scoping report on drugs and alcohol … report.pdf · with this in mind the group agreed that it...

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SCOPING REPORT ON DRUGS AND ALCOHOL SERVICES IN BELFAST

Based on information and views gathered by the Belfast Drug and Alcohol Working Groupbetween June 2010 and March 2011.

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Contents

Page

1. FOREWORD 5

2. INTRODUCTION 7

3. FUNDINGOFDRUGSANDALCOHOLSERVICESINBELFAST 11 3.1 Treatmentandsupportfunding 12 3.2 Preventionandeducationfunding 12

3.3 Communitydevelopmentandsupportfunding 123.4 Workforcedevelopmentfunding 123.5 BelfastRegenerationOfficefunding 133.6 BelfastCommunitySafetyPartnershipfunding 133.7 Costsofalcoholmisuse(NI) 13

4. INFORMATIONANDAWARENESS-RAISING 15 4.1 Whatdoestheevidencesay? 16

4.2 What’sinplace? 164.3 Gaps/Issues 18

4.4 Recommendations 18

5. EDUCATIONANDPREVENTION 21 5.1 Whatdoestheevidencesay? 22 5.2 Scaleoftheproblem 22 5.3 What’sinplace? 24 5.4 Gaps/Issues 25 5.5 Recommendations 26 6. TREATMENTANDSUPPORT 29 6.1 Whatdoestheevidencesay? 30 6.2 Scaleoftheproblem 31 6.3 What’sinplace? 36 6.4 Gaps/Issues 39 6.5 Recommendations 40

7. SPECIFICSERVICESFORVULNERABLEGROUPS 41 7.1 Whatdoestheevidencesay? 42 7.2 Scaleoftheproblem 43 7.3 What’sinplace? 44 7.4 Gaps/Issues 45


8. WORKFORCEDEVELOPMENT 478.1 What’sinplace? 48

8.2 Gaps/Issues 49 8.3 Recommendations 50


9. SKILLINGUPOFANDSUPPORTINGCOMMUNITIES 51 9.1 Whatdoestheevidencesay? 52 9.2 Scaleoftheproblem 52 9.3 What’sinplace? 54 9.4 Gaps/Issues 54 9.5 Recommendations 55

10. REDUCINGAVAILABILITY 57 10.1 Whatdoestheevidencesay? 58 10.2 Scaleoftheproblem 58 10.3 What’sinplace? 59 10.4 Gaps/Issues 59 10.5 Recommendations 60

11. TACKLINGSUBSTANCERELATEDCRIME/VIOLENCE 61 11.1 Whatdoestheevidencesay? 62 11.2 Scaleoftheproblem 62 11.3 What’sinplace? 65 11.4 Gaps/Issues 66 11.5 Recommendations 66

12. COORDINATIONANDINFORMATIONSHARING 67 12.1 What’sinplace? 68 12.2 Gaps/Issues 69


13 SUMMARYOFRECOMMENDATIONS 71

14 CONCLUSIONS 81

REFERENCES 83

APPENDIX1: Thefourtiermodel 88

APPENDIX2: Listofabbreviationsusedinthetext 90

APPENDIX3: MembershipofBDAWG 94

APPENDIX4: OverviewofservicesinBelfastcurrentlyfundedby 95EDACT/PublicHealthAgency

FOREWORD

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FOREWORD


1 ForewordThisreportpresentsasubstantialinsightintothecurrentsituationinrelationtodrugsandalcoholuseandmoreimportantly,itgivesanoverviewofserviceprovisioncurrentlyinplacetotacklesubstancemisuseintheBelfastarea.

Thedrivebehindthisscopingreportbeganinlate2009whenanumberofcommunityandstatutorysectorindividualscametogethertovoicetheirconcerns,especiallyinaNorthBelfastcontext,arounddrugandalcoholissuesimpactingonlocalcommunitiesandtheneedforamoreBelfast-focussedco-ordinatedapproach.ThissmallgroupfeltitwastimelytotakeaninnovativeBelfast-wideapproachtothisareaofwork.

InitialmeetingswereheldwithJohnMcGeown,AssistantDirectorofMentalHealthServicesintheBelfastHealthandSocialCareTrust;BillyHutchinsonofMountVernonCommunityDevelopmentAssociation;FrancesBlackandBrianAllenoftheRISEFoundationandMaryBlack,AssistantDirectorofPublicHealth,HealthandSocialWellbeingImprovementinthePublicHealthAgencyalongwithIreneSherryfromtheBridgeofHopeinordertoconsidertheissuesfacingagenciesinBelfast.However,itsoonbecameclearthatmorestakeholdersshouldbeinvitedtoparticipateinordertoensureafullyinclusivecollectiveapproachwasadopted.

Throughout2010representativesfromanumberofkeystatutoryorganisationsandcommunity/voluntaryprovidersmettoundertakeaninitialscopingexercise.Fromthisinitialanalysis,itwasclearthattherewasalotofworkbeingfundedorcommissionedbutthatawarenessofservicesand,moreimportantly,linkingupofserviceprovisionwasnotalwaysinplaceoraseffectiveasitneededtobe.Withthisinmindthegroupagreedthatitwouldbeworthwhiletospendsometimelookingatthegapsandissueslocallyandanalysethesituationwithaviewtocreatinganoverviewreportwithrecommendationsforconsideration,primarilybythePublicHealthAgencyandtheEasternDrugsandAlcoholCoordinationTeam,butalsobyotherstatutoryagencieswitharesponsibilityfor,orinterestin,addressingdrugsandalcoholmisuse.

ThisreportistheresultofalltheirhardworkandwewishtoacknowledgethecommitmentoftheBelfastDrugandAlcoholWorkingGroupmembers,whetheronbehalfoforganisationsorasindividuals,inworkingtogetherinpartnershipwiththesinglefocusofsupportingindividualsandfamilieswhoareexperiencingdrugandalcoholproblems.

Ourrecommendationsfocusonlongertermplanningandmorecohesivepartnershipworkingaswellassimplifyingaccesstoandparticipationinexistingserviceprovision.Itisacknowledgedthatwhilstmanyagenciesaredeliveringservicesinthisarea,thereisalackofawarenessofprovisionbothwithinthehealthandsocialcaresectoritselfandoutsideinthewidercommunity/voluntarysector.

Asaresultofourcollaborativeapproachandthesuccesswehavehadinworkingtogether,otherareashaveadopted,orintendtoadopt,thismodelwhenlookingattheirissuesspecifictotheirlocalities.ThetaskhasbeenchallengingbutwebelievethisreportsetsthetoneforthecreationofamoreeffectivedrugandalcoholsectorworkingacrossBelfastinwhatiswidelyregardedasadifficulthealthfieldbutwhichcanyielduntoldbenefitsforindividualsandtheirfamilies.

IreneSherry OwenO’NeillCo-chairofBDAWG Co-chairofBDAWGBridgeofHope/AshtonCommunityTrust PublicHealthAgency

INTRODUCTION

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INTRODUCTION

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2 IntroductionTheNewStrategicDirectionforAlcoholandDrugs(NSDAD)hasbeeninplacesince2006.TheDHSSPSiscurrentlyundertakingareviewoftheNSDADwiththeaimofproducingarevised5-yearstrategy(2011-2016)inmidtolate2011.

Themulti-sectoralDrugandAlcoholCoordinationTeamsarerequiredtodeveloplocalactionplanstosupportthestrategyandtoguidetheworkandfundingprioritiesoftheTeams/PublicHealthAgency(PHA).TheEasternDrugsandAlcoholCoordinationTeam(EDACT)coversboththeBelfastandSouthEasternHealthandSocialCareTrustareas.

GiventhechangesasaresultoftheReviewofPublicAdministration(BelfastHSCTrustandSouthEasternHSCTrustfocusratherthananEasternareafocus)andfollowingonfrommeetingsthePHAhadchairedwithconcernedNorthBelfastcommunityrepresentatives,itwasagreedthataDrugsandAlcoholWorkingGroupshouldbeestablishedandsupportedineachTrustlocality.

Thefollowingorganisationswereinvitedtoattend/participateintheBelfastDrugandAlcoholWorkingGroup(BDAWG):BelfastCityCouncilBelfastCommunitySafetyPartnership(ledbyBelfastCityCouncil)BelfastEducationandLibraryBoardBelfastHealthandSocialCareTrust(AddictionServicesandHealthPromotion)BelfastHealthDevelopmentUnitBelfastRegenerationOfficeCommunityOrganisationsDrugsandAlcoholVoluntarySector(fourrepresentatives)EDACTChairpersonNorthernIrelandHousingExecutiveAreaPartnershipBoards(tworepresentingthe5boardsacrossBelfast)PoliceServiceforNorthernIrelandProbationBoardforNorthernIrelandPublicHealthAgencyYouthJusticeAgency

On24thJune2010thegrouphaditsinitialmeetingwhereallinattendanceagreed,onbehalfoftheirorganisations/partnerships,toadoptthefollowingTermsofReference:Toengageandconsultwithorganisationswithaninterestinreducingdrugandalcoholrelated

harmatanindividual,familyandcommunitylevel;ToconsidertheinformationcompiledbyPHA/EDACTinrelationto:

o Assessmentofneedo Goodpracticeandtheevidencebaseforparticularapproaches,projectsor serviceso Monitoringandevaluationdataregardingtheimpactofservicescurrently funded;

ToprovideadviceandsupporttoPHA/EDACT,localandcentralgovernmentandotherrelevantorganisationsandpartnershipsonhowtoimprovethecoordination,designanddeliveryofdrugandalcoholserviceswithinBelfast;

Topromotelinkageswithotherrelevantstrategies;andToco-optmembersasappropriate.

ThegroupelectedIreneSherryoftheAshtonCentreandOwenO’NeillofthePublicHealthAgencyasCo-chairs.

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Thisreportistheculminationofaseriesofmeetingsandworkshops(fromJunetoNovember2010)wheremembersconsideredalloftheavailableinformationinthecontextofwhatthey,andtheorganisationstheyrepresent,considertobethegapsandareaswhichcouldbeimproveduponforEDACT/PHAtoconsiderwhendevelopingEDACT’sActionPlanfor2011-2016.

Thereporttakesasystematicapproachtoscopingandcompilingevidenceon:fundingofdrugandalcoholservices;informationandawareness-raising;educationandprevention;treatmentandsupport;servicesforvulnerablegroups;workforcedevelopment;skillingupandsupportingofcommunities;reducingavailability;tacklingsubstancerelatedcrime;andcoordinationandinformationsharing.Eachsectionofthereportendswithananalysisofthegapsandrecommendationsforaction,withalloftherecommendationspresentedinatabularformatinSection13.


FUNDING OF DRUGS AND ALCOHOL SERVICES IN BELFAST

3.1 Treatment and support funding3.2 Prevention and education funding 3.3 Community development and support funding3.4 Workforce development funding3.5 Belfast Regeneration Office funding3.6 Belfast Community Safety Partnership funding3.7 Costs of alcohol misuse (NI)

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FUNDING OF DRUGS AND ALCOHOL SERVICES IN BELFAST

3.1 Treatment and support funding3.2 Prevention and education funding 3.3 Community development and support funding3.4 Workforce development funding3.5 Belfast Regeneration Office funding3.6 Belfast Community Safety Partnership funding3.7 Costs of alcohol misuse (NI)

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3 FundingofDrugandAlcoholServicesInBelfast

Subsections3.1to3.6belowgiveanoutlineofthemaintypesofservicesavailableinBelfastaswellaswhoisresponsibleforcommissioning/fundingthemandtowhatamount.Itisbynomeansanexhaustivelist–forexampletherearemanycharitableorganisationsandtrustswhichwouldalsogiveshorttomediumtermfundingtoorganisationstodevelopanddeliverdrugandalcoholservicesorprojects.ItisenvisagedthatwhentheTotalPlaceinitiativeistakenforwardbytheBelfastHealthDevelopmentUnit(onbehalfoftheBelfastStrategicPartnership)thatamorecomprehensivereviewofthefinancialinvestmentbeingmadebyallrelevantcommissioningandfundingbodies(certainlyintacklingalcohol-relatedissues)willbeundertakenasoneofthefirststepsintheprocess.

3.1 TreatmentandsupportTotalfundingawardedin2008/09amountedto£3,333,243BelfastHealthandSocialCareTrust(BHSCT)invested£1,699,743(recurrent)instatutory

addictionservicesBHSCTalsoinvested£700,050(recurrent)inthevoluntary/communitysectordelivering

preventativeandtreatmentservices(CarlisleHouse,FASA,DunleweySubstanceAdviceCentreandFallsCommunityCouncil).

BHSCTreceived£247,000ofnon-recurrentfundingfromEDACTfortwoservices(prescribedmedicationanddrugoutreach).

BHSCTalsoreceived£212,000non-recurrentfundingfromtheNorthernIrelandOfficeinrespectoftheDrugArrestReferralScheme(DARS).

Thevoluntarysectorreceived£685,500ofnon-recurrentfundingfromEDACT(ASCERT/OpportunityYouth,Barnardos,AddictionNI[formerlyNICAS]andExtern)

3.2 PreventionandeducationTotalfundingawardedin2009/10amountedto£144,141LisburnYMCAreceived£50,696fromEDACTtodelivertheSchoolHealthAlcoholHarm

ReductionProgrammeinpost-primaryschoolsintheBelfastarea;ASCERTandOpportunityYouth£88,937todeliveryouthtargetededucationprogrammes;andLisburnYMCA£4,508toco-ordinatetheTalkingtoyourChildrenaboutToughIssues(TATI)programme.

3.3 CommunitydevelopmentandsupportTotalfundingawardedin2009/10amountedto£166,833.10FASAreceived£83,476fromEDACTtorecruit,houseandsupporttwodrugsandalcohol

communitysupportworkersforBelfast;andtheEasternDrugandAlcoholConsortium(ASCERT,FASAandFallsCommunityCouncil)£47,896todelivercommunitydrugawarenesstrainingcourses(bespokeandaccredited).

EDACTalsoawardedcommunitygroupsandorganisationsinBelfastatotalof£35,461.10insmallgrantstotakeforwarddrugandalcoholinitiatives.

3.4 WorkforcedevelopmentTotalfundingawardedin2009/10amountedto£122,211.29ASCERTreceived£49,760.29fromEDACTtoprovideworkforcedevelopmenttraining

(bespokeandaccredited)targetedatTier1and2serviceproviders;theCouncilfortheHomelessNI£34,394todelivertrainingtothoseworkinginthehomelessandaddictionsectors;andASCERT£7,905todelivertheTakingtheLidOfftrainingprogrammeforthoseworkingwithfamiliesaffectedbysubstancemisuse.

EDACTalsoawardedASCERT,CarlisleHouse,BHSCTandAddictionNI(inpartnershipwithFASA)workforcedevelopmentgrantstotalling£30,152totrainstaffworkingatTier3/4levelwithintheseorganisations.

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3.5 BelfastRegenerationOfficeawardedatotalof£393,085.15in2009/10toanumberofcommunity/voluntaryorganisationstotakeforwarddrugandalcoholwork/initiatives.

3.6 BelfastCommunitySafetyPartnership(ledbyBelfastCityCouncil)spendsapproximately£230,000perannumaddressingalcoholrelatedharm.Thisamountincludesthecostsofafulltime*ProjectOfficerforGetHomeSafe,an*AlcoholMisuseWorker,50%oftheoftheCommunitySafetyCo-ordinator(for‘Reducingalcohol-fuelledviolentcrime’)salaryandprojectcoststotakeforwardinitiativessuchastheoff-licencecodeofpracticeandstafftraining,barstafftraining,theworkoftheLicensedPremisesGroup,jointenforcementpatrolsonFridayandSaturdaynights,aninformation-sharingprotocol,nightzonesandtheGetHomeSafecampaignitselfintermsofmarketingandawareness-raising.*TheProjectOfficerandAlcoholMisuseWorkerpostsarefundedbyBelfastCityCouncil

3.7 Costsofalcoholmisuse(NI)InJune2010theDepartmentofHealth,SocialServicesandPublicSafetypublishedtheirreportintotheSocialCostsofAlcoholMisuseinNorthernIrelandfor2008/09.TheresearchteamlookedatawiderangeofinformationsuchasGPvisitsandprescribing,hospitaladmissions,fundingprovidedtoservices(includingPHAdrugandalcoholfunding),costsincurredbyservices(policing,prosecution,prison,youthjusticeandsocialservices)aswellasabsenteeismandunemploymentcostsduetoalcoholmisuse.

Totalestimatedcosttohealthcare £122.2

Totalestimatedcosttosocialwork £48.5

Totalestimatedcosttofireandpoliceservices £223.6

Totalestimatedcosttocourtsandprisons £83.8

Totalestimatedcosttowidereconomy £201.7

Totalestimatedcost £679.8

ThecosttosocietyofalcoholmisuseinNorthernIrelandbasedon2008/09prices,isestimatedtobe£679.8million(withinarangeof£500.8millionand£884.4million).Theresearchisasrobustandevidence-basedastheavailableinformationallows,butupperandlowerlimitsforeachthemehavebeenprovidedasitisrecognisedthatcostestimatesinanumberofareasmaybesubjecttoadegreeofuncertainty.

AssumingthatprevalenceandcostsareequallydistributedacrossNI,thecostofalcoholmisuseinBelfastamountstojustunder£102million(withthecosttoeachindividuallivinginBelfasttotalling£380).


INFORMATION AND AWARENESS-RAISING

4.1 What does the evidence say?4.2 What’s in place? 4.3 Gaps/Issues4.4 Recommendations

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INFORMATION AND AWARENESS-RAISING

4.1 What does the evidence say?4.2 What’s in place? 4.3 Gaps/Issues4.4 Recommendations

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4 InformationandAwareness-Raising

4.1 Whatdoestheevidencesay?Itisimportanttoacknowledgethatmassmediapublicinformationprogrammeshaveaparticularroletoplayinreinforcingcommunityawarenessoftheproblemscreatedbyalcoholuseandtopreparethegroundforspecificinterventions(AndersonandBaumberg,2006).

TheWorldHealthOrganisationhasstated:“Ingeneral,publicinformationcampaignshavebeenfoundtobeineffectiveinreducingalcohol-relatedharm(1).Exceptionsaremassmediacampaignstoreducedrinkinganddrivingwhich,whenimplementedinthepresenceofstrongdrinkinganddrivingcountermeasures,canhaveanimpact(85).Counter-advertising,avariantofpublicinformationcampaignswhichprovidesinformationaboutaproduct,itseffectsandtheindustrythatpromotesitinordertodecreaseitsappealanduse,hasinconclusiveeffects(1).”(Anderson2009)(References:(1)Baboretal2003;(85)Elderetal2004)

4.2 What’sinplace?CampaignsArangeofpublicinformationcampaignshavebeenandcontinuetobedeliveredataregionallevel.Manyofthesearemulti-agencyinitiatives.Someexamplesarelistedbelow:- Alcohol&breastcancer/bingedrinkingetc.(PHA)- Drink/drugdrivingcampaign(PSNI/NIO)- You,YourChildandAlcohol(PHA/PSNI/DOJ)- ThinkChild,ThinkParent,ThinkFamily(indevelopment)- HiddenHarmAwarenesscampaign(indevelopment)

Inaddition,localcampaignshavealsobeendeveloped,someexamplesoftheseare:- GetHomeSafe(BCC/BCSP)- ParentalAwarenessCampaign(EDACT/BCSP/DOJ)

WebsitesManydrugandalcoholorganisationshavetheirownwebsitesandthePHAhavearegionalwebsiteondrugsandalcohol(www.drugsalcohol.info).SomeoftheabovecampaignsarealsosupportedbyspecificwebsitessuchasKnowyourLimits.

LeafletsThePHAhasproducedarangeofleafletsandpostersondrugsandalcoholincludingsolventabusewhichareavailabletoorganisations.Inadditionsomeorganisationsproducetheirownleafletsonparticularissues,forexampleFASAhavedevelopedarangeofyouthfriendlymaterials.

DirectoriesEDACTpublishesitsdirectoryofsubstancemisuseservicesonanannualbasis.ThisisdistributedtoGPs,schools,libraries,relevantpublicsectororganisationsandcommunitygroups.In2009/10EDACTalsoproducedat-a-glanceA5wallchartdirectories(oneforBHSCTandoneforSEHSCT)detailinglocalitybasedserviceswhichweredistributedviathecommunitysupportserviceandlocaldrugandalcoholforums.

