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CHAPTER 6: DISCUSSION
6.1 Mandatory drug testing aims to encourage problem drug users who come into contact with the criminal justice system to engage with treatment services as a means of addressing the individual's drug misuse problem and associated offending behaviour. This evaluation sought to explore whether the pilot schemes, as originally conceived and implemented, have met this aim, exploring both the systems introduced and the activities undertaken by each of the main partners in delivery for the scheme. The data presented above represents a combination of statistical data collected by the schemes, as well as qualitative data collected by the evaluation team to achieve a better understanding of the way in which the pilots operated and were received.
Summary of Main Findings
Set Up and Operation
6.2 The pilot schemes all appear to have been implemented with relatively few problems at the early stages. Considerable efforts went into the planning of logistical operations and in recruiting what were perceived to be the appropriate levels of staff to deliver the schemes effectively. This meant that drug testing was operational in all areas at the planned start time of mid-June 2007.
6.3 There was a slight delay to the recruitment of dedicated PCSO staff to deliver the scheme, but the training of conventional PCSOs and other police officers meant that it was able to get started on time.
6.4 Assessors and treatment service providers were also in place for the start of the pilots in each area, to allow the full service to be offered from the start. The exception to this was Aberdeen, for whom problems with the availability of treatment services in the early months of the pilot meant that there was slow start.
6.5 The biggest challenge faced by the pilots has been a far lower than expected throughout of referrals into the scheme. At the planning stages, it was anticipated that around 15,000 arrestees per year across the three sites might be tested. The actual number, across all three sites was considerably lower and this has impacted on almost every aspect of delivery for the schemes. In particular, it has resulted in a low workload for the assessment and treatment staff appointed, and has meant a redefining of the roles of these staff to include more care management in the process.
6.6 Problems with the planned central Management Information System meant that each of the pilots had to develop their own bespoke systems for recording MDTA activity. Police monitoring systems appear to have been less than suitable for the purposes of ongoing monitoring evaluation, and this has made some aspects of the evaluation presented here more difficult. This is especially the case in Glasgow where the volume of arrestees being processed by the custody suite has made extrapolation of MDTA eligible clients difficult to identify from generic arrestee databases. It should be stressed that, the police were not unwilling or uncooperative, but were simply under-resourced and unable to find time to perform these kinds of administrative duties either to inform their own monitoring of activity or to inform the evaluation.
6.7 The administration time required to complete an MDTA referral and assessment have been highlighted as barriers to its smooth running, and also as a potentially off-putting characteristic of the scheme for the police.
6.8 The location of assessors in police stations to enable on-site assessments is something that was generally welcomed as a positive feature of the scheme, to capture arrestees at a time when they are able to reflect on their drug misuse and offending behaviour, and to access help straight away. Only a few reservations were raised about the appropriateness of this process in terms of placing additional stress on arrestee at a time when they may already be experiencing considerable anxiety and distress. Problems with the suitability of accommodation in police stations provided for the purposes of MDTA were also raised.
6.9 There have been few changes to the schemes operation as the pilots have progressed, with the exception of the role of assessors in each of the sites. Due to the considerably lower than anticipated numbers referred into each scheme, assessors have taken on more direct responsibility for the care management of arrestees referred into MDTA (in Glasgow and Aberdeen), and have sought opportunities to work across the drugs domain and to assist with Arrest Referral work (in Aberdeen) to maximise their time.
6.10 Partnership working between the police and assessor organisations has also been slightly problematic in each of the three areas at different points in the pilot. In particular, the police may have perceived a lack of feedback from assessors and treatment providers in terms of eventual outcomes for people referred, whilst assessors and treatment staff may have felt that the police were not sufficiently motivated and engaged with the principles of the scheme to make as many referrals as might have been possible. There has, perhaps, been a lack of understanding of the respective roles and cultures in each of the organisations which could have been broken down with more up-front awareness raising.
6.11 At the general level, it appears that the Crown Office and Procurators Fiscal Service ( COPFS) has failed to fully engage with the pilot.
