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THE GLASGOW DRUG COURT IN ACTION: THE FIRST SIX MONTHS
CHAPTER SIX: EFFECTIVENESS OF THE DRUG COURT
INTRODUCTION
6.1 In this chapter we consider how effective the Drug Court has been in its first six months of operation. Clearly it is too early to determine the impact that the Drug Court has had on drug use and associated offending. However the interviews with offenders made subject to Drug Court Orders give some early (if necessarily tentative) indications in this respect. In this chapter we also consider the perceived strengths of the Drug Court approach - including the advantages of having a dedicated Drug Court - and factors which might have served to limit its effectiveness. The chapter continues with some suggestions as to how the effectiveness of the Drug Court might be further enhanced and concludes with a discussion of target numbers and capacity.
IMPACT ON DRUG USE AND OFFENDING
6.2 All the Sheriffs interviewed were clear about the pilot status of the Drug Court in Glasgow and commented that a full evaluation of its effectiveness was necessary, although one Sheriff noted that media coverage 27 around the time of the six-month anniversary of the first Order being made had suggested the Glasgow Drug Court was working well and was 'very successful'. While all the Sheriffs stressed in their interviews that it was 'early days' for the pilot Drug Court in Glasgow, and that their knowledge concerning its operation had been gained from informal discussion in Chambers with either one or both of the Drug Court Sheriffs, there was a consensual view that Glasgow Sheriff Court was in need of alternatives to custody for drug-misusing offenders who were currently offending (mainly crimes of dishonesty) to fund their illicit drug use. The pilot Drug Court, with its dedicated team and resources, was seen by the Sheriffs to contribute to reducing drug-related offences in Glasgow:
"You're really … addressing this problem which is at the root of the offending of what brings them into court … whereas a traditional method of dealing with these cases might appear to address the symptoms, it isn't actually curing the problem, whereas it seems to be this is a real attempt which will have a reasonable prospect of success in a number of cases of curing the problem."
"I think it will be quite effective, I'm optimistic that it's going to make a difference."
6.3 The Supervision and Treatment Team were also optimistic, based on their experience of working with clients on Drug Court Orders, that the Drug Court would be successful in addressing drug use and associated offending. For example:
" I've dealt with people that have gone from two hundred a day drug habits to nothing, to zero, to abstinence within two or three months."
6.4 Team members also emphasised, however, that the Drug Court would only be effective in reducing drug-related crime:
"I think you have to be careful with some clients whose offending isn't necessarily correlated to their drug use… The fact that you're addressing their drug problem isn't necessarily going to reduce their offending… We are targeting the disposal on people who are thieving. Breaking into houses and theft by shoplifting are really serious offences and we can really do a lot with that because it's all to fund a drug habit. If you can address that you can address the offending."
"If there are other factors in people's offending behaviour or kind of acquired patterns of offending behaviour through their drug misuse that have bedded themselves in, then I'm not sure at the moment that I could say with confidence that it has or will impact with that group."
6.5 They also observed that in some cases offenders on Drug Court Orders had continued to commit offences, not because they needed to do so to fund their drug habit, but because they find it difficult to break a long-established pattern of offending behaviour:
"I've got one client who continued to offend after he got his Order and he was saying to me quite clearly that 'I didn't need to shoplift, it was just because I had been used to doing that'."
"There will be individuals that will say, especially in the early stages, they have still occasionally shoplifted when in terms of the drug use there is no reason for them to do that."
6.6 The Drug Court Sheriffs, as an indicator of how effective the Drug Court had been, pointed to the fact that there had been only one Order breached in the first six months of its operation as an indicator of how effective the Drug Court had been. However they also acknowledged that the low breach rate might also reflect over-leniency on the part of the court and a reluctance to revoke Orders where offenders were clearly not complying. As one Sheriff observed:
"It's rather hard to tell if the absence of breaches is due to the success of the Drug Court, the practice of the Drug Court or a little bit of each."
6.7 The Drug Court Sheriffs also pointed out that the very nature of drug misuse meant that success should not be too narrowly defined in absolute terms:
"You can't look at success as an absolute thing. We can't look at success and we can't define success as that person comes off drugs, doesn't ever do drugs again, end of story. That's not the kind of success we're liable to have - only a very few will be like that. It may be regarded as a success if we manage to keep somebody out of trouble and out of prison for a couple of years. It may be regarded as a success if we get someone who's on methadone for the rest of their life. We have to have different measures of success beyond the absolute. We can't expect absolute success in every case so when we're measuring the success we're going to have to have criteria other than drug abstinence… People have had ten years, twelve years, fifteen years of drug abuse and we're not going to have that kind of huge life change, complete life change in very many cases…Success may be different things for different people."
Both Sheriffs were reasonably optimistic that the Drug Court was having a positive impact on drug use and associated offending, as evidenced by the changes they had seen in offenders made subject to Drug Court Orders.
6.8 All of the Drug Court clients who were interviewed had extensively used a wide range of drugs prior to their referral to the Drug Court. While heroin and benzodiazepines appeared to be the most frequent drug of choice, all respondents were poly-drug users to varying extents:
"Heroin, temazepam, diazepam, but mostly heroin. I was using four or five bags a day of heroin you know, sometimes more than that but at the very least that anyway."
