Smart Justice on Drugs, Drink and Mental Health

Drugs, Drink and Mental Health:
The Facts

Drugs

There are about 400,000 major drug users in this country of which only half are receiving treatment. For every £1 spent on drug treatment £3 is saved by the criminal justice system (1)
The number of people in prison for drug offences is high and growing. At the end of October 2007, 15% of male sentenced prisoners had been convicted of drug offences. In 1995 drug offences accounted for 10% of male sentenced prisoners. For the sentenced female prison population at the end of October 2007 drug offences accounted for 30% of prisoners, by far the largest proportion. In 1995 they accounted for 27% of the sentenced female prison population (2)
There is a much wider group of prisoners whose offence is in some way drug related. Shoplifting, burglary, vehicle crime and theft can be linked to drug misuse. Over half of prisoners (55%) report committing offences connected to their drug taking, with the need for money to buy drugs the most commonly cited factor (3)
In 18% of violent crimes reported to the 2004/5 British Crime Survey, the victim believed that the offender was under the influence of drugs. More than a quarter (29%) of robbery victims believed their attacker to be under the influence of drugs (4)
Around 55% of those received into custody are problematic drug users. That is annual throughput of 70,000 a year, or 39,000 at anyone time. According to the Home Office around one sixth of problematic drug users are in prison at any one time (5)
In some inner city local prisons as many as eight out of ten men are found to have class A drugs in their system on reception and in the local women’s prison, Styal, the same number of new arrivals are thought to have drug problems (7)
Many prisoners have never received help with their drug problems. Officers at HMP Manchester have estimated that 70% of prisoners come into the jail with a drugs misuse problem but that 80% of these have never had any contact with drug treatment services (8)
Nine out of ten young adult prisoners say they used drugs prior to imprisonment but only one in three young offender institutions provide intensive drug treatment programmes (9)
Transfers between prisons due to overcrowding often disrupt drug treatment. Recent research found that a third of prisons were unlikely to be able to continue the treatment of prisoners transferred to them (10)
The Social Exclusion Unit found that the ‘chances of continuing drugs programmes and support on release are very slim’ and concluded, ‘prisoners are often viewed as ‘new cases’ when they are released and have to join the back of the queue’
Drug misuse is one of the strongest predictors of reconviction. Those who had been buying class A drugs regularly were spending around £600 a week in the period immediately prior to imprisonment. The highest weekly expenditure (£1,100) was reported by users of crack cocaine (11)
The DRR (drug rehabilitation requirement) is the part of the generic community order that provides drug treatment. The 2007 PBA annual report states that DRR completion rates have improved from 28% in 2003 to 44% in 2006/7. During the orders the volume and severity of offending decreases (12)
The average cost of a DRR has been estimated to be around £6,000. During 2002-3 the NAO estimated that this equated to between £25 to £37 a day compared with the cost of custody of £100 a day (13)
Offenders that receive residential drug treatment are 43% less likely to re-offend after release than comparable offenders receiving prison sentences (14)

