National Mission on Drugs: Annual Monitoring Report 2023-2024

10. Outcome 6: Children, families and communities affected by substance use are supported

10.1 Summary

Outcome 6: Children, families and communities affected by substance use are supported

• 77% of ADP areas have an agreed set of activities and priorities to implement the Whole Family Approach Framework. Small increase since 2022/23.
• There are no new data for the percentage of people who would be comfortable (a) living near, (b) working alongside, someone receiving support for problem drug use to provide insight into progress for the other headline metrics for this Outcome.
• Support for children, families and communities appears broadly in line with last year but there has been some variation in relation to specific services and areas. Data limitations restrict assessment of progress and experiential evidence from people with lived and living experience, families and communities would be valuable.

10.2 Background

Families and communities play a vital role in supporting people who use drugs. Families require dedicated support to empower them and allow them to support the recovery of their loved ones. They also need access to services to enable their own recovery. The Whole Family Approach Framework aims to ensure holistic family support that addresses the needs of children and adults within a family is consistently available for all families across Scotland at the time of need rather than at crisis point.^[83] The traumatic impact that parental drug use can have on children and the risk that drug use becomes intergenerational is now well understood.^[84] The role and attitudes of the wider community in supporting a person with problem substance use are also understood to be important to enable and promote recovery.

10.3 Headline metrics

10.3.1 Headline metric: Percentage of ADP areas with agreed activities and priorities to implement the holistic Whole Family Approach Framework

In 2023/24, over three quarters (77%) of ADPs had an agreed set of activities and priorities with local partners to implement the Holistic Whole Family Approach Framework in their ADP area^[85]. This has increased from 72% of ADP areas in 2022/23, the first year for which these data were available. Activities varied but included training sessions for statutory services and third sector partners, family learning hubs, parenting groups and support, outdoor activity programmes for young people and the introduction of a mother and baby rehab unit.

10.3.2 Headline metric: Percentage of people who would be comfortable (a) living near, (b) working alongside, someone receiving support for problem drug use

No new data is available to provide insight into progress for this metric for this 2023/24 monitoring report.

The most recent available data is from the 2021/22 survey where three in ten people (30%) reported they would be comfortable living near someone getting help to stop using heroin. Almost six in ten people (59%) reported they would be comfortable working with someone who was getting help to stop using heroin.^[86] Attitudes varied by sub-group. People with higher levels of educational attainment and people living in urban areas tended to report higher levels of comfort working with and living nearby to people receiving help to stop using heroin, compared to people with lower levels of educational attainment and people living in rural areas.

10.4 Supporting metrics

10.4.1 Supporting metric: Percentage of ADP areas with support services for adults affected by another person’s substance use

In the 2023/24 ADP Annual Survey,^[87] all ADPs outlined a range of support services in place for adults affected by another person’s substance use. All but one ADP (97%) offered naloxone training and nine in ten offered support groups (90%), in line with the 2022/23 survey. Commissioned services were in place in 93% of ADP areas, a reported increase from 79% in last year’s survey. There was a reduction in the number of ADPs reporting mental health support in place, from 66% last year to 43% this year. Other support services reported included social work services where the overall family needs meet the threshold for support and specific family support services provided by Scottish Families Affected by Alcohol and Drugs.

10.4.2 Supporting metric: Percentage of ADP areas with support services for children/young people affected by a parent’s or carer’s substance use

All ADP areas reported that treatment or support services for children and young people (under the age of 25 years) affected by a parent’s or carer’s substance use were available in their area in 2023/24.^[88],[89] This is in line with 2022/23. The most commonly provided services were carer support, diversionary activities and family support services (in place in 90% of ADP areas for one or more age groups under 25 years old).

The proportion of ADP areas with diversionary activities and outreach/mobile services in place for children and young people affected by a parent’s or carer’s substance use increased between 2022/23 and 2023/24. However, there was a fall in the proportion of ADPs reporting having some types of services in place for this group including information services and mental health services (both down 16%).