"Everything from valium to heroin, but heroin was my main problem. I could go without any other drug like cannabis, or alcohol or valium. It was just once I got introduced to heroin, it only took a few weeks…I can't explain, it's not like any other drug I can take and leave. Heroin I just had to take, take, take until I got addicted to it, it's really not nice at all, I couldn't give it up."
6.9 Since being on a Drug Court Order, all respondents had reduced their drug use significantly. All respondents were being prescribed methadone and were at various stages of stabilisation. In general, the early stages of a methadone prescription were characterised by occasional lapses when illegal drugs were used. However, for service users who had been in receipt of methadone for approximately three months, there appeared to be significant reductions in illicit drug use, with several respondents adhering to their prescribed medication alone.
6.10 All respondents had lengthy records of offending behaviour prior to being placed on a Drug Court Order, including shoplifting, house-breaking, drug offences, car thefts etc. All respondents stated that most or all of their offending behaviour had been drug-related, committed to obtain money for drugs and while under the influence of drugs:
"To fund the drug use cos, apart from anything else you wouldn't want to go shoplifting if you didn't need the money for drugs…because at the end of the day you don't want the jail."
"It always has been, nearly all my offending …it always has been related to drug use, always has."
"All of them were committed when I was on drugs, most of them to get money for drugs, except the breaches, that's when I was on them. You know shouting and bawling, making a fool of myself more or less."
6.11 The majority of respondents noted that they had offended daily in order to obtain money for drugs and would spend whatever they could afford on drugs (from 20-100 per day). Since being placed on a Drug Court Order, three of the respondents were facing further charges which were still to be dealt with but to which the respondents were intending to plead not guilty. Five respondents stated that they had not committed any further offences since being placed on a Drug Court Order:
"I couldn't walk into a shop and lift anything now, I'm terrified whereas before I was normal I didn't feel anything so lifting a bloody hi-fi and walking out a shop and everybody seeing me…you just did not care because you'd no feelings whatsoever. So it definitely worked for my offending anyway. I just couldn't do it now, I'm terrified."
6.12 Overall, all respondents considered Drug Court Orders to be a very positive opportunity, providing them with 'another chance' and 'something to work towards'. Several respondents noted that the Orders provided them with an opportunity to stay out of prison, address their drug use and receive help to do so:
"I don't think it's a soft option the Drug Treatment and Testing Order. It is not a soft option."
"To me, prison is the easier option than the Drug Treatment and Testing Order. Because in prison you don't need to answer to anyone…whereas on the Drug Treatment and Testing Order I've got to answer to social workers, to probation officers, I've got to answer to Glasgow Drug Problem Service when I do my urine test, I've got to answer to a judge at my monthly reviews and I've got to answer to myself, because I've got to look closely at myself every time I do take a slip or whatever."
"I think it's been the best thing that has ever been introduced…, because if you look at my record it speaks volumes…It's just been prison, prison (…) My longest sentence was eight years and nothing's ever worked for me and now, I don't know if you heard the Sheriff, he said I've done really, really well."
"I think it's been a good thing you know, it's helped me in a big way."
"They've got me on a methadone programme now and it holds me. Whereas if I wasn't on that and I had a drug habit I couldn't get up in the morning and do my everyday thing. Whereas now I just get up and take a walk to my nearest chemist …When I go back to when I had the drug habit there was a lot of things I couldn't do then but can do now."
"The DTTO has really changed my life more or less and I am quite happy with the Sheriff and what he has done for me, and the other workers. They've all been like a team and they have all worked to get me on well, so I'm not wanting to let them down anymore, I'm wanting to try and make it up to them, like be there on time and things like that…"
6.13 Respondents noted that the Orders had made a significant impact on their lives, had enhanced relationships with their families and resulted in considerable improvements in their health and appearance. All respondents noted that their families were pleased with their progress, although they acknowledged that they still had to prove they were trustworthy, having relapsed on previous occasions.
"Just now I have never been so close to my family since I was a young boy, since before I was on heroin. They see me trying."
6.14 Several respondents noted that boredom was a big problem and that they would like some organised structure to their lives.
"At the end of the day, boredom is (and any addict will probably tell you) the biggest thing that will cause you to relapse, because if you've nothing to do and you're sitting twiddling your fingers it's obviously going to be on your mind…"
"You see boredom plays a big part in it, you know you get bored but my girlfriend works now and I've got my daughter every day and that takes it away from me you know. But if she wasn't there I think, I don't know if I'd go back using or whatever but boredom does play a big part in it you know, so maybe if they can do something like employment-wise or a place to go, whatever…I think that would be a good thing in a way…"
6.15 This was being met, to some extent, by the possibility of group-work or day programmes which were offered by the drug treatment and testing team and external service providers. These activities were offered to service-users when they had made some progress with their Order. When such provisions did not materialise, respondents felt 'let-down'. One respondent had been told to wait until he had been on his Order for longer before participating in additional activities:
"And that is a negative for me. Hold on? Hold on for what? Have me hanging about for what? You know what I mean, I'm hanging about doing nothing. Having nothing else to do with my time…"
Several respondents had, however, sought out voluntary work using their own initiative and two respondents were employed on a casual basis.
