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4. ADDICTIONS
Management and Policy
4.1 There is a strong commitment to addiction services within the prison. The Governor is a member of the local Drug Action Team and the addiction manager is also a member of several of the Drug Action Team sub-groups. The prison has made important links with external drug services to develop throughcare addiction services for prisoners. In addition to addictions duties the addictions manager also has social inclusion as part of his remit and is responsible for Glenesk House. This is not an uncommon mix of responsibilities for addiction managers but it does make it more difficult for each manager to give the time to addiction that might be needed. There is a Drugs Strategy Group in place consisting of the Governor, the addictions manager, the health care manager and the addictions team manager. This group has not always met regularly and needs to do so to ensure management and co-ordination of a complex process within the prison.
4.2 There is also a fortnightly addictions case management meeting to discuss complex cases. While this is a useful and important process it does not perform the same function as the Drug Strategy Group.
Addiction Treatment Process
4.3 The prison has a clear, if complex, addictions treatment process adapted from the national addictions treatment process. This process was still in draft at the time of inspection as a result of Phoenix House taking over from Cranstoun, and also changes to throughcare. The outline process looks a very positive one, from Reception through health care to national harm reduction sessions, core screening and Phoenix assessment, addictions case management and a variety of interventions through to community integration.
4.4 The addiction treatment starts at Reception where checks are made about methadone maintenance, for those receiving methadone prior to sentence. Checks include questions about whether the prisoner's methadone maintenance will be picked up when they are liberated. No one has been started on methadone for many months as none of the medical or nursing staff are trained in this aspect. This should be addressed. Prisoners are placed on a detoxification regime or continued maintenance on methadone. At the time of the inspection there were 121 prisoners detoxifying and 71 on methadone maintenance. Prisoners are seen by a doctor who prescribes detoxification. Detoxification medication is administered in the halls and this was described by one person as "feeding time at the zoo". Prisoners are offered a national harm reduction session delivered by Phoenix within five days of admission, the KPI target for this is 95% of those with addiction issues, which is met.
4.5 A very useful initiative in Edinburgh is that one prisoner helps with addiction induction: the 'peer support worker'. This is an area of good practice described throughout this report.
4.6 After going through the core screening process, Phoenix becomes involved with those prisoners who want help with addiction problems. Prisoners serving under 31 days and those on remand do not receive a full specialist assessment but are offered some kind of help, for instance referral to outside agencies. Phoenix then put together a care plan and are responsible for monitoring the care plan for each individual prisoner. The addictions case management group meets fortnightly to discuss more complex cases.
4.7 A variety of interventions are available including detoxification, methadone maintenance, motivational interviewing, alcohol counselling, programmes (including Lifeline, Alcohol Awareness and Drug Action for change) safer injecting, paraphernalia advice and attendance at Alcoholics Anonymous and Narcotics Anonymous. Drug testing is available from the MDT Unit
4.8 Approximately eight weeks prior to liberation Phoenix refers to the Throughcare Addiction Service ( TAS) Edinburgh, managed by SACRO, and might also refer to the local methadone maintenance facility. The plan is to hold a 'community integration conference' with a Phoenix caseworker and someone from the Throughcare Addiction Service. A pre-release harm reduction session might be available, a care plan for life after release is put together and there is a pre-release meeting with TAS and the client. The success of this community integration process will depend, in part, on links with the community. This seems to be well developed in Edinburgh.
4.9 Phoenix play in important part in this process but only weeks prior to the inspection had taken this function over from Cranstoun Drug Services. The staff employed by Cranstoun are now employed by Phoenix to ensure continuity. There are plans for the future including the introduction of single shared assessment on the SPS prisoner records system ( PR2) in March 2006 as well as a review of the CAART. The links with the community services such as SACRO also seem very positive. Another initiative being set up is a strategy meeting with the addictions manager, the health centre manager and the Phoenix manager. Phoenix also intend involving prisoners in customising the addictions treatment process.
Mandatory Drug Testing
4.10 The team consists of three officers full time. However, this process was, at the time of inspection, in a state of change and uncertainty. Random drug testing was not taking place across the SPS following guidance from SPS Headquarters. Other testing: suspicion, risk assessment, frequent, reception, liberation and voluntary were still taking place. In 2003-04 random testing was 74% clear and in 2004-05 78% clear. The 2004-05 figure was against a KPI of 85%. Fewer tests were being done because some of these tests take longer than random tests, paper work had increased and it was taking longer to collect people for testing.
Programmes
4.11 Programmes are an important part of the treatment and care process for people attempting to deal with their drug problems. The prison runs a 'Lifeline' programme. Last year's KPI was 24 completions and 26 prisoners achieved this. An 'Alcohol Awareness' programme is in place with a KPI of 40: 43 prisoners achieving, and the 'Drug Action for Change programme' with a KPI of 39: 39 prisoners achieving. The prison has tried to focus more on alcohol in the recent past recognising the importance of alcohol in offending behaviour. Prisoners with addiction problems can also take part in other programmes - 'Independent Living Skills' and 'Relationship Skills'.
Community Links
4.12 Edinburgh describes itself as Scotland's first "Community Prison" and has strong and positive links with agencies outside the prison, many of whom have sessions in rooms in the Hub. These community links, with bases inside the prison include mainstream services such as housing services and benefits services which allow prisoners with addictions to begin to sort out problems in advance of being liberated. There are also important links with addiction agencies in Edinburgh and the other Lothian and Borders authorities who use the rooms in the prison to meet prisoners and to provide access to community services in preparation for release. This is an area of good practice.
4.13 There are other important community links. There is a proposal for a very innovative project: a 'Community Links Centre' where some of the services described above would be available in a "one stop shop" type facility in the community where prisoners could go for help after release. This project has support from the prison, the local drug action team, the local SACRO Office and the Scottish Executive who are hopeful that this project might get off the ground soon. Another aspect of good community links from Edinburgh is the community integration process described above which Phoenix House manages as part of the enhanced casework process but which needs support from local criminal justice social work services to succeed. This community integration process is also forming strong links with the local community drug treatment service both at the admission and release stages for prisoners.
Alcohol
4.14 The prison is beginning to focus more on help with alcohol problems for prisoners, recognising the importance alcohol plays in offending behaviour. There is a now an Alcohol Awareness Programme, Phoenix offers a specialist assessment for prisoners with alcohol problems, and Alcoholics Anonymous has a presence in the prison.
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