National Mission: annual report 2024-2025

6. Outcome 5: Quality of Life is improved for people who experience multiple disadvantages

6.1 Overview

Many people with problem substance use experience multiple disadvantages and therefore require support from a wide range of services to ensure these are addressed in a joined up and person-centred way.

The MAT Standards emphasise the importance of taking a person-centred approach. This includes access to independent advocacy and support for housing, welfare, and income needs; that all people receive mental health care at the point of MAT delivery in an integrated way; and trauma-informed principles underpin all care and support provided by specialist services.

Summary of MAT Standards 8 to 10:

• MAT Standard 8; All people have access to independent advocacy and support for housing, welfare, and income needs.
• MAT Standard 9: All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery.
• MAT Standard 10: All people receive trauma informed care.

For 2024-25, the National Benchmarking Report on the Implementation of the MAT Standards reported that MAT standards 6 and 10 (combined), was fully implemented in 22 out of 29 (76%) ADP areas and partially implemented in 7 out of 29 (24%) ADP areas. MAT standard 8 was fully implemented in 26 out of 29 (90%) ADP areas and partially implemented in 3 out of 29 (10%) ADP areas. MAT standard 9 was fully implemented in 21 out of 29 (72%) ADP areas and partially implemented in 8 out of 29 (28%) ADP areas).

6.2 Progress in 2024-25

6.2.1 Whole Government approach: Housing

We are continuing to upscale Housing First across Scotland, which provides settled, mainstream accommodation for those with problem substance use and other complex needs. The latest Housing First monitoring report noted that there were 27 local authorities with Housing First programmes as of September 2024, and it is estimated that over 2,000 Housing First tenancies have started across Scotland.

The National Mission has supported the actions in the Ending Homelessness Together action plan through the Dual Housing Support Fund, which provides support to individuals who want to keep their tenancies whilst in rehabilitation services.

The prevention of homelessness consultation highlighted that, for people facing homelessness, there is often increased contact with various health services, including drug and alcohol services, before homelessness occurs. The prevention of homelessness will be most effective when it is recognised as a priority across all public services, and this is why we have included new homelessness prevention duties as part of the Housing (Scotland) Bill, which was introduced in March 2024.

This Bill includes new duties on relevant bodies, which are listed in the Bill, to ‘ask and act’ about housing circumstances, alongside changes to existing legislation to ensure local authorities act sooner, to prevent homelessness. Stage 2 of the Bill is due to complete in 2025, with the timings for Stage 3 to be outlined by the Scottish Parliament. The Scottish Government have worked closely with stakeholders on potential amendments to be made at Stage 2 and will continue to work in partnership to ensure regulations and guidance on the operation of the new duties is fit for purpose.

6.2.2 Mental Health

Building on the work of the Healthcare Improvement Scotland (HIS) Pathfinder project in 2023-24, we commissioned HIS to lead on the creation of a national protocol that sets out a gold-standard of joint working between mental health and substance use services for co-occurring mental health and substance use conditions.

The National Mental Health and Substance Use Protocol was published in September 2024, and Healthcare Improvement Scotland are now working to support areas across the country to develop and implement their own local protocols by March 2026.

Everyone in need of emergency mental health care must receive that quickly, and wherever possible, close to home. This includes those who are substance affected and experiencing a mental health crisis. We are working with partners, including Health Boards, Police Scotland, the Scottish Ambulance Service (SAS) and NHS 24 through the Mental Health Unscheduled Care Network, to ensure this happens consistently across Scotland.

We published a Safe Spaces Scoping report in October 2024 which clearly demonstrates the value of safe spaces for people experiencing crisis across Scotland, and their ability to provide immediate access to crisis and distress support. We are now exploring ways to increase the availability of these services.

The national review of Psychiatric Emergency Plans has concluded and will be followed by the development of national guidance during 2025 to ensure reasonable consistency across 14 Health Boards. The review considered the specific needs of people who are at risk of detention, including those affected by substance use.

In February 2025, we published a Framework for Collaboration and a cross-sector Partnership Delivery Group Collaborative Commitment plan. The Framework for Collaboration (FfC) seeks to promote a multi-agency collaborative approach to improving local distress pathways and achieving the best outcomes for individuals, including people affected by substance use.

6.2.3 Whole government approach: Justice

Our Vision for Justice is for a safe, just and resilient Scotland. This cross-government approach acknowledges that there are frequent interactions with criminal justice by people who use drugs and there is a relationship between people having a drug related death and prior contact with the criminal justice system.

National Strategy for Community Justice

The National Strategy for Community Justice sets out a person-centred, rehabilitative approach to community justice and encourages a shift in the balance between custodial and community disposals in the longer term. It recognises that while public protection is paramount, there is clear evidence that community-based interventions and sentences can be more effective in reducing reoffending and assisting with rehabilitation than short term custodial sentences.

The strategy includes a priority action to improve the identification of underlying needs and the delivery of support following arrest through the provision of person-centred care and referral opportunities to services, including substance use and mental health services. The latest delivery plan covers the period up to December 2024.

Review of Community Sentencing

The Scottish Government published a review of the two main community orders specifically aimed at people with substance use problems. Summary findings were published in August 2023 and updated in December 2023. This review found that at the very highest level, the evidence suggests that court-ordered treatment is less effective than voluntary treatment but is still likely to produce more positive outcomes for people than custody. The findings of the review continue to inform Scottish Government action on sentences aimed at people with substance use problems and inform decisions on the future of existing orders.

Prison and Healthcare Recovery Team

The Scottish Recovery Consortium (SRC) continued to deliver the Prison Recovery Project that aims to create and embed an integrated and consistent approach to drug and alcohol recovery support and activities across the prison estate. This increases the opportunities for people to access recovery support, mutual aid and peer support within prison and creates robust and recovery pathways when people return to their community.

Over the last three years, additional staff time has been allocated to developing this partnership and that is a clear testament to the SPS commitment to give people in prison increased access to recovery support and activities. This is evidenced in the 2025 SPS Alcohol and Drug Recovery Strategy.

Due to the geographical challenges and operational reach of working across the prison estate it was identified that additional resource would provide more consistency, continuity, and capacity. t was therefore agreed that extra funding would be allocated, and two additional Prison Recovery Development Officers have been in post since March 2025. This will help to develop and deliver the work simultaneously across all prisons in Scotland.

Case Study

Gary McCafferty served a string of short sentences before being convicted of attempted murder in 2018. It was during his seven-and-a-half-year sentence at HMP Perth that Gary began his own recovery journey. Following his progression to HMP Castle Huntly, he became the first individual to return to closed conditions to carry out a work placement as a harm reduction peer mentor Lived Experience Recovery Peer Mentor.

Gary said, ‘recovery is hard and while not everyone recovers, anyone can recover - when you connect with someone you see it in their eyes - it’s like someone switches on a light right behind their pupils.’

Gary was also part of the panel of interviewers for the above recent recruitment for the SRC Prison Recovery Team.

Prison to Rehab Pathway

The Prison to Rehab pathway, launched in 2020, supports individuals who would benefit from accessing abstinence-based treatment, into residential rehab upon release from prison. This process has been designed to support individuals who have a history of problematic alcohol or drug use that has played a factor in their behaviour, resulting in them being incarcerated.

Throughout 2024/25 we have been working with stakeholders to refresh the current protocol to reflect experience to date and facilitate access and expect to publish an updated version in 2025. Public Health Scotland published their eleventh Interim Monitoring Report on Residential Rehabilitation Funded Placements, on 1 July 2025 which includes numbers on Prison to Rehab placements.