6.16 The requirements of the Drug Court Orders meant that service-users had to attend for treatment and testing twice weekly, and attend court every two weeks initially. For some respondents, this helped to provide some structure to their lives; however, when respondents had child-care responsibilities, this could be problematic as no provision was made for crèche facilities or assistance with child-care:
"My biggest problem is getting someone to look after the little one, because as I said, do you take her and get into trouble for taking her because it's not a place for children, understandably because some people are sitting full of it, and she can't crawl about or play with anything. Or do I stay at home and miss my appointments, this is the problem I have got."
6.17 One respondent also noted that they would like their partner and parents to see how they were progressing, but would not be happy to take them along to the offices of the treatment and testing team, or to the Sheriff Court. The respondent commented that perhaps occasional home visits would alleviate this problem:
"I just keep going back and saying to my girlfriend, my mum and dad, that I am doing great and for all they know I could be lying. So it would be good for a social worker or whatever to come out to the house an odd time and see you on a one-one basis…because I don't really want to bring my mum and dad along with me to see how I am getting on, it's not a nice place, the waiting area."
6.18 Drug Court Orders provided the respondents with what they considered to be 'another chance'. The majority of respondents noted that their ultimate objective was to be drug-free; several noted that they hoped to get a job and/or some educational qualifications or training experience. Three respondents were engaged in some form of voluntary work:
"I'm hoping to get to college in August to do [a college course] and progress to that and, you know, maybe do a university course on counselling, addiction, whatever, and hopefully get into a job that's going to suit me. Because I've got the life experience of it…but definitely total abstinence with drugs."
"It's good for us to have been there and done that and go back into the community and say 'listen, we've done all this and these are your rights', cos a lot of people don't know there rights."
"…I'd just like to put something back into the community 'cos I took so much out of it you know…"
"I want to get myself a job and be like everybody else instead of being an outcast because that's what you could call people out there who have a habit…Because you don't care about yourself when you are on them, the only thing that matters is getting that next bag."
6.19 The motivation of offenders on Orders requiring treatment of their drug addiction was stressed by the Sheriffs as the key variable relating to successful outcomes of Orders. One Sheriff stated " it very much depends on the offender as opposed to the court". In considering the role of motivation in determining suitable clients for the pilot Drug Court in Glasgow, another Sheriff responded:
"The expression is setting them up to fail and if there isn't a reasonable prospect and you really think that actually they are just going to breach it then what's the point because A) it's a lot of public money you're putting into this, B) and if it isn't going to work what's the point in doing it …The Drug Court Order is never going to work unless they want it to work and so you need that commitment from their part. Just the fact that they have the habit would certainly not be a good reason to put them on any Order like that unless you were assured that there was a reasonable prospect that they now had, they were prepared to make the commitment."
6.20 The Drug Court Sheriffs were "cautiously optimistic" that the Drug Court would be more effective than traditional approaches in making offenders less likely to offend. Traditional approaches had, they observed, been relatively unsuccessful in this respect compared with their success in meeting other sentencing objectives.
PERCEIVED STRENGTHS OF THE DRUG COURT APPROACH
6.21 The Sheriffs reported that the 'very full' Reference Manual of the Drug Court, produced by the Working Party, had been their main source of information about the Drug Court to date. Informal dialogue between the Sheriffs individually and the two Drug Court Sheriffs had satisfied their demand, such as it was, for further information about the progress of the Drug Court. They therefore felt able to comment upon what they perceived to be main strengths of the Drug Court approach.
6.22 The Sheriffs perceived the Drug Court in Glasgow to have particular strengths over and above the 'traditional' procedures elsewhere in the Sheriff Court. These included the Drug Court team, the fast-tracking of cases and the procedures relating to pre-court review meetings and reviews. The Drug Court team, with dedicated Sheriffs and Clerk, was felt to be " a team who work well together and they know what they're doing". One Sheriff commented that, compared to their experience of the implementation of the Drug Treatment and Testing Orders pilot scheme, the pilot Drug Court in Glasgow was benefiting from the investment in training of the Drug Court Sheriffs:
"I think the DTTOs are a halfway house which aren't totally satisfactory whereas the Drug Court Sheriffs are properly trained in dealing with these things…The Sheriffs are trained…they've had information about how, what it's like to be a drug abuser, about particular drugs."
6.23 The Drug Court was reported as being genuinely able to fast-track cases due to its resources. This was viewed as crucial in the treatment of drug-misusing offenders and contributed to the potential strengths of a dedicated Drug Court compared to other courts in the Glasgow Sheriff Court. As two Sheriffs expressed:
"I think the ability to deal with offenders quickly is the best root to trying to deal with the particular problems that they have, I think one of the difficulties that we have presently is where the offender pleads not guilty and then the trial is adjourned, and it's maybe a year later before you're dealing with the offender and so much has happened in that time, I think the fast tracking is probably the most important feature... I think the greater advantage that the Drug Court has is that it is dealing with the offender quickly after the offence is committed."
"The screening is very quick, overnight .. they've got a very good screening system, there's co-operation from all agencies which includes defence, prosecutor, police and .. I think they will be quite sensible about who they do pick …. they'll weed out those who are just trying to take advantage of this .. you know the chap who thinks get out of jail free."
