Cornwall & Isles of Scilly Drugs Needs Assessment
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CORNWALL & ISLES OF SCILLY DRUGS NEEDS ASSESSMENT 2016/17 Version 1.1 FINAL May 2017 Needs Assessment prepared by: Joint Commissioning Drug and Alcohol Action Team Kim Hager Manager (Cornwall Council) Primary Care Drug and Alcohol Action Team Angela Andrews Development Manager (Cornwall Council) Drug and Alcohol Action Team Jez Bayes Alcohol Strategy Manager (Cornwall Council) Drug and Alcohol Action Team Marion Barton Social Inclusion Officer (Cornwall Council) Drug-related Deaths Drug and Alcohol Action Team Sid Willett Co-ordinator (Cornwall Council) Strategic Intelligence and Amethyst Community Safety Erika Sorensen Performance Manager Intelligence Team (Cornwall Council) Amethyst Community Safety Alex Arthur Strategic Analyst Intelligence Team (Cornwall Council) Amethyst Community Safety James Butler Strategic Analyst Intelligence Team (Cornwall Council) Simon Roberts Drugs Liaison Officer Devon and Cornwall Police Phil Harris Researcher Independent Cornwall and Isles of Scilly Drugs Needs Assessment 2016/17 2 OFFICIAL-DRAFT Contents Executive summary 5 Commissioning priorities 8 Priority Outcomes 8 Complex needs 8 Overview of Recommendations for Commissioners 10 Introduction 15 What did we achieve in 2015/16? 29 What our people say 32 Why invest in treatment? 37 Trends in drug use 41 Drugs and Crime 48 Acquisitive crime 49 Drug trafficking and supply 50 Drug users and the Criminal Justice System 56 Families 64 The impacts of parental substance use 66 Together for Families Programme 68 Identifying families with multiple needs 72 Transitions and young adults in treatment 79 Mapping the treatment system 82 ‘Map and gap’ of existing services 84 Numbers in treatment 87 What is working well? 89 What needs to improve? 93 Tier 4 Review 105 Integrated Treatment Systems 106 Physical Health 109 Blood Borne Viruses 112 Needle Exchange 114 Chemsex and Slamsex 120 Sex Working 121 Drug related deaths 122 Suicide 126 Mental Health 130 National guidance on dual diagnosis 131 Contributing factors 133 How does this impact locally? 135 Wider complex needs 140 Homelessness and housing need 143 Street life: impacts on communities 152 Gypsy, travelling and migrant worker communities 154 Worklessness 158 Appendices 165 Cornwall and Isles of Scilly Drugs Needs Assessment 2016/17 3 OFFICIAL-DRAFT Page intentionally left blank Cornwall and Isles of Scilly Drugs Needs Assessment 2016/17 4 OFFICIAL-DRAFT Executive summary Overview: key trends What’s happening nationally? National surveys indicate that drug use is reducing, including class A drugs which are considered to present the greatest risk of harm to society; Drug seizures saw an 11% decrease compared with the previous year and the fourth consecutive annual fall. Over the same time period, there was a 13% decrease in the number of police recorded drug offences, which is highly correlated with the number of drug seizures. Although it should be noted that this may be indicative of a reduced focus by police forces to uncover drug-related criminal activity; Rates of theft offences (burglary, shoplifting, vehicle crimes), commonly associated with drug use as a means of funding an addiction, continue to fall; Against this backdrop, however, drug-related deaths have risen to the highest rate since comparable records began in 1993, driven by a sharp increase in heroin/morphine related deaths, particularly in men; In 2015, the Home Office identified a growing body of intelligence that vulnerable people are being exploited in order to facilitate the running of street level drug dealing; Research highlights risk factors associated with an aging population and increasing levels of poverty in communities. What’s happening locally? Drug markets and use are changing. There is evidence of wider availability of higher purity heroin and notification of increased availability and use of crack cocaine and methamphetamine; There are signs that crack use is escalating quickly through our local opiate using population, bringing with it a greater risk profile of more crime and health related harms, particularly related to injecting; There have been local cases of vulnerable people being targeted by Organised Crime Groups (OCGs) to use them and their home to sell illicit drugs. Drug offences increased last year, reflecting police focus on OCGs; Rates of theft offences saw a further fall in 2015/16 but with some localised spikes. The latest data, however, indicate emerging negative trends in all types of theft except vehicle crime; There are increasing reports of vulnerable adults with complex needs, homeless drug and alcohol users and associated problems with drug litter and anti-social behaviour; Numbers entering drug and alcohol