Drink

It is estimated that alcohol related crime costs the UK £7.3 billion per year in terms of policing, prevention services, processing offenders through the criminal justice system and human costs incurred by the victims of crime (15)
Overall alcohol-related harm costs the UK around £20 billion per year with alcohol-related crime accounting for the single largest area of expenditure (16)
In 2003 in the UK nearly two-thirds of sentenced male prisoners (63%) and two-fifths of female sentenced prisoners (39%) admitted to hazardous drinking prior to imprisonment. Offending is more prevalent among heavy drinkers. Of these, about half have a severe alcohol dependency (17)
In 2001 and 2002, 47% of all victims of violence described their assailant as being under the influence of alcohol at the time. This figure rose to 58% in cases of attacks by people they did not know (18)
Alcohol related violence accounts for just under half of all violent crime. In more than a million violent attacks the aggressors were believed to be drunk (19)
Alcohol use is associated with 70% of all stabbing and beatings (20)
Binge drinkers were more likely to offend than other regular drinkers. Among 18 to 24 year-olds, 27% of binge drinkers admitted they had committed an offence in the past 12 months compared with 13% of other regular drinkers (21)
Young male binge drinkers were more than twice as likely to commit a violent offence (16%) than other young male regular drinkers (7%) (22)
Young adult binge drinkers committed a disproportionate amount of the total number of crimes. 18 to 24 year-old binge drinkers accounted for only 6% of the total adult sample, but they committed 30% of all crimes reported by adults in the past 12 months, and 24% of all violent incidents (23)
81% of men drinking hazardously in the year before imprisonment received no help with their alcohol problem (24)
Children who have begun binge drinking by the age of 16 are 90% more likely to have criminal convictions by the age of 30 (25)
There are no specific accredited alcohol treatment programmes with ring-fenced funding in prisons in England and Wales. A Prison Service survey conducted in 2003, that received responses from half of all prisons in England and Wales, identified only one prison that had a dedicated alcohol strategy
In December 2004 the Prison Service published its long awaited alcohol strategy for prisoners, which focuses primarily on improving consistency of measures to prevent future hazardous drinking across the prison estate and builds on existing good practice. But it has not been supported by additional resources

Mental Health

10% of children at any one time suffer from emotional, behavioural or concentration difficulties but only a very small minority of children receive evidence-based treatments (26)
31 % of young people were identified as having a mental health problem (27)
£1.6 billion is spent annually arresting, convicting, imprisoning and supervising people with identified mental health problems (28)
42% of men with a psychotic disorder have received no help with mental or emotional problems over the previous year (29)
46% of people arrested who have mental health problems are unemployed but receive no benefits (30)
72% of male and 70% of female sentenced prisoners suffer from two or more mental health disorders. 20% of prisoners have four of the five major mental health disorders (31)
According to the NHS plan, around 5,000 prisoners at any time, between 5%-8%, have severe and enduring mental illnesses (32)
A significant number of prisoners suffer from a psychotic disorder. 7% of male and 14% of female sentenced prisoners have a psychotic disorder; 14 and 23 times the level in the general population (33)
10% of men and 30% of women have had previous psychiatric admission before they come into prison (34)
A total of 23,420 self-harm incidents were recorded during 2006 by the Prison Service. Women accounted for 11,503 or 49% of total incidents – even though they form only around 6% of the prison population (35)
A high proportion of prisoners have been treated in psychiatric hospitals - 20% of male and 15% of female sentenced prisoners have previously been admitted for in-patient psychiatric care (36)
The number of restricted patients under the Mental Health Act in England and Wales was 3,395 at the end of 2005, the highest for a decade. Those released from restricted hospitals in 2003 have a 7% reconviction rate after two years (37)
Prison regimes do little to address the mental health needs of prisoners. Research has found that 28% of male sentenced prisoners with evidence of psychosis reported spending 23 or more hours a day in their cells - over twice the proportion of those without mental health problems (38)
Prisoners with severe mental health problems are often not diverted to more appropriate secure provision. The Chief Inspector of Prisons has estimated, based on visits to local prisons, that 41% of prisoners being held in health care centres should have been in secure NHS accommodation (39)
There are up to 500 patients in prison health care centres with mental health problems sufficiently ill to require immediate NHS admission (40)
96% of mentally-disordered prisoners were put back into the community without supported housing, including 80% of those who had committed the most serious offences; more than three quarters had been given no appointment with outside carers (41)
Less than 1% of people issued with a community order had a treatment for their mental health problems in their sentence (i.e. the mental health treatment requirement) (42)
The report of the Joint Committee on Human Rights on deaths in custody stated: “The evidence we have gathered suggest that prison actually leads to an acute worsening of mental health problems. By sending people with a history of attempted suicide and mental health problems to prison for minor offences the state is placing them in an environment that is proven to be dangerous to their health and wellbeing.” (43)
Research by the Home Office (RDS Occasional Paper no 79, Home Office 2002) finds that court diversion schemes can significantly improve re-offending rates and treatment outcomes. Those admitted to treatment through the courts were half as likely to re-offend (28%) compared to those of a similar age and offence profile who had been given a custodial sentence (56%). The report concluded: ‘from these results, there is no justification for the view that diversion to a hospital is a ‘soft option’ or that it fails to offer public protection. On the contrary, these results indicate that it may constitute an effective means of crime reduction in those suffering from mental illness.’ (44)