6.24 The procedures for pre-court review meetings and the nature of the reviews in Drug Court sessions were reported by the Sheriffs to contribute to the unique strengths of the Drug Court compared to courts elsewhere in the Glasgow Sheriff Court. Based on the informal information from a Drug Court Sheriff, one Sheriff commented on the advantages of being able to hold frequent pre-court review meetings for each case. The pre-court review meeting was perceived to enhance the process of gathering information about client progress, ensuring accuracy and therefore strengthening the decision-making process of the Drug Court Sheriff:
"I think the Sheriff is much more involved in the discussions before the offender actually appears which of course in the ordinary situation, Sheriffs are not involved in that at all, so I suppose the Sheriff is perhaps getting a much better flavour of the contents of a report because he's able to speak more directly with the authors of the report, so perhaps the Sheriff is getting a much better picture."
6.25 Their role in the Drug Court meant that Sheriffs had to be able to engage with offenders and use their influence with them directly. Drug Court Sheriffs believed that they had to be capable of empathising with people with whom they shared little in common. One Sheriff described the work of the Drug Court Sheriff as emotionally more demanding than the work undertaken in the Sheriff Court, not least because in the Drug Court the offender may on occasion seek advice from the bench:
"I feel as if it's some sort of duty to give them at least some sort of advice and point them in the right direction. So, I mean, that's the thing that's the most difficulty part of it. It's probably the most rewarding part of it as well."
6.26 Sheriffs did not believe their practice to have changed markedly as a result of sitting in the Drug Court, though they reported having a more informed attitude towards drug users as a result of their contact with them and with other professionals involved in their treatment and supervision. One Sheriff explained how he was, for example, now much more aware of the enormous pressures upon ex-users to start taking drugs, having previously not fully understood the nature of the difficulty people faced.
6.27 The factors highlighted by the Drug Court Sheriffs as having contributed to the effectiveness of the Drug Court in its first six months were the regular contact between different members of the team and the opportunity for dialogue between an offender on a Drug Court Order and the bench.
Advantages of having a specialist Drug Court
6.28 The Drug Court Sheriffs saw several advantages in having a specialist Drug Court. For example, it meant that clients were not required to discuss their drug use and other problems in public among people appearing for a variety of other reasons. Everyone appearing before the Drug Court was known to be there for the same reason, which might make the experience less embarrassing. In addition, through sitting regularly in the Drug Court the Sheriffs were also becoming increasingly experienced in dealing with offenders on Drug Court Orders. As a result they were better able to empathise with them and more subtle in their approach to dealing with them, than would be possible in a traditional court.
6.29 The creation of a dedicated Drug Court in Glasgow was broadly viewed by the Sheriffs to be "a good idea" as a step-change in addressing the context of chaotic drug taking and offending behaviour in Glasgow. The lament of the societal costs of drug-related offending was evident across the members of the Drug Court Team:
"The fact is we have a very serious drugs problem. It's causing immense distress to all sorts of people because of the knock-on effects of the crime associated with drugs. You know you get mugging of old ladies and young people, you get, because people are thieving things and you get house break-ins. And I think the amount of money it's costing the economy is vast and the upset it's causing as well is vast."
"For the right people it's a better approach, at the end of the day if we can stop all this offending and giving of drugs, then it's got to be better I suppose."
FACTORS THAT HAVE DETRACTED FROM THE EFFECTIVENESS OF THE DRUG COURT
Defence agent remuneration
6.30 During the initial stages of the pilot, defence agents identified a number of concerns, which were being addressed to the Scottish Executive via the Glasgow Bar Association. These concerns centred primarily on the levels of remuneration for defence agents representing clients made subject to Drug Court Orders. Issues included:
- a verbal indication having been given that defence agents could not claim Advice and Assistance if a referral was being made to the Drug Court;
- the inability of solicitors to render interim feenotes, with the consequence that payment for all work undertaken with a client of a Drug Court Order could only be made on completion of the Order;
- the fact that no additional remuneration was being provided for defence agents to attend pre-court review meetings; and
- the fact that a single flat rate was being paid (50) regardless of the number of cases an offender had calling in the Drug Court.
A particular concern was that different fee regulations applied to Drug treatment and Testing Orders imposed in the Sheriff Court and Drug Court Orders, creating an anomaly and a likely reluctance on the part of defence agents to represent clients dealt with by the Drug Court. The implication of these concerns was that if they were not adequately resolved, offenders made subject to Drug Court Orders might find it difficult to obtain legal representation.
Media attention
6.31 One factor that might have detracted from the effectiveness of the Drug Court in its first six months of operation has been the intense media attention that has been aroused by this innovative approach to drug-related offending. Media attention has, in particularly, been intrusive for offenders on Drug Court Orders who have, on occasion, been 'hounded' by the press. One Sheriff was, however, confident that with time there would cease to be such intense media interest in the operation of the Drug Court, and that media interest in the early stages was inevitable in view of the innovative nature of the court:
"I think that'll die down if this pilot takes off and more and more courts around the country are doing it. The interest, I think, will wane because nobody comes in and watches community service being doled out."
