Latest figures, published by the Ministry of Justice and Public Health England, show that Middlesbrough local authority area accounts for the highest rate of adult re-offending, opiate users and drug-related deaths in the country.
Entrenched heroin dependency continues to be a key driver for acquisitive crime and offending behaviour in Cleveland.
As a result, there is a cohort of ‘revolving door’ offenders placing increased demand on the local Criminal Justice System.
Both nationally and locally, heroin addiction is commonly treated with oral methadone maintenance substitution.
However, about 5-10% of people addicted to heroin who remain in treatment fail to benefit and continue to inject street-bought heroin and continue in cycle of offending behaviour to fund their addiction.
Published evidence from the UK and other countries, shows that Heroin Assisted Treatment (HAT) is a clinically effective second line treatment.
It works for a small group of people, who have repeatedly failed to respond either to methadone or residential rehabilitation.
Currently, there are no HAT schemes operating in England and Wales.
The PCC seeks to introduce a 12-month HAT pilot scheme in Middlesbrough, which will deliver a targeted and intensive programme.
A partnership of South Tees Public Health, Foundations Medical Practice, Durham Tees Valley Community Rehabilitation Company and Tees and Wear Prisons Group will fund the pilot.
The programme aims to use the reinforcing effects of injectable diamorphine to promote adherence, social reintegration and recovery in people who have failed to benefit from traditional treatment.
The PCC has allocated £131,287 to support the delivery of this scheme which has an overall cost of £441,512.
The scheme will target up to 15 of the most ‘at risk’ individuals in Middlesbrough.
Those individuals are causing most concern to Criminal Justice agencies, as well as Health and Social Care Services.
How it works
The programme will promote independence, long term recovery and desistance from offending behaviour.
Delivered seven days per week, individuals will receive intensive psychosocial interventions (PSI.) They will be delivered via group work and individual key worker sessions.
Dovetailed with rehabilitation and re-settlement plans, individual treatment plans will include carers/family members in supporting patients along a recovery pathway.
A dedicated Recovery Co-ordinator will provide support for social reintegration (housing, employment.)
The ‘team around the individual’, including community peers in active recovery (Recovery Ambassadors), will also assist.
To focus on recovery and rehabilitation, recovery plans will support patients to consider non-injectable forms of treatment and facilitated access to mutual aid. In addition, they will provide the opportunity for detoxification (community or inpatient) and an abstinence programme via our local quasi-residential rehab services.
The process of identification of suitable candidates for the programme via multi agency panel (Health, Probation, police and specialist treatment Services will ensure targeted and well-considered initiation of treatment provision.
The panel will assess the suitability of the person to access the highly-structured treatment intervention programme.
Patients will initially be identified via agreed criterion. They will include failed first line treatment episodes, risk to self and community (high crime, high volume user of health and social services.)
Benefits and Efficiencies
The scheme will bring significant benefit and efficiencies to criminal justice agencies and wider society through:
- Reduction in offending/re-offending. This will be caused by the reduced need to buy and use street drugs. As a result, it will lead to less crime and victims and fewer short-term prison sentences.
- Reduction in anti-social behaviour and drug-related litter. This will be due to the stabilisation of the individual’s opiate use disorder, supervised injecting and increased engagement in a treatment programme as well as constructive, diversionary activities
- Reduction in in-patient admissions due to overdose and/or co-morbidity issues
- Engagement and retaining some of the most entrenched hard-to-treat heroin dependent individuals in treatment, for whom previous community or prison-based treatment and residential rehabilitation, appear to have had little beneficial impact.
In terms of the wider benefits to society, a local mapping exercise of 20 individuals, who meet the proposed criteria for the HAT scheme, shows that over a 24-month period they were linked to 351 crimes, costing society £784,000. That’s the equivalent of £5.58 per head of population in Middlesbrough.
To inform future commissioning arrangements, the pilot scheme will be independently evaluated by an academic institution. The pilot supports the PCC’s objective of tackling offending and re-offending