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CHAPTER 5: PERCEPTIONS OF THE PILOT SCHEMES
Eliciting Views
5.1 The main stakeholder groups (police, assessors and treatment agencies) in each of the three pilot areas were asked to reflect on the way in which the pilot had operated and, in particular, whether the processes employed could have been improved to allow for greater efficiency in the pilots' delivery. This involved semi-structured depth interviews with all three groups, as well as with Crown Office and Procurator Fiscal Service ( COPFS) representatives in each area. A total of 39 stakeholder interviews were carried out. A full list of participants consulted in each area is provided in Appendix C and the interview discussion guides are attached as Appendix D.
5.2 A total of nine arrestees also took part in the evaluation (four in both Aberdeen and Glasgow and one in Edinburgh). It is important to note that this group is not representative of all those who were eligible to be referred into MDTA, or who took part at any level. Indeed, the nine arrestees who took part in the evaluation were continuing to engage with treatment services after their initial assessment, unlike the majority of arrestees who had participated only in the mandatory drug test and/or assessment.
5.3 This chapter presents the main findings from the consultation activity, under a number of key themes, these being: the pilot processes; staffing and resource issues; partnership working; perceived impacts of the scheme; feedback from arrestees; MDTA and Arrest Referral; and lessons for the future.
Pilot Processes
5.4 For the most part, those involved in delivering the MDTA pilots provided positive feedback about the processes involved and the general day-to-day running of the schemes. The two main emerging issues affecting the pilot, however, appear to be the significantly lower than expected referral numbers, in addition to some smaller issues around the accommodation of the pilots in each area, and the drug testing equipment.
Throughput Numbers
5.5 In each of the pilot sites, there remains some confusion around the origins of the original estimates for throughput numbers, ie around 15,000 per year across each of the sites. It is thought that the initial estimates came originally from the police in each of the three areas, but changes in police staff mean that it was not possible to track a definitive explanation for the way in which the numbers were originally calculated.
5.6 The impact of this miscalculation has, perhaps, been felt most acutely by the assessor and treatment agencies. The numbers of staff appointed to these posts were a reflection of the anticipated level of activity that would be required for the pilot and, in practice, the workload generated by the pilot has been considerably less than is required to occupy all staff appointed.
5.7 Assessors in each of the three pilot areas generally felt under-worked, with several assessors reporting feeling demoralised and unmotivated. This may have contributed to the resignations that have taken place in some of the pilot sites. Several assessors reported carrying out other work not related to MDTA, as there is not enough MDTA work to fill their day and keep them interested. Similarly, assessors have reported undertaking work in addition to their MDTA workload, such as group work with arrestees, looking at 'life-skills' and relapse prevention work - goal setting, confidence, communication, etc.
"We're just not as busy as I thought we would be." [Assessor, Aberdeen]
"It can be quite demoralising for them just sitting there waiting for a customer." [ PCSO, Edinburgh]
"I just think that it's a very good scheme in principle but the practice has fallen so far short it's very frustrating, you know, on your own part because you want to, you want to do your job but you sort of see, um, that you're unable to." [Assessor, Glasgow]
5.8 In Edinburgh, there have been a number of resignations among assessment staff, as well as one long term absence. In Aberdeen, there was no treatment capacity at the start of the pilot and, due to a shortage of work, MDTA assessors in this site are now carrying out a dual MDTA/Arrest Referral role. A general issue is perhaps the need for greater motivation among those involved with the pilots ie more detailed feedback on the actual impacts of the scheme for those referred.
5.9 It emerged early on that carrying out assessments alone would be insufficiently stimulating or time consuming for the volume of staff appointed. In Glasgow, a decision was made to include care management of arrestees/clients in the social workers' portfolios, and this has been beneficial both for arrestees and the workers, in terms of their motivation and job-satisfaction.
5.10 This presents an important lesson to be learned from the pilots, that assessment activities alone are insufficient to occupy the time and motivational needs of staff. The additional benefits to clients from working directly with the same worker from assessment through to treatment engagement may be considered as justification for adoption of this model in any future continuation of the schemes.
Accommodation
5.11 In each of the pilot sites, assessors have a presence in police stations for speedy access to arrestees at the time of initial identification of eligibility to take part. In all cases, specific accommodation has been provided.
5.12 Almost all interviewees agreed that carrying out assessments at the police station resulted in more arrestees undertaking and engaging with the assessor, than if the arrestee was given an appointment to attend an assessment at a later date. This reduced the number of people potentially failing to attend initial assessments due to travel convenience issues, maximising opportunities for arrestees to engage with assessors early on. Importantly, it provides the full support network at a time when arrestees may be at their most vulnerable.
5.13 While the presence of assessors in police stations was seen a positive facet of the pilot by all, there do remain some reservations regarding the suitability of accommodation provided for MDTA assessors; they are either too hot, too cold, arrestees are separated from assessors by either a glass window or a wire grill, or assessments take place in the nurse's Room, or in the solicitor's room, which does not facilitate confidentiality and open discussion.