Multi-disciplinary Working
6.32 Inter-professional collaboration across a number of sectors is a relatively recent phenomenon within the UK. It has been spurred on in the past decade by the implementation of the NHS and Community Care Act, although multidisciplinary working (as opposed to multi-sectoral working) has been common within primary health care since at least the early 1970s. However, the fact that such arrangements are increasingly common should not belie their complexity. Handy (1992) notes that successful organisations are underpinned by a strong cultural ethos which may not readily coincide with that of another organisation, despite an apparent similarity in stated aims and objectives. There was certainly evidence that senior members of the Supervision and Treatment Team were aware of the actual and potential difficulties but often, in their analysis of these problems, appeared content to assume that they would be resolved through goodwill and the passage of time.
"The drug court started only in October and we started from that time. There is lot of room for improvement in the system. I see the communication continuing to improve though (we) will have to look further and see how we can improve it further."
"(We're) trying to marry up some pretty diverse cultures and traditions, who customarily are not in the pattern of working together… given that, the scale of that task, it's actually working extremely well. Again that's probably a product of the personalities who are all working hard to fit together."
"It's been quite a turbulent relationship… it's actually been quite difficult to actually work out a system whereby communication is seen working and it's regular and it's agreed that it's priority and it's something that should be committed to."
6.33 However, Ovretveit (1993) suggests that goodwill and familiarity alone will rarely deliver the hoped-for "added value" that inter-professional collaboration should, in theory, deliver. The basic prerequisite for such multi-disciplinary teams is communication:
"For clients to get the help they need, team members need to know what help others in the team can offer and be able to explain what they can do to help clients."
Such communication, or 'role understanding', should be complemented by clear leadership, management and teamworking arrangements, and by adequate, equitable resources (Ovretveit, Mathias & Thompson, 1997).
Communication
6.34 There was little evidence of role-understanding or even mutual respect amongst the Team members interviewed. Team members generally recognised that part of the problem was attributable to differences in organisational culture, but there was scant evidence of compromise and the few meetings which had involved the Team in its entirety had not apparently been used to foster an understanding of these issues. One senior team member remarked:
"I am just one component of (the) drug court team. I am not aware of what is happening in other components."
6.35 Nor did there appear to be clear lines of communication in the everyday working life of the Team. The social work and counselling section of the Team use a notice board system to indicate the current and planned activities of the various individuals. However, the notice board gives no parallel information regarding members of the health services section of the team. Both sections apparently operate separate diary systems, and whilst individuals were working hard to ensure that there was minimum inconvenience to both the staff and the clients, team members reported a number of occasions when a breakdown in these arrangements had resulted in lengthy delays or rescheduling of client appointments:
"People would be waiting to come in for an appointment to go to see the nurse and then they take off and the GDPS don't even tell you. Or they phone GDPS and say that they can't come in and GDPS don't tell you. What I say to my own clients is don't - if you can't come to GDPS let them know, if you can't keep your appointment with me let me know. (One client said) 'I told sister'. I said, 'it doesn't matter I'm not getting that information through'."
"I know our nurses are annoyed because the drugs workers try and pitch into our clinics to see clients at roughly the same time. Which isn't ideal if they are seeing a nurse and then coming to a doctor and before I have got hold of them they have been whipped off by a drugs worker."
6.36 There was considerable awareness of this as an issue at all levels of responsibility within the Team, but maingrade staff in particular seemed at a loss to understand how these differences might be resolved and expressed frustration over barriers they were neither able to adequately define or remove:
"One major difficulty in communication between addiction and GDPS is the speaking a different language. Coming from different places. That's not - well it's communication problems because people aren't hearing."
"As far as I can see we work very well with them and it's much better being across the hallway than being in a different building. But I think, sometimes they think we're too rigid and too structured with the clients."
Management and teamworking arrangements
6.37 The management arrangements for the Team appear to be somewhat complex and there appear to be significant areas of operation where issues of responsibility have not been resolved. This has led to an apparent lack of clarity over roles and duties:
" My role is to co-ordinate and ensure that the health bit are doing their bit as well, although I don't have line management responsibilities for health, they have their own."
Management of the health service section of the Team is the responsibility of the Senior Medical Officer, although the nursing staff are also responsible to the Health Board nursing hierarchy. Overall co-ordination of the Team lies with an independent Drug Court Team Co-ordinator but this post has no line-management responsibility.
6.38 Whilst the co-ordination of the different professional groups appears to work well at management and supervisory level, and the appointment of an independent co-ordinator has been useful in this respect, the mechanisms for translating this into practical co-operation at the client interface are not at all clear. Indeed, the rather confused nature of the management arrangements have led to many team members feeling that they are isolated from the decision-making processes and have little control over the direction of the project:
"More regular feedback from our own management team as to issues that are raised at our staff meetings, I think there should be more regular feedback from our management as to what the response from our management is."
"We don't actually know what management discuss when they're having their separate meetings. And I dare say it's about managing the Orders at a different level; managing the whole teams (sic) at a different level. But we really are not aware of what's actually going on. And I think we maybe could do with some feedback on how well or how not so well, we are doing. There's not a lot of that around to let us know if we are making really good steady progress; if we are making a difference."