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AwarenesscoursesSubstancemisuseawarenessprogrammes(bespoke&OCNaccredited)areprovidedbymanyservicesincommunitysettingstoarangeofgroups.Demandforthesecontinuestobehighparticularlywhennewsubstances(so-calledlegalhighs)emerge.

LocalforumsLocaldrugandalcoholforumsexistinsomeareas:SEBSAN(SouthandEastBelfastSubstanceAbuseNetwork)–drugandalcoholissuesare

alsodiscussedattheSouthBelfastPartnershipBoard’sHealthandWellbeingForumwhichwasestablishedinAugust2010;

WestBelfastDrugandAlcoholForum;andTheRADICALforuminNorthBelfastnolongerexistsandasaresultdrugandalcoholissues

areaddressedthroughtheNorthBelfastPartnershipBoard’sHealthandWellbeingForum.Someoftheseforumshaveundertakenawarenessraisinginitiativesinthepastbutafewhavebeenstrugglingwithattendance(especiallyinrelationtocommunityrepresentation)inmorerecenttimes.

BelfastCommunitySupportServiceThisserviceishostedbyFASA.Theprojectworkswithlocalcommunitiestoidentifydrugandalcoholissuesintheirareaandhowtheywanttorespond.Thefocusisonskillingupcommunitymemberstobeabletoaddresssomeoftheissuesaswellassourcingappropriateexternalsupport.Theservicealsosupportsgroupsinterestedinrunningdrugandalcoholawarenessevents,healthfairsetc.Anewsletter,“TheFix,”isproducedregularlyhighlightingcurrentissues/emergingtrends,providinginformationaboutservicesandlocalinitiatives.

Area-basedPartnershipBoardsTheseorganisations,especiallywheretheyhaveestablishedhealthandwellbeingforums,canprovideanopportunityfordrugandalcoholservicestoraiseawarenessaboutwhattheydoandwhatcantheyoffer.WorkerswithinthePartnershipBoardsassociatedwiththeseforumsarealsobestplacedtodistributeinformationondrugandalcoholissuestotheirmembers.

ResearchThereareanumberofstatutoryagenciesresponsibleforcollatingandreportingondrugsandalcoholstatisticsandresearchsuchastheNorthernIrelandStatisticsandResearchAgencyandthePublicHealthandInformationResearchBranchoftheDHSSPS,alongwiththeResearchandDevelopmentDirectorateandtheHealthIntelligencedepartmentofthePHA.

OverthepastfewyearstherehavealsobeenseveralpiecesofBelfast-focusedqualitativeresearchpublishedsuchasRADICAL’sStillBlottingitOut?reportandtheInnerNorthBelfastNeighbourhoodRenewalPartnership’sInnerNorthCommunityHealthAudit(moreinformationgiveninSection9).

TheEasternTraumaAdvisoryPanelpublishedareporton‘Trauma,AlcoholandDrugsCo-morbidity’inMarch2011.Theresearchexaminestheimplicationsofapersondealingwithbothpost-traumaticstressdisorder(PTSD)andsubstanceabuse(alcoholordrugs/prescriptiondrugs).Copiesofthereportareavailablebyemailingmartina.mullin-o’[email protected].

EDACTandtheBHDUcommissionedGEMSNItocarryoutsomequalitativeresearchintosubstancemisuseintheolderpopulationinBelfastasanissue.ThefinalreportwillbelaunchedinSeptember2011;emailelma.greer@bhdu.orgforfurtherinformationorforacopyofthereport.


4.3 GapsGeneralThepublicneedtobemadeawarethatearlyintroductiontoalcoholcouldleadtodependencyThedangersofdrinkingduringpregnancyneedtobehighlighted-woulditbepossibleto

incentiviseabstinenceduringpregnancy?TheroleoftheareaPartnershipBoard’sHealthDevelopmentWorkersandtheirHealthand

WellbeingforumsneedstobeconsideredinfutureplanningCommunicationMechanisms/systemsshouldbeputinplaceforgreaterlocalandregionalcoordination

regardingtheplanningofcampaignsThepublicshouldbeconsultedBEFOREdevelopingleaflets,campaignmaterialsetc.tofind

outifthemessagesandcontentarerelevant(suchtestinganddevelopmentisconsistentwithbestpractice)

Thereisaneedtoinformortrainpeopleonthegroundtobeabletorelayand‘translate’keymessages

Localinitiativesshouldbeconsistentwith,andreinforcethemessageswithin,regionalcampaigns–thereshouldalsobeamechanismforsharing/replicatingproven/well-receivedinitiativesinotherareasoronaregionalbasis

ThespecificneedsofgroupssuchasIrishTravellers,EthnicMinorities,OlderPeople,theLesbian,Gay,BisexualandTransgendercommunityandotherSection75groupsshouldbetakenintoaccountwhendevelopinganddisseminatinginformationondrugsandalcohol

ResearchThereareconsiderablegapsintheresearchandevidenceavailableatalocallevelThereneedstobemoresupportandfundingmadeavailabletoevaluateservicesinorder

tobeabletobuildanevidencebaseandtoensurethatfuturefundingisdirectedtoserviceswhichhaveastrongevidencebase

Thereisalsoaresponsibilitytoshareresearchresultsandevidenceofgoodpracticewiththewidercommunity

Thereneedstomorelongitudinalresearchcarriedoutsuchaslongtermfollowupofindividualsthroughtreatmentinordertoassessimpact

Informationonservices/servicedevelopmentCommunityworkersneedquickandeasyaccesstonames,telephonenumbersandservice

details;it’saboutmakingdirectories‘real’andensuringthatfrontlineworkersknowenoughtobeabletosignpostappropriately

ThereisaspecificneedaroundhowtoaccessTrustservicesespeciallyregardingemergencynumbersandcrisisresponse(needtoknowwho/what/how?)

Mechanismsneedtobeinplaceinordertobeabletorespondtoemergingissuesandtoshareinformationquicklywithservicesconsultedabouttheircapacitytorespond

Agenciesneedtobemorewillingtoworktogether

4.4 InformationandawarenessraisingrecommendationsGeneralThePublicHealthAgency,BelfastHealthandSocialCareTrustandBelfastCityCouncil

shouldmeettodiscusshowbetterlinkagescouldbemadebetweendrugandalcoholserviceprovidersandcommunitysupport/healthdevelopmentworkerssuchasthosewithintheareaPartnershipBoards,HealthLivingCentres,etc.toensurethattheyarekeptup-to-dateandcanavailoftrainingandsupportasappropriate

CommunicationThePublicHealthAgencyshouldproduceacomprehensive‘Communicationstrategy’for

drugsandalcohol(agreedmessages/mediaguidelines/processforcampaigndevelopmentandtimescales/informationonandpromotionofservices/processforsharinginformation)

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ThereisaneedtostrengthenthelinksbetweenthosecommissioningandprovidingservicesandrelevantumbrellaorrepresentativeorganisationsforSection75groupssothattheirviewsandneedsaretakenintoaccount

ResearchThereneedstobestrongerlinkagesestablishedbetweenthoseresponsibleforcommissioning

and/orcarryingoutresearch(DHSSPS-PHIRBandPHAResearchandDevelopmentdirectorate)andthoseresponsiblebothforcommissioninganddeliveringservicesinordertobeabletobetterdefineresearchgaps,decideobjectivesandprioritiesforanynewresearchtobeundertakenandensurethatthereisabalancebetweenlocalandregionalresearchagendas

Servicesneedtobesupportedtobeabletoevaluateandsharelearninginordertobuildontheevidencebase

Informationonservices/servicedevelopmentThePublicHealthAgencyshouldcontinuetoproduceanddisseminatearangeofservice

directoriesfordrugsandalcoholwhichshouldincludeclearinformationonreferralroutes/pathwaysforaccessingservices

BHSCT,inconjunctionwiththedrugandalcoholtreatmentserviceprovidersshoulddesignanddevelopa‘Pathwaytoservices’documentwhichshouldbewidelydisseminatedbothtoGPs(asakeytargetgroup)andgenericcommunityservices

PublicHealthAgencyshouldundertakeareviewoftheroleandimpactoftheCommunitySupportServices(fordrugsandalcohol),aspecificrequirementunderNSD,inordertosharethelearninglocallyandbuildonbestpracticeelements

An‘earlywarningsystem’shouldbeestablishedatbothlocal(i.e.bythePHA)andregionallevel(i.e.bytheDHSSPS)toensuretimelysharingofinformationandtheBelfastCommunitySupportServiceshouldbetaskedwith,andsupportedtobeableto,offerpracticalinformationsessionsonemergingissuesatcommunitylevel

PHAshouldtakeamodellingapproachandwherepossiblereviewandevaluateanyinitiativeswhichshowpromiseorarehavinggoodoutcomeslocallywithaviewtotriallinginotherHSCTareas

Aspartofthetacklinghealthinequalitiesagenda,PHAshouldconsiderincentivisingparticipationindrugandalcoholprogrammes/services(takingonboardthefindingsoftherecentlypublishedNICE’sCitizen’sCouncilreporton‘Theuseofincentivestoimprovehealth’)http://www.nice.org.uk/media/10C/48/CitizensCouncilIncentivesReport.pdf

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EDUCATION AND PREVENTION

5.1 What does the evidence say?5.2 Scale of the problem 5.3 What’s in place?5.4 Gaps/Issues5.5 Recommendations

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5 EducationandPrevention

5.1 Whatdoestheevidencesay?Overalltheimpactofeducationandpreventionprogrammesislimited.However,manyresearchershavecommentedonthefactthatthereisalackofconsistencyinthedesign,contentandimplementationofpreventionprogrammesandassuchitisverydifficulttoconcludewhatworksinprevention.(NICE,2006)

Evidencefromsystematicreviewssuggestthatthefollowingprogrammes(mostlyAmerican)providepromiseinaddressingyoungpeople’ssubstancemisusesomeofwhichhaveahighlevelofparentalinvolvement.(NICE,2007)StrengtheningfamiliesandBotvin’sLifeskillstraining(LST).Outcomes: long term reductions

in alcohol use (more than three years).Interventionsusingthelifeskillsapproachorfocussingonharmreductionthroughskills

basedactivities,SchoolHealthandAlcoholHarmReductionProject(SHAHRP).Outcomes: reductions in alcohol use, in particular risky drinking behaviours such as drunkenness and binge drinking.

SeattleSocialDevelopmentProject(SSDP)andLinkingtheInterestsofFamiliesandTeachers(LIFT)whichtargetarangeofproblembehaviours,includingalcoholuse.Outcomes: long term effects (more than three years) on heavy and patterned drinking behaviours.

AdolescentTransitionsProgram(ATP)apreventionstrategyfocussingonparentingpracticesanddeliveredaccordingtotheneedsofthefamilyidentified. Outcomes: decreases in overall substance use by young people and significant long term reductions in overall alcohol, tobacco and cannabis use. (NICE, 2007e)

Theprinciplesofeffectivefamily-basedinterventionsasoutlinedabovearenotspecifictopreventionorreductionofdruguse,butcoverbroaderbehaviouralproblemsinyoungpeople.Secondly,itshouldbenotedthatmanyoftheseprogrammesoriginatedintheUSAandtheeffectivenessoftheseprinciplesmightnotbegeneralisabletoUKsettingsorpopulations.

5.2 ScaleoftheproblemLatestprevalencedatashows:AdultsAccordingtothe2007/07DrugPrevalenceSurvey;cannabiscontinuestobethemostpopular

illicitdrugofchoicewithbothlastyearandlifetimeprevalenceratesincreasing.(Lastyearuseofcannabisincreasedfrom5.4%to7.2%andlifetimeuseofcannabisincreasedamongalladultsaged15-64from16.8%in2002/03to24.7%in2006/07.)

However,lastyearandlifetimeprevalenceratesforcocaineuseisalsoontheincreaseespeciallyamongsttheyoungwithfourtimesasmany15-34yearolds(9%)reportingeverusingcocaineascomparedto2%ofthoseaged35-64.Usedoesappeartoberecreationalwithallofcurrentusersreportingusingcocainelessthanonceaweek.

TheAdultDrinkingPatternsinNorthernIreland2008reportstatedthatacrossNorthernIreland72%ofthepopulationdrinkalcoholwhereaswithintheeasternarea(Belfast&SouthEasternHSCTrusts)prevalenceisslightlyhigherat78%.AhighproportionofthosedrinkingalcoholinNIaredoingsotounsafelevelswithalmostaquarter(24%)reportingdrinkingabovetheweeklysensiblelimitsandalmostathird(32%)ofthosewhodrankintheweekbeforethesurveyreportinghavingengagedinatleastonebingedrinkingsession.

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YoungPeopleWhilstencouraginglytheSecondaryAnalysisofthe2007YoungPersons’Behaviourand

AttitudesSurveyfoundthatlifetime,lastyearandlastmonthuseofanydrugsorsolventshaddecreasedbetween2003and2007theresearchstillshowedthat,in2007,almostafifth(19%)ofyoungpeoplesurveyed(aged11-16)reportedhavingtakendrugsandoverhalf(55%)statedthattheyhaddrankalcoholwithoverhalf(55%)ofthese,i.e.30%ofthosesurveyed,reportinghavingbeendrunkonatleastoneoccasion.

Almostthreequartersofpupils(73%)reportedknowingalotorquiteabitabouttherisks/effectsofdruguse,with18%sayingtheyknowsomethingand9%knowinglittleornothing.

QUB–YouthDevelopmentStudy(*Belfastschoolsonly)

Substance Year1 Year5

Boys Girls Boys Girls

Alcohol 75% 67% 93% 95%

Alcohol-intoxicated

23% 9% 71% 73%

Cannabis 17% 3% 53% 47%

Solvents 10% 4% 15% 15%

Ecstasy 3% 1% 13% 15%

Cocaine 3% 1% 9% 8%

Year1=Year8pupils(1styearofsecondaryschoolagedbetween11and12)InterviewedinJantoMay2001Year5=Year12pupils(5thyearofsecondaryschoolagedbetween15and16)InterviewedinJantoMay2005

Recent use

Substance Year5

Boys Girls

Alcohol 87 90

Alcohol-intoxicated 68 70

Cannabis 44 41

Solvents 8 7

Ecstasy 14 13

Cocaine 9 8Recentusereferstouseinthelast12months

InYear1moreboysthangirlsreportedeverusingalcohol,beingdrunkonatleastoneoccasionandeverusingdrugs.HoweverbyYear5thesedifferenceshadlevelledoutwiththegirlsevenovertakingboysinrelationtousingalcoholandhavingbeenintoxicated.

*ChildrenattendingBelfastHSCT-basedschoolsmayliveinadifferentHSCTarea


SHAHRP(*Belfastschoolsonly)

Atage13/1419%ofthechildrensurveyedwithintheBelfastschoolshadnevertriedalcoholandjustover42%weredrinkingonalessthanmonthlybasis,however10.3%weredrinkingonceaweek,and5.6%reportedthattheyweredrinking2-3timesperweek.Afifthreporteddrinkingmorethan8unitswhentheylastusedalcohol.Themajorityreporteddrinkingalcopops(45.4%),followedbycider(12.9%)andthenbeer(10.2%)atlastuse.

Byage16only4.2%oftheBelfastschoolchildrensurveyedreportedneverhavingtriedalcoholwiththemajoritynowdrinkingonamoreregularbasis;17.7%twotothreetimesaweekand19.5%onaweeklybasisandlessthanathird(28.6%)drinkinglessthanmonthly.Overhalf(50.8%)reporteddrinkingmorethan8unitswhentheylastusedalcohol.Themajorityreporteddrinkingalcopops(35.8%),followedbyspirits(24.4%)andthenbeer(15.5%)atlastuse.

Inanaccompanyingstudy,1,651BelfastschoolchildrenalsocompletedtheAdolescentAlcoholInvolvementScale(AAIS).Intotal,605wereclassifiedasabstainers,760asnon-problematicdrinkersand286asproblematicdrinkerswithtwiceasmanyfemales(67%)asmalesdrinkingatlevelsconsideredproblematic.InYear8only12ofthe324(4.2%)whocompletedAAISwereclassifiedasproblematicdrinkers;howeverbyYear12thatfigurehadrisento43%(309completedAAIS).

*ChildrenattendingBelfastHSCT-basedschoolsmayliveinadifferentHSCTarea

5.3 What’sinplace?SchoolHealthandAlcoholHarmReductionProgramme(SHAHRP)SHAHRPisatwophasealcoholharm-reductionpupileducationandteacher-trainingprogrammetargetedat3rdand4thyearpupilsinpost-primaryschoolsaswellasaone-offworkshopforyear9,12and13pupilsonage-specificalcohol-relatedissues.Theprogrammeisdeliveredinallbutoneofthepost-primaryschoolsintheBelfastarea(itisalsodeliveredintheSouthEasternHSCTarea).The3rd/4thyearprogrammeisdeliveredbytheteacherswhileLisburnYMCAstaffdelivertheadditionalinterventions.

BelfastEducationandLibraryBoardSchoolshavearesponsibilitytoprovidedrugandalcoholeducationthroughthelearningforlifeandworkprogrammeandtheEducationandLibraryBoardsoffertraining,supportandmaterialsforteacherstoensurethattheyarecompetenttodelivereducationonthisarea.Someschoolsstillpreferoutsideagenciestocomeinanddeliverdrugandalcoholeducation.

TheyouthservicewithintheEducationandLibraryBoardsprovidearangeofpersonaldevelopmentprogrammesforyoungpeoplewheredrugandalcoholissuesareaddressed.OutreachservicesalsoexistincertainareasacrossBelfastandplayavitalroleinsupportingyoungpeople.

VoluntaryandcommunityprovisionEducationprogrammesareprovidedtogroupsofyoungpeoplebyarangeofprovidersincludingOpportunityYouth,ASCERT,FASAandFallsCommunityCouncil.Aconsiderablenumberofyoungpeopleaccesstheseservicesmanyofwhicharetargetedtothoseatriskofdevelopingproblemsasaresultoftheiruse.Therearealotofcoursesonoffersomeofwhichprovidediversionaryactivitiesandoutdoorpursuits.Othersinvolveyoungpeopleindesigningdrugandalcoholeducation/informationmaterials.Themajorityoftheseprogrammesoccuroutsideoftheschoolenvironment.

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Inadditiontothese,numerousyouthorganisationsprovidepersonaldevelopmentprogrammesforyoungpeopleintheirareaswhichwilladdressdrugandalcoholissueswhennecessary.

ThePSNIdeliverdrugandalcoholeducationtoschoolsandyouthclubsaspartoftheCitizenshipandSafetyEducation(CASE)programme.Inadditiontothis,educationtalksaregiventootheryouthandadultgroupsonrequest.

BCChasundertakenworkaddressingvolatilesolventabuse.Thisincludesdeliveringtalksinschoolsandgivingoutinformationpackstoretailers.

YJAcommunityservicesstaffaretrainedintheuseoftheRegionalInitialAssessmentTool(RIAT)forassessingyoungpeople’ssubstancemisuseandcandeliverdrugandalcoholeducationprogrammes(subjecttoyouthconferenceplans).TheYJAisdesigninganin-housedrugandalcoholawarenessprogrammesothatyoungpeopleattendingservicesinlocalofficesandyoungpeopleincustodyreceiveauniformresponse/approach.

TheTalkingtoyourchildrenaboutToughIssues(TATI)programmetrainsfacilitatorstodeliverathreesessioncoursetoparents.Itistargetedtowardsparentsofchildrenaged10-13andfocusesonalcoholandiscoordinatedbyLisburnYMCA.OpportunityYouth,ASCERT,FASAandFallsCommunityCouncilalsoprovidecoursesforparentsfocusingondrugandalcoholeducation.

ASCERToffersaonedaycoursein‘Workinginprevention’andafivedayOCN-accreditedcoursein‘Puttingpreventionintopractice’undertheirworkforcedevelopmenttrainingprogramme.

