An integrated substance misuse service has been set up to work in the community and local prison.
There is an 11-strong team that works in Leicester HMP, but staff are supplemented by workers from the community team. It has created a more streamlined and consistent service for prisoners.
The challenge
An estimated third of prisoners are thought to have drug problems. When you include those with drinking problems the numbers rise to over half. It is the responsibility of NHS England Health and Justice to fund and coordinate health services in prison.
The group works closely with clinical commissioning groups and local authorities to ensure the full range of services are available. When it comes to treating substance misuse a variety of different approaches are taken. Some are run by the prison service themselves, while others are coordinated by the NHS-commissioned health service team at each site, which then liaises with community services, which are commissioned by local authorities.
At Leicester HMP both approaches have been used in the past. The most recent meant there were eight different services involved in the treatment and support of prisoners.
The solution
The three local councils – Leicester City, Leicestershire County and Rutland County – decided to take a more integrated approach two years ago.
Turning Point was appointed to run an integrated service which brought all drug and alcohol services both inside and outside of prison under one umbrella.
The contract started in July 2016. There is an 11-strong team of recovery workers, wellbeing nurses and other staff including a pharmacist and psychosocial lead.
But they are also supplemented by staff from the community teams.
Karen Blatherwick, the Manager of the Prison Substance Misuse Team, says: “As well as the three prison recovery workers we have, we also have two in the community that come in and help with some of the late shifts and extra work.
“It means when prisoners come in – if they have been in treatment in the local community – they are known to the service and perhaps even familiar with the staff. It also helps with release. We can book appointments and coordinate care plans together.
“This is so important for people using substance misuse services. They don’t want to keep having to repeat their stories, going back over their history each time. With the service as it is now, they don’t need to.”
Contact with prisoners starts as soon as they enter the site. On arrival a member of team is on hand to ask if they need support for alcohol or drug misuse.
If anyone collapses or falls ill because of substance misuse they are once again offered help. At any one point they provide support to one in three prisoners at the site.
Ms Blatherwick said there were also wider benefits too with the teams in and out of prison attending meetings together and sharing learning.“There are also opportunities for staff to work in the different settings. Prison work can be quite demanding and challenging so if someone needs a change there is the opportunity to do that.”
The impact
The benefit of the integrated working has been recognised in a recent joint Her Majesty’s Inspectorate of Prisons (HMIP) and Care Quality Commission (CQC) inspection.
The inspectors praised the work of the psychosocial and clinical interventions for reducing demand for drugs and harm minimisation.
They praised the “rich mix of staff skills in the service enabled prisoners to access an unusually well-integrated and responsive pathway of care”.
One member of the team who has seen the service be transformed in Psychosocial Manager Joe O’Callaghan.
He has worked at the prison since 2011. “We have transformed the service from one that simply issue prescriptions and left people parked on their medicine to one that is now really working towards recovery and able to better coordinate care. This is how treatment should be in prisons.”
Lessons learned
Ms Blatherwick said one of the most important aspects of care to get right is when a prisoner is being released.
“The first two weeks are essential,” she said. “That is the time when they are most likely to have an overdose.”
This has prompted the service to start prescribing Naloxone, a drug that can reverse a potentially deadly overdose. The service also works closely with local peer support group Dear Albert, which meets prisoners when they are released so they have someone to help them as soon as they are released. How the approach is being sustained To build on the arrangements for release, the service is working with the reducing reoffending teams by looking to launch family days when a prisoner is close to release.
The idea is to involve the prisoner’s immediate family in planning and preparing for their release so they can be supported as best as possible.
The service is also looking to introduce a drop-in facility in the prison. At the moment if prisoners want to make contact with the service it relies on them asking a prison officer to contact the service or submitting a request into a box.
Ms Blatherwick said: “We want to create something that is akin to what you would have in the community. It is about making it easy for people to ask for help when they want it.”
Contact details
Karen Blatherwick
Substance Misuse Team Manager Leicester HMP [email protected]