Substance misuse services in London prisons Substance Misuse Forum 25 th May 2016 Patricia Cadden Health in the Justice System Team, London

Health in the Justice System team, London- overview of work 8 prisons and YOIs (closure of HMP Holloway) Immigration and removal centres (2- Heathrow) Initial accommodation for homeless asylum seekers (2 sites- Croydon and Southwark) Liaison and Diversion- MH services full coverage in police custody and courts Courts- liaison and diversion team- total coverage in all London borough custody suites and courts Sexual assault referral centres (3- Southwark and Tower Hamlets)

Aim of substance misuse treatment interventions in prison Same as community in principle Building recovery including use of clinical interventions (medications in recovery) and evidenced based 1:1 and group interventions (psycho-social) Harm reduction- detoxification and stabilisation units Prevention- use of alcohol brief interventions by primary care and secondary services Integration- clinical and non-clinical service pathways- working together to drive behaviour change

Commissioned services in prison currently Identification and brief advice (IBA) and enhanced brief interventions (EBI) for non- dependent drinkers Detoxification and stabilisation for dependent use of alcohol/Opiates/Benzos 1:1 and group programmes to address addiction and promote recovery capital Clinical and non-clinical services for NPS Care planning to address co-morbidity and other vulnerabilities

ClinicalNon-clinicalIntegrated health and well-being model HMP Wormwood ScrubsPartnership with CareUK; Barnet Enfield and Haringey NHS Trust; RAPT and Atrium HMP WandsworthSt Georges NHS FTRAPT HMP BelmarshAddactionCGL HMP ThamesideAddactionTurning Point (NOMS comm) HMP IsisAddactionLifeline HMYOI FelthamAddactionLifeline/RAPT HMP PentonvilleCareUKPhoenix Futures HMP BrixtonCareUKRAPT

Substance misuse prevalence Never just SM- same issues as community re: SM/MH/trauma/PTSD co-morbidity Operational capacity approx. 8,500 with a turnover of received/released prisoners circa 30,000 per year Approx 20-25% entering a busy local prison will have SM dependency- obviously greater number at risk of dependency Feltham and Isis- less dependency but more use of cannabis/alcohol NPS use on increase with increased risk for population management

Commissioning and contract management Procured as in community- 3-5 year contracts dependent whether procured in the community pre- NHSE (NHSE 5 year block contracts) Inherited separate commissioned services for clinical and non-clinical NHSE trying to move to an integrated health and well being model (whether through procurement or local provider agreement) Contract management with oversight of NDTMS/quality/ and health in justice indicators of performance

Health and well-being model (procured in 2015) Move to evidence based interventions- psychologist led (primary and secondary care model) to better affect behaviour change Single assessment to determine focus for package of interventions Care co-ordination of recovery plans to ensure people get the right intervention at the right time CBT focussed interventions based on IAPT model (Increasing Access to Psychological Therapies) Integrated teams addressing MH/SM/PTSD/other trauma/eating disorder/self-harm etc.) Counselling Well-being to support resilience and self-efficacy/family work/building social capital

Health and well-being

Partnership working CRCs are key partners in local integrated offender management CRCs will be crucial to ensure greater efficiency in offender management and building on health gains Continuity of care (CoC)- GP registration programme and management of high risk patients Prisons a partner in IOM structures locally- CoC meetings with community SM agencies in boroughs where highest % of releases Use of FP10s for planned release in place

Prison reforms HMP Wandsworth- move to an autonomous predominantly remand prison- proposal due by 1 st July Possibility of transfer of health budgets to National Offender Management Services Change in functions of prisons- single function e.g. remand/sentenced/resettlement Category change from Cat A/B/C/D to low medium and high risk Closure of Victorian prisons/building 9 new prisons- 4 year project Move to smoke free prisons- no specific date but work underway to improve uptake of smoking cessation services Await further developments