5.4 GapsGeneralPreventionneedsastrategyofitsown;there’salotofworkgoingonbutitneedstobeco-

ordinated/joinedupanditneedstobelinkedwithotherissues(suchasmentalhealthandsuicideandotherrisk-takingbehaviours)assubstanceuse/misusecannotbeaddressedinisolation

Thereisaneedtotacklethe‘normality’ofalcoholandprescribeddruguse/misuse;ahugetaskbutitisimportanttotackletheacceptabilityofboth

Servicedevelopment/deliveryMostpeopleneededucationandprevention(tiers1and2)veryfewpeopleneedtreatment

(tiers3and4)thisfactneedstoberememberedwhendesigningandcommissioningservicesExistingservicesaremostlyavailableattier3levelandthereisaneednowtostartfleshing

outwhatisavailableattier2wherearguablythegreatestneedis/numbersofpeopleinneedare

Muchofwhatiscurrentlybeingprovidediseducation-focussedorfocussedoneducatingaboutpreventionratherthanactualprovisionofprevention-focussedprogrammes

Lotsoftrainingandcoursesoneducationandpreventionarehalfdaytoadayatbest(althoughRISEoffersthreedaytraining)howeversubstancemisuseisacomplexissueandneedstobetreatedassuchandthetimegiventoexploreitindetail

Thereisaneedformorebroad-basededucationprogrammesaboutaddictioningeneralThereisaneedtobemorecreativeinhoweducation/preventionsessionsareoffered

especiallyinthecommunitysetting(i.e.coffeemornings)Thereneedstobemoreeducationandpreventioninitiativestargetedatfamilies(partofthe

hiddenharmagenda)Thoughtneedstobegivenastowhoisbestplacedtodoeducationandpreventionwithadults

inrelationtoaddressingsubstancemisuseEmployersareakeytargetgroupintermsofensuringthattheyhavepoliciesinplaceGPsareoftenthefirstpointofcontactforsomeonewithsubstancemisuseissuesorconcerns


andsoareakeytargetgroupintermsofensuringthattheyarewellinformedinordertobeabletosignpost,referonandinterveneasappropriate

TheDrugsandAlcoholCommunitySupportWorkersService,basedinFASA,needstobepromotedmorewidely

Therearealsoanumberofothercommunitydevelopment/supportpostswhicharefundedtoraiseawarenessandsignpostwhowouldbeakeytargetgroupfordrugandalcoholtrainingandforkeepinguptodateonavailableservicesetc.

Providersshouldcometogetherandensurethatthereisconsistencyinwhatisbeingoffered/delivered(qualityassurance)

ServicesforyoungpeoplespecificallyWorkinschoolsneedstobecoordinatedasthereareinstanceswhenthereareseveral

agenciesgoingintoschoolsallofferingthesamethingtothesamepupils;thereisaneedtoensurethatservicescompliment,addvaluetoeducationandprovisionalreadybeingdeliveredinschools

Therearedifficultiesaroundbeingabletoworkinschools,especiallyinprimaryschools,yetresearchwouldsuggestthatitiswheredrugsandalcoholeducationshouldstart

Foryoungpeopletherearegapsineducation/preventionprovisionsuchasforthosenotattendingschoolandthosewhodon’t‘do’youthclubs

ThereisalackofknowledgeandawarenessofBELB’syouthserviceprovisionacrossthecityandthereisaneedtoencouragebetterlinksbetweenBELBandyouth-focusseddrugsandalcoholserviceprovidersandthatBELBisrepresentedonrelevantpartnerships(BDAWG/EDACT)astheyareakeystakeholder

5.5 EducationandpreventionrecommendationsGeneralAllthoseresponsibleforcommissioningservicesshouldworktogethertodevelopasystematic

andtargetedapproachtowardsraisingawarenessofplannedandexistingserviceswithinrelevantsectorssuchas:primarycare;communityandvoluntary;education;socialservicesandcriminaljustice

Servicedevelopment/deliveryWorkwiththoseprovidingeducationandpreventionprogrammestodefinewhattheyareable

tooffer(content/capacity)thusensuringbetterpromotion,coordinationandtargetingThoseprovidingdrugandalcoholeducationandpreventionprogrammesshouldensurethata

communitydevelopmentapproachistakentoengagementanddeliveryThoseresponsibleforcommissioningservicesshouldensurethatadditionalresourcesare

targetedatTiers1and2toensureamuchstrongerfocusisputonpreventionExistingestablishedcommunitynetworksshouldbeconsultedtoidentifygenericcommunity

workerswithahealthremitwithaviewtokeepingthemuptodateondrugandalcoholissues,servicesandtrainingavailable

ReviewthecurrentpromotionalactivitiesandawarenessraisingstrategiesoftheBelfastDrugandAlcoholCommunitySupportServicewithaviewtoensuringthattheyremainfitforpurpose

DHSSPSshouldreviewtheirguidanceondevelopingworkplacedrugandalcoholpolicieswiththegoalofputtinginplaceasystematicplanfordisseminationandpromotionofbestpracticetoemployers

TosupportthedisseminationandadoptionoftheregionalPHA/DHSSPS‘Guidingeffectivedrugprevention’documentandprinciplesandtoraiseawarenessoftheaccompanyingfreetrainingprogrammeinhowtodesignanddeliverdrugandalcoholpreventionprogrammes(offeredbyASCERT)

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GPsremainthefirstpointofcontactformanyindividualsandneedtobekeptuptodateaboutcurrentprovisionandreferralpathwaysinordertosignpostandreferpeopleontoappropriateservices

Moreeducationandpreventioninitiativestargetedatfamiliesshouldbedevelopedandresourced

Moreeducationandpreventioninitiativeslookingattheinter-relationshipbetweenmentalhealthanddrugsandalcoholshouldbedevelopedandresourced

Focusandsupportthetransitiontoa‘wholefamily’approachwithinbothpolicy(HiddenHarm/ThinkChildThinkFamily)andservicedevelopmentsuchaspilotingevidence-basedfamilyinitiativesliketheStrengtheningFamiliesprogramme

Thereisaneedtodevelopandresourcemoreeducation/preventionworktargetedattheadultpopulation

ServicesforyoungpeoplespecificallyDiscussionsshouldbeundertakenbetweenPHAandBELBtoexplorebestpractice

inrelationtoaddressingdrugsandalcoholissues(frompreventiontocrisisresponse) withintheschoolsetting(primaryaswellaspost-primary)andtoagreeaconsistent approachwiththeintentofdisseminatingwider

BELBshouldconsultwiththoseprovidingservicestothosenotinschool/notinyouth clubsi.e.alternativeeducationestablishmentsaswellasdetachedyouthworkersto assesstheneedsoftheseyoungpeopleinrelationtodrugsandalcohol


TREATMENT AND SUPPORT


6

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TREATMENT AND SUPPORT


6


6 TreatmentandSupport

6.1 Whatdoestheevidencesay?Children,youngpeopleandfamiliesTheNICEguidance,Community-BasedInterventionstoReduceSubstanceMisuseamongVulnerableandDisadvantagedChildrenandYoungPeople(NICE,2007e)providesguidanceonrecommendedinterventions,includingtheuseofmotivationalinterviewingforproblematicsubstancemisusers.

NationalTreatmentAgencyguidance,DrugMisuseandDependence:UKGuidelinesonClinicalManagement(2007),recommendsthefollowinginterventionsforyoungpeople:Briefinterventionsmaybeusefultodivertyoungpeoplewithless-severesubstancemisuse

problemsawayfromdevelopingmoresevereproblemsandsubstance-relatedharm.Moreintensesubstancemisusetreatmentepisodesmayberequiredforthosewithmoresevere

problems,perhapsinvolvingfamilyandtheyoungperson.Aminorityofunder-18sarelikelytorequirelonger-termretentionintreatment.Forthosewith

complexneeds,substancemisusetreatmentshouldbesetwithinthecontextofawiderpackageoftreatmentdeliveredbymainstreamchildrenandfamilyhealth,socialandeducationservices.

Thereisasignificantevidencebasefortheuseoffamilytherapyintreatingsubstancemisuseamongyoungpeopleincluding:NationalInstituteonDrugAbuse(2009),PrinciplesofDrugAddictionTreatment:AResearch

BasedGuide,2ndEdition http://www.nida.nih.gov/PDF/PODAT/PODAT.pdfNationalInstituteonDrugAbuse(2001),EffectiveDrugAbuseTreatmentApproach

http://www.nida.nih.gov/BTDP/Effective/Liddle.htmlCentreforTreatmentResearchonAdolescentDrugAbuse,UniversityofMiami

http://www.med.miami.edu/CTRADA/x14.xml

AdultsThereisextensiveevidencefortheimpactofbriefadvice,particularlyinprimarycaresettings,

inreducingharmfulalcoholconsumption.Howeverthereissomedisagreementaboutwhetherimpactsfoundinresearchprojectswillbereplicatedinnormalpractice:

‘Alcohol-usedisorders-preventingthedevelopmentofhazardousandharmfuldrinking’ http://www.nice.org.uk/nicemedia/live/13001/48984/48984.pdfThereisconsistentevidencethatbehaviouralandpharmacologicaltherapiesareeffectivein

treatingalcoholusedisorders.(Anderson2009)Theeffectivenessofwell-delivered,evidencebasedtreatmentfordrugmisuseiswell

established.UKandinternationalevidenceconsistentlyshowthatdrugtreatmentcoveringdifferenttypesofdrugproblems,usingdifferenttreatmentinterventions,andindifferenttreatmentsettingsimpactspositivelyonlevelsofdruguse,offending,overdoseriskandthespreadofblood-borneviruses(Hubbardetal.,1989;1997;Wardetal.,1998;Simpsonetal.,1999;SorensenandCopeland,2000;Gossopetal.,2003;Hseretal.,2005).

TheNationalTreatmentOutcomesResearchStudy(Gossop,2001)showedthat,forasignificantproportionofthoseenteringtreatment(betweenaquarterandathird),drugtreatmentresultsinlong-termsustainedabstinence.

TheNationalInstituteforHealthandClinicalExcellencepublishedtwotechnologyappraisals(NICE,2007a;2007b)andtwoguidelines(NICE,2007c;2007d)onarangeofdrugtreatmentinterventions,whichendorsemuchofthemainstreamdrugtreatmentprovidedintheUKasevidencebasedandcosteffective.(Dept.ofHealth2007)

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ACochraneReviewoftheeffectivenessofAlcoholicsAnonymousand12-stepprogrammesingeneralfoundthat,whileparticipationinsuchprogrammesmayhelptokeeppeopleintreatment(evidenceforthiswasnotconclusive),therewasnoevidencethatAAor12-steptreatmentswereanymoreeffectivethanothertreatments.(Ferrietal2006)

6.2 ScaleoftheproblemRegisteredaddicts(infoprovidedbyPHIRB)Therewere288personsregisteredontheNorthernIrelandAddictsIndexat31December2009(81%male,24%aged29orunder,80%addictedtoheroin).

BelfastHSCThad98registeredaddictsat31December2009andthehighestnumberofnewaddictswerenotifiedfromwithintheBelfastHSCT(23in2009).However,thiscouldpartlybeattributedtothefactthatBelfastCommunityAddictionServicehasadedicatedserviceforinjectingheroinandcocaineusers(theDrugOutreachTeam).

NeedleandSyringeExchangeScheme(infoprovidedbyPHIRB)In2009/10,therewere15,828visitstoparticipatingservicesacrossNIbyusersofthescheme(anincreaseof18%onthe2008/09figure).Eighty-sixpercentofvisitswerebymaleclientsandoverhalf(53%)ofallvisitsweremadebyindividualsaged31orolder.

ThelargestagegroupaccessingserviceswithintheBHSCTareawerethoseaged36-40accountingfor23%ofthetotal,and85%ofclientsateachvisitweremale.Therewereatotalof6,593visitstoBelfast-basedservices(41%oftheNItotal)andatotalof49,075syringesissued(40%oftheNItotal).

HepatitisC(infoprovidedbyCDSCNI)InfectionwithHepatitisCvirusisassociatedwithintravenousdruguseorbloodproducts.In2009,therewerea112labreportsofHepC(provisionalfigure).Ofthe112casesrecorded;twowereagedunderayear,sixty-sevenwereaged15-44years,thirty-fourwereaged45-64years,eightwereaged65oroverandoneperson’sdateofbirthwasunknown.

SubstitutePrescribingScheme(infoprovidedbyPHIRB)InNorthernIrelandduring2009/10,atotalof576individualswereincontactwithsubstituteprescribingtreatmentservicescomparedto550in2008/09.

On31March2010,466individualswerereceivingsubstituteprescribingand457ofthosehadbeenstabilised(52%onmethadoneand47%onbuprenorphine).Themeanageofclientswas35yearsandalmostthreequarters(72%)weremale.

TheBelfastHSCThadthesecondhighest(aftertheNorthernHSCT)incidenceofreferralsforsubstituteprescribing(45clientsper100,000population).Bothoftheseareashavewellestablishedserviceswhowouldworkwithinjectingdrugusers(mainlyheroinusers)withtheaimofsignposting/redirectingthemintotreatmentservicessuchastothesubstituteprescribingteams.

DrugMisuseDatabase(infoprovidedbyPHIRB)InNorthernIrelandduring2009/10,2,008individualspresentedfortreatmentandconsentedtotheirdetailsbeingincludedintheDMD(anincreaseof14%onthepreviousyear).Themajorityofclientsweremale(72%)andaswithpreviousyearcannabisremainedasthemostcommonlyreportedmain


drugofmisuse(42%).

Intotal1,427clients(67%male)presentedtoEasternarea-basedtreatmentservicesfordrugmisusein2009/10(ariseof29%onthe2008/09figureof1,102).

Eastern-areatotalbyagerangeofclientspresentingfordrugmisusein2009/10:

Agerange Total

17andunder 34

18-21 197

22-25 208

26-29 200

30-39 332

40andover 455

Unknown 1

Total 1,427

Ofthese1,427clients1,184(83%)presentedtoBelfast-basedservices(ascomparedto1,102in2008/09)andsixty-eightpercentoftheseclientsweremale.

Ofthe1,184overhalf,775clients(68%),wereseenbythestatutoryBelfastCommunityAddictionService(DOTfigureexcludedasnotprovidedbyPHIRB)–brokendownasfollows:

S&EBelfastCAT 33

N&WBelfastCAT 311

Prescribedmedicationservice 334

Drugarrestreferralproject 97

Community/voluntaryservices(CHILL-OpportunityYouthfigureexcludedasnotprovidedbyPHIRB)sawafurther397clientsfordrugmisuse–brokendownasfollows:

AddictionNI 172

AddictionNI-RATSDAM 87

Dunlewey 93

FASA 45NBAddictionNIwereformerlyknownasNICAS

Aswithpreviousyearsthemajorityofthe1,184clientsreportedcannabisastheirmaindrugofmisuse(34%)closelyfollowedbybenzodiazepines(30%).Acommonperceptionisthatbenzodiazepinesaremisusedmorebywomenthanmenbutofthe360clientsreportingproblembenzousetherewasmoreorlessanequalgendersplit(48%male/52%female).Sixty-ninepercentofclientsaged17andunderreportedcannabisastheirmaindrugofmisuseascomparedwith26%ofthoseaged26yearsandolder(38%ofthisagegroupreportedbenzosastheirmaindrugofmisuse).

Ofthe1,184clientsseenbyBelfast-basedservices,223(19%)reportedhavingdependentchildrenandthemaindrugofmisuseforthemajorityoftheclientswerebenzodiazepines(50%).

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ClientpostcodeanalysisAtotalof960clientswhopresentedtoservicesfordrugmisuseintheEasternareain2009/10residedintheBHSCTarea.

Atotalof297residedinSouthandEastBelfast(includingCastlereagh).ThetopthreewardsfornewdrugreferralsinthislocalitywereBallymacarrett(87),Botanic(61)andWoodstock(38).

Atotalof663residedinNorthandWestBelfast.ThetopthreewardsfornewdrugreferralsinthislocalitywereFalls(204),Legoniel(139)andShankill(126).

Alcoholreferrals(infoprovidedbyEDACT)AlcoholreferralstoEastern-areabasedtreatmentservicescontinuetoriseyearonyear–from3,039newclientsin2007/08,to3,372in2008/09,to4,485in2009/10(63%male).

Eastern-areatotalbyagerangeofclientspresentingforalcoholmisusein2009/10:Agerange Total17andunder 10818-21 16722-25 20326-29 24030-39 63140-49 68050-59 37660andover 172Unknown *1,908Total 4,485NB*BHSCTwereunabletoprovideagerangeinformationfortheir1,901clientsin2009/10

Ofthe4,485atotalof1,901clients(42%)wereseenbythestatutoryBelfastCommunityAddictionService(BCASreceivedafurther1,826referralswhodidnotattend/engage).

Thecommunity/voluntaryservices;CarlisleHouse,DAISY,Dunlewey,FallsCommunityCouncil,FASAandAddictionNI,andmostofwhicharebasedinBHSCTarea,sawafurther1,438clients(32%)foralcoholmisuse.

ClientpostcodeanalysisAtotalof2,879clientswhopresentedtoservicesforalcoholmisuseintheEasternareain2009/10residedintheBelfastLocalCommissioningGrouplocality.

ThetopthreewardsfornewalcoholreferralsintheBelfastLCGlocalitywereFallsandShankill(both162),Shaftesbury(131)andLegoniel(125).


Drugandalcoholmisuseamongstyoungpeople(infoprovidedbyPHIRBviaRIMT)In2009/10theDrugandAlcoholInterventionServiceforYouth(DAISY)deliveredinpartnershipbyOpportunityYouthandASCERTsawatotalof251youngpeoplewithsubstancemisuseissues(223oftheseclientsweredirectlyaffectedand28wereindirectlyaffected).Seventy-twopercentofclientsseenduringthisperiodweremale.

Theyoungestpersondirectlyaffectedwas9yearsofage(usingalcohol)andtheyoungestpersonindirectlyaffectedwas8yearsold.Agerange Total12andunder 1913-15 8716-18 11319-22 8Unknown 24

Themajorityofclientsaffecteddirectlyreportedalcoholastheirmaindrugofmisuse(128).Ofthe95clientswhoreportedmisusingdrugsalmostthree-quarters(73%)weremisusingcannabis.

Ofthe251clientsseenbyDAISYin2009/10,51%(129)residedintheBHSCTlocality(5%ofclientsresidedoutsideoftheEasternareaortheirpostcodewasn’trecorded).

Prescribedmedication(infoprovidedbyHSCB)Atotalof604,346scriptsfor*Benzodiazepineswerewrittenin2009,intheEasternareaatatotalcostofover£1.5millionpounds(NItotalforsameperiodwas1,443,145scriptscostingjustover£3millionpounds).*BenzodiazepinesincludeChloradiazepoxide,Diazepam,Lorazepam,Lormetazepam,Nitrazepam,Oxazepam,Temazepamandthe‘3Z’drugs–Zalepon,ZolpidemandZoplicone.

Atotalof393,356scriptsforbenzodiazepines(for13,818,116tablets)werewrittenoutin2009intheN&WandS&EBelfastLHSCGlocalitiesatacostof£917,676.

LHSCGlocality 2009 2008 2007TotalScripts TotalScripts TotalScripts

S&EBelfast 169,033 163,775 165,330N&WBelfast 224,323 231,919 241,639Belfasttotal 393,356 395,694 406,969

Upuntilthestartof2010,HSCBfurtherbrokedowntheEasternareadatabyLocalHealthandSocialCareGrouplocalities–NBtheLHSCGsdisbandedin2006.From2010onwardsthisdatawillbebrokendownbyLGDarea.

Ascanbeseenfromthetableabovebenzodiazepineprescribingonthewhole(itroseslightlyinS&EBelfastfrom2008to2009)inBelfastcontinuestosteadilydecreaseyearonyear.ServicessuchastheBHSCT-basedprescribedmedicationservice(PHA/EDACTfunded)whichworkswithGPsurgeriestoraiseawareness,helpreduceprescribinglevelsandassistpatientstodecrease/desistusealongwiththeHSCB-basedprescribingadviserswhoalsoofferadviceandsupporttoGPshavehadanimpactincontributingtothisreduction.

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HospitaladmissionsDrugandalcohol-relatedadmissionstoEastern-areabasedhospitalscontinuetoriseyearonyear–from2,022in2008/09,to2,216in2009/10(basedonprimarydiagnosis)andafurther4,277in2008/09and4,346in2009/10(basedonsub/secondarydiagnosis).