5.14 In particular, in Glasgow and Aberdeen, physical barriers are restricting communication between assessors and arrestees. In these sites, wire grills in Aberdeen, and glass screens in Glasgow, are present to provide a protective shield between assessors and arrestees and (in Glasgow) the two have to communicate via a basic intercom system. This may be impacting on the quality of client-carer relationships that are being established:
"The interview set-up at Queen Street doesn't lend itself to really productive engagement with people." [Assessor, Aberdeen]
"It has a very negative effect…that's especially the case for people who aren't very motivated, if you're trying to use motivational interviewing techniques, or if someone's upset, it's really difficult…it's a real communication barrier." [Social Worker, Glasgow]
5.15 This issue is difficult to resolve as, for the police, the possibility of having MDTA assessors in a confined space with a prisoner, with no separation, contravenes health and safety rules. For assessors, this is not perceived as problematic since the perceived level of risk posed by clients is not considered any greater than the risk posed at off-site assessments (ie that take place at the assessor organisation). This issue is, perhaps, something to be resolved on a case-by-case basis should the scheme be implemented elsewhere, but is noted here as something which may have impacted on the quality of interaction that occurred between arrestees and assessment staff.
Testing equipment
5.16 Some problems with the drug testing equipment were experienced in the early stages of the pilot. PCSOs reported that while the test itself is straightforward, and the process itself on paper is not a long process, in reality, to get enough saliva on the stick to do the test properly, can be a long process, and can take anything from a few minutes to over an hour.
5.17 Other issues with the testing equipment include the wrong number of drops added to the sample, samples not being sealed properly, and samples being labelled wrongly.
5.18 Interviewees also questioned the reliability of the testing equipment. Some arrestees revealed that they had taken drugs prior to being arrested, but that their test produced a negative result. PCSOs were divided on their feelings as to why this was the case; while some thought this meant the arrestee had taken 'duff stuff', or that the drugs had not passed through their system in time for the drug test, others thought that this may be because the testing equipment was not reliable.
5.19 Issues with the testing equipment did seem to resolve as the pilot progressed and do not appear to have presented any meaningful barriers to its overall operation.
Staffing and Resource Issues
5.20 Whilst early changes were required to the pilot to increase the workload of assessment staff, in each of the three sites, the police have experienced a converse problem of being under-resourced to meet the demands of the pilot:
5.21 The police, as with other stakeholders, are unsure about where the initial estimates for throughput originated, and there is general agreement that the numbers were aspirational.
5.22 In each of the three pilot sites, the limited availability of police staff to carry out the necessary police functions associated with the MDTA pilot was an ongoing problem. This includes the presence of police staff to undertake initial identification of eligible arrestees and to initiate the MDTA process, as well as to perform the testing and fill in the associated paperwork prior to making referrals for assessments:
"Depending on how many staff are on, and how many custodies there are, MDTA does take a back seat depending on how busy you are in that shift." [ PCSO, Aberdeen]
5.23 One PCSO in Glasgow provided a good summary of the likely problems encountered:
"On occasions, particularly on a Friday and Saturday night there are lots of prisoners, and we have three PCSOs on but their main job is to look after the prisoners, only one of them has the duty of drug testing and he has to look after the prisoners as well. So although Friday and Saturday nights are an ideal time to get people testing, due to the huge numbers of people coming in through the doors we often don't have enough manpower at times, especially for the corroboration. It would be better if they had maybe two PCSOs on duty for drug testing, designated, or if we just had more staff in general." [ PCSO, Glasgow]
5.24 Assessors were frustrated by this, but were also sympathetic to the core functions that the police had to perform:
"You know, they're too busy, they've got a lot of other tasks to do and testing people is really last on their list. They've got to care for the prisoners and make sure they don't have any other pressing issues." [Assessor, Glasgow]
5.25 In Glasgow, as early as the first implementation group, the police raised concern about the 10 minute observation time required prior to testing, suggesting that it would present resource difficulties. Similarly, the need for corroboration during sampling and testing may prove challenging for the police, for whom there were only two dedicated PCSOs, each working at different times to ensure maximum coverage throughout the day. This inevitably meant that other police staff (Custody Sergeants or Constables) would need to act as corroborating officers whilst tests were performed.
5.26 Similarly, there were general staffing issues with PCSOs such as long term sickness, which reduced their availability to undertake drug tests and, therefore, may explain the low number of arrestees tested at some points during the pilot. In Glasgow, this has mainly been linked to changes in police staff which has meant that overall support for the project may have fluctuated as management has changed. Some problems with sickness absence in Glasgow among the police have also meant a lower number of referrals at some stages in the pilot.
5.27 In sum, the main barrier to performing more tests has been a lack of resources to fund more MDTAPCSOs and the fact that the primary purpose of the conventional Custody Suite PCSOs is to look after the care and welfare of the prisoners above all else.
Administration Time
5.28 A general view shared by the police and assessor organisations is that MDTA takes a lot of time, approximately 20-30 minutes for each person whether or not they test positive or negative, largely due to the paperwork involved:
"Unfortunately, 20-30 minutes isn't time that the PCSOs downstairs can really spend, especially when their primary role is to look after the care and welfare of prisoners. It's just not practical, so we can't always be committed to doing the MDTA all the time." [Police, Glasgow]
5.29 The administrative workload and testing time have been highlighted as potential barriers to police willingness to participate in MDTA at times when custody suites are busy and, in particular, is considered by most of those interviewed to be considerably more burdomesome than the tasks involved in Arrest Referral:
"The Arrest Referral paperwork takes about five minutes, whereas the MDTA paperwork takes about half an hour, so you can understand the resistance." [Social Worker, Glasgow]
5.30 Data recording, especially in light of the problems with the Management Information System, and the requirement to fill in handwritten MDTA forms, was considered labour-intensive. If the scheme were to be continued into the future, the establishment of a centralised electronic data management system was seen as something which would significantly reduce the administrative burden of data recording to an acceptable level and avert many of the data exchange issues between partner organisations that occurred during the pilot.