treatment are on an upward trajectory and above contracted capacity for the service; Cornwall has one of the highest rates of drug related death in the South West. Poly-drug use is a key contributing factor to the increase in deaths, in particular an increase in people using heroin and crack in combination, and people using illicit drugs with prescribed medicines. Other factors include higher purity heroin within the drug market and increases in street homelessness. Cornwall and Isles of Scilly Drugs Needs Assessment 2016/17 5 OFFICIAL-DRAFT Our current treatment system Local services are cost effective. Cornwall and the Isles of Scilly pays significantly less per successful outcome than the national benchmarks; We are better than average locally at getting the most complex problem drug users (opiate users) into treatment; We are good at achieving abstinence/reduced drug use in treatment, positive housing outcomes and successfully engaging people in treatment in the crucial first 12 weeks; We need to improve the proportion of people completing treatment successfully, which has declined across all drug groups. Key themes impacting on successful completions include housing, employment, injecting, family and relationships and drug use whilst in treatment. Increased complexity within our service user population related to crack cocaine use is also starting to impact; We need to reduce/prevent injecting , which is higher than average at all stages of the treatment journey and this will be having an impact on successful completions; The treatment population is aging and becoming more complex. The proportion of people in treatment with entrenched dependence and complex needs will increase and thus the proportion successfully completing treatment will continue to fall. All indications suggest that it is challenging to help people with complex needs and a long treatment history to achieve recovery; Numbers accessing residential rehabilitation services are lower than expected (based on national estimates) but the successful completion rate is high. Negative factors include being unable to manage lump sum PIP payments, relationship issues and lack of sufficient preparation. What people say about it Outreach is highly valued; The quality of support from staff is high; Services are flexible and accessible and there is a wide range of support offered, but communication about what is available could improve; The services cited by service users as being most helpful to recovery were the Mutual Aid Programme (MAP) groups, volunteering, training and extra activities; Stakeholders said that stronger joint working between agencies is helping to support people more effectively, particularly vulnerable people; The DAAT training is enabling staff in a range of other agencies to identify substance misuse and can offer an intensive support package working closely together to promote recovery and community integration; Naloxone delivery to service users and in supported housing is saving lives; Better access to and joint working with mental health services was universally identified as a priority for improvement; Other areas to improve include more childcare/child friendly services, help with transport costs and developing a better service offer to vulnerable women with multiple needs; Stakeholders want to see an expansion of assertive outreach and better range, co-ordination and supervision of supported accommodation options. Cornwall and Isles of Scilly Drugs Needs Assessment 2016/17 6 OFFICIAL-DRAFT Mental and physical health Drug and alcohol problems are usual rather than exceptional amongst people with mental health conditions but the relationship between the two is complex. Health guidance stresses the importance of drug/alcohol and mental health services working together effectively, otherwise both will fail; Violence and abuse, particularly when experienced in childhood, is strongly associated with later onset and persistence of mental health conditions and problematic use of drugs and alcohol; Although we have higher than average levels of concurrent contact with mental health and drug/alcohol services, local data indicates that there is significant unmet need, particularly in the offender population that commonly present with this combination of issues; A survey with staff across a range of community safety services found that experiences of successfully referring into mental health services were mixed, with dual diagnosis, increasing theresholds, ease of contact and unclear pathways being described as the barriers; The delivery of Mental Health First Aid training has been successful in raising staff confidence and knowledge when working with someone with a mental health condition; The rise in crack use introduces a higher risk profile for health harms (including