Effectiveness of the Three Schemes
6.12 It was hoped that the main measure of efficacy for the schemes would be the numbers of referrals into MDTA which resulted in a positive drugs test and onward assessment, as well as the numbers of people engaging with drug treatment services as a result of their engagement with the scheme.
6.13 In practice, it has been difficult to use these criteria as stand alone measures of the effectiveness of the scheme, since the data collected has been limited in some cases and there has been some lack of reconciliation between the figures held by each of the partner agencies with regards to testing, referral and treatment activity.
6.14 Looking at the numbers alone, it would appear that the MDTA pilot has helped relatively few people enter into drug treatment services, especially those who were not previously engaged. The total number of referrals for assessment in each area was broadly comparable with 310 in Aberdeen, 381 in Edinburgh, and 301 in Glasgow. Of these, 42 people in Aberdeen were referred for an initial treatment appointment who were not already in existing services. A further 25 people reported that they were already engaging in treatment, but were referred on for further treatment through the MDTA pilot. In Edinburgh, 46 people were referred by Turning Point at their initial assessment to a treatment agency. A total of 79 arrestees received information and advice as part of their initial assessment meeting, but were not referred on to treatment. In Glasgow, all of the 152 people who attended an assessment received treatment or support of some kind. In some cases, this was limited to information provision regarding harm reduction or service availability, but in most cases involved more in depth support and engagement with service providers. Of the 152 people who attended their assessment, 68 (45%) were not engaged with a Community Addiction Team in Glasgow, at time of assessment. This group represents those who, had it not been for the MDTA pilot, may have remained unknown to Glasgow Addiction Services.
6.15 While the numbers of people entering treatment is, therefore, relatively small, the schemes do appear to have been effective at providing information, help and support at the generic level.
6.16 The data has also shown that the pilot has been successful in engaging a small number of chaotic drug users, many of whom may not have otherwise have engaged with drug treatment services. While the demographic of those referred into MDTA in each area has not been notably different from those referred into drug treatment per se (ie mostly white, males in their 20s and 30s), there have been some smaller sub-groups who have been more prevalent in the pilots than might be the case in generic drug services, most notably recreational cocaine users and, in Glasgow, women in prostitution.
Feedback from Arrestees
6.17 Although the focus of this evaluation was not on the impacts of the schemes for arrestee in terms of their reduced offending or drug consumption (this would require a longitudinal model), efforts have been made to examine at the crude level what the perceived benefits may have been to the clients who took part in the pilot, so that it too might contribute to our understanding of the schemes' effectiveness.
6.18 Accepting the limitations of the qualitative data generated (ie that the sample was not representative), all nine interviewees provided positive feedback on the MDTA scheme in terms of it having provided them with valuable help and support. Good relations appear to have existed between assessors and arrestees, as well as with the police, insofar as they provided a reasonable level of information about the scheme and what would be involved.
6.19 Arrestees also seemed to welcome the opportunity to engage with assessors at the time they were in police cells. The time of arrest was seen as a time when they could consider their current lifestyle, and make the most of the opportunity to make a change.
6.20 Compared to alternative, conventional drug treatment services, there was feeling that MDTA was helping arrestees access a wider range of help and support options, including assistance in tackling the route causes of their offending and drugs misuse. Help with accommodation, employment opportunities and mental health were all cited as examples of additionality from the scheme.
6.21 Among those interviewed, there was widespread recognition that MDTA was only effective among people who wanted to change their lifestyle and that it would not be appropriate for all drug users who met the eligibility criteria. Being at a point in their lives when they wanted to change appears to have been the main motivation for participation.
6.22 Despite recognising the benefits of the scheme and offering generally positive feedback on its outcomes, both in terms of reduced drug consumption and offending, there does appear to have been a certain level of confusion among arrestees regarding the principles and main requirements of participation in the scheme. These included perceptions that the scheme was a form of ongoing random drug testing, and that participation in the scheme would mean that arrestees were not charged with their arresting offence (instead of not being charged with non-compliance).