5.31 Among all parties, it seems that the time and administrative workload involved in the MDTA processes is a factor that is perceived as a barrier to the schemes success.
Partnership Working
5.32 Within each of the pilot sites, communication between the main partners in delivery has been facilitated by regular operational and strategic meetings. This has provided a mechanism for feedback from each of those involved to allow greater understanding of the respective roles fulfilled by the partner agencies. It has also allowed process issues to be flagged early and to be rectified as the pilot has progressed.
5.33 Despite this, some disappointment was raised by both the police and assessors/treatment providers that the level of feedback could have been greater in terms of outcomes for referred arrestees (future offending or drug misuse). In Glasgow, presentations have been offered to the police by assessors/treatment providers to give this level of feedback, but this has been a late development and is perhaps something that would have been welcomed earlier on.
5.34 The police commented that there has been little in terms of feedback provided regarding the impact of the scheme on arrestees' future drug taking which may, potentially, have contributed to a lack of motivation for staff to fully engage with the scheme:
It might be an incentive to us to know that it is working because some people have got off drugs and are doing well, we just don't know." [ PCSO, Aberdeen]
"I would be interested to know how many people attend appointments and attend assessments because then we would see if it is making a difference." [ PCSO, Edinburgh]
"We do hear sometimes that MDTA has really helped somebody turn their life around, but the PCSOs don't get any feedback reminding them of how important MDTA is." [Police, Glasgow]
5.35 In all areas, the police worked closely with assessor organisations to arrange meetings between their respective staff, to help with interaction, but these could have taken place, perhaps, more regularly.
5.36 Throughout the pilot, there may have been a perception among social work staff that the police considered their role to be 'too soft':
"They think we're too soft an approach, but that's because they don't understand what we offer - it's not about tea and sympathy." [Social Worker, Glasgow]
"Wishy-washy social workers coming in to help these drug users out doesn't seem to be high on their agenda." [Assessor, Aberdeen]
"You know, obviously the police environment is a very regimented, very strict environment, well they maybe don't have an understanding of where we come from a social worker point of view. And equally, you know, well maybe we have a lack of understanding as to why they need to be so regimented in relation to these prisoners. So, I think there could have been more thought, from both sides, put into how we could understand each other a bit better." [Assessor, Glasgow]
5.37 There may also be an issue with a lack of understanding of the police role from others involved in the pilot. In particular, there may be unrealistic expectations about what the police can achieve with the resources that were allocated to the pilot. There is also, perhaps, a lack of understanding about the multiple other tasks that need to be undertaken by PCSOs in caring for arrestees, rather than simply referring into MDTA:
"I do think that quite a few individuals don't have a good grasp of the police role here. But there is an expectation that we will do a lot more than is our job to do, there is a lot of blame placed on the PCSOs, and it just isn't necessary in most instances." [Police, Glasgow]
5.38 The critical approach by some partners towards the police may have been a de-motivating factor for some of the police staff involved and third-party intervention may have been required to more clearly explain and delineate the respective roles of the different agencies and, importantly, where one agency's responsibilities end and another's begin. The role of the police should have been clear-cut but seems to have been complicated by the expectations of others involved.
5.39 In Glasgow, the police and GAS worked hard together in the later stages of the pilot to achieve a better understanding of respective roles. This included meetings between the Practice Team Leader and local Chief Inspector overseeing the pilot and the offer of a number of seminars by GAS staff to inform the police of the treatment routes available to those referred into MDTA.
5.40 In Aberdeen and Edinburgh, partnership working between the police and the assessors was perceived as both positive and negative over the time period of the pilot. Several assessors reported PCSOs were hesitant at first, and quite mistrustful. Several assessors reported that the relationship with the PCSOs was strained, and felt frustrated because, unless a drug test is carried out, they cannot undertake an assessment.
5.41 Suggestions were made for a day where the PCSOs, assessors and treatment providers could learn what each others roles are. There needs to be more communication at a grass roots level, not just amongst the managers: the assessors need to explain to them why they do not have much work to do, otherwise the PCSOs may resent the fact that assessors spend all afternoon and evenings in the police station. The assessors perceived that the police seem to think social workers are there to give arrestees a smooth path out but it would be better to show that assessors do work to challenge offending behaviour, and try to get arrestees stable on treatment.
5.42 In sum, there is a perception that the strategic priorities of the two main stakeholders (the police and assessors) have been different from the start of the pilot. This has meant that there have been some frustrations expressed by both parties regarding the running of the pilot and the level of responsibility that each should bear for its success. The importance of good partnership working seems to be a key principle underpinning the efficient running of MDTA into the future. Lack of understanding between the two types of organisation has, perhaps, been one of the biggest barriers to the success of the pilot scheme.
Engagement from Crown Office and Procurator Fiscal Service
5.43 Both the police and assessors/treatment providers would welcome more engagement and communication with COPFS for the duration of the pilots. COPFS's involvement was minimal at the early stage, and involved advising the local implementation groups of the legality of some issues surrounding the MDTA scheme, and what the perceived difficulties might be. Thereafter, the main COPFS involvement was dealing with reports from the police regarding offences being committed under the MDTA legislation and ultimately prosecuting the offenders. COPFS were also scheduled to attend quarterly meetings at the local implementation group.
5.44 Only Edinburgh could provide a rough breakdown of the statistics of arrestees going through the courts, the other areas were not aware of any data source that would provide this information, and although the system may be able to filter this out, this was only a possibility.
