National Mission on Drugs: annual report 2022-2023

Outcomes 5: Quality of Life is improved for people who experience multiple disadvantages

6.1 Overview

Many people with drug problems have multiple complex needs, and therefore require support from a wide range of services to ensure these are addressed through joined up, person-centred services.

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.

Summary of MAT Standards 8 to 10

8. All people have access to independent advocacy and support for housing, welfare, and income needs.

9. All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery.

10. All people receive trauma informed care.

6.2 Progress in 2022-23

6.2.1 Whole Government approach: Housing

We have continued to upscale Housing First across Scotland, which provides settled, mainstream accommodation for those with problem substance use and other complex needs.

The full evaluation of the Housing First Pathfinder (covering Aberdeen/shire, Dundee, Glasgow, Edinburgh, and Stirling) was published in November 2022 and reported that 579 individuals with experience of homelessness and multiple disadvantages had been allocated a tenancy by the end of September 2021.^[7]

• 579 individuals allocated a tenancy by the end of September 2021
• 26 local authorities with Housing First programmes
• 1,400+ Housing First tenancies started across Scotland

There are now 26 local authorities with Housing First programmes with the result that over 1,400 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. Funding has been made available to ensure that when an individual accesses rehabilitation their housing payments on their core residence do not stop for the time that they are in treatment.

We know that people facing issues with homelessness and problem substance use often engage with various services before reaching out to specific homelessness organisations, often at the point of crisis. 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 committed to introducing new prevention duties as part of the forthcoming Housing Bill.

This will include new duties on public bodies, including in justice and health and social care, to ‘ask and act’ about housing circumstances to help prevent homelessness at an earlier stage, including for those with more complex needs.

6.2.2 Mental Health

In November 2022 we published a rapid review of care for people with co-occurring mental health and substance use conditions. This included a literature review, a survey of staff in substance use services and a set of recommendations written by two clinicians. The government responded to these recommendations in March 2023 by setting out our improvement plan to ensure that people with co-occurring mental health and substance use conditions get timely access to the care they need, regardless of which service they attend.

There are three phases to the plan: first, putting together a gold-standard protocol which sets out how mental health and substance use services should work together to provide joined-up care. Then we will move into implementation, supported by HIS. The final phase will ensure change is sustained and that this is being felt by people on the ground. The plan is underpinned by up to £2.4 million of funding over the remaining years of this Parliament (23/24 to 25/26).

In addition, we commissioned HIS to continue an ambitious programme to test new approaches to integrating substance use and mental health services in five local areas. This work aims to improve the quality of care, increase access to treatment and ultimately improve overall health outcomes for people with substance use and mental health problems. This programme will end in March 2024, but HIS will continue to support local areas through our improvement plan.

6.2.3 Whole government approach: Justice

Bail and Release from Custody (Scotland) Bill

The Bail and Release from Custody (Scotland) Bill ended Stage 1 in the Scottish Parliament on 16 March 2023. The provisions in the Bill are intended to ensure that, as much as possible, the use of custody for remand is a last resort for the court, and greater focus is given to the rehabilitation and reintegration of individuals leaving custody.

Part I of the Bill focuses on the use of bail and remand in recognition of the negative impact that short periods of imprisonment can have. Part II of the Bill focuses on arrangements around release from prison custody and contains a provision to further restrict the days of the week on which individuals can be released from prison custody so that releases do not take place on Fridays or the day before a public holiday. This is intended to ensure individuals are not released from a prison sentence where access to services and support is more limited.

National Strategy for Community Justice

The revised National Strategy for Community Justice supported a shift towards greater use of community sentences and other interventions. It highlights key areas for partners to focus on including the provision of support for substance use issues. A Delivery Plan to drive the ambition behind the strategy published in June 2023 and will drive actions at a national, as well as local, level.

Diversion from Prosecution: Joint Review

A Joint review of diversion from prosecution was published on the 21 February 2023 by HM Inspectorate of Prosecution in Scotland, HM Inspectorate of Constabulary in Scotland, HM Inspectorate of Prisons for Scotland, and the Care Inspectorate. This assessed the operation and impact of diversion from prosecution in Scotland.^[8]

It found there was strong support for diversion from prosecution among those agencies involved in the diversion process. The use of diversion has risen in recent years and the diversion partner agencies are keen to extend its use further, in line with the government’s national strategy for community justice. The Scottish Government will establish a working group or other appropriate structure to consider the Joint review of diversion from prosecution report and the implementation of recommendations as appropriate.

Review of Community Sentencing

In December 2022, Scottish Government Justice Analytical Services undertook a review of Drug Treatment and Testing Orders (DTTOs) and Community Payback Orders (CPOs) with drug treatment requirements to assess how they have been used, their outcomes and whether they are the most effective mechanism to support an individual’s recovery and reduce recidivism rates. Summary findings from the review were published in August 2023.^[9]

Prison and Healthcare Recovery Team

The Scottish Government funded the Scottish Recovery Consortium £47,935 to employ staff for the Prison Recovery Project in 2022-23. Developing access to recovery options and choice in prison and creating links to the community has helped people find their own type of recovery.

Crucially people with lived experience are involved, empowering them to take ownership of their own recovery journey and to support them to adopt a right and asset-based capacity building approach to sustainable recovery development. This creates a resilient and supportive community for everyone within prisons.

The Prison Recovery Project connected with 14 prisons across Scotland in 2022-2023, with 420 people attending the learning and development opportunities, including 56 staff. More broadly, the project hopes to build awareness of the positive outcomes that can be achieved and the importance it has in creating recovery opportunities within prison and the transition back community.

Case Study: Prison Healthcare Recovery Team

The Prison and Healthcare Recovery Team identified two residents from HMP Perth and one from HMP Glenochil who had completed the prison recovery workshops and were progressing to HMP Castle Huntly.

Following their induction into HMP Castle Huntly, all three were recognised as Recovery Champions. This led to one person securing a work placement in a recovery organisation in Dundee, another a placement as a lived experience peer in HMP Perth, and the third a work placement with a recovery service in Fife.

All are stable in recovery from alcohol and drugs. The staff that were involved in both HMP Perth and HMP Glenochil have noticed the positive impact of this work and are now committed to continue the development of self-sufficient Recovery Communities and promote this work to residents and other staff members.

“I now have a better understanding of recovery and as a group we are hopeful we can develop a Recovery Wing and bring recovery to the wider prison.” (SPS Officer HMP Glenochil)

Prison to Residential Rehabilitation

The National Mission includes a commitment of £100 million to be available for residential rehab and associated aftercare over this parliamentary term. The Prison to Rehab pathway enables individuals to access residential rehab on release from prison. More details are available in the Residential Rehabilitation section of this report (section 5.2.5).