending was
26% lower following DIP
identification
Number of DRRs increased from
4,854 in 2001/02 to 16,607 in
2007/08. Completion rates improved
from 28% to 43% in the same
period
some numbers…
On average, 55% of all prisoners are problematic drug misusers
45% of men and 65% arrive drug dependent – of these 40% report
injecting drug use within 28 days
Problematic drug use can be as high as 75%-80% in some local
prisons
75,000 PDUs per year will enter the prison system
16% of all problem drug-users in prison at any one time
Prison based drug treatment….
The good news…
Massive increase in funding
(from £7.2m in 1997 to over
£100m in 2010)
Improving range of treatment
options including clinical,
CARATs and structured
programmes
The bad news…
High profile class actions by ex
prisoners citing clinical
negligence result in out of
court settlements
Inconsistent approach, variable
quality and lack of join up
between clinical and
psychosocial provision
Continuity of care
arrangements remain fragile
IDTS
Better treatment for offenders, with a range of effective needs
based treatment and realistic treatment opportunities,
including to become drug free
Improved clinical management including opioid stabilisation
and maintenance prescriptions where appropriate
Intensive psychosocial support for all patients
Greater integration with an emphasis on clinicians and drug
workers working as multi-disciplinary teams
Better targeting of interventions to match individual need
Strengthening links to community services including Primary
Care Trusts, Criminal Justice Integrated Teams (CJITs), Drug
Treatment providers etc.
What’s been achieved in prisons?
£40m per year of DH investment to support IDTS
IDTS now implemented in the majority of English prisons and
full coverage will be achieved by April 2011
Arrangements in place to begin recording prison based drug
treatment on National Drug Treatment Monitoring System
(NDTMS)
A work in progress – more to be done
Implementing the DIP review
IDTS – finishing the job and getting the balance right
The Prison Drug Treatment Strategy Review Group chaired by Lord
Patel is charged with taking forward the recommendations of PWC
review and producing a unified prison drug strategy
System Change Pilots – more joined up, more efficient, more
effective
Integrated Offender Management – addressing the reintegration
agenda and delivering case management
http://www.nta.nhs.uk/uploads/nta_criminaljustice_0809.pdf