5.45 With regard to training, this was discussed in the planning groups, and leaflets were distributed in some areas, although staff changes render it difficult to assess how widely training took place and these leaflets were distributed. The COPFS representatives interviewed as part of this evaluation were not aware of the level of legal professionals' understanding of the MDTA pilots (for example, solicitors and sheriffs), but surmised that it would be minimal.
5.46 COPFS had little contact with other partners involved in the scheme aside from the local implementation group meetings. COPFS stated that as they are involved at the end of the process (ie when the arrestee has refused a drug test or has failed to attend an assessment), there is a slightly odd tension as, although it is a process designed to help people, they are ultimately referred to the COPFS to be prosecuted for non-attendance at assessment. The underlying objective of the legislation was to help people.
5.47 Whilst involved in the early planning stages of the pilots, the involvement of COPFS in the running of the pilot schemes has been minimal, as has their engagement with the operational and strategic planning partners.
5.48 Several PCSOs were frustrated at the time required to write a statement when an arrestee failed to attend an appointment, and felt that in most cases, even though the PCSOs received a letter from the Procurator Fiscal stating they had been cited to court, the arrestee was rarely charged for non-attendance at an assessment. When attendance at court was required, PCSOs were usually put on stand-by, meaning that the court could call at any time and they would be required to appear in court to give a statement. This was problematic, however, as the PCSO could be on duty at the time, or on annual leave, but would still be required to attend the court if they were called to give evidence. PCSOs reported feeling aggrieved when they made the effort to write a statement, and attend court when, in most cases, the case was 'thrown out' of court.
5.49 Similarly, several assessors commented that they were required to provide paperwork and reports when an arrestee did not attend an assessment but that this proved to be time consuming and problematic for prioritising workloads and booking annual leave. Moreover, assessors felt that the time taken to receive a confirmatory test back from the lab was, on occasion, not in conjunction with the date of the scheduled assessment, and this sometimes caused a problem because arrestees were attending assessments when their results were not back from the lab at that time, and therefore, an assessment could not be undertaken.
Perceived Impacts of the Scheme
5.50 Due to the low numbers of people being processed through MDTA, there was some general reservation among partners regarding the true success of the scheme. There was a general feeling in all areas that the pilots would have been more successful had the case loads been higher, and there was a general air of disappointment that this had not been achieved from both the police and assessors/treatment providers.
5.51 Among the police, this was perhaps mixed with some reservations about how successful the scheme may be in practice, due largely to the fact that they have received little in the way of feedback as the pilots have progressed, either from assessors and treatment provider agencies, or from COPFS. The majority of PCSOs were unaware what impact the Mandatory Drug Testing of Arrestees Pilot has had on arrestees in the short term, and said that the only feedback they receive is the arrestee coming back into custody having previously already taken the drug test.
People who are benefiting from MDTA
5.52 Among assessors and treatment staff, the pilot was considered a success for those who had engaged.
5.53 The mandatory element encourages the arrestee to take help while they are actually in the cells, this has the advantage of approaching them at what is considered an 'ideal time'; when they are low and thinking about the consequences of their actions, and when there are counsellors on hand so that they do not need to attend an assessment at a later date. Although there is also the possibility that arrestees were still under the influence, or were not feeling well while they were in the police station, this was still perceived as the best time by most interviewees to carry out an assessment with an arrestee:
"I think the mandatory nature of it forces people to come here and find out what it's about, and that's definitely a good thing." [Assessor, Aberdeen]
5.54 MDTA will have tested many people who would not normally have been tested, and therefore, given the opportunity of help and the possibility of engaging with a drug treatment service. People are accessing a service that they wouldn't normally access, and generally, counsellors in the cells were thought of as useful as people can access help 'there and then'. At the very least, MDTA has made some arrestees think about their drug use, and has identified possible ways of getting them into treatment. Assessors and treatment providers have commented that arrestees are able to more easily and quickly access treatment (particularly methadone) if referred via the MDTA pilot, when compared to GP waiting lists. The specific provision of funding to support this activity as part of the pilot is viewed by all as an essential component of the pilot.
5.55 In Glasgow, the pilot was considered especially valuable in having targeted vulnerable female offenders as well as a new and emerging group of recreational cocaine users:
"It's captured a whole range of cocaine only users, who are mostly employed, and who would never have taken up voluntary assessment because they don't see themselves as having a drug problem. This has given us the opportunity to issue them with a lot of detailed information about the consequences of cocaine use, and of using cocaine and alcohol together - both the long term and the short term use of these two substances…It's enabled us to speak to a whole new group." [Social Worker, Glasgow]
5.56 Consultees reported that MDTA does not appear to have been in any way differentially beneficial for people in equalities groups, or those with special needs.