6.39 Three Team members expressed concern that a planned observational visit to an American Drug Court had been arranged without full discussion within the Team:
"Well, senior officers who make the decisions on all of the jobs are actually invisible. Well, we had an incident just the other day over the Washington trip where a senior manager made a decision that there shouldn't be representation from social work or addiction in Washington."
6.40 The normal vehicle for relaying senior management discussions and decisions to maingrade staff is the Team or staff meeting. However, the Drug Court Supervision and Treatment Team has struggled to establish a regular sequence of meetings and attendance by all sections has not yet been achieved:
"We have this big staff meeting and, to be honest with you, they just go on and on forever because people get all bogged down. They don't stick to business any more (and) we get sidetracked very easily… it would be much better if they just addressed one thing and then we could actually deal with them and go onto the next one and people might be more eager to participate."
"But actually we've never at this stage sat down as a full team with full representation from GDPS and I think that's a failure because if we did that I know that we'd be talking about whether to do it monthly or bi-monthly. As yet it still hasn't happened."
6.41 In many multi-disciplinary teams, where all-member staff meetings are not possible for a variety of reasons, day-to-day multi-disciplinary task working is facilitated in order to foster communication and mutual role understanding organically. In such situations, joint supervision arrangements and rotation of staff ensure good understanding of the overall team ethic and the role of the individual disciplines within it. However, this too appears not to have occurred in any systematic way:
"We should all work together, I believe and instead of the GDPS and the social worker and the addiction workers being kind of a separate, we should have an addiction worker, a GDPS worker and a social worker who are a team, I think."
"It's only as good as the two or three people involved. If you have three people working with any one client… there has to be communication between the three of you… I think because of the time factors and the workload… we haven't really got settled with some of things… like informal sessions where the three workers would get together and talk about individual cases… because people are so busy that hasn't fallen into place."
6.42 Where there is significant co-working at this level is in the production of court reports. Members of each of the three sections of the Team are assigned as keyworkers for individual clients. These keyworkers are responsible for producing written reports for the pre-review and review process. Overall 'editorial control' lies with the social worker who co-ordinates report production and ensures that the views of the professionals involved are reflected in the final document. Although examples of good practice were cited where keyworkers had met to discuss their respective client and agree report content, this was by no means commonplace and appeared to occur usually where a client had proved difficult, or where progress was disputed by one section or another. This appears to have led to some dissatisfaction amongst some Team members regarding the content of reports:
"I am not suggesting there is any agenda there but what I am suggesting, is the process itself is open to misinterpretation and a number of mistakes can taken place when you are interpreting a technical report."
"We are giving the report to social workers every month and then we see the social worker's report going in, quite often it's your report! So I do get a bit miffed about that sometimes."
6.43 In part, this appeared to be as much a resourcing issue as one of communication. Heavy workloads left staff with little time to meet outside their respective disciplinary commitments, and poor resources, or resource training, meant that reports were often physically typed and retyped with consequently little opportunity for contributors to comment upon the final draft:
"I think we should all have access to the internet, have a drugs court website…there should be some form of system where we can communicate quicker. There is too much paperwork flying about."
However, it should be noted that there was a general acceptance of the value of such multi-authored reports:
" I think they're very useful 'cause one person's report can be interpreted in several ways and it's not always the one person that's involved with the client. It's a kind of team effort."
Resources
6.44 Ovretveit et al. (1997) argue that where inter-professional collaborative initiatives are established without clear management structures and an agreed and transparent approach to problem-solving, the resources available to the enterprise tend to be inappropriate for overall team needs. Almost inevitably, this will result in territorial disputes between the partner professions.
6.45 In the case of the Drug Court, there was general recognition that the problem of forging a working relationship between different professional groups had been compounded by inadequate premises. One senior member of the team remarked:
"…tension between the medical team and the addiction team and the social work team, but mostly between the medical and addiction and I think that's because in no small part of the fact that we have a very unsuitable premises here and they've placed us in offices where we don't nearly have enough interview space and when peoples environment aren't suitable for the job that they have to do, that's inevitably going to cause tension…"
6.46 This view was echoed throughout all sections of the team with staff noting particularly the pressure upon interview/counselling rooms. This had caused tension between different sections of the Team and disagreements over proprietorial rights:
"There's two rooms downstairs plus there's a night porter's room so that only leaves like maybe one interview room for the social worker and addiction staff to see people. And if we have a clinic, say we have maybe two or three clients don't turn up so we're like quite… there's nobody really there to see for twenty minutes, half an hour, the addiction can't see why we just can't give over our room to them…"
6.47 The shortage of interview/counselling rooms has a consequent impact upon the waiting room and, again, there was concern at all levels that the facilities provided were inadequate and possibly deleterious to the treatment ethic of the project:
"I would probably think it's quite difficult, very difficult considering you are sitting… downstairs in this waiting room for so long as clients are required to wait because of just lack of space amongst people who are stable on script or unstable and it really is rubbing peoples nose in it."
