Prison population: substance use and wider support needs

Research into the substance use support needs of people in prison. One of four studies on the health needs of Scotland's prison population.

Chapter 8: Conclusions

The headline message from this study is that prison is the wrong place to try and address the wide range of intensely complex environmental, emotional, physical, psychological, and social needs experienced by people in prison who have problems with substance use.

Evidence gathered through this study (and the concurrent Mental Health Needs Assessment study) indicates that individuals in Scotland's prisons are more likely to have a substance use problem than to not have one. Existing provisions for supporting and meeting the needs of those who experience problems with substances (whilst living in a Scottish prison) are inconsistent across the country. There are also inadequacies and deficiencies for individuals in relation to the continuation of their treatments and support – both from the community into prison, and back to the community following liberation, and when being transferred from one prison to another. There has been too much focus placed on throughcare arrangements as being the period immediately up to and post release, rather than over a longer period of time. This has been epitomised through an over emphasis on the role of prison (TSO) staff, over and above the role of other key provision by Third Sector and Criminal Justice Social Work across Scotland. All of this is reflected in the report's title and key findings which underline the need to redefine throughcare to include the whole criminal justice pathway and all relevant stakeholders.

There is a need to challenge underlying assumptions regarding substance use. In the main, substance use is viewed and treated within the prison system as a 'problem'. This is not suggesting that substance use is not problematic, but rather that substance use should not be problematised. For most, substance use is considered to be a coping strategy, both outside prison and inside prison to medicate the traumas of past and present experiences. Further, it could be argued (and we often heard) that using substances whilst in prison is considered to be a logical response to the traumatic situation that individuals find themselves in (e.g. 'getting yer heid down', dealing with peer pressure, and/or dealing with emotional/physical/psychological pain).

It is clearly important to know what substances are coming into prisons. However, the most prevalent substances currently in Scottish prisons are much less identifiable than the previously most prevalent substances (e.g. heroin), all of which sits in a much bigger marketplace of organised crime. The nature of the substance use inside Scotland's prisons does not fully mirror that on the outside and used in the community, either prior to or post release. The challenge is to apply an appropriate level and balance of resource and time to continually develop understanding, whilst avoiding the danger of constantly chasing rainbows. It was regularly noted that the substances being used in prison are those that are available, and of necessity, rather than always those of choice.

The primary needs of those individuals who use substances through their time in Scotland's prisons are not particularly substance use related. Substance use does come with consequences but it doesn't represent the real needs of individuals (particularly: housing, trauma, mental health, finance, and emotional intelligence/regulation). The needs should be about, and focused on, how individuals are best prepared for release – and that these preparations should start from the first moment an individual steps inside a prison. The dominant presentation of the majority of these non-substance use specific needs (i.e. housing) indicates that the discourse around 'substance use in prisons' needs to shift beyond criminogenic and health considerations to include significant regard for the social (justice) agendas. From a substance use point of view the biggest challenge is one of continuity of care/treatment (or lack of) through and beyond prison.

Prisons do not fit neatly into local health and community planning structures but also do not sit comfortably with national structures, given each individual prison has different population groups and catchment areas, and that individual GICs have significant levels of autonomy and decision-making in how their prison is run (priorities etc.). As a result, there is a lack of consistency on how substance use issues in prisons are managed, accounted for, and governed. This complexity more often than not leaves prisons as a fringe partners in structures such as ADPs.

There is also the complexity of relationships and different organisational cultures between key partners (SPS, NHS, Local Authorities, Third Sector). These relationships are not based on equal and reciprocal partnerships, so it is no surprise that solutions to the issues presenting due to substance use are neither co-designed nor co-produced.

Credit needs to be given to the Scottish Government in relation to substance use policy development and the perceived future direction of travel. The appointment of a dedicated Drugs Minister in 2021 has been welcomed along with the additional £250m investment into drug services over the next five years. The priority focus on implementing the new MAT Standards is seen as a 'game-changer' although there is a need to prioritise prisons in this regard as they have received less focus when compared to MAT Standards implementation in community settings.

The continued drive of the Scottish Government to pursue a policy of depenalisation has to be welcomed and encouraged, particularly as a key response to the substance use issues highlighted in this report. Depenalisation would provide a better starting place for meeting the wider needs of individuals who experience problems with substances. It would also facilitate a shift away from viewing substance use as 'the problem' towards a more holistic and person-centred approach of tackling the underlying traumas which are often at the root of why people use substances. However, despite some positive developments, there was consensus that more could be done to improve support for people with problematic substance use living in Scotland's prisons.



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