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CHAPTER FOUR: REFERRAL

Criteria

4.1 The Commissioning Group for 218 established the eligibility criteria for the service as:

4.2 Women from Glasgow ¹⁸ can access 218 from the courts, from prison, as part of an order, or can refer themselves as long as they have been in custody (including police custody) at some time in the last 12 months, or if they are facing prosecution for any offence. Any service can refer women to 218. Although it is generally hoped that women will have a criminal justice care manager or supervising social worker, this is not a requirement. A team of workers (Assessment Team) has a presence in the District and Sheriff Courts on a daily basis and can assess women appearing in court for their suitability for referral to 218. Workers also liaise regularly with the Drug Court. Women who appear for warrants may also be assessed at the request of sentencers, Procurators Fiscal, social work, solicitors, or the clients themselves. Full assessments are then carried out at 218, though they can also be undertaken at court for women provisionally destined for Cornton Vale; or at HMPs Cornton Vale and Greenock where women may be held in custody. ¹⁹ If the court deems it appropriate, 218 can accept a woman directly for a full assessment if it prevents her being remanded in custody.

4.3 Women considered suitable for attendance at 218 undertake a full assessment, which includes a social care and health assessment that highlights both support and treatment needs ( see Annex One). Assessment usually takes place in 3 stages. This is intended to explore the exact nature of the woman's needs and to design services accordingly. The purpose of conducting this assessment over 3 sessions is to ensure that a potential client appears committed to attend 218 on the required basis. In practice the third assessment session for clients needing the residential service takes place as she enters the unit. In addition, the 3 stages can be collapsed into one if the woman is otherwise at immediate risk of custody.

4.4 The service does not provide arrest referral. Such cases would normally be referred to the Glasgow Drug Crisis Centre (also run by Turning Point) or another appropriate service. Priority for referral to 218 goes to the criminal justice system including the Drug Court, Procurators Fiscal, and court orders. Self-referral is possible, but priority is given to existing referrals from direct criminal justice routes.

Who was referred?

4.5 The data for this section were collected manually from clients' case files. The information is therefore a rough description of the overall characteristics of the clients: the quality of the data is tempered by the extent to which details were recorded and the extent to which the researchers were able to locate the relevant information. Most of the information was collected from the clients' initial assessment forms.

4.6 From August 2005, 218 project staff began to record the characteristics of clients on a computerised data base. These records are based on a core data set, standardised throughout Turning Point Scotland; and the Christo Inventory for Substance Misusers, which records social functioning, general health, risk behaviour, psychological factors, occupation, criminal involvement, use of drugs and alcohol, ongoing support, compliance, and working relationship.

Source of referral

4.7 From 1 April 2004 - 31 March 2005, 493 new referrals ²⁰ were made to 218, involving 343 women. Referrals came from a variety of sources, and a single referral could come from more than one source. The highest proportion of referrals came from criminal justice sources: of the 483 referrals that listed a source, 36% (n=174) came from a purely criminal justice source (see below). These included referrals from Procurators Fiscal, Criminal Justice Social Work, the Sheriff Court, Drug Court and District Court as well as 13 from other criminal justice sources such as bail teams (4), Clyde Place diversion team (4), Cornton Vale (4), and the Youth Justice Team (1). Criminal justice related services were also responsible for a high proportion of referrals. These included addiction teams and addiction related services such as Cranstoun (9), Turning Point services such as Cactus (7), 218 (6), the Drug Crisis Centre (7), and Link Up (1), and the Homeless Addiction Team (1). Additional referrals were listed simply as 'social work', which in practice usually included drug workers. Other closely related services included Base 75, Routes Out Intervention Team (2), and SACRO (1). Direct criminal justice referrals were initially low; however from 1 April 2004 - 31 March 2005, the number of criminal justice referrals (both direct and indirect) accounted for 68% (n=327) of all referrals.