Primarydiagnosisadmissionsaremostlymale(68.8%in2009/10)andaverageagewas43years.Therewere4.7timesasmanyadmissionsforalcohol(1,830in2009/10)asdrugs(386).Themajorityofadmissionsin2009/10wereinanemergency(2,100asopposedto104planned),and85.8%ofthesewereaged26orolderhoweverjustover3%(69)ofprimarydiagnosisadmissionswereforthoseaged16orunder.

In2009/10therewereatotal1,083primarydiagnosisalcohol-relatedadmissionstoBelfast-basedhospitalscomparedto223drug-relatedadmissions.

PrimaryDiagnosis BelfastCity Mater RoyalVictoria WindsorHouse

TotalAlcohol 338 300 442 3

PrimaryDiagnosis BelfastCity Mater RoyalVictoria WindsorHouse

TotalDrug 81 84 56 2

TotalCombined 419 384 498 5

NBPeoplewhoattend/areadmittedtoBelfast-basedhospitalsmaynotnecessarilyresideintheBHSCTarea.

Drugandalcohol-relateddeathsThemostsizeableinequalitygapsbetweendeprivedareasandNorthernIrelandoverallwereevidentinalcoholrelateddeaths(121%higher),drugrelateddeaths(113%higher),admissionsforself-harm(94%higher),teenagebirths(80%higher),suicide(73%higher),respiratorydeathrates(66%higher)andlungcancerincidence(65%higher).Northern Ireland Health and Social Care Inequalities Monitoring System (NIHSCIMS), Third Update Bulletin 2009

Alcohol-relateddeaths(providedbyNISRA)In2009,therewere283alcoholrelateddeaths;187menand96women.Thisisamarkedincreasefromtenyearsagowhentherewere174alcoholrelateddeathsrecorded.

Thealcoholrelateddeathraterosebyaround10%between2005and2008inbothdeprivedareasandNorthernIrelandgenerally.Despitesomeminorfluctuationsinthegapacrosstheperiod,thedepriveddeathratehasremainedlargeataround120%higherthantheNIrate.Northern Ireland Health and Social Care Inequalities Monitoring System (NIHSCIMS), Third Update Bulletin 2009

Northern Ireland Health and Social Care Inequalities Monitoring System (NIHSCIMS),


Sub-regional inequalities – HSC Trust 2010 Thelargestsub-regionalinequalitygapsbetweenthehealthoutcomesexperiencedinthemostdeprivedareasinBelfastTrustandtheTrustitselfoccurredinalcoholrelatedmortality(103%),self-harmadmissionstohospital96%)andteenagebirthrates(93%).

Overtheperiod(2001-2008)theincreaseinalcoholrelatedmortalitywithintheBelfastTrustanditsmostdeprivedareas(2%and3%respectively)grewataslowerratethaninNIoverall(10%increase).Despitethis,thealcoholrelateddeathrateinBelfastTrustwasstill69%higherthaninNIin2008.TheStandardisedDeathRate(SDR)indeprivedareaswasconsistentlydoublethatintheoverallTrustacrosstheperiod.

Locality 2004-2008

Deathsper1000population

BelfastdeprivedSOAs 48.8

BelfastTrust 24

NI 14.2

Drug-relateddeaths(providedbyNISRA)In2009,therewere84drugrelateddeathsinNorthernIreland.Thisisamarkedincreasefromtenyearsagowhentherewere50drugrelateddeathsrecorded.

Thereareproportionatelyfewerdeathsinvolvingheroin/morphineandmethadone.However,thereisagreaterroleplayedbyhypnotics/sedativesandanti-depressants.Therelativelyhigherinvolvementofhypnotics/sedativesissimilartothepatterninScotland,andtoalesserextentinWales(asopposedtoopiatesinEngland).

AlthoughthenumberofdrugrelateddeathsinNorthernIrelandarerelativelow,thestandardiseddeathrateduetodrugrelatedcausesincreasedsteeply(byalmost40%)inbothdeprivedareasandNIasawholebetween2005and2008.DrugrelatedmortalityindeprivedareaswasconsistentlymorethandoubletheNIratethroughouttheperiod.Northern Ireland Health and Social Care Inequalities Monitoring System (NIHSCIMS), Third Update Bulletin 2009

6.3 What’sinplace?

StatutoryprovisionThissectionoutlinesthemaindrugandalcoholfocusedtreatmentandsupportservicesinplaceacrossBelfast.Itshouldberememberedthattheseservicesareinadditiontotheservicesprovidedbyprimarycare.

AlltheservicesonthefollowingpageareadultservicesmanagedbytheBHSCT’sBelfastCommunityAddictionService(BCAS)withtheexceptionoftheDrugandAlcoholMisuseMentalHealthService(DAMMHS)whichworkswiththoseaged17andunderandwhichisaccessedviaCAMHS.

NB For a description of the tiered approach to service provision please refer to Appendix 2

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TIER 1AlcoholHospitalLiaisonServicesProvidesarangeofassessment,care,treatmentandsupportserviceswithinA&Eandmedicalwards.CurrentlybasedwithintheMaterandRVHhospitals.ServicealsoplannedforBelfastCity.

TIER 2DrugArrestReferralScheme(DARS)Triageandassessmentservicesforindividualswhoarearrestedforcrimesrelatedtotheirdrug/alcoholuse.

DrugOutreachTeam(DOT)Lowthresholdserviceforinjectingdrugusers.

AssertiveOutreachServiceBCASprovidesanassertiveoutreachserviceinpartnershipwithanumberofvoluntaryagenciesforthosewhoareidentifiedasvulnerableandatriskandhavefailedtoattendtheirinitialappointments.

TIER 3CommunityAddictionTeams(CATs)Providearangeofassessment,care,treatmentandsupportservicesthroughouttheTrustareaincluding:AlcoholdependencywithdrawalprogrammesManagementofwithdrawalfrombenzodiazepinesandClassA,BandCillicitdrugsAlcoholAssertiveOutreachServiceinpartnershipwithvoluntarysectorproviders

AddictionDayTreatmentServices(ADTS)Psychologicalinterventionssuchassolutionfocusedtherapy,motivationalinterviewing.Patienteducationprogrammesincludingaccesstoalternativetherapiessuchasreflexology,

acupunctureandIndianheadmassage.DailyopiatedetoxificationFamilysupportservicesPatientsupportgroups

SubstitutePrescribingTeam(SPT)Opiatesubstituteprescribingservice.

PrescribedMedicationTeamProvidesadedicatedprescribeddrugmisuseserviceinprimarycareassistingGPstoidentifypatientswhoarebenzodiazepinedependentandtosupportthepersontoreducetheirdependence.

DrugandAlcoholMisuseMentalHealthService(DAMMHS)Theserviceworkswithyoungpeopleaged17andunderwhoareexperiencingmentalhealthproblemsrelatedtotheirsubstancemisuse.ItispartofCAMHSandismanagedbyBelfastHSCT.

TIER 4BelfastTrustdoesnotprovideaTier4adultinpatientservice.IthasacontractwithCarlisleHouseTreatmentCentreproviding6bedsforBelfast.Youngpeoplewithdualdiagnosisproblemscanbereferredtotheregionalin-patientCAMHSservicewhereappropriate.


Voluntary/CommunityProvisionTIER 1 and 2FASAFASAhastwoofficesinBelfast,ontheWoodvaleandShankillRoads,providingarangeofeducation,supportandmentoringservicesaswellasalternativetherapies.Servicesareavailabletobothyoungpeopleandadultsandfamilies(FamilyMattersProject).

ExternThealcoholtenancysupportprojectprovidessupporttovulnerableadultsinmaintainingtheirtenanciesandworkstopreventtheiralcoholissuesdeterioratingfurther.

DAISYThisserviceprovidesarangeofsupportandinterventions,includingmentoringanddiversionaryactivities,foryoungpeopleexperiencingsubstancerelatedharm.Serviceisprimarilyforthoseaged17andunderbutwillacceptreferralsofyoungpeopleagedup21whereappropriate.

RISEFoundationServiceprovidesafamilyprogramme(grouptherapybasedresidential)andacommunityeducationandtrainingprogramme.

FallsCommunityCouncilThecommunitydrugsprojectprovidessupporttofamiliesexperiencingproblemsasaresultofsubstancemisuse.

TIER 3FASAServicehastwoofficesinBelfastprovidingcounsellingforindividuals(youngpeopleandadults)andtheirfamiliesaffectedbysubstancemisuse

DunleweyServicehasoneofficeinBelfastprovidingacounsellingandstructureddayprogrammeforindividualsover18andtheirfamiliesaffectedbysubstancemisuse

NICASServicehasthreeofficesinBelfastprovidingcounsellingforindividualsover18andtheirfamiliesaffectedbysubstancemisuse.

NICAShasaspecialistserviceforthoseagedover55–CounsellingforOlderPeopleatHome(COPAH)andalsodeliverstheRATSDAMservicewhichworkswithoffendersreferredfromthecourts.

PharosServiceprovidesasupportandinterventionserviceforfamiliesaffectedbysubstancemisuse.Servicesareavailableforboththeparentsandchildren.

DAISYThisserviceprovidescounsellingandstructuredfamilysupportforyoungpeopleexperiencingsubstancerelatedharm.Anintensivesupportpilotforchaoticusersisalsoavailableforalimitednumberofyoungpeople.Serviceisprimarilyforthoseaged17andunderbutwillacceptreferralsofyoungpeopleagedup21whereappropriate.

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TIER 4CarlisleHouseServiceprovidesa4-8weekresidentialprogrammefordrugandalcoholusers.Thereare6bedsreservedforreferralsfromBelfast(HSCT)CommunityAddictionServices.

In addition to the above, many other community based services particularly those providing mental health interventions and generic counselling offer treatment and/or support to people with drug and alcohol problems. However, scoping these services is outside the remit of this report.

SelfhelpgroupsTherearealsoarangeofselfhelpgroupsinexistenceacrosstheTrustareabasedonvariousmodelsincludingthepopular12-stepapproach(suchasadoptedbyAA,NA,Alanonetc.)–theseareeitherrunindependentlyorinsomeinstancesareofferedorsupportedbyaddictionservices.

6.4 GapsGeneralConsiderhoworganisationscanworktogethertoensurethatpeoplereceivethesameservice

irrespectiveofwhateverservicetheyenter(‘Nowrongdoor’agenda)Awarenessofoverlapamongstservices–eatingdisorders,drugsandalcohol,mentalhealth

andgambling–focusonaddictionsRemovecompetitionandproviderscompeting–needtolookattheissue(s)collectivelyNeedtobeabletotrackpeople/clientsacrossservicesThereneedstoberecognition,andtrackingof,servicesabilitytorespond

Informationon/promotionofservicesLittleknowledgeonthegroundaboutTrustservices–especiallyre.howtoaccessthemand

whattodoinacrisissituationGPs,ingeneral,havelittleknowledgeaboutcommunityservicesandwhattheycanoffer

yettheyarethefirstpointofthecontact(needtobeawareofallavailableprovisionnotjuststatutory,capacitytorespondandhowtoaccess)

Needstobeappropriateandtimelyfollowuptocrisisincidents(especiallywithinA&E–cardbeforeyouleaveschemeastartbutpooruptakereportedanecdotally)

Servicedevelopment/deliveryCommissionersneedtorecognisetheneedforflexibility–6or8sessionsisn’tenoughforthe

majorityofclients–ifservicescouldofferlongertermtreatment(whichisproventobemoreeffective)itwouldallowtimetoexploreotherimpactingissuesandultimatelyhelptobreakthecycleofreturningclients

Needstobearangeofmodelsoftreatmentavailable(includingearlyandbriefinterventionsaftercareservicesandpostventionsupportforclientsandfamilies)

Ensurethatservicesareaccessiblelocally–thatsupportisavailablewherepeopleliveNeedbetterservicesinplaceforpeoplewhoneedhelpandsupportbutnotfullblown

treatment(i.e.largerpopulationdrinkinghazardouslythandrinkingdangerously)Exploringtheneedforaresidentialrehabfacilityforyoungpeople(suchastheICAPinitiative)Dualdiagnosisisabigissue–criteriaforaccessingstatutoryservicesistoorigidandasa

resultcomm./vol.servicesareholdinglargenumbersofclientswithco-morbidityissues–thereneedstobeawiderrangeofsupportservicesavailableandthecomm./vol.sectorneedstobeadequatelyresourcedtorespondappropriately

Widerangeofsupportneedswiththosegroupswhofallshortofthecommunityaddictionteamand/orthementalhealthteamcriteria

FamiliesThedevelopmentofspecificfamilybaseddrugandalcoholservicesistobewelcomedbut

securefundingfortheseservicesremainsaconcern


Thereisgeneralagreementamongserviceprovidersthattheneedsoffamiliesarenotaddressedsufficiently

Needstobewidersupportavailableforfamilieswherethe‘addict’isn’tengagedintreatment(stat.servicescanonlyworkwithfamiliesofclients)

Theremaybemeritinlookingathowtheconceptof“enabling”canhelpinformhowtosupportfamiliesinaddiction

6.5 TreatmentandsupportrecommendationsInformationon/promotionofservicesNeedtoensurethataplannedandtargetedapproachistakentowardsdisseminatingand

promotingasharedunderstandingaboutexistingprovision,capacityandreferralpathwaysDHSSPS/PHA/HSCB/HSCTsshouldinvestigatethedevelopmentofaco-ordinateddata

contentmanagementsystemtoensurethatagreedinformationandprotocolsareenforced,therebypromotinglessduplicationandensuringthattheindividual’sneedsarebestmetacrossallservicesandsectors

Servicedevelopment/deliveryWhendesigningtendersandcontractscommissionersshouldembedaprocessofengaged

flexibilityintohowcommissionedserviceswillbedeliveredi.e.itshouldbeprimarilyaboutmeetingtheneedofclients

Thoseresponsibleforcommissioningservicesshouldensurealltreatmentandsupportservicesadoptawholefamilyapproachtotreatingdrugandalcoholaddictionandthataftercare/followonsupportisbuiltinasanessentialelementforbothclientsandtheirfamilymembers

PHA,andspecificallytheBamfordSubstanceMisuseGroup,shouldbesupportedinundertakingtheplannedreviewofaddictionservices:theplannedreviewshouldensurethatthereareadequateservicesavailableateachtier(tomeetneed)forbothadultsandyoungpeopleandthatservicesareabletoprovidearangeoftreatmentmodelstobothclientsandtheirfamiliesasappropriate

Inrelationtodualdiagnosis(specificallymentalhealthandaddiction)PHAandBHSCTshouldestablishaworkinggroupwiththegoalofcreatingaseamlessreferralpathwayforpeoplepresentingwithcomplexneedsconsistentwiththetheoryof‘nowrongdoor’

Considerationshouldbegiventodevelopingacrosstraining/placementprogrammeforthoseworkingintheaddictionsandmentalhealthfields

Crisisresponse:actionneedstobetakenatanumberoflevelstoensureplannedandevidence-basedcrisisresponsei.e.thosewhofund/commissionservicesneedtoensurethatcrisisresponseisbuiltintotheserviceprovisionandatcommunitylevelthereneedstobeawarenessraisinginrelationtowhattodoandhowtoaccessservicesforpeopleincrisis

SPECIFIC SERVICES FOR VULNERABLE GROUPS


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SPECIFIC SERVICES FOR VULNERABLE GROUPS


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7 Specificservicesforvulnerablegroups

AkeyprioritywithintheNSDADis‘TargetingthoseatRiskandVulnerable’,whichreferstobothyoungpeopleandadults.Inrespectofalcoholanddrugmisuse,anumberofgroupsweredescribedinthedocumentaspotentiallyvulnerable:Homeless,includingroughsleepersRefugeesandasylumseekersEthnicminoritiesPeoplelivingwithdomesticviolenceSexworkersEx-offendersVulnerableyoungpeople(i.e.younghomeless,looked-afterchildren,youngoffenders,school

excludees,andchildrenofsubstanceusingparentsOlderpeopledependentonalcoholand/ordrugsPeoplewithmentalhealthproblemsPeoplewithlearningdisabilitiesStreetdrinkersThoseexcludedfromcommunitiesbecauseoftheiralcoholanddruguse.

Itisrecognisedthatthisisnotanexhaustivelist,andassuch,whentenderingforservicestosupporttheneedsofvulnerablegroupsEDACTaskedthoseapplyingtooutlinethelevelofneedfortheparticulargroup(s)thattheywishedtocaterfor.

7.1 Whatdoestheevidencesay?Thereisarangeofevidenceavailableonawidevarietyofgroupsandtheirneedsinrelationtodrugsand/oralcoholmisuseataregional/worldlevel,althoughthereismuchlesslocal(NI)researchinexistence.ThisreportconcentratesforpracticalpurposesonpresentingevidenceforthegroupswhichEDACTcurrentlyfundsservicestosupport.

OffendersTheUKDrugPolicyCommission(2008)notesthattheevidencebasefordrugtreatmentinterventionswithinthecriminaljusticesystemisweak,andthatthisisaconsiderableimpedimenttothedevelopmentofpolicyandpractice.TheCommissionalsofoundhoweverthatthemodelofcounselling,assessment,referral,adviceandthroughcare(CARAT)seemstoworkeffectively.

McMurran(2007)foundthatcognitivebehaviouraltherapiesandmotivationalinterviewingwereeffectivewiththistargetgroup.TheeffectivenessofCBTgenerallyintreatingsubstancemisuseproblemsiswelldocumented.

HomelessTheScottishGovernmentpublishedareporton“EffectiveServicesforSubstanceMisuseandHomelessnessinScotland:EvidencefromanInternationalReview”in2008.Thisreport,producedbyNicholasPleace,CentreforHousingPolicy,UniversityofYork,foundthatsubstancemisuseamongthehomelesspopulationwasstronglyassociatedwithmentalhealthproblemsandwasmoreprevalentamongyounghomelesspeopleandlonehomelesspeople,withratesofsubstancemisuseamonghomelessfamiliesbeingonlyslightlyhigher,orthesameas,thegeneralpopulation.Theresearchalsofoundthatabstinence-basedserviceshadmuchlowerratesofsuccesswithhomelesspeoplethanharmreductionservices,withthefloatingsupportmodelbeingparticularlysuccessful.

Thereportacknowledgesthattheharmreductionserviceshavemorelimitedgoals,butmakesthepointthatservicesandcommissionersneedtosetrealistictargets.Thereportalsonotesthatthe

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interventionsbeingprovidedmayneedtobelong-termandthatsuchinterventionswillneedsecurefundingandthatthereareareaswherethenumberofhomelesssubstancemisusersdonotjustifyadedicatedserviceandthatmodificationofexistingservicesmaybemoreappropriate.Thereportalsomakesthepointthatamixtureofservicesneedtobeprovidedforthisgroupasthereisarangeofneeds.

Thisechoesthefindingsofthe‘ResearchintoHomelessnessandSubstanceMisuse’publishedbytheDHSSPSNIinSeptember2004.Thisreportrecommended“acontinuumofintegratedservicesinrelationtosubstancemisuseandhomelessness…appropriatetodifferentgroupswithdifferentneeds”(pg93)includingoutreachservices.Thereportalsorecommendedthedevelopmentofbetterlinksbetweentreatmentandaccommodationservices.

ElderlyAlcoholdependenceinolderpeopleisoftenunder-detected(O’Connelletal,2003)andunder-estimated(Mehtaetal,2006).Researchintothissubjectacknowledgesthatinordertoensureolderpeoplehaveaccesstotreatmentforalcoholdependency,anage-specific,outreachapproachshouldbedeveloped(Dar,2006).ItisenvisagedthattheBelfast-focussedresearchintosubstancemisuseintheolderpopulationwhichEDACTandtheBHDUhavecommissionedGEMSNItocarryout(anticipatedcompletiondateJune2011)willgiveamorelocalisedoverviewoftheneedsofolderpeopleaswellasthoseworkingwith/caringforolderpeoplewhohaveasubstancemisuseproblem.

“LookedAfter”YoungPeopleNICEguidanceliststhisgroupasasubsectionof‘vulnerableanddisadvantagedchildrenandyoungpeople’.Guidanceexistson“Community-basedinterventionstoreducesubstancemisuseamongvulnerableanddisadvantagedchildrenandyoungpeople”(NICE2007e).Thisguidancerecommendsastrategicresponsetotheissueofsubstancemisuseamongvulnerableanddisadvantagedchildrenandyoungpeople,uptoage25,andthatthefollowinginterventionsareused,dependingonthecircumstances:screeningandassessment,family-basedprogrammeofstructuredsupportovertwoormoreyears(11-16yroldsathighrisk);group-basedbehaviouraltherapyoveronetotwoyearsbeforeandduringthetransitiontosecondaryschool(10-12yroldsathighrisk;motivationalinterviewingforproblematicusers.