References
1 National Treatment Agency
2Offending Management Caseloads Statistics 2005 and Ministry of Justice, Population In Custody, England and Wales, (Home Office, October 2007
3 Ramsay, M. - Prisoners’ drug use and treatment: (Home Office 2003
4 Home Office Statistical Bulletin, 02/06, January 2006: Violent Crime Overview, Homicide and Gun Crime 2004/5
5 Home Office FOI Release 4631, 6 Dec 2006
6 Interview with Prison Service Director General, Phil Wheatley, Independent, December 1st 2003
7 HM Prisons Inspectorate (2004) Report on a full unannounced inspection of HMP and YOI Styal 19-23 January 2004, London: Home Office
8 Social Exclusion Unit (2002) Reducing re-offending by ex-prisoners, London: Social Exclusion Unit
9 Social Exclusion Unit (2002) Reducing re-offending by ex-prisoners, London: Social Exclusion Unit
10ibid
11 UK Drug Policy Forum
12 ibid
13 ibid
14 Matrix Knowledge group (The Economic costs of Imprisonment)
15 2004 alcohol harm reduction strategy
16 (Cabinet Office Strategy Unit Alcohol Project, 2003).
17 Prison Reform Trust, Alcohol and re-offending : Who Cares?
18 (Flood-Page and Taylor, 2003).
19 (Cabinet Office Strategy Unit Alcohol Project, 2003).
20 Alcohol Concern
21 Alcohol-Related Crime and Disorder, Home Office, (2005)
22 ibid
23 ibid
24 Revolving Doors Agency, Britain’s Social Dustbin (2007)
25 Viner, Russell M. and Taylor, Brent, Adult outcomes of binge drinking in adolescence: findings from a UK national birth cohort, 2007
26 Institute of Psychiatry
27 Mental Health Needs and Effectiveness of Provision for Young Offenders in Custody and in the Community (Harrington and Bailey, Youth Justice Board for England and Wales, 2005)
28 Revolving Doors Agency, Britain’s Social Dustbin (2007)
29 ibid
30 ibid
31 Paul Goggins, minister for prisons and probation speaking in a debate on prisons and mental health, Hansard, 17 March 2004
32 Department of Health, 2000: The NHS Plan: a plan for investment, a plan for reform
33 Singleton et al (1998) Psychiatric Morbidity among Prisoners in England and Wales, London: Office for National Statistics
34 Department of Health, Conference Report, Sharing Good Practice in Prison Health, 4/5 June 2007
35 NOMS, Safer Custody News, May/June 2007
36 Singleton et al (1998) Psychiatric Morbidity among Prisoners in England and Wales, London: Office for National Statistics
37 Home Office Statistical Bulletin, Statistics of Mentally Disordered Offenders 2005, 1 March 2007
38 Singleton et al (1998) Psychiatric Morbidity among Prisoners in England and Wales, London: Office for National Statistics
39 HM Inspectorate of Prisons (2004) Annual Report of HM Chief Inspector of Prisons for England and Wales 2002-2003, London: Stationery Office
40 Reed, J. (2003) Mental Health Care in Prisons, British Journal of Psychiatry 182
41 Melzer et al (2002) Prisoners with psychosis in England and Wales: a one-year national follow-up study, The Howard Journal
42 Sainsbury’s Centre for Mental Health
43 The report of the Joint Committee on Human Rights on deaths in custody (2004)
44 Home Office (RDS Occasional Paper no 79, Home Office 2002)