Table 4.1: Source of all referrals to 218

4.8 Referrals from criminal justice sources, though part of the core purpose of 218, were in themselves a point of contention. Staff and clients alike believed people referred to 218 as part of a criminal justice order were likely to attend the service for the 'wrong reasons':

"I think to a degree it changes their motivation because there's a different level of motivation from someone who chooses to come here from someone who is sent here or … you know, where the choice is go to prison or go to 218". (Member of 218 staff)

4.9 The suggestion that people who self refer may be more likely to have positive outcomes was not a consistent view but was one that was shared by both staff and clients. However there was also some support for the opposite view. One client sent to 218 by court order believed this helped her:

"Because you don't have your own choice, you've got to stick with it, you've got to stay clean or whatever, I mean a court order does sort of make you, it kicks you up the backside a bit, but it is your own choice because there are a lot on court orders and they don't do it…, so it just depends." (Focus group 2)

4.10 This issue is discussed further in relation to effectiveness in Chapter Seven.

4.11 While referrals from criminal justice sources were initially slow to develop, ²¹ this soon increased as awareness of 218 developed. The Drug Court supervision and treatment team for example, would contact 218 when assessing any woman referred to the Drug Court. Appropriate clients were referred on to 218 particularly for structured deferred sentences. Criminal justice respondents noted the importance of liaising and identifying the needs of individual women at the earliest possible point and thereafter enacting effective joint working to provide a longer menu of options to the court and a wider range of options for the women.

4.12 One criminal justice worker suggested that there had been problems in the past in obtaining assessments from 218 for women on remand, or when women required an urgent treatment plan. However, this appeared to have been resolved with the increasing number of assessments carried out at Cornton Vale. Indeed the number of assessments carried out while women were in prison had increased significantly, with 18 assessments conducted with women in Cornton Vale since April 2005.

4.13 The next highest proportion of referrals came from the women themselves, with 23% (n=109) of the referrals listed as self-referrals. This enabled women to access help when they believed they were ready for it:

"… it's good that you can self refer to it as well… you can put yourself in. There are a couple of lassies that were in when I first came in that have self referred and like I say, there is no really long waiting list, I got in really quick, so that's a good thing too. Because I think when you put your mind to doing something like this, I think the longer it gets left, the more nervous you would get." (Exit 16)

4.14 Anecdotally 'self-referrals' could also come from a criminal justice base, such as women who spoke with members of the assessment team in the custody court then chose to contact 218 at a later date, or those who learned about 218 from a criminal justice social worker or addiction worker but who chose to make contact with 218 directly.

4.15 Other referrals came from housing sources (25, or 5% of the total), health sources (16, or 3%) including mental health services (8 referrals) and physical health services including 2 from a clinic that provided a needle exchange service. Fifteen referrals came from other agencies such as Say Women, the Young Women's Project, Barnardo's, the Family Support Group, and the Community Casework Team.

218 Assessment Team

4.16 As noted above, members of the Assessment Team at 218 attend the custody courts at both the Sheriff and District Courts every day. Team members conduct brief assessments of individuals to determine their suitability for intervention from 218 and to apply for diversion for these women where appropriate. From September 2004 - March 2005 (the proportion of the study period for which statistics are available), the Assessment Team conducted a total of 1,207 interviews in the Glasgow District (737 interviews) and Sheriff Courts (470 interviews) with women both with new charges and with warrants. The team applied for diversion in 183 cases (126 in the District Court and 57 in the Sheriff Court). Diversion was granted in only 7% (n=12) of these, 6% (n=7) in the District Court and 9% (n=5) in the Sheriff Court. The Assessment Team applied for diversion for women considered appropriate for 218, but in most cases these women received some other form of disposal.

Criminal justice status

4.17 The criminal justice status of women referred to the project varied, and some women fell into more than one category. Of the 375 referrals that had information on criminal justice status at the time of the referral, 30% (n=112) of these listed outstanding (96) or pending (9) cases. Twenty percent of referrals (n=74) made to 218 were for people on probation, though in only 4 cases was 218 recorded as a condition of probation (in 3, 218 was not a condition, while records of the remaining 67 referrals did not record this information). In 15% of cases (n=55), women were referred to 218 on diversion from prosecution. In 13% of cases (n=47), referrals to 218 were for women who were actively offending. Twenty-seven records (7% of the total) cited bail as the criminal justice status, including 2 cases in which women were bailed directly to 218 and 3 cases of supervised bail (though whether 218 was a condition of this was unclear). In one further referral a woman was referred to 218 upon breach of her supervised bail. Five percent of referrals (n=18) recorded criminal justice status as 'previous offending', while 17 referrals were for women subject to Drug Treatment and Testing Orders ( DTTOs). Remaining referrals recorded criminal justice status as reports ²² (7), deferred sentence (6), custody (2), post-release (2), and a small number of referrals from individual agencies .