7.2 ScaleoftheproblemIn2008,EDACTcommissionedtheClinicalEffectivenessSupportUnitwithinKeeleUniversitytoundertakesomeresearchintotheneedsofvulnerablegroupsinrelationtosubstancemisusewithintheEasternarea.

Thekeyfindingsfromtheirscopingstudywereasfollows:Alcoholand/ordrugmisuseisasubstantialissueamongstvulnerableadultgroupsfora

varietyofreasons.Certaingroupsappeartobeatparticularrisk,andtheseareex-offenders,peoplewithmentalhealthproblems,peopleexcludedbecauseofsubstancemisuseissues,olderpeople,andsexworkers.

Mentalhealthissuesappeartobecommonacrossadultvulnerablegrouppopulations,andmentalhealthissuesareoftenaccompaniedbyotherproblematicissuesinindividuals’lives.

Beingvulnerableisnotnecessarilyaprerequisiteforalcoholand/ordrugmisuse.Rather,thereisamorecomplexrelationshipbetweenanumberoffactors,andthisrelationshipbetweenfactorshelpstodeterminewhetherornotavulnerablepersonhasasubstancemisuseissue.Thiscanbeexpressedascomplex,multipleissuescomingtogethertocreateaproblematicclusterinanindividual’slife.Forservicestoaddressthisclusteringofissuesintheserviceuserstheysupport,accountneedstobetakenoftheinterrelationsbetweenissues.

Organisationsworkingwithvulnerableadultgroupshaveahighlevelofawarenessabout


substancemisuseissuesinthesepopulations,areknowledgeableaboutspecialistsupportforsubstancemisuseissues,andarefamiliarwithgapsinprovisiontosupportvulnerablegroupswithalcoholanddrugmisuseissues.

HomelessnessTheResearchintoHomelessnessandSubstanceMisuse(DeloitteMCSLtd2004)commissionedbytheDHSSPS,whichinterviewed154homelesspeopleandconsultedkeystakeholders,indicatedthatsubstancemisuseisasignificantissueamonghomelesspeopleintermsofbothprevalenceofuseanddependency.Riskbehaviourswereassociatedwithsubstanceuseandtheincidenceofmentalillhealthamongthepopulationwashigh.Theresearchalsoindicatesthatsubstanceuseisafactorinbecominghomeless,repeathomelessnessandremaininghomeless.Thekeyfindingsarepresentedbelow:Themajorityofalcoholuseamongthehomelesssamplewasathazardouslevelsandaround

23-27%indicatedsymptomsofdependencyandharmfulalcoholuse.NorthernIreland-widestudiesindicatealowerlevelofhazardoususeamongthepopulationasawhole.

Theprevalenceofdruguseamongthestudy’shomelesssamplewasmuchhigherthanforNIasawhole–two-thirdsofthesamplehaduseddrugsandmorethanathirdwerecurrentdrugusers–almostalldrugusewasfoundtobeatproblemlevelsandtestsindicatedsymptomsofdependency.

Inthesample,mostdrugandalcoholusebeganbeforeindividualsbecamehomelessandtherewasastrongconnectionbetweenageoffirstsubstanceuseandageoffirsthomelessness.Howevertherewasalsoevidenceofpeoplebeginningtousesubstancesaftertheybecamehomelessandmorelimitedevidenceofpeoplestoppingsubstanceuse;althoughsomehadneverengagedinsubstanceuseatall.

Therewasahighlevelofriskbehaviourgenerallyamongthosetakingpartintheresearch–aroundhalfreportedsuicidalbehaviourandpracticingunsafesex;two-fifthswereinvolvedincriminalbehaviourandtwofifthsreportedself-harming.

Therewasahighincidenceofillhealthamongthesample,inparticularmentalillhealth–35%hadadiagnosedpsychiatricillnessand22%werereceivingtreatmentforpsychiatricillness.

RegionalImpactMeasurementTooldataforPHA/DACTfundedservicesfor2008/09EXTERNworkedwith88clientsintotalacrosstheBelfastHSCTarea(andalsohadcontact

withanother5).Justover77%ofclientsweremaleandallweremisusingalcohol.CHNIdeliveredatotalof41trainingcoursestoatotalof461participants(286female/174

male)acrosstheBHSCTandSEHSCTareas.AddictionNI’sRATSDAMservicesawatotalof276clients(98%male)acrosstheBelfastand

SouthEasternHSCTs.Alcohol(64%)wasthemostcommonlyreportedsubstanceofabuse.AddictionNI’sCOPAHservicesawatotalof141clients(55%male)acrosstheBelfastHSCT

area.Alcohol(94%)wasthemostcommonlyreportedsubstanceofabuse.Barnardos’PHAROSserviceworkedwith54familiesintotalacrossBelfastandSouthEastern

HSCTs.Injustover70%ofthefamiliesthemotherhadproblemswithsubstancemisuse,in15%thefatherandintheremaining15%bothparentshadissueswithsubstancemisuse.Alcohol(83%)wasthemostcommonlyreportedsubstanceofabuse.

7.3 What’sinplace?HomelessExtern’sMultidisciplinaryHomelessSupportTeamhastwomembersofstaffdevotedtopreventingtenancybreakdownduetoalcoholmisuse.

TherearearangeofhostelsinBelfastthatprovidetheirservicestothoseaffectedbyalcoholanddrugs.

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NIHE’sSupportingPeoplehavefloatingsupportservicesinplacetopreventtenancybreakdown;therangeofissuesaddressedincludessubstancemisuse.

CHNIprovidestrainingtothosewithintheaddictionandhomelessnessfields.

OffendersAddictionNI’sRATSDAMserviceforoffenders,referralsmadeviathecourtserviceandprobation.

ElderlyAddictionNI’sCOPAHserviceforolderpeopleprovidedintheirownhomeswhichoperatesonanopenreferralprocess.

VulnerableyoungpeopleRegionalInitialAssessmentTool:thePublicHealthAgencyisofferingkeystaffwithinagenciesworkingwithyoungpeople(i.e.youthjustice,socialservices,education,community/voluntaryyouthproviders,etc.)traininginhowtousetheRegionalInitialAssessmentTool(RIAT)forassessingsubstancemisuseinyoungpeople.Thistwo-daytrainingenhancestheirknowledgeofsubstances,servicesandappropriateinterventionstousewithyoungpeopleandthetoolitselfallowsthemtoidentifylevelofuse,associatedrisks,toassessneedsandmotivationandtorespondbyeitherreferringonorinterveningthemselves.Todate,YouthJusticeAgencycommunityservicesstaff,earlyinterventionprojectstaffwithinNIACRO,ActionforChildrenandExternandasmallnumberofsocialservicesstafffromtheBHSCTandSEHSCTareashavebeentrained.

StrengtheningFamilies:theBelfastHealthDevelopmentUnit(BCC,BHSCTandPHA)havejustcompletedapilotrunoftheStrengtheningFamiliesprogramme.This14-weekintensiveprogrammeistargetedathighstressfamilies.

DAISY:theyouthsubstancemisusetreatmentandsupportserviceprovidesarangeofinterventionstoyoungpeopleusing/misusingsubstancesandwillacceptselfreferralsaswellasfromstatutoryservicesfocussedonaddressingtheneedsofvulnerablegroupssuchaslookedafterchildrenandthoseintheyouthjusticesystem.

ThePHAROSservice:deliveredbyBarnardo’s,workstoaddressthe‘hiddenharm’agendaandofferstreatmentandsupporttofamiliesaffectedbysubstancemisuse.

7.4 GapsTherearelotsofgroupswhocouldbeclassedas‘vulnerable’todrugsandalcoholmisuseand

whodidn’tmaketheNSDAD’slistforexampletheLGBTgroup/communityThosewithmentalhealthissues(especiallythosewithanon-diagnosedordiagnosablemental

healthdisorder)areakeygroupForsomegroupsthereislittleornoknowledgeaboutwhattheirneedsareinrelationto

substancemisusei.e.ethnicgroups,Travellersandsoitwillbeimportanttoconsultandengagewithsuchgroupstofindouttheirneedsandwhatthebarrierstotreatmentare,orcouldbe,forthem

Itshouldbeuptothoseagencieswhorepresentvulnerablegroupstoassessandinformservicesaboutneeds

Servicesneedtobeawarethatclientsmayhavespecificneedsbecausetheybelongtooneormorevulnerablegroupsandbewillingandabletoworkwiththemwhentheypresenttoovercomeanybarriers


Itcouldbearguedthat,duetohealthinequalities,allthosewholiveinareasofdisadvantage,regardlessofgrouping,arevulnerable

Thoseworkingwithsubstancemisusingclientsarealsovulnerableandneedsupportandthissupportshouldbedeliveredinaconsistentandequitableway

7.5 SpecificservicesforvulnerablegroupsrecommendationsAprocessofsystematicengagementshouldbedesignedandsupportedincollaborationwith

thoseagencieswhorepresentvulnerablegroupstoenablesharingofinformationwithregardstodrugandalcoholneedsandbarrierstoaccessingexistingservices

DHSSPS,PHA,HSCBandBHSCTshouldconsidertheneedsofethnicminorities,specificallyinrelationtoaddressinglanguageandculturalbarrierswhenaccessingandavailingofdrugandalcoholservices,ensuringthatanappropriatepackageofsupportisputinplaceandthatbothserviceprovidersandclientsareawareofwhatthisisandhowtoaccessit

WORKFORCE DEVELOPMENT

8.1 What’s in place?8.2 Gaps/Issues 8.3 Recommendations

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WORKFORCE DEVELOPMENT

8.1 What’s in place?8.2 Gaps/Issues 8.3 Recommendations

8


8 WorkforceDevelopment

8.1 What’sinplace?TIER 1 and 2

ASCERTworkforcedevelopmenttrainingTheworkforcedevelopmentprogrammeisprovidedbyASCERT(fundedbyEDACT/PHA)targetingnon-specialistworkers/skillingthemuptobeconfidentandskilledinaddressingsubstancemisuse.Thecoursesarefreeandincludeaccreditedandnon-accreditedoptions.BelowisasummaryofwhatiscurrentlyavailablefromASCERT;Understandingapproachestoeffectivelyworkingwithandtreatingsubstancemisuse(5days/

OCNlevel3–6credits)Educatingandsupportingindividualsabouttheeffectsofalcoholanddrugmisuse(2days/

OCNlevel3–3credit)Practicalwaysofworkingwithsubstancemisusingclients:assessmenttoreferral(5days/

OCNlevel3–6credits)Understandingbriefinterventionapproachesandhowtousethemwithdrugandalcohol

misusingclients(2days/OCNlevel3–3credits)Puttingpreventionintopractice(5days/OCNlevel3–6credits)Additionalonedaycoursescovering;basicdrugawareness,legalhighs,alcoholandyoung

people,usingCBTapproaches,supportingandengagingclients,workinginprevention,conflictmanagementandtrainingintheuseoftheRegionalInitialAssessmentToolandspecifictrainingforfostercarers.

TakingtheLidOff(livingwithaddiction)trainingprogrammeASCERT,inpartnershipwithBarnardosandSEHSCTofferthefollowingcourses:Atwo-dayskills–developmentcourseaimedatthoseinroleswheretheymayencounter

substancemisusewithinafamilywhichwillenablethemtoidentifyandsupportindividualslivingwithaddiction/substancemisuse.

Ahalf-day‘IntroductiontoHiddenHarm’coursewiththeaimofincreasingtheawarenessoftheharmlivingwithsubstancemisusehasonfamilies,childrenandyoungpeopleandtheneedsofthosefamilymemberstoreducethatharm.

RegionalInitialAssessmentToolAgenciesworkingwithvulnerableyoungpeoplearebeingtrainedtoassessyoungpeople’sdrugandalcoholuse,todeliverinterventionsandhowtoreferontomorespecialistdrugandalcoholservicesasappropriate.TheYouthJusticeAgency,anumberofvoluntaryorganisationsnamelyExtern,NIACROandActionforChildren(earlyinterventionprojects)havebeentrainedintheuseofthetool–withsocialservicesandschoolcounsellingstaffcurrentlyconsideringthetraining/tool(PHAco-ordinating).

GPtrainingEDACT/PHAranthe‘HowMuchisTooMuch’coursewhichwasapilottrainingprogrammeforprimarycarecliniciansondeliveringbriefalcoholinterventionson11thMarch2009intheWellingtonParkHotelinBelfast.Thecourseprovidesasimplewayofidentifyingwhichpatientsaredrinkingatriskylevels(usingarangeoftools/materials),andasaresultwhoshouldbeofferedsimplestructuredadvice,amoreextensivebriefintervention,orwhoshouldbereferredontoamorespecialistservice.Twenty-fiveprimarycareprofessionalsworkingintheEasternareaparticipated.ThetraininghassincebeenevaluatedandisnowbeingconsideredforfurtherrolloutbythePHA.

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TeachertrainingAsstatedunderthesectiononeducationandpreventiontheEducationandLibraryBoardshaveresponsibilityfortrainingteacherstodeliveronthenewcurriculum.InadditiontothisLisburnYMCA,aspartoftheirfundingagreementwithEDACT/PHA,aretaskedwithensuringthatteacherswithintheschoolstheyaredeliveringinareultimatelyabletodelivertheSHAHRPprogrammethemselves.

BelfastCommunitySafetyPartnership/BelfastCityCouncilBCSPprovidesfreetraining,freeofcharge,tooff-licenceandbarstafftoencourageresponsibleservingwhichaimstoreducealcoholrelatedanti-socialbehaviour.In2009,twelvetrainingsessionswereheldwithatotalof135participantsattending.

TIER 3 and 4

CHNItraining(alsospansTier2)CHNIarefundedbyEDACT/PHAtodeliverarangeofbespokeandaccreditedtraining(fromknowledgeandskills-basedcoursestoseminarsandplacements)tostaffwithinthehomelessnessandsubstancemisusesectors.

EDACTranagrantsprogramme(2009-2011)foraddictiontreatmentservicestoidentifytheirworkforcedevelopmentneedsandhowtheycouldbemet.Thefollowinggroupsarecurrentlyfundedthroughthisprogramme:AddictionNI(formerlyNICAS)/FASACarlisleHouseBelfastHealthandSocialCareTrustASCERT/OpportunityYouth–DAISYstaff

NB Furthermore all services funded by EDACT/PHA are tasked with offering advice, support and training to external agencies as appropriate.

8.2 GapsNon-specialistworkersneedtobeskilledupinordertobeabletoassistpeoplewithdrugsand

alcoholproblemsFrontlineworkersneedtobeabletoassessriskandadequatelysignpostinrelationtoa

numberofissuessuchasmentalhealth,suicideandsubstancemisusethereforethistrainingshouldbelinkedwherepossible

Twodaytrainingisenoughtoraiseawarenessoftheissuebutisn’tlongenoughtodevelopskillsandconfidenceforpeopletoaddresstheissueinanygreatdepth

Itisunclearhowthequalityoftrainingprovidedisvalidatedandconsistencyensuredbothintermsoftheskillsofthestaffandintheservicesprovided

Forrealimpactthereneedstobeorganisational‘buyin’withtrainingmanagerstargetedandthetrainingembeddedintrainingschedules

Trainingneedstobeincorporatedintocollege/universityprogrammesforteachers,socialworkers,primarycareprofessionals,etc,itneedstobesubstantial,consistentandpartofthecoreprogrammeoftheirstudying

TrainingforGPsshouldinvolvethecomm/volsectoraswellasthestatutorysectorandshouldalsocoverawareness-raisingofservices

Ifneedbe,GPsshouldbepaidtoaddressdrugsandalcoholmisuse(DES)TrainingneedstobedevelopedaroundprescribedmedicationChurchesareakeytargetgroupfordrugandalcoholtrainingRegulartrainingforthoseprovidingteir3/4servicesiscrucialAstrategicregionalapproachisneeded:weneedtodefinewhoneedswhat,towhatlevel,and

tobeconsistentintermsofcontentanddelivery


8.3 WorkforcedevelopmentrecommendationsEDACTshouldundertakeareviewofwhattraininghasbeendelivered,tohowmany

participants(ateachlevel)whatnumbersandwhattheimpacthasbeenwithaviewtoinformingfuturestrategiccommissioningoftraining

Thereneedstobestrategicplanningandtargetingoftrainingi.e.PHA/EDACTshoulddevelopadrugandalcoholworkforcedevelopmentstrategywhichshouldidentifywhatleveloftrainingshouldbeprovidedtowhoandgiveclearguidancearoundwhatthattrainingshouldcoverandwhatitthenequipstraineestodo

PHA/EDACTshouldalsoexaminebestpracticeanddevelopguidanceonamodelofselfcarefortheworkforcewhichcanbetailoredtomeetthedifferentlevelsofriskresultingfromexposuretodrugandalcoholrelatedtrauma

Thoseresponsibleforcommissioningservicesshouldensurethatself-careforstaffisincludedasanessentialrequirementwithintenderspecsand/orcontractsforthosewhowillbeprovidingdrugandalcoholservicestoclients

Availabletraining,forbothspecialistandnon-specialiststaff,shouldbeevidence-basedandconsistentinitscontentandhowitisdelivered

PHA/EDACTshouldensurethatoneofthecoreelementsofallworkforcetrainingoffered/deliveredisaboutincreasingknowledgeofexistingcross-sectoralprovisiontoenablesignpostingorreferraltoappropriateservices

Across-sectoraltrainingmodel,toincludecrossplacements,shouldbedevelopedforthosesectorsand/oragencieswhointerfacemostwithaddictions(i.e.homelessness,mentalhealth,criminaljusticeandsocialservices)toallowfortransferofknowledgeandskills

Genericcounsellingproviders(private/stat/comm/vol)shouldbeofferedappropriatedrugsandalcoholtrainingwhichshouldcoverassessmenttechniquesandwho,andhow,tomakereferrals

PHAshouldadvocatefordrugandalcoholtrainingtobeincorporatedasasubstantial,consistent,corepartofcollege/universityprogrammesforteachers,socialworkersandhealthprofessionals

BriefinterventiontrainingforGPsshouldalsocoverawareness-raisingofservices(bothstatutoryandcomm/volprovision)andwherepossiblebedeliveredbyrepresentativesfrombothsectors

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SKILLING UP OF AND SUPPORTING COMMUNITIES


9


9 Skillingupofandsupportingcommunities

9.1 Whatdoestheevidencesay?Researchliteratureshowsahighassociationofalcoholanddrugproblemswithinequalityandthatwhererelativeinequalityislower,soarealcoholanddrugproblems.InNI,foragivenlevelofalcoholconsumption,peoplefromlowersocioeconomicgroupsareatincreasedriskofanalcohol-relateddeath,compoundedbyareaswithahigherdegreeofdisadvantage.(NorthernIrelandHealthandSocialCare,InequalitiesMonitoringSystem,3rdUpdateBulletin2009:alcoholrelateddeaths121%higherindeprivedareas)

Emphasisneedstobeonstrengtheningthesocialcapitalofcommunitiesandtheircapacitytodeveloptheirownpreventiveandharmreductionresponses.StrongevidenceexistsforinvestmentinearlyyearsprovisionsuchastheNurseFamilyPartnership.Scotland’sFuturesForum(2008)

CommunityActionInitiativesAddressingSubstanceMisuseThereisevidencethatcommunitybasedinitiativescanbeeffectiveinreducingarangeofproblemsassociatedwithdrinkinginlicensedpremises(e.g.noiselevels,customerbehaviour,aggressivebehaviour,etc.).Thisevidenceislargelyconcernedwithaction‘atacommunitylevel’,ratherthannecessarilyactionbyacommunity;thelevelofinvolvementoflocalcommunitiesvariesacrossthesestudies.ManyoftheproblemstackledbytheseprojectswouldcurrentlyinNIbeaddressedbyCommunitySafetyPartnerships,sotheevidencewouldseemtosupporttheCSPscontinuedengagementwithcommunitiestofindsolutionstolocalproblems.Theevidenceonthisissueisreviewedin:Anderson2009Evidencefortheeffectivenessandcost-effectivenessofinterventionstoreducealcohol-relatedharm,WorldHealthOrganisationRegionalOfficeforEurope.

