Integrated Drug Treatment Systemlessons 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)

Under 24 hours11%

24 hrs - 7 days21%

1 wk - 1 mth 19%

Over 1 mth 49%

Timing of 172 suicides by period of time in custody (DH 2003)

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)

Left prison on methadone

Left prison not on methadone

Death rates of drug users leaving prison (Dolan et al 2005)

0.95

0.96

0.97

0.98

0.99

1

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

Rate of survival

months

Rule 4

Fight to keep control

Rule 5

Construct a local, regional and national structure

NDPDU CARATs Support Managers

CSIP H&SCCJ Programme Director (Kieron Murphy)

IDTS Regional SteeringGroups (9)

IDTS Regional Development Manager (CSIP/ NTA)

IDTS Central Project Team

CARAT Area Support Manager

Area Drug Coordinator

SHA/ PCT Representative

Regional HSCCJ CSIP Lead

ROM Representative

DIP Regional Representative

NTA Regional IDTS Lead

Central Project Team Representative

Prison Health Clinical Lead

(The Regional IDTS Lead may be either)

NTA IDTS Programme Manager(Fintan Hayes)

Establishment IDTS Implementation Group (for each First Wave prison)

… plus others as agreed locally

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