The assessment process

Staff perspectives

4.18 Few 218 staff were familiar with the assessment process ( see Annex One), as this was the remit of designated workers. The general impression was that the assessment process worked fairly well and that the division of assessment into 3 stages helped determine which women were genuinely willing to participate. Members of staff who conducted assessments seemed generally content with the tools ²³ they had and believed they were able to reflect the needs of the individual women. With the assistance of the psychologist and community psychiatric nurse, they were working on an assessment tool (now completed) that gave more detailed information about mental, emotional, or physical risk. The nursing staff had just begun to develop a role in the assessment process. Staff believed the women themselves could express their views regarding care plans and that staff reviewed this with them regularly.

4.19 Staff seemed generally content with the referral routes, though some believed these could be opened up more to include women who had not yet been involved in the criminal justice system but were at risk of doing so. Most referrals were believed to be appropriate (bearing in mind that most staff would only come in contact with women who had already been through the assessment screening process). On one or two occasions staff said they had experienced some difficulty with women who had mental health problems that detracted from their ability to fit in with the residential programme:

"I mean we've had ones where women… that have come in … and have quite severe mental health problems and obviously there's self-harm and there was a suicide attempt, and it's really how best can we manage that and keep the unit safe because obviously then that impacts on the women… We've also had someone with … learning disabilities who hasn't perhaps got the ability to sit in a group and that, … what came out of that is really we need to be looking at material and ways of working to be able to offer a service… to women with … learning disabilities." (Residential staff member)

4.20 This is not to say that staff did not feel able to manage such clients, but rather that they needed full information and practical supports in order to do so. They believed the revised assessment process would give them more information and an opportunity to prepare to deal with such cases. Staff in the residential unit, however, were keen for information about clients due to stay on the unit to be passed to them prior to the client's arrival - something which did not always happen in practice ²⁴:

"I've never seen an assessment for a woman before she's actually been sitting in front of me in residential." (Residential staff member)

"…you don't know who is coming in, what their background is, you know, we get no information before they arrive. Which is difficult because you know one person can completely alter the shape and the dynamic of the unit, you know, and if there's 14 women it can be chaos." (Residential staff member)

4.21 The value of assessment is, of course, only as good as the information the women are willing to provide, something of which staff were fully cognisant.

Client perspectives

4.22 With one exception (a client who tried to self-refer during a brief period in which self-referrals were not being accepted), clients were offered a place on the programme at 218 very quickly following 2 or 3 assessments. Clients viewed the speed of access to services very favourably: "When I came up for my interview I thought it was going to take absolutely months you know the way you get into a rehab normally, you wait months" (Focus group 1).

4.23 Most women understood and appreciated the fact that assessments were spread over a short period of time: "It was ok because it gave me time to get into my mind. You really didn't do that because if it happened on the spur of the moment I'd have got away, I really would have… I think it would have been all too much too quick". (Focus group 3)

4.24 Others were clearly anxious to get help as quickly as possible: "I would have liked it to have been the next day, to be honest with you … but … I mean, it would be really … it would be excellent if there could be something like that." (Exit 44)

Who engaged with the services at 218?

4.25 Of the 343 women (and 493 referrals) made to 218, 143 women engaged with the services there at least once from 1 April 2004 - 31 March 2005. ²⁵ Because they completed assessments and engaged in the service, considerably more detail is available about this sample. It is important to note however, that this information is based on information recorded in client files and in some cases, is based on initial assessments of women during which, some women may not have been ready to divulge complete details of their background.

4.26 Reasons women did not engage with services at 218 were not always clear. These were often women who failed to turn up for one or more of her assessments, despite repeated attempts from the assessment team to encourage this. Clients themselves said people did not engage until they were ready to do so and that the 3 assessments were a useful means of distinguishing between those who were ready and those who were not. In a few cases, the reasons clients failed to engage were recorded: 4 were remanded in custody; one was diverted from prosecution; one was transferred to services in another area; in one case the Procurator Fiscal opposed referral to the service; one was assessed as not appropriate for the service; and in one case the client died.