Communitiesaremorelikelytogetinvolvedinresponsestodrugswhichareleasttightlyprofessionalised,e.g.educationandprevention,andleastlikelytogetinvolvedinactivitieslikelawenforcementandtreatmentwhicharemoretightlyprofessionalised.Thereisverylittlerobustevidenceontheeffectivenessofsuchcommunityactivities.Shineretal.(2004)

9.2 ScaleoftheproblemAlotofpeopleatcommunitylevelwanttobeabletoaddresstheissuestheyareseeinganddealingwithbutdonotknowhowtoengageeffectively.Thereisalsothefearthatfamiliesareafraidofbeingstigmatisedbystatutoryservices–itisoftenaviciouscircle.

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NeighbourhoodRenewalPartnershipsThereareatotalof14NeighbourhoodRenewalAreaPartnershipsinexistenceintheBelfastLocalGovernmentDistrictarea.EachofthesehasdevelopedaNeighbourhoodRenewalActionPlantopromoteregenerationoftheirareaandtoaddressidentifiedneedsorissuesofconcerns.Alloftheseplanshaveahealthandwellbeingelement,withsomehavingalreadyidentifiedspecificactionsinrelationtodrugsandalcohol.ItisacontractrequirementoftheCommunitySupportService(hostedbyFASA)thattheylinkinwith,andwherepossiblesupporttheworkof,theNRPsinrelationtosubstancemisuse.

NorthBallysillan/UpperArdoyneCrumlin/ArdoyneBelfast-InnerNorthLigoniel

SouthBelfast-InnerSouthBelfast-SouthWest

WestGreaterFallsColinUpperSpringfield/WhiterockLenadoonAndersonstownGreaterShankill

EastTullycarnetBelfast-InnerEast

InnerNorthCommunityHealthAuditTheInnerNorthBelfastNeighbourhoodRenewalpartnership

DuringJulytoSeptember2009,85peopleparticipatedinaCommunityHealthAuditconsultationthroughinterviewsorcompletingandreturningasurveyorquestionnaire.Thoseinvolvedintheconsultationcamefromthestatutory,voluntaryandcommunitysectors,andfromthecommunity.

Throughouttheconsultationtwomajorissuesofconcernwerefrequentlyraised:mentalhealthandemotionalwellbeinganddrugs,alcoholandsubstanceabuse/misuse.

AsaresultoneofthesuggestedactionfortheInnerNorthBelfastNeighbourhoodRenewalPartnership’sActionPlanis:Tobringtogethercommunity,voluntaryandstatutoryorganisationsprovidingsupport

servicestothoseabusingandmisusingdrugs,alcoholandothersubstances,andraisingawarenessabouttheuseofdrugsandalcohol;toagreeastrategyforlong-termstructuredintervention,withasharedvisionandstrategicapproachforInnerNorthBelfast.


SixYearsOn…StillBlottingitOut?RADICALtheNorthBelfastdrugandalcoholforumcommissionedthispieceofqualitativeresearch,carriedoutin2007,whichlookedattheimpactofalcoholandsubstancemisuseonfourcommunitiesinNorthBelfast(Ardoyne,Duncairn,NewLodgeandTiger’sBay)andwhetherthingshadchangedsinceasimilarpieceofresearchwascarriedoutin2001.Inthereportunderthesectionon‘CommunityWorkers–OverLoadedandUnderResourced’thefollowingwasnoted:

ProblemstatementCommunityworkersinNorthBelfastareacutelyawareoftheseriousproblemsofdrugandalcoholmisuseandtheimpactitishavingontheircommunities.Theyshouldbekeystakeholdersintheformulationofanystrategicresponseandoperationalactionbutarecurrentlyunabletodoanythingotherthan‘fire-fighting.’Thisisdue,astheysay,toalackofresourcesbutalsoinmanyinstancestoalackofinterestorapathywithinthecommunitiestheyserve.IssuesforconsiderationCommunityorganisationsandworkersareakeygroupforproviderstotargetinrelationtothetrainingandservicestheycanofferinrelationtosubstancemisuse.Again,itismorethanjustsendingthemaleafletoraservicedirectory–theyneedtobeequippedwiththein-depthknowledgeofwhatservicesdoandhowtheycanbeaccessed,and,intheirsignposting/firstpointofcontactrole,theywouldbenefitfromhavingsomeskillsintermsofbasicdrugawarenessandmotivatingpeopletogethelp.

9.3 What’sinplace?CommunityDrugAwarenessTrainingThistrainingisprovidedfreeofchargetocommunitygroupsbyASCERT,FallsCommunityCouncilandFASA.BespokecoursesareprovidedalongwithOCNlevel1,2and3courses.Level3coursesavailableinclude‘trainthetrainer’whichskillsparticipantsuptobeabletodeliversubstancemisusecoursesthemselves.

BelfastCommunityActionandSupportTeamThisservicesupportslocalcommunitiestoaddresslocalconcernsarounddrugandalcoholmisuse.Someoftheworklocalcommunitieshaveundertakenincludeskillinguplocalcommunityleaders,holdingdrugawarenesseventsandconsultations,planninganddeliveringeducationprogrammesforawiderangeoftargetgroupswithinthecommunity.

AsnotedearlierinthereportPartnershipBoards,andtheirHealthDevelopmentWorkersandHealthandWellbeingForumsinparticular,couldplayavitalroleinlinkingdrugandalcoholserviceprovidersandcommissionerswithlocalcommunity,voluntaryandstatutoryproviders.TheyalsohaveestablishedlinkswiththeNeighbourhoodRenewalPartnershipsintheirarea.

9.4 GapsAcriticalpointistheneedforunderstandingtheissueofaddictionanddealingwithitasan

illness,usingcompassionandempathy,withthosecommunityvolunteersandworkersallhelpingtoeducatefamiliesusingtheguidanceonearlysignsandsymptoms

Withregardtotheissueofalcohol,‘buyin’fromlocalcommunitiesisessential–the‘TotalPlace’approachcurrentlybeingconsideredbytheBHDUandbeingtrialledatamorelocallevelwithinMountVernoncouldprovideausefulmodel

OCNaccreditedtraining:thereneedstobebetterfollowupinrelationtothosetrainedand/orbettertargetingorstrategicselectionintermsofwhoisputforwardforthistraining(needto

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reachoutbeyondtheusualsuspectsandbeyondthoseworkingdirectlyindrugsandalcohol)Thereiscurrentlynomechanisminplacetoreportbackontraininganditseffectiveness

(qualityassurance)andthereisalackofsupportregardingputtingitintopracticeThereneedstobesomeworkdonearoundtheneedsofcommunityworkersintermsofwhat

trainingtheyfeeltheyneedasexistingcommunitydrugawarenesstrainingonlyequipsthemtobeawareoftheissueandtosignpostbuttheypossiblyneedmorein-depthorspecifictraining

CurrentlythereisalackofclarityabouttheroleofthosewhohavebeentrainedThereareopportunitiestodevelopvolunteersandtoexamineingreaterdepthwhatrolethey

couldplayThereisaneedforbothplannedandresponsivetraining/courses

9.5 SkillingupofandsupportingcommunitiesrecommendationsTocontributetotheexplorationofthedevelopmentofalocalityapproachtoaddressingdrugs

andalcoholmisuseinBelfastwithinacommunitysettingThequality,quantityandleveloftrainingprovisiondeliveredwithincommunitiestodateshould

beidentifiedandassessedandthisinformationshouldbeusedtoinformthefuturedirectionofcommunitydrugawarenesstraining

Clearinformationshouldbegivenaboutthecommunitydrugawarenesstrainingavailableinorderthatcommunityorganisationsand/orworkerscanmakeinformeddecisionsspecificallyaroundthedesired/requiredlevelofcompetencyinaddressingdrugandalcoholissues

Trainingorganisations,fundedtodelivercommunitydrugawarenesstraining,shouldworkwithkeycommunityrepresentatives/organisationstodevelopatrainingprogrammesuitedtotheirneeds(fromscreening/initialassessmenttoreferringonandinterveningifappropriate)


REDUCING AVAILABILITY


0

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REDUCING AVAILABILITY


0


10 ReducingAvailability

10.1 Whatdoestheevidencesay?Thereisstrongevidencefortheeffectivenessofpoliciesthatregulatethealcoholmarketincluding:Pricing/taxation.Outcomes: young drinkers tend to choose cheaper drinks.Managingtheavailabilityofalcoholbyrestrictionsonhoursanddaysofsaleandonthe

numberanddensityofoutlets,raisingtheminimumdrinkingageandtrainingofbarstaff(requiresreinforcementwithrefreshercourses).

Enforcement-salestounderagedrinkers/responsiblesales.Alcoholpricepromotion.Outcomes: point of purchase promotions is likely to affect the overall

consumption of underage drinkers.Actiononalcoholadvertising:thereisevidenceofsmallbutconsistenteffectsofadvertisingon

theconsumptionofalcoholbyyoungpeople.Restrictionsshouldfirsthavethesupportofcommunitiestoensureeffectiveness.(AndersonandBaumberg,2006;Hawksetal,2002;Boothetal2008;NationalDrugResearchInstitute,2007)

DrugsThereisevidencetoshowthat,despitetoughersentencingofsellersofcontrolleddrugs,anddespiteincreasingeffortsatinterdictioninternationally,pricesofthesesubstanceshavedecreasedbetween10%and30%overthepast10years,indicatingagreateravailabilityoftheseproducts.ReuterPandTrautmannF[Eds.](2009)

Retailpriceshavegenerallydeclinedinwesterncountries,includingthosethatincreasedthestringencyoftheirenforcementagainstsellers,suchastheUnitedKingdomandtheUnitedStates.Therearenoindicationsthatthedrugshavebecomemoredifficulttoobtain.Indeed,surveydatasuchasMonitoringtheFuture,showverylittleevidenceofchangesinperceivedavailability.Johnston et al. (2007)

10.2 ScaleoftheproblemPSNIseizuresAtotalof3,319drugseizureincidentswererecordedacrossNIin2009/10andasinpreviousyearscannabiswasthedrugmostcommonlyseized.Thestreetvalueofdrugsseizedamountedto£9,055,735and2,250peoplewerearrestedintotalacrosstheregion.

Therewere1,512seizureincidentsintheEasternareain2009/10andatotalof845arrests.ClosetohalfofallseizuresinNorthernIreland(46%),and38%ofarrests,occurredintheEasternarea.

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PSNISeizuresintheBelfastHSCTarea

DCUlocality Seizureincidents No.ofarrests

2009/10 2008/09 2009/10 2008/09

NorthBelfast 303 322 131 150

SouthBelfast 374 284 231 192

EastBelfast 157 137 89 84

WestBelfast 151 137 89 84

Castlereagh 69 49 21 32

BHSCTtotal 1,054 929 554 545

Almost70%ofseizuresandalmost65%ofarrests,intheEasternareain2009/10occurredintheBelfastTrustarea.

10.3 What’sinplace?PSNIhaveundertakenactionsagainstunderagedrinkingthroughoperationSNAPPER.InadditiontheyworkverycloselywithBCCundertakingjointenforcementsonlicensedpremisesandeventsinthecity.

DistrictPolicingPlansprioritisewhatissuesneedtobeaddressed.ManyoftheplanswithinBelfasthaveidentifiedunderagedrinkingasapriority.

Legislationisnowinplacetoallowfor‘testpurchasingofalcohol’withpilotsduetohappenbeforetheendof2010/11.Theschemeisamechanismforreducingtheamountofalcoholillegallysoldtopersonsunder18yearsofageinlicensedpremises.ItalsoallowsPSNItogatherevidenceregardingunderagesaleswithaviewtoprosecutingwhereappropriate,thosewhoarefoundsellingalcoholtominors.

DrugdisposalbinsarealsolocatedinanumberofGPsurgeriesacrossthecityandPSNIhavealsoestablishedprotocolswithsomelocalcommunity/voluntaryorganisationsforsuchbinstobelocatedintheiroffices.

BCCmonitorthesalesofButanegastounder18’s.Theyundertaketestpurchasinginrelationtothesellingofalcoholtominors.BCCalsoinvestigatecomplaintsinrelationtoconcernsabouttheuseofalcohol.

10.4 GapsProductplacementandsponsorshipofsportingeventsbyalcoholfirmsshouldbeaddressedThereisaneedtotacklecheapalcoholinsupermarketsanddialadrink/drugtaxifirmsWhilstproxybuyingisdifficulttoproveandtackle,itisanissuewhichneedstobeaddressed

(particularlyinrelationtoparentssupplying(buying)alcoholfortheirchildren)perhapsthroughawareness-raisingre.thedangers/risksifnotthroughenforcement

Otheroptions(ratherthanviaseizuresand/orprosecution)shouldbeexploredtotacklingunderagedrinkingsuchassignpostingtocomm/volservicesorthedevelopmentofjointinitiatives

Needtohaveservicesavailableattherighttimesforyoungpeoplei.e.eveningsandweekends


Needtolistentowhatyoungpeoplefeel/wantinrelationtobothalternativeandsupportservices

Legalhighsshouldbebannedorregulatedandmoreofafocusgiventothepremisessellingthemintermsofregulations

TheBHSCTprescribedmedicationserviceisunderresourcedandneedscomm/volservicesputinplacetosupportandcomplementit

Reducingtheprescribingof,andmisuseof,painmedicationisanotherkeyareafordevelopment

10.5 ReducingavailabilityrecommendationsTosupportthePHAandBCCtoadvocateforareductionintheavailabilityofalcoholby

legislativemeasures(e.g.minimumpricing,bans/restrictionsonpromotionsandadvertising)TosupportthePHAandBCCintakingonanadvocacyrolearoundreducingavailabilityofso

called‘legalhighs’Totestalternativeapproachestoreducingunderagedrinkingandtodevelopprotocols

betweenPSNI,BCCandrelevantcomm/volyouthdrugandalcoholserviceprovidersToidentifybestpracticeinworkinglocallywithsupermarkets,off-licencesandlicensed

premisestodevelopstrategicapproachesforreducingavailabilityPHAandHSCBtoinvestigatelevelsofpainmedicationprescribingandassesswhethera

specificresponseisrequired(suchashasbeentakenforaddressinghighlevelsofanti-depressantprescribing)

TACKLING SUBSTANCE RELATED CRIME/VIOLENCE


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TACKLING SUBSTANCE RELATED CRIME/VIOLENCE



11 Tacklingsubstancerelatedcrime/violence

11.1 Whatdoestheevidencesay?In2008SouthBankUniversityproducedareporton‘What works’ to tackle alcohol-related disorder? An examination of the use of ASB tools and powers in London.

Thereportconcludedthatitwasdifficulttoassesstheimpactofanyparticularinterventionbecause:1)thedefinitionsofalcohol-relateddisorderandASBarefluidandcontested;2)localstrategiesworktoachieveoverallaimsandhencetheintendedoutcomesforinterventionsareoftenmultipleandoverlappingandformpartofanoverallstrategy;3)alcoholuseiscloselyconnectedtoarangeofotherissuessuchasdruguse,mentalhealthconditionsandsocialexclusion;and4)acrossLondonthecontextsinwhichtheyareimplementedandthemechanismsthroughwhichtheyworkarediverse.

ResearchcarriedoutbyYoungetal(2008)suggeststhatthemainpredictorofalcoholrelatedanti-socialbehaviour(includingviolence)isapropensityforsuchbehaviourearlierinlifeandthatalcohol(mis)usemerelyexacerbatessuchbehaviour,ratherthanbeingaprimarycause.Thiswouldsuggestthatinterventionstopreventsuchbehaviourshouldfocusonearlyidentificationofthosewithsuchpropensities.

Violenceassociatedwithillegaldrugstendstobesystemicviolence,i.e.violenceassociatedwiththetradeinillegaldrugsratherthanviolentactsperpetratedbyusersofillegaldrugs.(Stevens et al 2009)

11.2 ScaleoftheproblemPSNIcrimesfordrugoffencesAcrossNI,in2009/10atotalof3,146crimesrecordedwerefordrugoffences(up5.8%on2008/09figure),ofthese668werefortraffickingoffenceswhilst2,478werefornon-traffickingoffences.

AcrossNI,in2008/09atotalof10,402peopleweresearchedunderPACE(PoliceandCriminalEvidenceAct1984)fordrugsandasaresultofthesesearchesatotalof695peoplewerearrested.

PSNIroadtrafficcollisionsThemostcommoncausesoffatalandseriousinjuryroadtrafficcollisionsinNIin2009/10were:Excessivespeedhavingregardtoconditions–158collisionsAlcoholordrugs(allroadusers)–112collisionsInattentionorattentiondiverted–81collisions

IntotalacrossNItherewere369injurycollisionswerealcoholordrugs(allroadusers)wasidentifiedastheprincipalfactorandintotaltherewere582casualties.Ofthese528,23peoplewerekilled,120seriouslyinjuredand439slightlyinjured.

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Tacklinganti-socialbehaviour(PSNIandBCSP)

PSNIdrugandalcoholanti-socialbehaviourincidentsrecordedintheBelfastHSCTarea

DCUlocality StreetDrinking Substancemisuse

2009/10 2008/09 2009/10 2008/09

NorthBelfast 333 407 0 2

SouthBelfast 141 184 0 2

EastBelfast 27 46 0 1

WestBelfast 300 159 0 4

Castlereagh 46 97 0 0

BHSCTtotal 847 893 0 9

*FromApril2009onwards‘Substancemisuse’dataisnowcountedunderthe‘Rowdy/Nuisance–Environmentaldamage/Littering’category.

BelfastCommunitySafetyPartnership

Month 2009/10 2008/09Unitsofalcoholseized

No.ofunderagecautions

Unitsofalcoholseized

No.ofunderagecautions

April 4,174 4

DatanotcollectedatthistimeMay 421 13June 544 10July 373 0August 103 2 446 5September 321 3 140 6October 365 11 433 7November 266 5 144 1December 38 3 140 7January 126 4 572 32February 818 20 1,118 14March 2,086 0 2,052 15Total 9,634 75 5,045 87

Over18’ssentforprosecutionunderalcoholbye-lawApril2009toMarch2010–576April2008toMarch2009–444


NIPrisonService(NIPS)statisticsTheinformationbelowrelatestothethreeoperationalsitesoftheNIPrisonServicenamely:HMPMaghaberry(Easternarea),HMPMagilligan(Westernarea)andHydebankWoodYOC(Easternarea).

Sentencedreceptionsfordrugoffences,2006/07to2009/10

2009/10 2008/09 2007/08 2006/07

Male 102 95 89 85

Female 2 4 2 5

%oftotalnumberofsentences

7.5% 7.2% 6.9% 7%

DrugfindsinformationNIPS,2007/08to2009/10

Year(MarchtoFebruary) 2009/10 2008/09 2007/08

Averageno.ofprisonerscommittedondrugrelatedcharges

135 119 122

Drugsdependencyoncommittal

Year(MarchtoFebruary) 2009/10 2008/09 2007/08

Alcohol 1,108 1,047 1,104

Cannabis 608 715 622

Prescriptiondrugs 220 258 154

Ecstasy 188 242 299

Heroin 101 100 34

Amphetamines 67 88 86

Voluntarydrugtesting

Totalno.ofvoluntarydrugtestsforperiod 4,660 4888 3,989

Totalno.ofnegativeresultsrecorded 3846(83%) 3637(74%) 2,863(72%)

Averageno.ofvisitorsfortheperiod 129,824 118,474 27,969

Passivedogindications

Totalno.ofpositiveindicationsmadebythepassivedog

1,049 1,819 1,643

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Illicitdrugfinds

TotalamountofAmphetamines(grams/tablets) 13.7g 19.2g 38.7g1tablet

TotalamountofCannabis(grams) 838.5 1,241.8 474.9

TotalamountofEcstasy(tablets) 12 - 100

TotalamountofHeroin(grams/tablets) 74.9g 3tablets 3.4g8tablets

TotalamountofOtherDrugs(tablets) 1,602.01 637 2,310

TotalamountofPrescriptionDrugs(tablets) 481.5 179.5 971.5

TotalamountofSteroids^(tablets) 202 547 70

TotalamountofTemazepam(tablets) 2 18 61^While the use of steroids is not considered illegal, their abuse in prison is

Thefindsofillicitdrugsinprisonestablishmentslistedaboveweremadebyprisonstafffollowingrandomandtargetedsearches.Thefiguresexcludefindsmadeonvisitorsbeforeenteringprisonestablishments–thepolicearenotifiedandaskedtoinvestigateinthesecases.