Lessons Learned
6.23 Examples of good practice to emerge from the pilots include the development of a robust data monitoring system in the Glasgow pilot, which has greatly assisted in ensuring that staff in that area can monitor the progress of clients as they progress in their treatment trajectories.
6.24 The information sharing events run in Glasgow also provide an example of good practice but this was marred by difficulties in getting the police to attend.
6.25 The main lesson learned is that resources required for the police to successfully run the MDTA pilot were hugely underestimated. The police provide a 24/7 service, however, in Aberdeen and Glasgow, there was no provision for MDTA drug testing for much of the working week. While it is unlikely that providing full 24/7 coverage would capture sufficiently large numbers of eligible arrestees to warrant the resources required to staff the operation, an analysis of peak times when eligible arrestee might e captured could perhaps allow for better targeting of police resources at busy times, including the provision of extra police staff dedicated solely to MDTA at peak times. This would help to maximise effectiveness of the scheme.
6.26 A better balance was clearly needed between police and assessor resources allocated to the schemes, since assessors were under-worked and police were over-worked for the duration of the pilots.
6.27 The smooth running of MDTA in the future would require better communication between the police and assessors, particularly in terms of feedback about the impact on arrestees future drug taking and engagement with services. There is a need to build strong bridges between organisations at the start of such schemes if they are to run successfully.
6.28 Finally, changes to the legislation may be required to ensure that a wider audience of arrestees could be captured by the scheme and, importantly, those who may benefit most from its offerings.
Comparison of the Three Schemes
6.29 It is difficult to provide a reliable comparison of the effectiveness of the three schemes, since the models employed were so different, and the level of resourcing also varied considerably. At the operational level, it seems that each of the models had their own advantages and disadvantages.
6.30 In Aberdeen, the role of the assessors in providing wider care and support packages to MDTA clients appears to have worked well. This resulted from under-utilisation at the start of the pilots, as with Glasgow. The main problem in Aberdeen was with the lack of treatment services at the beginning of the pilot.
6.31 In Edinburgh, the availability of large numbers of trained PCSOs meant that large numbers of arrestees were tested, and the assessors and PCSOs also appear to have had good relationships. The presence of the assessors in the police stations acted as a motivation for PCSOs to more fully engage with the scheme. The main problem in Edinburgh was the lack of joined up services and, in particular, people getting lost in the system between assessment and access to treatment. This was the only site where assessors did not take on the role of longer term care management for MDTA clients. This may have resulted in lower levels of eventual uptake of treatment services.
6.32 In Glasgow, the integration of the MDTA team within the wider Glasgow Addiction Services meant that clients were offered access to a wide and varied network of services which were readily available and, in some cases, co-located at the sites where arrestees were attending for assessment and ongoing treatment sessions. What worked less well was the involvement of conventional PCSO staff in the performance of MDTA tasks, and it seems that most of this responsibility fell to just two officers who were unable to provide the coverage required for the scheme.
Cost Effectiveness
6.33 The cost effectiveness analysis has shown that, under the MDTA pilots, the level of grant per person referred for assessment is lower in the Aberdeen (£2,123) and Edinburgh (£2,123) areas compared to Glasgow (£2,432). In terms of the level of grant per individual who turned up for assessment, the figures show that Aberdeen was the lowest (£2,502), followed by Edinburgh (£3,275) then Glasgow (£4,816). However, when one focuses on the level of grant per person entering treatment, which is clearly the key factor in the process, then it is clear that the Glasgow pilot (£6,655) is the most cost effective and performs significantly better than both Aberdeen (£9,821) and Edinburgh (£17,586).
6.34 Comparing the cost effectiveness of the MDTA pilots against the Arrest Referral schemes shows that, on the whole, Arrest Referral appears to be more cost effective than MDTA. This applies to both the level of grant per individual attending assessment and the level of grant per individual engaging with drug treatment. The results are particularly marked when one compares the performance of the Glasgow and Edinburgh/Lothian & Borders schemes. For example, the cost per individual engaging in drug treatment in Glasgow under MDTA is £6,655, compared to a figure of £865 for Arrest Referral. In Edinburgh, the same figure for MDTA is £17,586, compared to an Arrest Referral figure for the Lothian & Borders of £2,797. Indeed, using this measurement, the Edinburgh MDTA pilot scheme performs poorest of all the schemes over the period June 2007 to November 2008.