Feedback from Arrestees
5.57 All of those interviewed provided positive feedback on the MDTA scheme. It is important to note, however, that this sample was not representative since all those interviewed were people who were engaged with treatment services. This meant that most were already feeling the benefits of engagement:
"It's a really worthwhile programme, and if there's one more person like me who can actually take it up then that's a good thing…I was going to put myself into an early grave to be honest. So if it helps me there must be other people out there it can help as well." [Arrestee, Edinburgh]
"If anyone had said to me they were tested and had to go to an assessment, I'd say go, it's worked for me." [Arrestee, Aberdeen]
5.58 Most arrestees demonstrated a genuine desire to change their lifestyle, and to reduce their drug habit, with the ultimate aim of eliminating their drugs consumption. Most realised that this would be a long term goal and, that, in the short to medium term, they should focus on controlling and managing their existing drug problem:
"A life, I suppose, a better life than I was living. To cope better." [Arrestee, Glasgow]
"In another few months, I'm going to try and get a job, no not try, I am going to get a job…and then gradually I'm going to come off methadone. I don't want to run before I can walk, but when I'm ready I'll come off methadone." [Arrestee, Aberdeen]
"I just wanted my life sorted out, basically. Cause I've got two young children, and it's not fair on them, like, sneaking in places to put a needle in your arm, you know. And so I really wanted to get everything out my system." [Arrestee, Glasgow]
"Trying to get on a stable dose of methadone and stick to that dose without using anything on top of it, and then to try and take things from there. Hopefully, then, to try and work on a reduction in my methadone once I'm at a stable point." [Arrestee, Glasgow]
5.59 Arrestees who were interviewed were also unanimous in their view that the scheme might assist in breaking the cycle of drugs misuse and offending:
"It does stop me offending as well. Cause, you see, before I came here I was on cocaine and everything. I was out and going into hotels and stealing everything, and that. I don't do that now. I don't do nothing cause I'm off everything [drugs] now." [Arrestee, Glasgow]
"I was breaking the law but now I can get help, and think about getting a job or going to college…" [Arrestee, Aberdeen]
"I've not been out stealing, or robbing or anything like that. So, it's already helped." [Arrestee, Glasgow]
5.60 Although not a representative group of arrestees, the views of those consulted provided generally positive feedback regarding the schemes success in helping them to change their lifestyle, reduce drug consumptions and reduce offending behaviour.
Interaction with Assessors
5.61 Generally, assessors commented positively on relationships with arrestees, and this was reciprocated among the clients who took part in an interview:
"They've all been truthful, you know. They've not messed about. They've always kept in contact and let me know what's happening and all that." [Arrestee, Glasgow]
"The ongoing support from here has helped, when I was feeling stressed, anything like that, and if I feel like I am slipping back I can phone them. My support worker is great, phones me all the time, etc. Just somebody to sound off at, and she's really good about it." [Arrestee, Aberdeen]
"They're always willing to help you as much as they can, and do what they can." [Arrestee, Glasgow]
"It's a bit of support, someone I can tell anything to, something I can't tell my mum or girlfriend, a bit of support." [Arrestee, Aberdeen]
"I couldn't have asked for a nicer assessor, we just clicked. She was upfront and straight with me, and I thought this was the perfect opportunity to get my life sorted, I'd been on drugs for 14 years." [Arrestee, Aberdeen]
5.62 Arrestees spoke of the difficulties they faced in tackling their drug problems, but all those who had participated in the scheme, and were in treatment, spoke positively of the scheme, and the informative and supportive relationship with the assessors in particular. In Aberdeen, assessors were talked of positively for their relaxed and informal manner of dealing with assessments, but also for their follow up work with arrestees where arrestees stated that this follow up work such as attending a doctor's appointment with an arrestee, looking for a homeless shelter for an arrestee, providing numbers to help an arrestee sort out their debt problems, all helped provide a more supportive role in all aspects of life, not just to tackle their drug addiction.
5.63 Information leaflets designed to provide arrestees with information about the MDTA scheme have been viewed as a success by both assessors and arrestees. While arrestees recalled being given an information leaflet, and stated this was useful, they also appreciated assessors explaining the MDTA scheme to them personally, especially if they suffered from poor literacy or dyslexia. Similarly, even where arrestees participate in only the mandatory requirement of the scheme, assessors have welcomed the opportunity to use the initial MDTA assessment to provide harm-reduction information to those most vulnerable and at risk adults.
On-site assessments
5.64 Arrestees also seemed to welcome the opportunity to engage with assessors at the time they were in police cells. This was mostly because arrest was seen as a time when they could consider their current lifestyle, and make the most of the opportunity to make a change:
"You get time to think when you get arrested." [Arrestee, Glasgow]
"It's better that way [being offered assessment in the cells]. If they said to you out of there [the cells], you might not have done anything about it." [Arrestee, Glasgow]
5.65 There was, however, a small minority of arrestees who felt that the timing of the assessment in cells was inappropriate. One commented that:
"It's a bit of a bad time, because they've just been charged with whatever their offence is and then they're sitting and worrying overnight, or all weekend, what's gonna happen to them at court, and then they've got this at the back their mind as well. That's why I think it's only good for people who are ready for it, you know." [Arrestee, Glasgow]
5.66 This was also recognised by assessor staff who suggested that people seen in police stations were sometimes more hostile and less trusting of assessors than when seen in a more neutral location.
Complete Care Packages
5.67 There was a feeling among arrestees that the package of care that was being delivered by MDTA was more fit-for-purpose than some of the standalone services which they had engaged with before.