Theincreaseindrugrelatedincidentsandevidenceofincreasedmisuseofdrugsineachoftheprisonswascausingsignificantconcernandasaresultin2007thePrisonsMinisteratthetime,PaulGoggins,askedthePrisonServicetoreviewcurrentarrangementsforreducingthesupplyofillegaldrugstoprisoners.InthesubsequentmonthsacomprehensivereviewofthosearrangementswascarriedoutbytheProjectTeamandareportentitled‘ReportonminimisingthesupplyofdrugsinNIprisons’waspublishedinJuly2008whichmadeanumberofrecommendationsonhowsystemsandprocedurescouldbeimproved.Thefindingsofthisreport,alongwiththoseofanin-depthreviewofaddictionserviceswithinprisons,andindividualcasereviewsbythePrisonsOmbudsman,haveledNIPStomakeseveralchangestoPrisonRuleswhichwillenabletheServicetotacklemorerobustlytheissueofillicitdrugswithinprisons.Forexample,from1June2010thePrisonServicewillintroducesalivatesting,whichwillallowformoreimmediateindicationofthepresenceofdrugs.

TheSouthEasternHealthandSocialCareTrust,responsibleforhealthcareinprisons,havealsodevelopedacomprehensiveHealthcareImprovementPlan,includingacontractforthedeliveryofAddictionServices,whichwillbetakenforwardin2010/11.

11.3 What’sinplace?LisburnYMCAdeliversSHAHRPinallbutonesecondaryschoolsintheBelfastHSCTarea–thisalcoholeducationprogrammefocusesnotonlyon‘ownharm’fromusing/misusingalcoholbutalsoon‘elseharm’(i.e.passengerinacardrivenbysomeoneundertheinfluence/victimofanalcohol-fuelledassault).Italsonowincludesaspecificinterventionaimedat16-yearoldswheretheyareshownfacialtraumainjuriescausedbyalcohol-relatedassaults.

YouthJusticeAgencyhasacentralrolewithyoungpeopleinvolvedinsubstancerelatedcrime.Itsaimistopreventreoffendingthroughreparation,rehabilitationandreintegration.YJAprovidesdrugandalcoholprogrammes,andusestheRegionalInitialAssessmentToolforsubstancemisuseinyoungpeople(RIAT),asandwhenappropriate.YJArefersyoungpeopleontoarangeofserviceswhichareavailableinBelfastandarealsoapartnerinthepilotoftheDAISYservice’sIntensiveSupportProgramme(ISP).


BCSPprovideanumberofprojectsthroughitsGetHomeSafePartnershipwhichaimstoreducealcohol-relatedviolentcrimeincluding;AlcoholBye-Laws–Enforcementofalcoholbye-lawswithPSNIJointenforcement–BCCofficersworkwithPSNIatweekendsandeventstotackleonstreetandunderagedrinkingOff-LicenceCodePractice–Workwithoff-licencestoimplementcodewhichlooksatresponsibleretailinginordertoreduceunderagedrinking&ASBOff-Licence&BarStaffTraining–ProvidefreetrainingtostafftoencourageresponsibleservingwhichaimstoreducealcoholrelatedASBParentalAwarenessCampaign–InpartnershipwithPHA&DOJrunacampaignaimedencouragingparentstoseekadviceabouttheirchildandalcoholGetHomeSafeMarketingCampaign–Regularcampaignaimedat18-24yearoldswhichchallengespeopletothinkabouttheirbehaviourwhentheyareoutdrinkingLicensedPremisesGroup–ImprovesoncoordinationbetweenPSNI/BCCtoworkwithlicensedpremisestosolveissuesandreducealcoholrelatedviolenceInformationSharingProtocol–ProjectthatallowslicensedpremisesshareinformationregardingpatronswhocausetroubleinentertainmentvenuesandbarsinBelfastNiteZones–Projectwhichisdevelopingsafespacesin4pilotareasofthecitybyintroducing,taxis,streetpastors,lighting,emergencycontactpointsetcCommunitySafetyWardens–thewardenserviceisdeployedinvariouspartsofBelfastanddealwithanti-socialbehaviourandalcoholabuse

PSNIworksverycloselywiththeBCSP/BCC.Italsoaddressesalcohol/drugrelatedviolencethroughreferringyoungpeopletoyouthdiversionandanti-socialbehaviourforumsaswellasspecialistsubstancemisuseserviceswhereappropriate.

11.4 GapsSpecificworkrequiredaroundeducatingyoungmenabouttherisksassociatedwithsubstance

misuseandsex–beingaccusedoforactuallycommittingsubstancerelatedsexualassaultsLinksshouldbemadewithdomesticviolenceservicesNeedtotackletheprescribedmedicationblackmarketNeedtotackledialadrink/drugtaxifirmsNeedtotackleproxybuyingPSNI/BCCshouldworkwithlocalcommunitiestodevelopplans/initiativestotackleASBAftercareservicesneededforoffenders(toreduceriskofreoffendingand/orrelapse)

11.5 Tacklingsubstancerelatedcrime/violencerecommendationsThoseresponsiblefordevelopingcampaigns/initiativesshould,wherepossible,makelinkages

betweensubstancemisuseandrisktakingbehaviourswhichresultincrime/violenceSupportthePHAinworkingwiththeSEHSCT,PrisonServiceandProbationBoardinrelation

tosubstancemisuseprevention,interventionandpost-ventionwithregardtoensuringthereisadequatemeasuresinplacetoreducetheriskofre-offendingand/orrelapse

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CO-ORDINATION AND INFORMATION SHARING

12.1 What’s in place?12.2 Gaps/Issues12.3 Recommendations

2


12 CoordinationandInformationSharing

12.1 What’sinplace?TheHealthandSocialCareBoardisresponsibleforcommissioningstatutoryaddictionserviceswiththeHSCTs.

BamfordSubstanceMisuseGroupisasubgroupoftheBamfordImplementationGroupandwillbetakingforwardtheregionalreviewofaddictionservices,aswellasanumberofotherinitiativeswhicharebestprogressedonaregionalbasis.

EDACTcurrentlycoordinatesthePublicHealthAgency’sresponsetoreducingthehealthimpactofdrugandalcoholuseintheBelfastandSouthEasternHSCTlocalities.Arangeofrelevantstakeholdersarerepresentedontheteamincluding;PHASEHSCTBHSCT4representativesfromtheVoluntary/CommunitysectorPBNIEducation

(PSNIattendona‘asrequired/requested’basis).

TheIndependentSectorForumcurrentlyprovidesaforumforthevoluntaryandcommunitysectortofeedintoEDACT.Theforummeetseverytwomonthsandisopentoallwithaninterestinaddressingsubstancemisuse.

Localdrugandalcoholforumsexistinsomeareas;SouthandEastBelfastSubstanceAbuseNetwork(SEBSAN)WestBelfastDrugandAlcoholForumTheRADICALforuminNorthBelfastnolongerexists.Drugandalcoholissuesarenowraised

andaddressedthroughtheNBPB.

TherearetheHealthDevelopmentWorkersandtheHealthandWellbeingForumswithinthefivearea-basedPartnershipBoardsinBelfast.InadditiontherearethehealthandwellbeingsubgroupswithintheNeighbourhoodRenewalPartnerships(rolesandfunctionsasoutlinedinprevioussectionsofthisreport).

TheDrugandAlcoholCoordinationProjectBoardwasestablishedinNovember2006.TheBoardwassetupundertheHAZpartnership.CurrentandpastmembershipincludedBelfastHealthandSocialCareTrust;EastBelfastPartnershipBoard;EDACT;FallsCommunityCouncil;FASA;GreaterShankillPartnershipBoard;HealthActionZone;NorthBelfastPartnershipBoard;RADICAL;SEBSAN;SouthBelfastPartnershipBoard;WestBelfastDrugandAlcoholStrategyGroupandWestBelfastPartnershipBoard.

TheProjectBoardwassetuptoprovidedirection,supportandadviceonthedevelopmentandimplementationofacoordinatedapproachtosupportcommunityorganisationstodevelopeffectiveresponsestoneedandsubstancemisuseinBelfast.Itmetupto4timesperyearandcontinuedtomeetupuntilNovember2010.ThecontinuationoftheBoardwillneedtobeconsideredbythemembershiptakingaccountoftheoutworkingoftheBelfastDrugsandAlcoholWorkingGroup.

BROinvestapproximately£400,000indrugandalcoholprojects/servicesacrossBelfast.Theyarecurrentlyexploringnewdeliverymodelsforalltheirservicesandarekeentopilotthisnewapproach

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withthecurrentfundingallocatedtoaddressdrugandalcoholissues.DiscussionsareongoingwithinthePHAandBHSCTonhowfuturefundingmightbeadministered.

BCSPcurrentlycoordinatearangeofinitiativesaimedatreducingtheimpactofdrugandalcoholrelatedviolenceandcrime.SimilartoEDACT,arangeofrelevantstakeholdersarerepresentedonthepartnership.Theinitiatives/projectsBCSPleadonaredetailedinSection11ofthisreport.GoodrelationshipsexistbetweenEDACTandBCSPandtogethertheyhavefundedaparentalawarenesscampaignforanumberofyears.

BCC/BelfastHSCThaveappointedaProgrammeDevelopmentOfficer(ChildrenandYoungPeople’sHealth)focussingonalcoholharmreductionwhocameintoposton16thAugust2010.

BelfastCityCouncil/PHAandBHSCTaredevelopinga‘TotalPlace’approachtoaddressingthemisuseofalcoholacrossthecity.

12.2 GapsStrategicfocusThereisaneedforaBelfast-widemodeland/orapproachtotacklingsubstancemisuse

focusingongoalsoroutcomesthatlocalareascanthentranslateintolocalactions/plansThereisalackofsecurityinrelationtoresources:longertermfundingcommitmentsare

requiredsothatservicesareabletoestablishthemselvesonafirmerbasisThereisaneedtolookattheinter-connectionamongstallthestrategiesbothatdepartmental

leveli.e.fordrugsandalcohol,mentalhealth,suicideprevention,sexualhealth,earlyyearsintervention,etc.aswellasthespecificlocalityfocussedstrategiessuchasthoseproducedbythearea-basedPartnershipBoards,etc.

Considerationshouldbegivenastohowthelearningfromthedevelopmentandimplementationofthesuicidepreventionstrategyistakenonboard

Thereisaneedtomakedrugsandalcohola‘big’issue,itneedstobefocussedwithdedicatedgroupslookingattheissueatalllevels(strategic-operational-local)

ThereisaneedtoraisetheprofileofEDACTasthereappearstobealackofawarenessofwho/what/why

BDAWGhasaroletoplayespeciallyinrelationtolobbyingandadvocacybutallrepsneedtoattendandparticipate

AlldrugandalcoholservicesneedtobemoreinvolvedinthedevelopmentofanyBelfaststrategy

Information-sharing/datamanagementInformationsharingisabigissueespeciallyforthosefunding/commissioningservicesand

thereneedstobebettercommunicationespeciallyinrelationtowhatthestatutorysectorisfundingbothwithotherstatutoryagenciesandwiththecommunity

Needtomakebetteruseofthedatawealreadycollectandputinplaceinformationmanagementsystemsand/orprotocolsforsharinginformation

Jointworking/increasedcoordinationNeedtoestablishaserviceprovidersforum(i.e.thedrugandalcoholservicescouldwork

moreoncoordinationbetweenthem)NeedtohavebetterlinksandcommunicationamongstallkeyplayersEachareaofBelfastisdifferentyetthereneedstobeadegreeofconsistencyandequityin

relationtoservicesbeingprovidedandinabilitytoaccessservice

12.3 Coordinationandinformation-sharingrecommendationsAllthosewithaninterestin/remitforaddressingdrugsandalcoholshouldusetheconsultation

process(ontherelaunchoftherevisedNSD)toensurethatitadequatelyreflectsthepriorities


identifiedbyBDAWGandmembersshouldspecificallycommentonwhethertherevisedstrategydemonstratesinter-connectednesswithallotherrelevantstrategiesandissuesforexamplementalhealthandwellbeingandsexualhealth

Aninformationandcommunicationsstrategy(asstatedearlier)shouldbedevelopedbythePHAasaprioritytosupporteffectivecommunicationandinformationsharingatregionalandlocallevel;thisshouldincludeaspecificactionaroundsupportingbettercoordinationandinteractionbothbetweenandwithinfundedservices;andthestrategyshouldalsoclarifyroles,responsibilities,membershipandexpectedcontributionofpartnersandpartnershipstoaddressingtheissueofsubstancemisuseinBelfast

AllrelevantstakeholdersandpartnershipsshouldadviseandsupporttheBelfastStrategicPartnershipandBelfastHealthDevelopmentUnit(BHSCT/BCC/PHA)indeveloping,anddeliveringon,aBelfast-widemodelfortacklingsubstancemisuse–ensuringthatassociatedprioritiesandactionsareevidence-based

SUMMARY OF RECOMMENDATIONS

3

//71

SUMMARY OF RECOMMENDATIONS

3


13 SummaryofRecommendations

Therecommendationsasoutlinedinthepreviouschaptershavebeensummarisedinthefollowingtable.Themainagencieswho,couldeitherhaveleadresponsibility(highlightedinbold),orwhocouldbeinfluentialintakingtherecommendationsforward,havebeenidentifiedhowevertheremayalsobeotherswhocouldprovideassistanceandtheagencywithleadresponsibilityshouldconsiderwhoelseshouldorcouldbeconsultedand/orinvolved.

Timescaleshavealsobeenassignedandaredefinedasbelow:Short-term–withinthenextyearMedium-term–withinthenext2-3yearsLong-term–withinthenext4-5years

SomeoftherecommendationsappliedwiderthanjusttheBelfastlocality(i.e.theyshouldbeconsideredandtakenforwardataregionallevelaswell)andthesehavebeenhighlightedinblue.

BDAWGisawarethatthisreporthasbeenproducedduringaperiodofongoingrestructuringduetoRPAandsoresponsibilityhasbeenassignedtothoseagencieswhocurrentlyleadon/andorcommissiondrugsandalcoholworkandservices.However,thoseconsideringtheserecommendationsshoulddosoinlightofthenewandevolvingstructures–especiallyinrelationtotheBelfastHealthDevelopmentUnitandthefactthatithasalreadyhighlighted‘alcohol’asapriorityareaunderitsdraftactionplan.TheBelfastStrategicPartnershipisintheprocessofdevelopinga‘FrameworkforActiontoAddressLifeInequalities.’TherecommendationspresentedinthisreportshouldalsobeconsideredbytheBSPwhenconsideringanddevelopingprioritiesundertheframework,fortheBelfastlocality,overthecomingyears.

//73

Issue

Recommendation

Responsibility

Timescale

Commissioning

Tho

se r

espo

nsib

le fo

r co

mm

issi

onin

g an

d de

sign

ing

serv

ices

sho

uld:

whendesigningtendersandcontracts,embedaprocessofflexibility

intohow

com

missionedserviceswillbedeliveredintermsofmeeting

theneedsofclientsratherthanpre-settargets

ensurethatself-careforstaffisincludedasanessentialrequirement

withintenderspecsand/orcontractsforthosewhowillbeproviding

drugandalcoholservicestoclients

PHA(EDACT),

HSCB,B

HSCT,

BRO,B

CC

(BCSP),PSNI,

NIHE,etc.

Short-term

Coordination

andinform

ation

sharing

BHSCT,inconjunctionwiththecommunity/voluntarydrugandalcohol

treatmentserviceproviders,shoulddesignanddevelopa‘Pathw

ayto

services’docum

entw

hichshouldbewidelydissem

inatedtoGPsasa

keytargetgroupalongwithgenericcom

munityserviceproviders

BHSCT,P

HA/

EDACT,Relevant

EDACT-funded

serviceproviders

Short-term

An‘earlywarningsystem’shouldbeestablishedatbothlocaland

regionalleveltoensuretimelysharingofinformation.Inthefirstin-

stancetheBelfastCom

munitySupportServiceshouldbetasked,and

supportedto,offerpracticalinformationsessionsonem

ergingissues

atcom

munitylevelw

hereappropriate

DHSSPS,P

HA

BHSCTandPSNI

Short-term

Moreformalmechanism

sshouldbeputinplaceforbettercoordination

andinteraction,bothbetweenandwithin,agencies/servicesfundedto

deliverdrugandalcoholservices

PHA(EDACT)

Short-term

BHDUandtheBelfastStrategicPartnershipshouldbesupportedand

assistedindeveloping,anddeliveringon,aBelfast-wide‘TotalPlace’

modelfortacklingsubstancemisuse

BHDU,B

CC,

BHSCT,PHA

andallrelevant

stakeholders

Shortto

medium-term

BHSCTshouldestablishaworkinggroupwiththegoalofcreatinga

seam

lessreferralpathw

ayforpeoplepresentingwithcom

plexneeds

(mentalhealthandaddiction)consistentw

iththetheoryof‘nowrong

door’

Afram

eworkandassociatedtrainingprogram

me(RIAT)hasbeenput

inplaceforassessingandrespondingtotheneedsofyoungpeople

inrelationtosubstancemisuse(includinghowandwhotoreferon

to)–perhapsasimilarfram

eworkcouldbedevelopedfortheadult

population

BHSCT,H

SCB,

PHA/EDACT,

PHA-funded

serviceproviders

Shortto

medium-term


Acoordinateddatacontentm

anagem

entsystemand/ordata/informa-

tionsharingprotocolsshouldbedevelopedtherebyprom

otinglessdu-

plicationandensuringthattheindividual’sneedsarebestm

etacross

allservicesandsectors

DHSSPS,P

HA

HSCB,B

HSCT

andBRO

Mediumto

long-term

Communication

andinform

ation

sharing

Arangeofservicedirectoriesfordrugsandalcoholshouldcontinueto

beproducedwhilstensuringthataplannedandtargetedapproachis

takentowardsdisseminatingandprom

otingasharedunderstanding

aboutexistingprovision,capacityandreferralpathw

ays

PHA(EDACT),

BHSCT

Short-term

Adrugsandalcoholinformationandcommunicationsstrategyshould

bedevelopedasaprioritytosupporteffectivecommunicationandin-

formationsharingatlocallevel–thestrategyshouldalsoclarifyroles,

responsibilities,mem

bershipandexpectedcontributionofpartnersand

partnershipstoaddressingtheissueofsubstancemisuseinBelfast

PHA(EDACT)

Shortto

medium-term

Thoseresponsiblefordevelopingcam

paigns/initiativesshould,where

possible,m

akelinkagesbetweensubstancemisuseandotherrisktak-

ingbehavioursandtheincreasedriskofparticipatingin/beingavictim

ofcrim

e/violence

DHSSPS,P

HA,

BHSCT,BCC,

PSNI

Medium-term

Currentservice

provision

Educationandpreventionservices

Thoseprovidingdrugandalcoholeducationandpreventionpro-

gram

messhouldensurethat,w

herepossible,acom

munitydevelop-

mentapproachistakentohow

clientsaretargetedandengagedand

howsessions/programmesaredelivered

PHA(EDACT)&

relevantEDACT-

fundedservice

providers

Short-term

Communitysupportservices

Thequality,quantityandleveloftrainingprovisiondeliveredwithin

communitiestodateshouldbeidentifiedandassessedandthisinfor-

mationshouldbeusedtoinformthefuturedirectionofcom

munitydrug

awarenesstraining

PHA(EDACT)

