national drug programme delivery unit supporting the implementation and quality delivery of drug...

National Drug Programme Delivery Unit

Supporting the implementation and quality delivery of drug treatment services.

Drug Treatment in PrisonsFuture Directions

Integrated Drug Treatment System (IDTS)

Jan PalmerClinical Substance Misuse Lead - Prison Health

Prison Health Research NetworkCelebrating Excellence In Prison Healthcare Research & Delivery

20th October 2006

National Drug Programme Delivery Unit

Supporting the implementation and quality delivery of drug treatment services.

Introduction

The objectives of IDTS are to expand and improve provision of drug treatment for prisoners, 18 years and over, within HM Prisons by: increasing the availability, consistency and quality of these services;Diversifying the range of treatment options available to those in prisons;integrating drug treatment provided by prison healthcare and CARATs servicesStrengthening continuity of care for drug users entering, moving between and exiting prisons

National Drug Programme Delivery Unit

Supporting the implementation and quality delivery of drug treatment services.

Background Recognition of dual need to provide:

Enhanced clinical treatment for drug users

More intensive psychosocial support during first 28

days

Successful SR04 bid to improve these services for substance misusers in prison

National Drug Programme Delivery Unit

Supporting the implementation and quality delivery of drug treatment services.

Funding 2006/7 comprises £5 million from NOMS/Home Office – additional provision of CARATs services during the first 28 days of custody to deliver increased psychosocial support

£12 million Department of Health – enhance and develop clinical services for substance misusers in prisons in line with “Clinical Management of Drug Dependence In The Adult Prison Setting” (DH 2006)

National Drug Programme Delivery Unit

Supporting the implementation and quality delivery of drug treatment services.

Rationale

Prescribed management of substance misuse has been found to be consistently more

effective, when augmented by a variety of psycho-social interventions.

(Amato 2004; Gerra 2003; McLellan 1993)

Rationale

Vulnerability of drug using prisoners to self inflicted deaths and self harming behaviours during withdrawal

62% of those who died were problematic drug users (HMP Safer Custody Internal Report 2002)

National Confidential Inquiry study of 172 prison suicides 1999/2000

National Drug Programme Delivery Unit

Supporting the implementation and quality delivery of drug treatment services.

RationaleDrug-related mortality among newly released offenders

1998 to 2000 - Home Office Online Report 40/05 Michael Farrell & John Marsden National Addiction Centre – Institute of PsychiatryAll recorded deaths in first month after release for women were drug related, (69 times more likely to die in the week following release than the general population)In the week following release from prison, men were 29 times more likely to die than males in the general population – 90% were drug related causesOpiates were involved in almost 97% of drug related deaths that occurred in the first two weeks of release from prison

Post-release mortality rates (males)Farrell & Marsden [2005] n = 36,515

Post-release mortality rates (females)Farrell & Marsden [2005] n = 12,256

MMT

non-MMT

Follow-up study of mortality (Dole et al 2003)

0.95

0.96

0.97

0.98

0.99

1

0 3 6 9 12 15 18 21 24 27 30 33 36

Probability of survival

months

National Drug Programme Delivery Unit

Supporting the implementation and quality delivery of drug treatment services.

Rationale

Prison regime management problems related to illicit drug useClinical services should correspond to National Treatment Agency (NTA) Models of Care and international good practiceContinuity of care between prisons, and between prisons and the community

National Drug Programme Delivery Unit

Supporting the implementation and quality delivery of drug treatment services.

Timetable

2005/06 – Development of IDTS model and systems to inform roll-out in 06/07

2006/07 First wave of implementation – 17 sites have received funding to develop both clinical and psychosocial interventions

28 sites have received clinical funding only

Further development as funding is released

National Drug Programme Delivery Unit

Supporting the implementation and quality delivery of drug treatment services.

Integration

Joint working/information sharing by CARAT’s and Healthcare staffContinuous (rather than duplicated) assessment – Healthcare initiate then CARAT’s continue resulting (usually) by day 5 in a joint care plan including the prisoner’s views and wishesAbove + involvement of Mental Health Teams for Dual Diagnosis

National Drug Programme Delivery Unit

Supporting the implementation and quality delivery of drug treatment services.

Psychosocial Support Psychosocial interventions – delivered as part of a client’s care plan, which assist the client to make changes in their drug & alcohol using behaviour (MoC update 2005)Key worker - CARAT worker will draw up and ensure delivery and ongoing review of a care plan + 1:1 interventionsGroup work opportunities – menu of optionsPhases (1-7) + (8-28) + beyond (as now)

National Drug Programme Delivery Unit

Supporting the implementation and quality delivery of drug treatment services.

Clinical Services – Key Components Prescribed management of withdrawal by a Dr. on night of arrival in prisonStabilisation onto a licensed opiate substitute medication – minimum of 5 daysOpiate reduction regimes – individually tailoredOpiate substitute maintenance regimes for all remand and short sentence prisoners (6 months)

National Drug Programme Delivery Unit

Supporting the implementation and quality delivery of drug treatment services.

Clinical Services – Key Components Alcohol DetoxificationBenzodiazepine withdrawal managementWithdrawal monitoring/clinical observations at least twice daily x 5 daysClinical “observations” of stimulant users x 72 hrs + management of withdrawal symptoms as requiredStabilisation Unit which permits unrestricted observation 24 hours a day by healthcare staff

National Drug Programme Delivery Unit

Supporting the implementation and quality delivery of drug treatment services.

Clinical Services – Key Components Dual Diagnosis – A harm minimisation approach is recommended (RCPsychiatrists 2003)

In Cell TVHot Chocolate (etc) at nightMunchie packs at nightAdditional bedding

National Drug Programme Delivery Unit

Supporting the implementation and quality delivery of drug treatment services.

Continuity of Care

Prisoners will be able to transfer between prisons without interruption to treatmentTreatment commenced in community – continued in prison Treatment commenced in prison – continued upon release Prison can provide a period of stabilisation to allow for new treatments to commence

National Drug Programme Delivery Unit

Supporting the implementation and quality delivery of drug treatment services.

Drug Treatment in PrisonsFuture Directions

Integrated Drug Treatment System (IDTS)

Jan PalmerClinical Substance Misuse Lead - Prison Health

Prison Health Research NetworkCelebrating Excellence In Prison Healthcare Research & Delivery

20th October 2006