Evaluation of the Substance Misuse Services in HMP Berwyn, North Wales
Research type
Research Study
Full title
An evaluation of Medicine Management Programme and Substance Misuse Services in prison and upon release in the community: a mixed methods study.
IRAS ID
322290
Contact name
Sadia Nafees
Contact email
Sponsor organisation
Bangor University
Duration of Study in the UK
1 years, 5 months, 30 days
Research summary
Research Summary
Substance use by offenders is a significant concern for all health and criminal justice systems. The WHO European health policy framework, Health 2020, highlighted the importance of health in prisons as part of public health that can reduce health and societal risks (Enggist, 2014). Fazel et al. (2006) suggested that a greater understanding of the proportion of men abusing illicit substances would be helpful for the development of appropriate services and inform safer and proper treatment interventions (Fazel, 2006).
Betsi Cadwaladr University Health Board (BCUHB) is the responsible Health Board for health care for individuals residing in HMP Berwyn and commissions this mixed-methods research to evaluate their Medicine Management Programme (MMP) and the Substance Misuse Services (SMS) in HMP Berwyn and service users within three to six months post-release. This research will provide in-depth qualitative data on the experiences of 25 service users engaging with the MMP and the SMS within HMP Berwyn and 15 service users in the community by undertaking semi-structured interviews. In addition, this research will capture the routinely collected information about the demographic, clinical and offending history to explore links with the social determinants of physical and mental health among the study participants. It will include all men entering HMP Berwyn between 1st January 2022 and 31st December 2023. Thus, developing an understanding of how the services operate, including barriers and facilitators in HMP Berwyn and three months post-release.
The research will further add to the existing knowledge on barriers and facilitators to substance misuse treatment (Carroll & Rounsaville, 1992; Kennedy et al., 2001; Neale et al., 2007) and service users' experience of prisons (Tompkins et al., 2007), however, will be unique by researching these facets in one study and doing so in a UK prison, which has not been undertaken to date.
References:
Carroll KM, Rounsaville BJ: Contrast of treatment-seeking and untreated cocaine abusers. Archives of General Psychiatry. 1992, 49: 464-471.
Enggist, Stefan, Møller, Lars, Galea, Gauden & Udesen, Caroline. (2014). Prisons and health. World Health Organization. Regional Office for Europe. https://apps.who.int/iris/handle/10665/128603
Fazel S, Bains P & Doll H (2006) Substance abuse and dependence in prisoners: a systematic review. Addiction 101, 181-191.
Kennedy C, Neale J, Barr K, Dean J: Good practice towards homeless drug users. 2001, Edinburgh: Scottish Homes.
Neale, J., sheard, L. & Tompkins, C.N. Factors that help injecting drug users to access and benefit from services: A qualitative study. Subst Abuse Treat Prev Policy 2, 31 (2007). https://doi.org/10.1186/1747-597X-2-31.Tompkins, C.N.E., Neale, J., Sheard, L. and Wright, N.M.J. (2007), "Experiences of prison among injecting drug users in England: A qualitative study", International Journal of Prisoner Health, Vol. 3 No. 3, pp. 189-203. https://doi.org/10.1080/17449200701520123
Summary of Results
This study highlighted several key barriers and facilitators to engagement. The main barriers included limited treatment availability, insufficient staff and prison resources, fragmented staff-patient relationships, stigma, a lack of integrated and individualised approaches and inadequate inclusion of individuals in decision making.The findings from this study suggest individuals felt uncared for, judged and unable to trust anyone or seek help in the prison. Most participants felt they had no input in their OST prescribing, decisions were made on their behalf by the prescriber. This lack of involvement left many feeling disregarded and belittled. Participants described being unable to request small reductions in their methadone, fearing this may lead to withdrawal of their prescription altogether. Some individuals acknowledged using substances illicitly in prison, while others described facing false allegations. Regardless of the reason, participants felt the resulting decisions for their prescribing were punitive, such as having their methadone stopped, and represented a step backwards. Consequently, individuals reported giving up asking for help, using the ACCT (Assessment, Care in Custody and Teamwork) to get their voice heard, increased suicidal ideation, self-harm and illicit drug use to manage their withdrawal.
Moreover, purposeful activity was identified as highly beneficial; therefore, efforts should be made to reduce the amount of time individuals spend in their cells. The caveat to this, is limited resources usually stemming from broader systemic policies. Having an increased financial investment, would provide the resources to allow more time out of their cell and would enable greater participation in education, work and exercise-based activities. Establishing minimum standards of care and treatment interventions, extending into the community, is essential. Pre-release planning should start when the individual is in prison and include coordination with community-based agencies to ensure that individuals have access to a supportive network and are linked to the relevant services.
Furthermore, onward treatment was often limited to the continuation of OST treatment rather than encompassing a throughcare approach that connects individuals to appropriate services.
The transition from prison to the community was described as overwhelming, highlighting the need for comprehensive release planning. This would include having someone meet them at the prison gates, having consistent ongoing support, structured group work to provide substance misuse support and maintain a routine and practical assistance with housing, benefits, education and navigating everyday life.
During interviews, individuals often spoke about areas of life where they struggled and needed support, including family relationships and ongoing poor mental and physical health. For many, these experiences, both past and present, were seen as directly contributing to where they find themselves now in life, shaping their pathways into prison with ongoing difficulties. Many described histories of abuse, time in the care system, and difficult childhood circumstances. Participants described the prison system itself as a source of further trauma. There were no interventions in the prison to support the individuals to address these needs. Participants requested counselling and group work.
Based on these findings, this research recommends that in prison there needs to be an integrated approach, involving close collaboration between SMS, the mental health team and the MMP. This approach should ensure that individualised needs are met through incorporating individuals in their treatment plans, access to sufficient evidence-based group work and one-to-one sessions. Purposeful activity was identified as highly beneficial; therefore, efforts should be made to reduce the amount of time individuals spend in their cells. Currently, individuals reported spending up to 23 hours each day in their cell.
REC name
Wales REC 4
REC reference
23/WA/0152
Date of REC Opinion
26 Jun 2023
REC opinion
Further Information Favourable Opinion