Source of referral

4.27 Sources of referral for women who engaged with services at 218 tended to come from Criminal Justice sources. Figure 1 below shows some variation in sources, however:

Figure 1: Source of referral to 218

4.28 Figure 1 suggests that women referred from non-criminal justice agencies were the most likely to engage with services at 218, at least as a proportion of those referred. This does not mean that these agencies are not criminal justice related services, however: recall that most of the 'other agencies' include those such as Base 75. Women referred from court were the next group who were more likely to engage in services at 218, at least in the short term, generally because they were there as part of a court order. Least likely to engage, proportionally, were those referred from addiction teams or general social work services (often drug workers, though this was impossible to tell from the method of recording). Recorded sources of referral appear roughly similar to those reported in Pagan (2004), though differences in definition make direct comparisons difficult. ²⁶

Offence history

4.29 The women who engaged with services at 218 had been involved in a variety of types of offences prior to their referral there. Table 4.1 shows these offences in descending order of prevalence:

Table 4.1: Offence history of women who engaged in services at 218

4.30 Consistent with statistics on female offenders generally, the highest proportion of women had committed at least one offence of shoplifting or other theft (Scottish Executive, 2002a; Home Office, 2004a). More surprising perhaps was the high proportion who had committed an offence of violence. However, this was largely accounted for by charges of minor assault and bag-snatching, or police assault (which can include 'technical' assaults such as spitting). Resisting arrest can also be placed in this category. The next most prevalent category of offending was 'other' offences. This included offences such as perverting the course of justice, possession of a weapon, opening a lockfast place ( OLPs), vandalism, and public order offences. Arguably all of these offences, as well as most of the remaining offence categories, relate to the women's addiction. This is either to feed their addictions ( i.e. shoplifting or prostitution), behaviour resulting from the addiction (such as violence or public order offences), or offences that follow on from the ensuing chaotic lifestyle ( i.e. breach of Criminal Justice orders). Levels and types of offending reported in Pagan (2004) were roughly similar, with the exceptions that 90% of women admitted to shoplifting and 50% to prostitution.

Criminal Justice history and current status

4.31 Less than half of the women (57, or 40%) were recorded as having been remanded or sentenced to custody. Half (70 women, or 49%) had been or were currently subject to a probation order, and (n=85) 59% had received another sanction at some stage ( i.e. fines, Community Service Orders, suspended sentences). The relatively small proportion of custodial experience seems surprising in view of the requirement for women who enter 218 to have been in custody at some point in the previous year. However the requirement for custodial experience includes custody in police cells; statistics collected in a 'snapshot' survey within 218 found that, while only 41% of clients had ever received a prison sentence, all had been locked up in police cells (Pagan, 2004).

4.32 Where information was recorded, the highest proportion of women who engaged in services at 218 had outstanding or pending cases at the time of their referral (40 women, or 28%) or were subject to probation orders (39 clients or 27%, with 6 of these listing 218 as a specific condition of their order). 12% of women (n=17) had been sent to 218 as a diversion from prosecution, while 11% (n=15) were on bail (7 women) or conditional bail (8). Eleven percent (n=16) were listed as current offenders. The remainder were subject to a variety of criminal justice interventions, including deferred sentence (7 women), reports (6), and Drug Treatment and Testing Orders (6).

General characteristics

4.33 Women who engaged in services at 218 ranged in age from 18 - 57 years, with an average age of 30 and a median age of 31 (also the case in Pagan, 2004). All but one were white, including one with Irish nationality. The one ethnic minority client described herself as half Indian, half Scottish. Clients came from a variety of areas across Glasgow, though with higher proportions from post codes G21 (9%) and G22 (8%) - the Springburn and Maryhill areas - and 21% (30 women) were listed as having No Fixed Abode. ²⁸ Four percent (n=6) were referred from outside Glasgow, including Aberdeen, Edinburgh, Paisley, and Stirling.

4.34 Information on employment history and qualifications was patchy. Only 10% (n=14) of women out of the 143 who engaged with 218 were recorded as having ever been in employment, and none were currently employed. Only 8% (n=12) were recorded as having any type of qualification, though equally only 2 were recorded as having learning difficulties.

4.35 The lives of the women prior to entry to 218 were often focused entirely on supporting their addictions:

"... my probation officer phoned up because my life was chaotic. I was working the streets…. I've got my own house and that, but I wasn't caring, and I wasn't doing nothing, I wasn't spending time with the kids, didn't know what 'normal' was. I got up in the morning, got ready, go and score in my pyjamas in a taxi, come back, sleep all day, go out at night." (Focus group 4)

Children

4.36 Sixty seven percent of the women (n=96) who started a programme at 218 had at least one child (also Pagan, 2004), and another was pregnant with her first child. Of those with children, 29% (n=28) at least one child was in care or adopted. Forty-four percent of women (n=42) had children in the care of a family member, though in 4 cases the client had no access to these children. Seventeen percent of the women (n=16) had at least one adult child; in contrast, 15% (n=14) were primary carers of a child upon entry to 218.