"We need to improve our waiting area substantially, and make it much more user friendly and I think that we need to move out of these premises which have been unsuitable for us. We need an environment where the client comes in and feels relaxed, because a lot of the clients come in feeling quite tense and anxious and agitated and they know that they have to give a urine sample and I don't think they've been given the proper facilities to give that urine sample because the waiting area is overcrowded, people in for assessment sitting alongside people who are withdrawing or gouching…"
6.48 The procedures adopted for testing (urine analysis) too, have also had an impact upon the waiting area:
"What he (the client) says is, a lot of times there's a sort of atmosphere in the waiting room. Folk in all sorts of states and he's obviously quite anxious and uptight about passing the test anyway or doing the urine test anyway. And all the shouting and noises around and having to go to the toilet and it's very open. I think it's not conducive to… I don't think it's helping that client anyway."
6.49 Team members also noted that problems in dealing with clients timeously undermined the treatment ethos of personal accountability and responsibility:
"…we ask clients to turn up within twenty minutes and then we keep them waiting around for - how long is a piece of string - till we get a room. Or we send them away because we can't get a room and I just think that's not good practice…"
"You're having to wait around maybe three quarters of an hour to get a room and you're expecting them to turn up on time or they're going to be gaoled. And then they come in and they've got to sit around for three quarters of an hour to see you for ten minutes! To give them feedback? Hah!"
6.50 Frustration, even anger was also expressed at staffing levels, which had increased workloads to an extraordinary degree, particularly within the social work and counselling section of the team. Senior members of the team noted:
"We don't have the capacity in terms of staff to deal with the wider issues because we are in crisis, we've been in crisis for six months, we're still in crisis. We don't have enough social workers, we don't have enough addiction workers, we can't recruit… well we'll not recruit quick enough. To me, we should have had 8 social workers, 7 addiction workers, a full medical team at the beginning of the drug court… we're six months down the line and we still don't have them. And people are leaving the team. We've had a very unstable start, we've had an unstable start to it and that's affecting everything."
"We don't have enough social workers and we don't nearly have enough addiction workers. Therefore, when people are worked off their feet - literally off their feet - there is only so much they can do. We want this to work but this won't work with the current staffing levels. It won't work with the current level of management support either, because there has not been enough management support to this team."
6.51 One senior member of the team noted that this was in part due to an underestimation of the likely demand:
"I think the working party worked on the base that once the drug court came in, DTTO's might fall away, because the drug court is taking away business, whereas in fact the drug court does seem to encourage other people to start using them and the number of DTTO's suddenly swelled… instead of having those resources set up to deal with drug court cases and the anticipated small amount of (other) DTTOs you are suddenly looking at drug court cases and almost twice as many DTTO's in the same period."
6.52 Whatever the reasons, there was almost universal recognition that some sections of the team were labouring under extremely heavy workloads. Maingrade staff particularly were quite direct in their criticism of the staffing levels and consequent workload:
"The social workers are just constantly report writing. I mean, someone should really seriously sit down and look at how many hours a week does it take for one client, including the interview time, the paperwork time, the report writing time, your liaison with other agency's time and figure out what the maximum caseload is. And then folk on high should make sure the staff compliment is adjusted accordingly."
"I think, because it's working well at the moment, because they're doing good work but it's going to cave in, staff are getting demoralised, they're going to just throw the dummy out the pram, they're going to get burned out. You can't expect staff to keep working at such a pace, and are no better paid, the addiction staff here are no better paid than they are in an area team and that is a disgrace. I've worked in local drugs projects and I know how some people operate and they are not under this level of pressure at all."
6.53 A number of team members claimed that the workload had reached levels that were seriously undermining the quality of service they were able to provide:
"I'm a skilled social worker and I have things to offer clients that I could actually use my skills more effectively. But in many cases… I'm a care manager rather than a care worker… I could be doing more. Addiction workers could be doing more. But because of the volume of workload and because of the roles sometimes we play, it restricts the services we offer clients."
"You're not really getting a chance to stand back and sit down and actually structure your work, plan for it and prepare for it and take in materials with you. There's not many resources here, we don't have the leaflets, we should have information there for the clients."
"Because of the time, because, I have never ever been so disorganised in my life as I have been since I've come to this place. I was always organised, a very, very good time manager. Used my time efficiently and effectively. And some days you are reduced to tears because it's so much to do."
6.54 One senior member of the team felt that the uniqueness of the project had not been reflected in appropriate staffing levels:
"This is not an area team, this is not probation, this is not community service. This is drug court DTTO and drug court probation. These are unique Orders that we are servicing for the first time, and I'll tell you, they require a lot more input than your average criminal justice disposal."
FACTORS THAT WOULD FURTHER ENHANCE THE EFFECTIVENESS OF THE DRUG COURT
6.55 The Drug Court Sheriffs identified a number of developments that they believed would made the Drug Court even more effective. These included the availability of sanctions to respond to non-compliance; the development of a more sophisticated system of rewards for good progress; and the possible introduction of a mentoring or 'buddy' system in which offenders who have been on an Order for some time provide support to others who are in the early stages of their Orders.
6.56 The Drug Court Sheriffs stressed the importance of continuing to learn from developments in other jurisdictions that have more experience of operating Drug Court. That said, they also recognised that approaches adopted in different jurisdictions needed to be culturally relevant and that some ways of doing things in, for example, North America, would appear incongruous in the Scottish context.