5.68 In Glasgow, arrestees placed a strong emphasis on the 'whole package' of care that was delivered, including attention to the mental as well as the physical wellbeing of clients, and attempting to meet their social (housing and employment) needs, as well as addressing their drug problems:
"[My MDTA worker] has been more helpful [than ordinary social worker], I think, 'cause he's been trying to get me housing and everything else." [Arrestee, Glasgow]
"[They offer] help to get off of drugs. Help and support. Help to get accommodation, obviously. Get a job. And, he [ MDTA worker] has put me in touch with other people." [Arrestee, Glasgow]
"They [ MDTA workers] listen to your more [than ordinary social workers] and take more interest in your problems. They put you in contact with people that they think might help you." [Arrestee, Glasgow]
"I've not taken drugs for a few weeks now, I've been clean for a long time. I've been keeping focussed on things, 'cause I see them every week." [Arrestee, Glasgow]
"They give you full support, and if they think you're in any danger, they try and help you out of that." [Arrestee, Glasgow]
5.69 Support and information on the drug treatment programme, but also on issues such as homelessness, debt, and family issues was cited as a particularly important to the arrestees who would appreciate a package of support:
"It's not just come in and dish out a prescription and go again, they give you advice and support. What's the point in fixing the body if it's not fixing the mind?" [Arrestee, Aberdeen]
5.70 In particular, it seemed that arrestees welcomed a service which was not focussed solely around the issuing of prescription, but that helped them to address psycho-social needs:
"I would say it's really good, I would say, go for it, 'cause it is really good. 'Cause you get a chance, to sit back, and listen to people, rather than just getting a prescription. If you listen to your worker, you get a chance in life, basically." [Arrestee, Glasgow]
"[Before MDTA] I would just go in and pick up my prescription. But in here, you're sitting and talking to your counsellor, you can come and talk to somebody when you need to. They give you a lot more options about what's out there for you. It's a lot more helpful that way, than just going and picking up a prescription and then just leaving." [Arrestee, Glasgow]
5.71 In terms of additional support and information, some suggested that the full potential of participation was not made clear. In particular, the fact that services available were not exclusively methadone provision or drug related alone:
"It would be helpful if people pointed out that they could get help for the problems that led to my drug use as well. 'Cause you've got to deal with these problems, before you can deal with your drug problems, you know. It's helped me a lot, talking about things that have happened in the past, and things that have led to my drug use." [Arrestee, Glasgow]
"All it would be would be picking up my prescription from the doctor, and nothing else. A lot of people like me haven't got any family connections and they need that bit of support and encouragement, you know. For somebody not to look down on you if you fall back, they're not gonna judge you or anything like that." [Arrestee, Glasgow]
5.72 While the pilot was considered particularly successful in terms of providing speedy access to medical staff, a cautionary note to emerge from the pilot was that increased awareness of the scheme among arrestees may result in future engagement with the scheme for the wrong reasons:
"We don't want people getting themselves arrested just so they can get a script - so we can't shout it from the rooftops too much." [Assessor, Edinburgh]
5.73 Indeed, some of the arrestees interviewed, especially in Aberdeen, suggested that one of the main benefits of the scheme had been speedier access to methadone and a perception that they had by-passed waiting lists:
"Anyone coming through by MDTA will benefit because they can get a script quicker." [Assessor, Aberdeen]
"If I wasn't on this programme, I would be back on that waiting list, there wasn't any other choice for me." [Arrestee, Aberdeen]
5.74 One arrestee admitted that his initial decision to take part in the scheme was linked to his perception that, if he did not, his existing methadone prescription would be cancelled:
"They done it just before I got my methadone and so I think they maybe done it, maybe, I don't know, to make you feel like, if I says no, you're not getting your methadone. Well, that's the way I felt, anyway." [Arrestee, Glasgow]
5.75 This provides valuable learning for the future in terms of ensuring that MDTA is not considered as a fast track access scheme to methadone, but is recognised for the full potential package of support that can be offered.
Understanding of the Scheme
5.76 Despite recognising the benefits of their current engagement with services, there appears to have been a general level of confusion among arrestees about the existence of Mandatory Drug Testing of Arrestees as a standalone pilot scheme.
5.77 In particular, when asked if they understood what the MDTA pilot was all about, many believed it was a form of continuous random drugs testing:
"It's not like, if you go to a normal drugs counsellor, they don't always give you urine samples, and all that. They [current workers] give you one just out the blue, so if you are taking other stuff, you get caught. And I give urine samples all the time." [Arrestee, Glasgow]
5.78 It is, perhaps, the case that some drug users in contact with other social work services or drug treatment providers will be subject to mandatory or random drug testing as part of other programmes with which they are engaged and, perhaps, this was confused with the MDTA scheme.
5.79 There was some confusion among arrestees with regard to the name of the scheme, where some arrestees thought at first that it meant they had a Drug Treatment Testing Order, because of the mandatory drug test. However, arrestees stated that the aims of the mandatory drug testing scheme were fully explained to them when they attended their first assessment, and generally, the information they were given was easy to understand, and they understood what they were required to do as a participant in the scheme.
5.80 There was also some confusion regarding the consequences of not taking part in the mandatory element of the scheme. One arrestee in Glasgow suggested that he thought his participation in the scheme would prevent him from being charged with the arresting offence (ie cannabis possession):
"If you go voluntary to this, you don't get charged, but if you don't go voluntary to this you will be arrested for cannabis…and they said, because you're going to this thing, you won't get charged." [Arrestee, Glasgow]
"The police seen me when I got caught with cannabis and that's when I got sent here. They says, you can go to it, or you can get the jail. They told us everything." [Arrestee, Glasgow]
5.81 There was mixed response in terms of whether arrestees had been informed by the police of what the service entailed. Indeed, even where people said that the scheme had been explained to them, there was generally poor understanding of what was involved in agreeing to take part ie assessment after the drugs test.
5.82 There was also some confusion about who was responsible for taking the test and there seemed to be poor recollection of what had occurred at the early stages of the pilot.