4.37 Previous research states clearly that children must be included in any discussion of disposals for female offenders (see Fairweather, Loucks, and McIvor 2003; Scottish Executive, 2003; Scottish Executive, 2004a). Service provision at 218 in relation to children is discussed more thoroughly in Chapter Five.

Housing

4.38 Housing was clearly unstable for the majority of women who entered 218. Forty percent of clients were of No Fixed Abode or in other temporary accommodation such as temporary residence with family or friends. An additional 8% (n=11) were in supported accommodation, while 20% (n=28) had accommodation which was unsafe or otherwise unsuitable ( i.e. in a house with an abusive partner or with someone who misused drugs or alcohol). Thirty-one percent of women (n=44) were in stable accommodation.

Abuse and trauma

4.39 Abuse and trauma were a significant feature of the lives of the women at 218. Based on client records, 21% (n=30) were recorded as currently being in abusive relationships, while 41% (n=58) were recorded as having suffered abuse in the past and 46% (n=66) were recorded as having suffered a major trauma other than abuse. It is worth bearing in mind that these numbers are likely to be underestimates: they are based on the initial assessment of women who may not have been ready to reveal present or past abuse as well as on information the researchers were able to glean from the case files. Direct interviews with arguably similar populations of women on this subject, such as those conducted in HMP and YOI Cornton Vale in 1997 (Loucks, 1998), have revealed higher rates of abuse.

4.40 An interview with one client, while more extreme, shows the type of backgrounds and experiences many of the women shared:

"I had a couple of miscarriages and I had an abortion when I was 14 … so … that was just after my dad died.… I tried to gas myself, and my brother found me, …I don't remember much about it, but I just know I had been raped and all that ……. Then after that … I was taken away to a quarry in Greenock and dumped for dead when I was 16 … I've had a few bad [relationships]… I went out with a guy … he used to beat me up for 5 year as well.… then I was going out with another guy. We were on a motor bike and we had a crash and I smashed my pelvis and my legs… he died on the road there.…"(Exit 6)

Substance misuse

4.41 The majority of women entering services at 218 said they had been using heroin or heroin had been an issue for them in the past. This was the case for 120 women, or 84% of those who engaged with services in the study period. Other drug use included diazepam (100 women or 70%), alcohol (74 women or 52%), cannabis (85 women or 59%), and cocaine or crack cocaine (67 women or 47%). In addition over half (82 women or 57%) had used other substances such as temazepam, illegal methadone, or solvents. The daily cost of clients' substance misuse, based on their own estimates, ranged from £10 - £400, though a further 7 women said they were already stable when they engaged with support services at 218.

4.42 Reported figures of substance misuse were higher in Pagan (2004). For example 97% of women said they had used heroin regularly. This figure is likely to differ because she interviewed people after they had engaged in services, while the figures on client records were based on the initial assessment, a time in which clients may deliberately underestimate drug use or choose to withhold information. Regardless, addiction was clearly a long-standing problem for many of the women:

"… I touched downers, and I started alcohol since I was 12. And then I touched hash when I got older, when I was about 14." (Exit 39)

"… by the time I was 12, I was in detox." (Exit 21)

Physical and mental health

4.43 Poor physical and mental health characterised the clients who entered 218. Besides the immediate problem of addiction, 66% of clients (n=94) were recorded as having a poor diet, including one reported eating disorder. This was often directly related to their drug use, especially heroin: women who used heroin tended to stop eating and to have serious deterioration of their teeth and gums. Asthma was also commonly listed as a problem (40 women or 29%), which tended to result both from smoking (Pagan, 2004 reported that all 30 women in her sample were smokers) and from poor general health and living conditions. Problems with mental health, also evident in previous research (Loucks, 2004), were common in the client base at 218. Most had previous or ongoing problems with depression (119 women, or 83%), anxiety (94 women, or 66%), a history of self-harm or attempted suicide (not including suicidal thoughts; 64 women, or 45%) or other problems with mental health ( i.e. mood swings, PTSD; 85 clients or 59%).

