Focus On: Independent Review of Drugs (Parts 1 & 2) – Prof. Dame Carol Black

In February 2019 Professor Dame Carol Black was appointed to lead a major 2-part review into drug use and its continuing impact on society, in particular, the way in which the drugs market fuels crime and serious violence, and how services are supporting individuals impacted by substance misuse.

Last month, Dame Carol published the final part of her review which focused on prevention, treatment and recovery from drug addiction, and made recommendations for significant changes to the ways in which services were commissioned. An early finding from her research was that around 3 million people used illicit drugs in England and Wales in 2020, and that the “…total cost to society of illegal drugs is around £20 billion per year, but only £600 million is spent on treatment and prevention”

These findings gain more significance when measured against the background of record-high drug related deaths, a figure which has tragically continued to rise year on year for the past 8 years.

Dame Carol also highlighted the strong links between the illicit drug market and rising levels of violent crime, including county lines activity which has seen increased levels of knife-crime and the criminal exploitation of children and vulnerable adults.

In the second part of Dame Carol’s review, she concluded that existing provisions for prevention, treatment and recovery are inadequate and fail to make significant changes in the lives of the people impacted by substance misuse in the UK.  The report includes 32 recommendations for improving drug policy.

Funding:

Dame Carol Black’s exhaustive review of the drug and alcohol sector found that lack of funding has led to failures in client outcomes and that many front-line workers are overworked and feel demoralised.

She recommends a ‘whole-system approach’ in supporting individuals impacted by substance misuse, including the requirement of local authorities to develop effective joined-up working between health, housing, criminal justice and employment support service

Of particular focus in the review was the role the prison and probation services could play in supporting people whose use of substances had led them into a cycle of criminal activity, incarceration and relapse.

The review found that “…people with serious drug addiction occupy one in three prison places”, with the majority of these prisoners often relapsing into drug use and offending behaviour shortly after release due to the limited time in prison treatment and lack of a structured integration pathway back into the community.

Dame Carol recommended that more police diversion and community services, alongside court ordered referrals into treatment, should replace custodial sentences for drug-related, non-violent crimes. Naturally the demand on treatment services will increase, so it’s imperative this demand is met with increased funding.

Also key is the pathway from prison into treatment, with one of the recommendations being that the Ministry of Justice improve collaboration with different departments to ensure a smooth transition from a custodial setting to a community one, particularly where an individual requires ongoing substitute prescribing.

Employment:

Accessing employment for anyone recovering from drug / alcohol problems remains incredibly difficult, with employers reluctant to hire people who they perceive as ‘untrustworthy’, a component of the societal stigma with which this cohort is associated.

Historically, treatment services have not focused as much attention on finding clients work, beyond signposting to specialist agencies like DWP. With workforces already overstretched and juggling caseloads of 80+ clients, this is perhaps not surprising.

But finding effective employment is a crucial part of recovery as it not only financially provides individuals and their families, but it also offers people a chance to ‘fill the gap’ left by abstinence with a purposeful and worthwhile activity.

The Individual Placement and Support (IPS) initiative has since been piloted across 7 treatment services, with early findings indicating it has been successful in getting individuals in drug and alcohol treatment back into work.

Dame Carol Black recommends an increase in funding across the treatment sector to extend the IPS initiative and implement it across all treatment services in England.

Preventative Interventions:

One way of reducing the £20bn cost to society would be the development of an effective strategy of ‘preventative interventions’, targeted at children and Young People, with the urgent need of such a strategy highlighted by a recent report showing that “…drug use among children aged 11 to 15 has increased by over 40% since 2014, reversing a previous long-term downward trend”.

The government has the power to implement policies and include ‘Preventative Interventions’ to the school curriculum, which, it’s hoped, would lead to a reduction in the number of young people who initiate drug use in the first place.

Involving Service Users:

The involvement of service users in decision making, strategy and delivery of treatment services is a key recommendation of Dame Carol’s report.

Dr. Keith Humphries, who also contributed to the report, advised “…it is very important that people in recovery are at the table at all discussions … we need that expertise and that wisdom.”

Rough Sleeping and Homelessness: Rough sleeping and homelessness inthe UK has risen over the last two years, and findings from a recent PHE reports on substance misuse found that ‘one fifth of adults starting treatment in 2019 to 2020 reported a housing problem‘. Engaging in specialist treatment is one step to recovery, but the housing needs of rough sleepers need also to be addressed if this recovery is to be maintained. The government has pledged to eliminate all rough sleeping by 2024 and have since been working with PHE to improve provision of drug and alcohol treatment for people who are sleeping rough. By continuing to work with local authorities and services they can seek to integrate a flexible trauma-informed service across housing and health.

Next Steps “We need a positive culture, a capable workforce … and a team of teams. There’s no one agency that can solve this issue, so we need to collaborate and continually improve and innovate”  – Dr Linda Harris OBE, Chief Executive of Spectrum Community Health CIC The second part of Dame Carol Black’s review has been published during a time when the UK continues to record record-breaking numbers of drug-related deaths, is witnessing increasing levels of violent activity associated with drug supply through the county lines model and services are reporting rising addiction problems and associated mental health concerns as a result of the pandemic and three national lockdowns. Set within this context, it may seem misplaced to feel optimistic about the future of the sector, however, there is much to be positive about. For example the creation of a new Office of Health and Promotion which will lead the UK’s efforts to improve and elevate the nation by improving mental health and promoting physical activity. It will enable more joint action between local government, the NHS and cross government. The Office will also help governments to focus on agendas to track determinants (such as diet, alcohol smoking) and to also create policies in different apartments where appropriate. A sum of £80 million pounds will be allocated to local authorities in the next financial year to improve access to residential, community and inpatient drug treatment, and to expand harm reduction interventions The continued funding and roll out for Rough sleeper initiative has also come to light as recent analysis has shown that rough sleeping is 32% lower in funded areas than they would be without the initiative. The government thus announced an allocation of £112 million funding to support local services and authorities to reduce the number of people living on the streets. How can ILLY help? The ILLY teams have been working with their partners across PHE, NHS and prison services to make a real difference within the sectors we work. Key within this are the innovative, therapeutic tools that help practitioners deliver effective interventions for clients that present with increasingly complex drug issues. ILLY have recently partnered with Public Health England to support the Rough Sleeping Drug and Alcohol Treatment Grant initiative. We are currently in the process of on-boarding local authorities that have already been awarded the grant so that they can use our Rough Sleeping system to evidence the work they’re doing with their clients, as well as capture the data needed for PHE. In May 2018 we supported Haringey council in their pilot of the IPS (Individual Placement and Support) programme – an initiative Dame Carol has recommended is ‘rolled out in treatment settings across the whole of England’. For over three years, Employment Specialists within the Haringey drug and alcohol service have been providing intensive support to individual clients around accessing employment, including offering periods of in-work support to prevent people from dropping out of employment. This support has been captured on the LINKS CarePath case management system, with the monitoring of client’s progress being reported to PHE across a number of datasets, including NDTMS and Employment Services.