Life Stages and Engagement
5.83 Arrestees who had taken up the scheme felt it important to emphasise that they took part in the scheme because they were ready to take part, and because they had made the decision to take part. Consensus was that if an arrestee was not ready to take part in a drug treatment programme, or had a chaotic lifestyle due to drug addiction, homelessness, etc, they would not take part, despite any measures that are put in place to facilitate them taking part:
"People won't participate in the scheme if they aren't ready, there is a lot going on, and it's difficult to keep up appointments. When you wake up in the morning your first priority is how to get drugs, not to go to an appointment…you've got to be in the right frame of mind to do it." [Arrestee, Aberdeen]
"You've got to want the support at the time, it won't work if you aren't ready for it." [Arrestee, Aberdeen]
"It was me that decided to go for it, if it had been anyone else that had decided for me there would be no point. I think you have to make up your own mind if you want to take it further. I think just coming here had made me turn around and think, well actually there are people that can help." [Arrestee, Edinburgh]
5.84 There was a consensus that the MDTA scheme may not help all drug users:
"It's just getting people at the right time, isn't it, you know? I mean, I had been in and out of jail about fifty times or something, since I was 15 and I was just sick of it. I just had enough of it. It was time to change. If they'd have done it with me when I was four or five years young, I wouldn't have done it. It's just getting people at the right time." [Arrestee, Glasgow]
"The person's got to be willing to do it themselves. If they are half-hearted about it, it won't work." [Arrestee, Glasgow]
5.85 Moreover, arrestees who were drug tested as part of the MDTA scheme more than once stated that the first, or even second time, they were tested they did not want to take part and missed their assessment appointment either because they did not want to attend or because their life was so chaotic that they missed the appointment and did not feel as if they could make another appointment of their own accord. However, when they felt ready, perhaps a year further down the line, the arrestee decided to take part in order to take control of their life:
"The next time I was arrested they asked me if I wanted help again and this time I took it with both hands." [Arrestee, Aberdeen]
5.86 Personal motivation was also stressed by police and assessor staff as a fundamental requirement for success of the scheme.
"The motivation needs to be there to get off the drugs and a lot of them just don't want to get off the drugs." [ PCSO, Aberdeen]
"If they aren't ready to engage, then they aren't ready to engage." [Assessor, Edinburgh]
"I think the ones who want the help are getting it, but a lot of the arrestees don't want to get off drugs, they don't want to see an assessor because they don't want to drop their habits. I do think there are a lot of decent people who come in though, who just get caught up in drugs, and who really benefit from this help with getting off them." [ PCSO, Glasgow]
5.87 The message here, perhaps, is that MDTA is especially beneficial when it reaches those who are ready to change, including those who may have been contemplating change but who lacked an easily accessible route into treatment or introduction to a suitable support agency.
MDTA and Arrest Referral
5.88 Attitudes were divided with regard to the voluntary approach of Arrest Referral and the mandatory approach of MDTA. Several interviewees felt the mandatory approach works much better than the voluntary approach because there are consequences to it, whereas there are no consequences to a voluntary approach, although those who seek help are usually motivated to do so. Some felt that motivation and engagement is just as high with the mandatory scheme than with the voluntary scheme because there seems to be some sort of realisation that people can get help. The part that is mandatory helps people who have not convinced themselves yet:
"For some clients not in the correct frame of mind, the motivation to get themselves sorted isn't there." [Assessor, Edinburgh]
"If I hadn't been arrested, I wouldn't have gone for it, so while it's a crap thing to have happened, at least something good has come from it." [Arrestee, Edinburgh]
5.89 Most interviewees saw a relationship between Arrest Referral and MDTA. A number of respondents felt that a combination of MDTA and arrest referral would be useful because a lot of people are happy with their lifestyle, and their friends and family are also involved in drugs, so it is only when they are in the police station and withdrawing that they may think it would be a good opportunity to participate in a drug treatment programme. The mandatory element forces them to think about it, however, if they are not ready to participate at that time, the voluntary element allows them to participate when they are ready:
"If it wasn't mandatory, hmm, I don't know…I would have come up actually, because I was screaming for it at the time, I'd been to the doctor's and everywhere. It's just waiting in line to get the help that's the biggest problem with the scheme." [Arrestee, Aberdeen]
5.90 On the other hand, a number of interviewees felt arrestees might be more motivated if it was voluntary, as some people are not motivated to seek help, and there was a feeling that if they are not forced, they might be more willing to participate. It was felt that the way mandatory drug testing works, if people refuse to be tested or refuse to be assessed, that can constitute a criminal offence, so although there is no coercion involved in the actual treatment, there certainly is coercion involved on the way towards it. Treatment providers in general felt that in substance misusers, change generally happens slowly, the clients have to be psychologically ready in order to even contemplate making a change, and sufficiently motivated if they are going to sustain it. If change is forced on them they are more likely to falter, revert to old behaviour and fail.
5.91 It was felt that a voluntary test might be a good idea as the number of tests carried out would go down, but the numbers of people attending assessment would go up because they are the people who do want help. This would also target police, assessor and treatment resources better.
5.92 An ongoing theme throughout the pilot has been suspicion that many people who are eligible for MDTA have been referred, instead, to Arrest Referral whilst in police custody:
"Well, I think it could be quite a bit better, a lot of people have been offered Arrest Referral when their trigger offences have actually been MDTA. I think there are a lot more eligible arrestees than they're actually testing for. We're losing clients who we could have offered care and treatment because they've been offered Arrest Referral first and have refused it." [Social Worker, Glasgow]
5.93 In Glasgow, the Practice Team Leader oversees all the MDTA staff and Arrest Referral staff, the Throughcare addiction services referrals, Persistent Offenders Project referrals, the drug court referrals and the criminal justice referrals. This single coordinative role enables the various criminal justice addiction activities to maintain a consistent approach and to ensure that individual clients are receiving the most suitable care and attention.