CAPACITY OF THE DRUG COURT
6.57 The Drug Court currently sits for four days per week, with pre-court review hearings held at 12 noon and the court sitting at 2 p.m. The Sheriffs acknowledged that their work was, at this stage, relatively sporadic because the court had only recently been established and caseloads would take time to build up. They therefore perceived themselves currently to have some extra capacity, but acknowledged that this situation was unlikely to persist. The Supervision and Treatment Team, on the other hand, were perceived to be working to full capacity even with the addition of further staff members and the Sheriff wondered how they would cope as numbers increase without having further additional resources.
6.58 An unexpected consequence of the Drug Court being introduced had been a perceived increase in DTTOs imposed by the Sheriff Court. One of the Drug Court Sheriffs reported that the number of DTTOs made in the Sheriff Court in the first month of operation of the Drug Court exceeded the number made in the whole of the previous year. He attributed this to the fact that Sheriffs' awareness of drug treatment disposal had been heightened by the training that was provided in relation to the setting up of the Drug Court.
6.59 When the Drug Court was established it was anticipated that it would make 150-200 Orders per annum during its first two years of operation. The Drug Court Sheriffs emphasised that the target was an absolute maximum and may, indeed, be an unrealistic workload for two Sheriffs. Their concern was that this might undermine the effectiveness of the Drug Court approach:
"A dozen cases, 15 maybe, a day would probably be the optimum. Any more than that and you'd begin to get very, very fed up and you would then go round in circles and start mixing people up."
6.60 The Sheriffs believed that the target numbers would pose more of a problem for the Supervision and Treatment Team and that their ability to maintain a high quality service should be a primary factor in establishing the appropriate target numbers for the Drug Court:
"I think their ability to cope is the most important thing because unless they're able to provide reports on time, quality reports, unless they're able to do their job properly we're kind of pointless. So I think they're the crucial factor in determining capacity rather than us."
6.61 The Drug Court Sheriffs did not consider the introduction of the Drug Court to have had any significant impact on the workload of the Sheriff Court. This was partly because offenders dealt with in the Drug Court represented a very small proportion of the total business going through the Sheriff Court. Furthermore, those appearing at the Drug Court would only appear once or twice every six months in the Sheriff Court since the nature of their offending and their criminal records would make it likely that they were, on each occasion they appeared, imprisoned. The Drug Court Sheriffs suggested that, on balance, the impact of the Drug Court on Sheriff Court workloads was probably neutral: the Drug Court Sheriffs were not available to assist with jury courts, but the Drug Court was probably increasing the incidence of guilty pleas and therefore resulting in fewer cases going to trial. However, they suggested that the introduction of a Drug Court in smaller courts would have a significant impact on other workloads.
6.62 The capacity of the Drug Court during the pilot scheme was considered by the Sheriffs sitting in the Sheriff Court to be modest in terms of its stated target. Views ranged from an acceptance of the status of the Drug Court as a 'pilot' to the view that 'they should be aiming for more':
"It depends how much work they get through, at the moment. . . I think there is only about thirty, thirty three, which doesn't really seem an awful lot to have taken, I understand that the pilot group was to be about two hundred or there about, I think with the major drug problem that exists, then four days is not too much providing they could put into to those four day a few more customers."
"I think the Drug Court is a very good idea, the trouble is it only scratches the surface, now truth be told if you're really interested in Drug Court you're going to have quite a lot of Drug Courts. One is not going to be nearly enough we're talking about what two hundred cases."
"It's certainly not too much, about right, well I suppose it is at this stage in the game but It seems to me that this is an area where we really do have to go hard at it and there may well be a good case for putting a lot more into it."
SUMMARY
6.63 There was a general optimism among those involved in the operation of the Drug Court that it would be successful in reducing drug use and associated offending behaviour. All of those on Drug Court Orders who were interviewed reported significant reductions in drug use and offending, and were positive overall about their experience of Drug Court treatment and supervision. Boredom was, however, a common problem and Drug Court clients would welcome more organised structure in their lives.
6.64 The main strengths of the Drug Court were perceived to be the 'fast-tracking' of offenders, the existence of a trained and dedicated team with regular contact with clients, and the system of pre-court review meetings and reviews. The Drug Court Sheriffs reported feeling much better informed about drug use as a result of their contact with other professionals and with offenders on Drug Court Orders. There was support for the existence of a specialist Drug Court, including from among other Sheriffs who sat in Glasgow Sheriff Court.
6.65 Issues around multi-disciplinary team working within the Supervision and Treatment Team were believed to have undermined the effectiveness of the services provided to offenders in Drug Court Orders. The management arrangements were said by staff to be unnecessarily complex, the premises were inadequate and the staffing levels were too low, resulting in unrealistic workloads for the social workers and addiction workers. Each of these factors undermine opportunities for a genuinely collaborative, multi-disciplinary approach.
6.66 The workload for different professional groups involved in the Drug Court was variable, being more manageable for the Sheriffs and less so for the Supervision and Treatment Team. The Sheriffs who sat in the Drug Court did not believe that its introduction had impacted significantly - in either a positive or negative way - on the workload of the Sheriff Court.
6.67 Factors that the Drug Court Sheriffs thought would further enhance the operational effectiveness of the Drug Court included the availability of additional sanctions for non-compliance, a more sophisticated system of rewards and, possibly, the introduction of a mentoring system for offenders on Drug Court Orders.
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