UK: Addressing alcohol and drug-related deaths within the criminal justice system

14th January 2022

A new UK report entitled “Protecting lives: a cross-system approach to addressing alcohol and drug-related deaths within the criminal justice system” presents the joint findings of the Independent Advisory Panel on Deaths in Custody (IAPDC) and the Royal College of General Practitioners (RCGP) on alcohol and drug-related deaths in the criminal justice system. The report relies on evidence already available, and on findings from an online roundtable event hosted by IAPDC and RCGP in April 2021. 

Current Evidence 

The report finds a lack of clarity in the number of people who die in prison because of alcohol or drug misuse. This is due to the deaths being classified under different categories. In spite of this, the report found a significant increase in drug-related deaths from 2015 onwards, with a peak of 50+ deaths in 2018. The report also notes the role drug misuse plays in suicides during the first week of custody. It was found that in 2019-2020, 99 people, or 22% of post-release deaths, were categorised as “self-inflicted: drug overdose.” This number increased to 146 in 2020-2021. The risk of death in the first week after release was also estimated to be 8 times higher for people with substance abuse issues.  

COVID-19 does not seem to have reduced drug use in prisons, and the availability of in-person drug treatment services has also decreased. Some prisons reported a reduction in the flow of drugs but an increase in illegally made alcohol and drug smuggling methods. 

The report recommends the use of naloxone as a method of harm reduction for opioid use, and increased training for prison officers on dealing with drug overdoses. 

The report notes that only a third of people who are referred for community treatment after release from prison avail of the service within three weeks. They also found that Court-given Drug Rehabilitation Requirements and Alcohol Treatment Requirements fell significantly over seven years, which are a tool to divert people from the prison system. There was also evidence that focusing on the causes of addiction rather than the consequences of criminality would save money in the long run, as it would reduce the number of hospitalisations. 

The report therefore recommends increasing the resources for diversion programmes, coupled with better-funded drug and alcohol community services.  

Roundtable Evidence 

The roundtable found that Liaison and Diversion schemes should be available at an early stage, and that treatment providers should be easily accessible. They also found that short custodial sentences should be replaced by alternatives, such as Community Sentence Treatment Requirements. When transitioning between community and prison, the roundtable found that if a person is engaging with treatment in the community, this should continue to be available on discharge.  

Upon release from prison, the roundtable found that staff should be aware of the risks of relapse, and greater outreach with community services was needed. Those at risk should be released from Monday to Thursday, so that services will be available to them in their first few days post-release. Every person should have a treatment plan and there should be a ‘special point of contact’ in each prison aware of community services. 

The report recommends a specific approach to substance abuse treatment for women in the criminal justice system and wider community, the introduction of a ‘bridging liaison’ role, where people in the community assess their clients before release, and the increased use of opioid substitution therapy (OST) to help with the transition between community and prisons. 

Funding was often not allocated based on the prevalence of substance misuse in an area, which should be rectified. Greater investment in counselling and psychological services is needed in prisons and in the community.  Hospital transfers from prison should be easier, and substance misuse services more accessible within prisons. Training in trauma and mental health should be available to all staff members in prison, and staff should collaborate more with healthcare workers. Accurate record-keeping is also needed to avoid deaths in the long term. 

After a death has occurred, there is no timeframe placed on coronial investigations. Well-communicated timeframes are recommended to ensure consistent attention to the investigation. Jury findings should be available, and public reports would assist bereaved families. A central database of recommendations to prevent further deaths should be established, and non-means tested legal aid should be available to families. 

The report recommends that after a death has occurred, independent recommendations should be given. Greater attention must be paid to grieving families, and a national oversight body would ensure timely compliance with recommendations. The report further recommends that investigators consider both clinical and security factors related to the death. Missed opportunities for diversion should be made clear in the report.  

Read the full report here.