The Evaluation of the Drug Recovery Wing Pilots Final Report Charlie Lloyd Geoff Page Mental Health and Addiction Research Group University of York Neil McKeganey Christopher Russell Centre for Substance Use Research Glasgow Alison Liebling Institute of Criminology University of Cambridge 1 Contents Summary ................................................................................................................................................. 4 Chapter 1: Introduction .......................................................................................................................... 9 Chapter 2: The Literature ...................................................................................................................... 11 Chapter 3: The policy and practice context .......................................................................................... 21 Chapter 4: Aims and Research Methods............................................................................................... 30 Chapter 5: MQPL findings ..................................................................................................................... 37 Chapter 6: The Process Evaluation. ...................................................................................................... 59 DRW overview and interviews in prison ............................................................................................... 59 Section A: Site overviews ...................................................................................................................... 59 Section B: Staff interviews .................................................................................................................... 73 Section C: Prisoner Interviews ............................................................................................................ 103 Chapter 7: Prisoner Follow-Up Interviews .......................................................................................... 155 Chapter 8: Outcome Evaluation Findings ........................................................................................... 213 Chapter 9: Costs of DRWs ................................................................................................................... 256 Chapter 10: Synthesis, Discussion and Conclusions ........................................................................... 260 References .......................................................................................................................................... 271 Appendix 1: Data on DRW regimes ..................................................................................................... 277 Appendix 2: MQPL data ...................................................................................................................... 281 Appendix 3: Cost of crime calculations ............................................................................................... 291 Declaration of interest This is an independent report commissioned and funded by the Policy Research Programme in the Department of Health (ref no. 011/0056). The views expressed are not necessarily those of the Department. 2 Acknowledgements We would like to thank the many prison staff and prisoners that directly took part in, or enabled, this study. We have been struck by the candid way that prison staff have approached the interviews: engaging in the process in a self-critical and honesty way. We are also very grateful to the prisoners who have been involved in the research, for their patient involvement in interviews that were often lengthy and covered many sensitive issues. We are also very grateful to the Advisory Group that provided such valuable input into the research as it progressed, our research manager in the Department of Health, Dr Ruth Chadwick, for her advice over the course of the study and ensuring the link-up with policy-makers; and to NOMS policy contacts for their engagement with the research and agreeing to interview. DRW Evaluation Team May 2017 3 Summary Ten pilot Drug Recovery Wing (DRWs) were launched in two phases over 2011 to 2012 in eight men’s and two women’s prisons in England and Wales, with the intention of delivering abstinence-focused drug recovery services. Prisons were given licence to develop their own DRW models to reflect local needs and the ten resulting projects varied considerably in terms of size, aims, target population, accommodation, regime, and therapeutic content and intensity. In 2012, the Department of Health commissioned an evaluation of these pilots, which has been undertaken by researchers at the University of York, the Centre for Drug Use Research in Glasgow and the University of Cambridge. This mixed methods evaluation consisted of five parts: 1. A Rapid Assessment of all 10 pilot DRWs. 2. An analysis of Measuring the Quality of Prison Life (MQPL) data for the 10 pilot DRWs. 3. A process evaluation of 7 DRWs. 4. An impact evaluation of 5 DRWs. 5. An economic evaluation focused on the same 5 DRWs. These were undertaken in two phases: the Rapid Assessment and MQPL survey over March 2012 to October 2013; and the process, impact and economic evaluations over November 2013 to April 2016. In the course of this work, we have undertaken and analysed 345 lengthy qualitative interviews, obtained and analysed data from 631 detailed prisoner questionnaires in the impact evaluation and analysed the data from 1,246 prisoners taking part in the MQPL survey. This report focuses in particular on studies 2-4. Findings Previous research Previous studies have shown problematic substance users to be greatly overrepresented among prison receptions, though substance use generally declines in prison. There is a lack of reliable trend data on self-reported drug use prior to, and within, prison. There is therefore a pressing need for a nationally representative survey of self-reported substance use prior to reception and within prison. Evaluations of the two most studied prison treatment approaches – Opioid Substitution Therapy (OST) and Therapeutic Communities (TCs) – show positive results but point to the importance of linking treatment in prison with support on release. 4 Implementation DRW pilots were implemented in a rapidly changing prison policy context. Responsibility for all drug treatment services had recently shifted to NHS England and two major reviews of staffing, pay, and conditions were impacting on prisons over 2012 to 2013, both aimed at ensuring that public prisons were sufficiently lean in terms of staffing and resources to be able to compete with private agencies for prison contracts. Prisons were given licence to develop their own DRW models to reflect local needs and £30,000 to cover initial set-up costs. The resulting pilots were very varied: capacity ranged from 20 to 140 beds; therapeutic content varied from structured, full-time programmes to little more than the basic support offered elsewhere in the prison; some were run by uniformed prison officers and others by third sector drug treatment professionals; and some were segregated from the rest of the prison while others shared the wider regime. The MQPL data and the qualitative interviews showed the DRWs in Manchester, Styal and Swansea represented promising DRW models that improved prisoners’ quality of life. Key to these DRWs’ success appeared to be a mixture of physical separation from the rest of the prison, protection of DRW beds for people engaged in the therapeutic programme, a strong sense of community and good relations between staff and prisoners. A strong sense of community seemed to develop in small or medium-sized, well-controlled wings where prisoners underwent treatment as a cohort. Also key was the careful selection of positively motivated officers who were also able to manage professional and personal boundaries well. However, none of these features were necessary or sufficient. In particular, shutting off DRW residents from the rest of the prison appeared to intensify relationships and dynamics. This could either result in a close, supportive community where relationships were good; or considerable discord where relationships were poor. Despite their name, DRWs did not universally focus on abstinence-focused recovery. In two, the only treatment input was harm reduction. The nature and intensity of therapeutic input varied greatly across the seven DRWs and also across time in some of the individual DRWs. Only two DRWs had adopted conventional, well-established treatment models, both run by the third sector. Other, well-received programmes were designed in fairly ad hoc ways by prison staff. Prisoners tended to put much more emphasis on peer relations and prisoner communities than they did on the type or nature of therapeutic provision. Therapeutic input could not fill the whole day. If DRWs wished to maintain a credible degree of segregation from the rest of the prison, they had to fill the time that prisoners would otherwise spend in employment, workshops or education. Some allowed additional association time, which was received with mixed reviews. Others resorted to lock-up. Perhaps surprisingly, this was not necessarily unpopular with prisoners. Mutual aid groups, such as Narcotics Anonymous were very popular: providing prisoners with powerful examples of alternative ways to live their lives. 5 Throughout the study, abstinence-focused DRWS experienced difficulties attracting prisoners on OST. In all but one DRW, drug availability