4.44 Chronic health problems were commonplace, including depression, hepatitis C and HIV, blood clots, infections, and abscesses. One woman had recently had her leg amputated due to a loss of blood supply below her knee. Two women in a group discussion talked with us about such problems:

"I'm the same with my arms [injecting], I did try my feet a couple of times but it was too sore… and there was one time actually…my heart and pulse and everything had stopped for 3 minutes and I had to get rushed to hospital.... See the next day when they told me, they were like 'you were so lucky to be alive'... Well that was such a fright and that was when I came clean, that 9 months ."

"It's sometimes like that, a near death situation for you to go, I better stop doing this you know. Like I was, last year I was in hospital, I had a blood clot from my groin going up to my heart. The doctor said… if I hadn't went on the Saturday come the Monday morning I would have had a massive heart attack with the clot travelling up… and I got out the hospital and what do I do? Go 'well it's in that leg, so it's alright I'll go to the other one now'."(Focus group 4)

4.45 Chaotic use of drugs and alcohol was a common denominator in the health problems for all clients:

"… the first time when I came in I was using £580 worth of coke and £50 worth of heroin, as much diaz[epam] as I could get, about 40 valium, it would last me about 2 days. I got into prostitution to feed my habit, the coke…. I came here and I was under six stone." (Exit 39)

4.46 Clients often viewed referral to 218 literally as a lifesaver:

"… when I went there … it was about 2 weeks later or something because of how I was and everything … and… the state my health was in … I got took in right away because… I was, em … what do you call that … em …"
(interviewer): "Dying?"

"Aye, well … (LAUGHTER) … em … 'high priority'."(Exit 43)

4.47 Research by Zadar et al. (2005) into drug-related deaths in Scotland bears out the relationship between the poly-drug use (especially benzodiazepine and alcohol) and the chaotic life-styles of many of the individuals who died as a result of drug misuse.

Previous support

4.48 Every client had accessed some form of support in the past. This ranged from very little ( i.e.GP only, or 'only family and prison', though this was rare), more commonly to contact with a wide range of services over many years. The extensive range of previous supports reinforces the understanding that addiction is a long-lasting and highly complex issue to address, and that many attempts and relapses are likely. The following excerpt from an interview with an older client exemplifies the pattern: "…since the age of 22, I had 58 to 60 detoxes … in the hospital as well, you know, all the way through. At least twice, three times a year I was in there." (Exit 6)

4.49 In practice the level of previous support differed from that in 218: "I didn't find the [outside addiction service] very helpful. It was basically just getting a prescription and that was it"(Exit 16).

Summary

4.50 Women were referred to 218 from a variety of sources. While many of these were not direct referrals from criminal justice agencies, they were almost always related to these in some way. For example addiction services, social work or agencies aimed at supporting women involved in prostitution. Women may need to be referred a number of times before they engage in the service. Between 1 April 2004 and 31 March 2005, 343 women were referred to 218. 143 women engaged with the service, attending at least once. A number of women were referred at least twice before they engaged. The initial court assessment and 3 stage formal process of assessment was designed to distinguish between those who were ready to engage and those who were not. Levels of engagement were highest for women referred by non-criminal justice agencies, however some of this intervention was often offence-related (eg supporting women to exit prostitution). Although initially slow to develop, court-based referrals had increased as knowledge about 218 was disseminated. Links between Cornton Vale and 218 workers were viewed positively by both agencies and this contact had alleviated initial difficulties of assessing women held on remand.

4.51 The women referred to 218 were clearly involved in the criminal justice system some more actively than others - and all were clearly vulnerable women at (usually immediate) risk of physical and psychological harm to themselves and to others. The characteristics of clients are similar to those of women who end up in custody (Loucks, 2004). Addiction and trauma were long-standing issues for the majority of women who attended 218, and depression, anxiety, self-harm and mental and physical health problems were a feature of their lives. All of the women had been in police custody during the previous year and could thus be viewed as vulnerable to custody or re-offending. Not all the women were facing the prospect of a custodial sentence at the point of referral to 218, but all were at risk of progressing in this direction. Therefore, 218 has met the criteria for eligibility the Commissioning Group established in terms of involvement with the criminal justice system, vulnerability to custody or re-offending, and incidence of substance misuse problems.

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