6.35 Comparing the three Arrest Referral schemes shows that, in cost effectiveness terms, Lothian & Borders (£540) performs better than Glasgow (£815) and Northern (£1,811) in getting individuals to attend assessments. However, the level of grant required per individual engaging with drug treatment is lower in Glasgow (£865) than Lothian & Borders (£2,797) and Northern (£9,169). This suggests that, in terms of getting arrestees to engage in drug treatment, the Glasgow Arrest Referral scheme is the most cost effective scheme, while the Edinburgh MDTA scheme is the least cost effective.
Future of MTDA
6.36 It is difficult to make recommendations about the future of the MDTA scheme, since the level of data that are available to evidence it's success are somewhat limited. It is important to stress that this research was a process evaluation, rather than an impact evaluation. Consequently, the data collected and reported here has a process focus and the research has not sought to explore or examine the impact of the pilots, to any notable degree. Whilst perceptual information has been presented from consultations regarding the likely impact of the schemes on arrestees (in terms of reduced offending and future drug use), and on the community (in terms of reduced offending), no statistical data has been collected to support this. This means that the conclusions from the evaluation are also, in themselves, somewhat limited with regard the true success of the pilots.
6.37 It may be desirable to run a remodelled version of the scheme which takes account of the need to rebalance police and assessor staff resources. The availability of more police staff to identify eligible arrestees, to perform drugs tests and to make onward referrals for assessment may impact greatly on the numbers of people being captured by the scheme. This, in turn, would increase the workload of assessors and, potentially, treatment staff, the results of which may represent better value for money than the models which have been implemented to date. Other variants to the models, including the possibility of allowing home visits for assessment purposes, assessments in prisons or the option of flexible on-call assessment services may maximise assessor staff's time and the potential reach of the scheme.
6.38 Based solely on the numbers of people who have been referred into the scheme and attended a full initial assessment, and those who have gone on to engage in treatment services, it would appear prima facie that the schemes have had limited reaching impacts. This is especially true when considered against the level of resources allocated to the pilots, and when compared to both the Arrest Referral scheme and against the initial anticipated numbers who may be helped by the scheme.
6.39 It might, however, be argued that the pilots have been successful in assisting some of the most vulnerable and at risk drug users in each of the three sites to access support, help and information, as well as drug treatment services which they might otherwise not have accessed. Feedback from arrestees and from the police, assessor and treatment staff suggests that the pilots may have also reduced offending among those who have engaged with the scheme.
6.40 It seems that the hard work and enthusiasm of those involved in running these pilot schemes has provided a valuable opportunity to learn more about the patterns and associations of drug use and offending behaviour in each of the three areas targeted by the pilot. This, alongside the benefits felt by the individuals who have maximised on the opportunity to engage with support, information and drug treatment services, reflects a positive outcome of the pilots which cannot be quantified either monetarily or otherwise.
6.41 What does seem clear is that existing legislation appears to have restricted the activities of the police and others in reaching some of those who may have benefited most from the provision of a MDTA service. In addressing the problem of the low numbers of arrestees engaged with the scheme, there may be a need to revisit the '6 hour rule', to broaden the eligibility criteria and to remove restrictions imposed by the exclusion of people arrested on warrant.
6.42 A modified approach which builds on the lessons learned to date could, perhaps, be implemented in one of the existing areas as a continuation of the pilot, to provide a more accurate insight into what might be achieved with improved efficiency in the processes employed. Such a continuation would, however, need to be subject to close monitoring and evaluation and, to achieve a full understanding of its success, should be coupled with a long-term evaluation approach to explore impacts on offending for those participating in the scheme, as well as exploring the longer term benefits of their engagement with treatment services on drug use, offending, psychological and social well-being.
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