10.4.3 Supporting metric: Percentage of adults saying drug use or dealing is common in their neighbourhood

In 2023, 16% of people reported that ‘drug misuse or dealing’^[90] was either very or fairly common in their neighbourhood.^[91] This is a small increase on previous years (2022: 15%, 2021: 13%).

People living in the most deprived areas tended to report that ‘drug misuse or dealing’ was common in their neighbourhoods at higher levels (33%) than those in the least deprived areas (5%); this pattern is consistent with that observed in previous years. The percentage of people who reported that ‘drug misuse or dealing’ was common in their neighbourhood was highest amongst those living in remote small towns (24%), a notable increase on previous years (2022: 15%, 2021: 16%). Percentages in other area classifications (large urban, other urban, accessible small towns, accessible rural and remote rural) were broadly in line with the previous year. Finally, people aged between 25 and 34 years reported the highest rates of ‘drug misuse or dealing’ being common in their neighbourhood (19%), followed by people aged 16 to 24 years (18%), 45 to 59 years (17%) and 35 to 44 years (16%). Those aged 75 and over reported the lowest rating of drug misuse of dealing being common in their neighbourhood at 8%. This profile of responses by age was consistent with previous years.

10.4.4 Supporting metric: Number of new Child Protection Register registrations with an identified parental substance use concern

There were 2,179 new registrations onto the Child Protection Register during 2023 where parental drug misuse or parental substance misuse was identified as a concern at the Case Conference^[92],[93]. This is a decrease of 181 (8%) compared to 2022, when there were 2,360 such new registrations and a decrease of 17% (445) since the start of the National Mission in 2021. This follows a downward trend that has been observed since 2019.

10.5 Discussion

Support for children, families and communities appears broadly in line with last year but there has been some variation in relation to specific services and areas. Data limitations restrict assessment of progress and experiential evidence from people with lived and living experience, families and communities would be valuable.

Over three quarters of ADPs reported having an agreed set of activities and priorities with local partners to implement the Holistic Whole Family Approach Framework in their area, an increase of one ADP from last year. These activities varied across ADPs. However, it is not possible to understand how widely activities were available within ADP areas or the extent to which these met the needs of people in that area. No new data is available to assess progress in relation to social attitudes to living near or working alongside someone receiving support for problem drug use. This data gap contributes to the challenges in drawing clear conclusions for this outcome.

The supporting metrics indicate similar findings to last year. Support services for adults affected by another person's substance use were generally widely available. However, there was a decrease in ADPs reporting mental health support services being in place to fewer than half, which may indicate a gap in service coverage. However, this could also reflect variation in the perceived need for this in different ADP areas. Support services for children/young people affected by a parent or carer's substance use were reported in all ADP areas, in line with last year, with an increase in some activities and a decrease in others. While this indicates availability of services for both adults and children affected by other people's drug use across ADPs, this data does not provide insight into how widely available or utilised these services are within ADPs areas. It is also difficult to understand the extent to which provision of services adequately responds to the volume and type of demand, which is likely to vary in different areas. Experiential evidence from people with lived and living experience, from family members and from communities would be valuable in understanding this.

The downward trend in new Child Protection Register registrations with an identified parental substance use concern continued this year. This trend started before the National Mission and may be due to a variety of factors. Reporting of drug use or dealing in local communities increased a small amount since last year and was notably higher for those living in remote small towns. This could be reflective of a number of developments in behaviours amongst both those selling or using drugs, as well as perceptions and attitudes to drug use. This also indicates a potential need for greater research directly with people lived and living experience, families and communities.

The metrics available to support this outcome have a relatively high-level focus and are generally only reported at ADP or national level. This means there is a gap in understanding the views and impacts for those in staff roles, at service level, and critically, those with lived and living experience and their families. While activities associated with the National Mission evaluation may provide some insight, there is a lack of routinely collected information that could be built into monitoring metrics in future.