5.94 The role of the leader was considered essential by local staff, especially in coordinating tasks between AR and MDTA staff:
"Right from the beginning there was recognition that MDTA and Arrest Referral had quite a bit of overlap, and that the team would have to deal with them both. My view was that, as long as there was a logistic overlap between the two, it made sense for our workers to do both. And the more the scheme's gone on, the more we've realised what a good decision that was in terms of the evidence. And that wouldn't have been possible without [the Practice Team Leader's] post, without input from a senior manager to create that agenda. In the past there were two or three of us creating the agenda, but with the introduction of MDTA it's no longer effective to share out this task - you need a practice team leader to manage that and make sure everything runs smoothly in an integrated way, and that's about the sheer number of arrestees coming through as well as the quality of the service." [Social Work Manager, Glasgow]
Learning for the Future
5.95 There is a general consensus among the pilots' staff that the pilot period has been too short to provide a meaningful measure of how successful MDTA could be. Some assessors commented that, for arrestees, the pilot period had been too short to assess its real impact, but that MDTA had 'set the seed' in their mind that they could get help:
"The scheme has the potential to be a success but it needs to be tweaked quite a bit if it is to be rolled out." [ PCSO, Edinburgh]
"…a lot of the benefits won't be apparent in such a short time scale, we don't yet know what the outcomes are for people who come through addiction services again and again." [Assessor, Glasgow]
5.96 Despite this, there has been some incidental learning which may be considered as an added benefit from the scheme. In particular, the pilot has been helpful in providing additional information to drug treatment workers in the three areas regarding the drug using population in the area. This has been one of the best examples of incidental learning from the pilots:
"But the information we're gathering about vulnerable clients, about cocaine users, and about poly-drug users is all very valuable too, and I don't think we would have got that sort of information without the MDTA scheme." [Assessor, Glasgow]
"…and it has made us aware of some major problems that we were only anecdotally aware of before…That evidence is becoming very clear now, it's much more concrete and we can really see how significant these problems are now." [Social Work Manager, Glasgow]
5.97 If MDTA were to be continued into the future, a number of suggestions were made for potential changes to the legislation, to assist in the smooth running and efficacy of the pilots.
'6 Hour Rule'
5.98 Legislation currently dictates that arrestees cannot be drug tested if they were held in custody for more than 6 hours without being arrested. Many interviewees have surmised that this piece of legislation was taken from English legislation where a person can be arrested straight away, compared to Scottish legislation where an arrestee can be first detained and then arrested. This piece of legislation has proved difficult for PCSOs to work under. Furthermore, even if there was time to test the arrestees during this 6 hour period, many arrestees were too intoxicated, and therefore possibly too aggressive or unwilling to undergo a drug test within 6 hours:
"At the start of the night you are running about and before you know it the 6 hours have been and gone. Friday night fingerprinting and photographing is usually done on the Saturday afternoon because it is so busy on the Friday night, but we can't test them then too because it is after the 6 hours." [ PCSO, Edinburgh]
"I would say it could be good if that 6 hour barrier was taken down or made more flexible. Then we could test more people in the day, as far more are arrested in the evenings and night time than could possibly be tested in that time." [ PCSO, Glasgow]
Trigger Offences
5.99 The trigger offences were deemed to be an issue of contention where PCSOs stated that there are both a lot of people who are 'missed' from the testing process such as street workers or those carrying a weapon, but also that there were many people tested who did not need to be tested such as people arrested for reset or embezzlement, where it is obvious the test will provide a negative result, but who are still required to be tested:
"You can usually tell whether someone's test will come up positive or negative…and these boys that have been out drinking and have gotten into a fight…they haven't been taking drugs." [ PCSO, Edinburgh]
5.100 Females are hard to reach, the trigger offences do not facilitate women's access to drug services if a woman is involved in prostitution and/or is homeless, and it is thought that many women are caught up in a vicious cycle and are obliged to a lot of people for drugs and accommodation. Females may need to have the help more readily available for when they are ready for it; a package of support for this hard to reach group. Moreover, a lot of women have children and do not have appropriate childcare in place to attend an assessment or follow up treatment appointments.
Eligibility Criteria
5.101 There was consensus that the eligibility criteria may be too restrictive, in particular in respect to excluding people on warrant. There was also concern that the scheme did not cover people living outwith the pilot area and it was felt that there was no reason to eliminate these people when it would have been feasible for them to attend an assessment. This was mentioned particularly in Edinburgh as arrestees can be taken to St Leonard's from Edinburgh city but also from as far away as Bonnyrigg and Musselburgh. There were general calls for the eligibility criteria to be broadened:
"Even if their original offence was stealing or shoplifting, they don't get tested because they're on a warrant. We're losing a huge amount of people that would have definitely come through the system." [Assessor, Edinburgh]
"I think it would be better to test everybody who comes into police custody, because there's a strong link between all types of crime and drug use. I know that would be very difficult with our current resources but I think it would be more useful." [Police, Glasgow]
5.102 The COPFS felt that if the scheme was to continue, some changes would need to be made including the issue with the detention time, the issue that people on warrant cannot be tested, the fact that the individual has to be resident in the pilot area, and the expansion of the trigger offences to include housebreaking with intent, opening lockfast places with intent and contraventions of s.57 of the Civic Government (Scotland) Act 1982.
5.103 In sum, there was consensus that the legislation had been taken too literally from the English experience and that it was not fit-for-purpose in a Scottish context. In any continuation of the scheme, it seems that there may be a need to revisit the legislation to ensure that it better fits the requirements of Scots Law.
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