Excluding direct staff and general practitioner costs, the IPS and the Probation Service have combined expenditure of €3.33m on the provision of addiction services for adult offenders. Spending has declined in recent years in line with the fall in the number of prisoners held in the prison estate as more initiatives, such as community return, have been introduced. During the course of the review, concern was expressed about the lack of investment in health in the prison system and the absence of a clinical director or health director at senior management level. Reduced expenditure on addiction counselling has resulted in a reduction in the number of addiction counsellors provided by Merchants Quay Ireland (MQI) and changes in the types of services they provide. Some prisons only have part-time access and waiting times for addiction counsellors have increased.
Consultations with service providers, the Probation Service, the IPS and the Health Service Executive (HSE) all highlighted a number of recent changes that were affecting the capacity to treat offenders with addictions:
- A decline in opiate-based addiction and an increase in the abuse of benzodiazepines, novel psychoactive substances, opiate-based analgesics, and other narcotics as well as increased polysubstance abuse;
- Increasing numbers of offenders presenting with comorbidities, most notably mental illness combined with drug and/or alcohol addiction;
- The ready availability of drugs within the prison system;
- Younger people with complex needs, such as drug addiction combined with chaotic personal lifestyles, homelessness, mental health issues, poor literacy, and communication skills deficits.
A cohort of offenders moving in and out of the criminal system poses significant challenges to effective treatment. Female offenders are more likely to be chaotic substance users than their male counterparts. This results in particular challenges when treating their addictions.
Model of effective practice
The review sets out a model of effective practice aligned with the principles set out in the National Drugs Rehabilitation Implementation Committee (NDRIC) framework and refined following consultations with community-based organisations (CBOs), prison-based health teams and addiction counsellors, and a review of international literature.
The model recognises that recovery takes time and often requires several episodes of treatment and that the person in recovery should have a broad range of options available to facilitate the process. Good communication both within the prison system and between the prison environment and the community are necessary to ensure clear treatment pathways and that the opportunity provided by time in prison to address addiction is taken. The core components of the model are pre-work and preparation, referral, assessment, care planning, case management, treatment and recovery management.
Apart from initial outcomes monitored by MQI in Mountjoy Prison, there is currently no robust systematic tracking of outcomes for prisoners treated in the prison estate. The review acknowledges that, while work needs to be done regarding the identification and measurement of outcomes, good progress has been made by community-based organisations (CBO)in developing outcome models. Most of these are abstinence based but there is a recognition that other outcomes, such as completing treatment, increased social skills and behavioural change, are also valid outcomes in recovery programmes.
A number of CBOs have conducted research into outcomes for clients and provide data on outcomes named in their service level agreements with the Probation Service. These outcomes included treatment completion, attending aftercare, and returning to training or education.
The authors recommend that the IPS adopts this model and provides the required resources and funding to support its implementation. Some of the gaps in provision identified in the review include availability of drug-free environments within the prison setting for prisoners who have completed detoxification and treatment programmes, development of non-opiate-based detoxification services, alcohol treatment services, and access to treatment for difficult cohorts such as sex offenders. Coordination of services for prisoners between the prison and outside agencies is very important in ensuring prisoners receive the services they need. Continuum of care depends on reliable referral pathways to HSE treatment services and CBOs, and this process needs to be refined through clearer protocols and mechanisms to support greater interagency information sharing. A related issue is coordination of services with a more defined role for prison addiction nurses in care planning and case management required.
The authors of the review recognise the considerable progress that has been made in recent years in the management of release planning from prisons, for instance, the involvement of integrated sentencing managers. However, prisoners with an addiction still face considerable problems on release from prison, especially if homeless. The review makes a number of recommendations that should help the coordination of pre-release planning and communication with probation and other external services. These recommendations include the involvement of relevant prison health staff and a specialised resettlement support service. As coordination and communication between services is such an important part of addiction services, the review pays particular attention to the role of service level agreements in the overall governance of external providers and CBOs.
1 Clarke A and Eustace A (2016) Drug and alcohol treatment services for adult offenders in prison and in the community. Dublin: Probation Service and Irish Prison Service. http://www.drugsandalcohol.ie/26569/