&relevantE

DACT-

fundedservice

providers

Short-term

//75

Existingestablishedcommunitynetworksshouldbeconsultedto

identifycommunityworkerswithahealthrem

itinordertokeepthem

uptodateondrugandalcoholissues,servicesandtrainingavailable

Clearinformationshouldbegivenaboutthecom

munitydrug

awarenesstrainingavailableinorderthatcom

munityorganisations

and/orworkerscanmakeinformeddecisionsspecificallyaroundthe

desired/requiredlevelofcom

petencyinaddressingdrugandalcohol

issues

RelevantEDACT-

fundedservice

provider

Short-term

Thecurrentpromotionalactivities/awarenessraisingstrategiesofthe

BelfastDrugandAlcoholCom

munitySupportServiceshouldbere-

view

edtoensuretheyrem

ainfitforpurpose

PHA(EDACT)&

relevantEDACT-

fundedservice

provider

Short-term

TheroleandimpactoftheCom

munitySupportServices(fordrugs

andalcohol)currentlyfundedregionallyshouldbeevaluatedinorder

tosharethelearninglocallyandbuildonbestpracticeelem

ents

PHA&relevant

PHA-funded

serviceproviders

Medium-term

Workforcedevelopment

PHAshouldundertakeareview

ofcurrentworkforcedevelopment

trainingatbotharegionalandlocallevelwithaviewtoinforming

futurestrategiccom

missioningandensuringbetterlocalandregional

consistency

Oneofthecoreelem

entsofalltraining(tocom

munitiesortothe

workforce)deliveredshouldbeaboutincreasingknowledgeofexisting

provisiontoenablesignpostingorreferraltoappropriateservices

Availabletrainingshouldbeevidence-basedandconsistentinits

contentandhow

itisdelivered

PHA&relevant

PHA-funded

serviceproviders

Short-term

Treatm

entandsupportservices

Theneedsofethnicminorities,specificallyinrelationtoaddressing

languageandculturalbarrierswhenaccessingandavailingofdrug

andalcoholservices(andfollowonsupport)shouldbeaddressed,en-

suringthatanappropriatepackageofsupportisputinplaceandthat

bothserviceprovidersandclientsareaw

areofwhatthisisandhow

to

accessit

DHSSPS,P

HA,

HSCB,BHSCT

andrelevantPHA-

fundedservice

providers

Short-term


Alltreatmentandsupportservicesbeencouragedandsupportedto

adoptawholefamilyapproachtotreatingdrugandalcoholaddiction

andaftercare/followonsupportshouldbebuiltinasanessential

elem

entforbothclientsandtheirfamilymem

bers

Carepathwaysneedtobedevelopedtoenablethosewithmore

complex/im

mediateneedstobefast-trackedintoservicesaswell

asasystemformonitoringresponseratesandappropriatenessof

responses

Atcom

munitylevelthereneedstobeaw

arenessraisinginrelation

towhattodoandhow

toaccessservicesforpeopleincrisisand

inparticularhow

toaccessoutofhoursprovisionwithinstatutory

services

PHA(EDACT),

HSCB,B

HSCT

andrelevant

EDACT-funded

serviceproviders

Medium-term

Futureservice

development

Educationandpreventionservices

AdditionalresourcesshouldbetargetedatTiers1and2toensurea

muchstrongerfocusisputonprevention

Moreeducationandpreventioninitiativestargetedattheadult

population,atfam

iliesandatthosewithcom

binedmentalhealthand

drugs/alcoholneedsshouldbedevelopedandresourced

PHA(EDACT),

HSCB,B

HSCT,

BRO,P

HA,

BHSCT,BRO

Medium-term

Communitysupportservices

Trainingorganisations,fundedtodelivercom

munitydrugaw

areness

training,shouldworkwithkeycom

munityrepresentatives/organisa-

tionstodevelopatrainingprogram

mesuitedtotheirneeds(from

screening/initialassessm

enttoreferringonandinterveningifand

whenappropriate)

Relevant

EDACT-funded

serviceprovider

&com

munity

agencies

Short-term

Workforcedevelopment

Thereneedstobestrategicplanningandtargetingoftraining–adrug

andalcoholw

orkforcedevelopmentstrategyshouldbedevelopedasa

prioritytoincludebestpracticeandguidanceondevelopingamodelof

selfcarefortheworkforce

PHA

Shortto

medium-term

TheplannedbriefinterventiontrainingforGPsshouldcoveraware-

ness-raisingofservices(bothstatutoryandcomm/volprovision)and

wherepossiblebedeliveredbyrepresentativesfrom

bothsectors

PHA&HSCB

Shortto

medium-term

//77

Across-sectoraltrainingmodel,toincludecrossplacem

ents,should

bedevelopedforthosesectorsand/oragencieswhointerfacemost

withaddictions(i.e.hom

elessness,mentalhealth,crim

inaljusticeand

socialservices)toallowfortransferofknowledgeandskills

Genericserviceproviders(comm/vol/stat/private)shouldbeoffered

appropriatedrugsandalcoholtrainingwhichshouldcoverassessment

andreferral

PHA&Relevant

EDACT-funded

serviceprovider

Shortto

Mediumterm

Drugandalcoholtrainingshouldbeincorporatedasasubstantial,con-

sistent,corepartofcollege/universityprogram

mesforteachers,social

workersandhealthprofessionals(lobbyingrole)

DHSSPS,P

HA

andUniversities/

FEColleges

Mediumto

long-term

Treatm

entandsupportservices

Levelsofpainmedicationprescribingshouldbeinvestigatedandan

assessmentm

adeastowhetheraspecificresponseisrequired(such

ashasbeentakenforaddressinghighlevelsofanti-depressantpre-

scribing)

PHA&HSCB

Medium-term

Anincreasedrangeofprogram

mesandservicesneedtobemade

availableforfamiliesaffectedbysubstancemisusewhethertheperson

withinthefamilywhoismisusingsubstancesisseekinghelpfortheir

addictionornot

PHA(EDACT),

HSCBand

relevant

fundedservice

providers

Medium-term

Arangeofservicesfrom

prevention,interventionandpost-vention

shouldbeavailablewithinthecriminaljusticesettingtoensuread-

equatemeasuresareinplacetoreducetheriskofre-offendingand/or

relapse

PHA,H

SCB,

SEHSCT,

NIPS,P

BNI&

YJA

Shortto

medium-term

TheBam

fordSubstanceMisuseGroup,shouldbesupportedinun-

dertakingtheplannedreview

ofaddictionservices–thereview

should

ensurethatthereareadequateservicesavailableateachtier(tomeet

need)forbothadultsandyoungpeopleandthatservicesareableto

providearangeoftreatmentm

odelstobothclientsandtheirfamilies

asappropriate(andfamilymem

bersshouldbeabletoaccesssupport

serviceswhethertheactualsubstancemisuserisengagedornot)

BSMG,P

HA,

HSCB,H

SCTs

&PHA-funded

serviceproviders

Shortto

medium-term


General Aspartofthetacklinghealthinequalitiesagenda,incentivisingpar-

ticipationindrugandalcoholprogram

mes/services(takingonboard

thefindingsoftherecentlypublishedNICE’sCitizen’sCouncilreport

on‘Theuseofincentivestoim

provehealth’)shouldbeconsidered/

explored

PHA,H

SCB,

BHSCT&BRO

Shortto

medium-term

TheDHSSPSguidanceondevelopingworkplacedrugandalcohol

policiesshouldbereview

edwiththegoalofputtinginplaceasystem-

aticplanfordissem

inationandprom

otionofbestpracticetoemployers

DHSSPS

Shortto

medium-term

Goodpractice

Anyinitiativeswhichshowpromise/arehavinggoodoutcom

eslocally

shouldbereview

edand/orevaluated(modellingapproach)withaview

totriallinginotherHSCTareas

Aprocessofsystematicengagem

entshouldbeundertakenwith

relevantumbrellaorrepresentativegroupsforminoritiesand/or

vulnerablegroupsinrelationtodrugandalcoholneeds/barriersto

accessingservices

ThedisseminationandadoptionoftheregionalPHA/DHSSPS

‘Guidingeffectivedrugprevention’docum

entandprinciplesshould

besupportedregionally,andtheaccompanyingtrainingprogram

me

availableintheEasternareainhow

todesignanddeliverdrugand

alcoholpreventionprogrammesshouldbereviewed/evaluatedwitha

view

towiderrolloutifim

pactproven

PHA

Medium-term

//79

Needs

assessment/

Researchagenda

DiscussionsshouldtakeplacebetweenPHAandBELB

toexplorebest

practiceinrelationtoaddressingdrugsandalcohol(from

preventionto

crisisresponse)withintheschoolsetting(prim

ary&post-primary)and

toagreeaconsistentapproach

PHA&BELB

Shortto

medium-term

BELB

shouldleadinaconsultationwiththoseprovidingservicesto

thosenotinschool/notinyouthclubsinordertoassesstheneedsof

thisgroupofyoungpeopleinrelationtodrugsandalcohol

BELB,E

DACT,

AEPs,Com

munity-

basedDetached

YouthW

orkers

Shortto

medium-term

Ascopingexerciseshouldbeundertakenwithdrugandalcoholserv-

iceprovidersacrossthetiersinordertoassesstheextentandim

pact

ofthosepresentingtoserviceswithdualdiagnosisneeds(substance

misuseandmentalhealthissues)andhowthenspecificallytheirmen-

talneedsarecurrentlybeingmetandwhattheneedsareofthese

servicesinthefutureinordertobeabletomeettheirneedsbetter(the

findingsoftheWestB

elfastPrim

aryCarePartnershipmappingexer-

ciseintomentalhealthservicesmayalsofeedintothisprocess)

PHA(EDACT),

BHSCTandPHA/

HSCBfunded

serviceproviders

Shortto

medium-term

Servicesneedtobebettersupported/resourcedtobeabletoevaluate

andsharelearninginordertobuildontheevidencebase

PHA,H

SCB,

BHSCT,BRO

Medium-term

Ataregionallevel,discussionsshouldtakeplacearoundwhatare,

andhowbestdowemeet,theneedsof‘N

EET’s’–thoseNotinEdu-

cation,EmploymentorTraininginrelationtosubstancemisuse

PHA,D

E,D

EL,

PSNI,YJA

Mediumto

long-term

Betterlinkagesneedtobeestablishedbetweenthoseresponsible

forcommissioninganddeliveringservicesinordertobeabletobet-

terdefineresearchgaps,decideobjectivesandprioritiesforanynew

researchtobeundertaken,andtoensurethatthereisabalancebe-

tweenlocalandregionalresearchagendas

DHSSPS(PHIRB),

PHA(R&D),

BHSCT,PHA-

fundedservices

Mediumto

long-term


Reducing

availability/

Tacklingcrime

Lobbyinglocally(ultim

atelyforaregionalapproach/response)should

continueforareductionintheavailabilityofalcoholbylegislative

measures(e.g.introductionofminimum

pricing,bans/restrictionson

prom

otionsandadvertising)andwherepossiblyweshouldtakeon

boardandadoptlearningfrom

elsew

hereonhowtoinfluencechange

ontheseissues

PHA(EDACT),&

BCC(BCSP)

Short-term

Optionsshouldbeexploredandconsideredlocallyforreducingavaila-

bilityofsocalled‘legalhighs’soldviaretailprem

isesinBelfastknown

asheadshops/sm

artshops/hydroponicshops

PHA(EDACT),

BCC(BCSP)&

PSNI

Short-term

Bestpracticeinworkinglocallywithsupermarkets,off-licencesand

licensedprem

isestodevelopstrategicapproachesforreducingavail-

abilityshouldbeexploredanddissem

inated

BCC(BCSP)

Short-term

Alternativeapproachestoreducingunderagedrinkingandprotocols

forworkingwithcom

m/volyouthdrugandalcoholserviceprovidersto

addressthisissuelocallyshouldbedevelopedandtested

Jointinitiatives(suchasthoseundertakenfortobaccocontrol)should

bedevelopedandtestedtoaddressunderagedrinkinginbarsand

socialclubsacrossBelfast

BCC(BCSP),

PSNI&

Relevant

EDACT-funded

serviceproviders

Short-term

Testpurchasingofage-restrictedproducts(tobacco,alcoholand

solvents)shouldbeimplem

entedasapriorityandcarriedoutregularly

Amappingexerciseshouldbeundertakenofallthelicensedbarsand

socialclubscurrentlyinexistence(aswellasplanned)intheBelfast

areaandthefindingsconsideredinrelationtoavailabledrugand

alcohol/crim

estatisticswithaviewtomakingrecommendationsto

informfuturelicensing/planningpractice

BCC,B

CSP&

PSNI

Shortto

medium-term

//81

CONCLUSIONS

4


14 Conclusions

Itwastheintentionofthosewhohavebeeninvolvedinthisscopingexercisenotonlytoidentifygapsandmakerecommendationsforserviceimprovementbutalsotohighlighttheconsiderableamountofworkthathasalreadybeenundertakenbyarangeofpartnershipsandagenciesindevelopingtheserviceswehaveinplacetodate.

Whilstthisreportisbeingpublishedinatimeofuncertaintyduetothefinancialsituationandongoingrestructuringwithinthestatutorysector,membersoftheBelfastDrugandAlcoholWorkingGroupfeltthatitisalsoatimeofopportunityintermsofmakingbetteruseofexistingresourcesandtoallowusalltobemorecreativeandflexibleinhowweworktogethertoaddressthecomplexandwide-rangingneedsofthepeopleofBelfastinrelationtosubstancemisuse.

Giventhebackgroundtohowthispieceofworkwasinitiatedtheremustalsobeacommitmentinthefuturetoestablishingbettermechanismsforcommunicationandinformationsharingbetweenthoseresponsiblefordevelopinganddeliveringdrugandalcoholservices,whethertheyarestatutoryorcomm/volproviders,withthosecommunityprovidersandrepresentativeswhoareoftenthefirstpointofcontactformanyinlocalcommunitiesconcernedaboutdrugsandalcoholeitheronapersonalleveloronacommunitylevel.

MembersofBDAWGhavebeenencouragedtousethisreportasabasisforrespondingtotheconsultationprocess(ontherelaunchoftherevisedNewStrategicDirectionforAlcoholandDrugsfortheperiod2011-2016)toensurethatitadequatelyreflectstheprioritiesidentifiedbyBDAWG(particularlyinaddressingtherecommendationswhichwerehighlightedinthepreviouschapterasbeingapplicableregionally).

AllrelevantstakeholdersandpartnershipsinvolvedwithBDAWGarewillingtoadviseandsupportthenewly-formedBelfastStrategicPartnershipandBelfastHealthDevelopmentUnitindeveloping,anddeliveringon,aBelfast-widemodelfortacklingsubstancemisuse,andtosupportthePHA’sEasternDrugsandAlcoholCoordinationTeaminthedevelopmentofitslocalactionplanandinparticularhowneedsareidentifiedandaddressedwithinBelfast.

MembersaskthatthePHAconsiderthebestmechanism(s)forimplementingandoperationalisingtherecommendationsasoutlinedinthisreportandfeedbackondecisionstakentotheBelfastDrugandAlcoholWorkingGroup.

//83

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NICE(2007c)Drug Misuse: Psychosocial Interventions. NICEclinicalguideline51.London: NationalInstituteforHealthandClinical Excellence.http://www.nice.org.uk/nicemedia/live/11812/35975/35975.pdf

NICE(2007d)Drug Misuse: Opioid Detoxification. NICEclinicalguideline52. London:NationalInstituteforHealthandClinical Excellence.http://www.nice.org.uk/nicemedia/live/11813/35997/35997.pdf

NICE(2007e)Community-basedInterventions to reduce substance misuse among vulnerable young people PublichealthguidancePH4.London: NationalInstituteforHealthandClinical Excellence.http://www.nice.org.uk/nicemedia/live/11379/31939/31939.pdf

NICE(2007f).Interventions in schools to prevent and reduce alcohol use among children and young people.LondonNationalInstituteforHealthandClinicalExcellence.http://www.nice.org.uk/nicemedia/live/11893/38407/38407.pdf

NISRA(2008),Adult Drinking Patterns in Northern Ireland 2008,DepartmentforHealth,SocialServiceandPublicSafety,NorthernIrelandhttp://www.dhsspsni.gov.uk/adult_drinking_patterns_report_2008.pdf

NISRA,Northern Ireland Health and Social Care, Inequalities Monitoring System, 3rd Update Bulletin 2009,DepartmentforHealth,SocialServiceandPublicSafety,NIhttp://data.gov.uk/dataset/northern_ireland_health_and_social_care_inequalities_monitoring_system_third_update_bulletin

NISRA,Northern Ireland Health and Social Care, Inequalities Monitoring System, Sub-regional Inequalities – HSC Trusts 2010,DepartmentforHealth,SocialServiceandPublicSafety,NIhttp://www.dhsspsni.gov.uk/subreg_inequalities_monitoring_1.pdf

NISRA,Secondary Analysis of the 2007 Young Persons’ Behaviour and Attitudes Survey,2009,DepartmentforHealth,SocialServiceandPublicSafety,NIhttp://www.dhsspsni.gov.uk/secondary_analysis_of_2007_ypbas.pdf

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NISRA,Statistics from the Northern Ireland Drug Addicts Index 2009,DepartmentforHealth,SocialServiceandPublicSafety,NIhttp://www.dhsspsni.gov.uk/drug_addicts_stats09.pdf

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Appendix1:TheFourTierModel

TheNew Strategic Direction for Alcohol and Drugs 2006-2011summarisedthefourtiermodelforadultsasfollows:

Adultservices

Tier1-NondrugtreatmentspecificservicesTier1consistsofservicesofferedbyawiderangeofprofessionals(e.g.primarycaremedicalservices,genericsocialworkers,teachers,communitypharmacists,probationofficers,housingofficers,homelesssupportstaff).Tier1servicesworkwithawiderangeofclientsincludingsubstancemisusers,buttheirsolepurposeisnotsimplysubstancemisuse.

Tier2-OpenaccessdrugandalcoholtreatmentservicesTier2servicesprovideaccessibledrugandalcoholspecialistservicesforawiderangeofdrugandalcoholmisusersreferredfromavarietyofsources,includingself-referrals.Thistierisdefinedbyhavingalowthresholdtoaccessservices,andlimitedrequirementsondrugandalcoholmisuserstoreceiveservices.OftendrugandalcoholmisuserswillaccessdrugoralcoholservicesthroughTier2andprogresstohighertiers.

Theaimofthetreatmentintier2istoengagedrugandalcoholmisusersindrugtreatmentandreducedrug-relatedharm.Tier2servicesdonotnecessarilyrequireahighlevelofcommitmenttostructuredprogrammesoracomplexorlengthyassessmentprocess.

Tier2servicesincludeneedleexchange,drug(andalcohol)adviceandinformationservices,andadhocsupportnotdeliveredinthecontextofacareplan.Specialistsubstancemisusesocialworkerscanprovideserviceswithinthistier,includingtheprovisionofaccesstosocialworkadvice,childcare/parentingassessment,andassessmentofsocialcareneeds.Tier2canalsoincludelow-thresholdprescribingprogrammesaimedatengagingopioidmisuserswithlimitedmotivation,whileofferinganopportunitytoundertakemotivationalworkandreducedrug-relatedharm.

Tier3-Structuredcommunity-baseddrugtreatmentservicesTier3servicesareprovidedsolelyfordrugandalcoholmisusersinstructuredprogrammesofcare.Tier3structuredservicesincludepsychotherapeuticandpharmacologicalinterventions(e.g.cognitivebehaviouraltherapy,motivationalinterventions,structuredcounselling,substituteprescribingprogrammes,communitydetoxification,ordaycareprovidedeitherasadrugandalcoholfreeprogrammeorasanadjuncttosubstituteprescribingprogrammes).Community-basedaftercareprogrammesfordrugandalcoholmisusersleavingresidentialrehabilitationorprisonarealsoincludedinTier3services.

Tier4-ResidentialservicesfordrugandalcoholmisusersTier4servicesareaimedatindividualswithahighlevelofpresentingneed.Servicesinthistierinclude:in-patientdrugandalcoholdetoxificationorstabilisationservices;drugandalcoholresidentialrehabilitationunits;andresidentialdrugcrisisinterventioncentres.

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Youthservices

TierOneThefrontlineofservicedeliverytowhichchildren,youngpeopleandtheirfamilieshavedirectaccessandwhichprovidethefirstresponsetotheneedsofchildrenandadolescents.Examplesofsuchservicesincludeschoolsprovidingsubstancemisuseeducationandprimarycareservicesofferingmedicaladvice.TheyalsoreferindividualyoungpeopletoTier2/3/4servicesifappropriate.

TierTwoFrontlineyoungpeople'sspecialistservicesarecriticaltotheidentificationofvulnerablechildrenandearlyidentification.Theirrolesshouldbeconcernedwiththereductionofrisksandvulnerabilitiestosubstancemisuse,andthereintegrationandmaintenanceofyoungpeopleinmainstreamservices.Examplesofsuchservicesincludesocialservicesassessingsubstancemisuseamonglookedafterchildren,voluntaryagenciesprovidingcounsellingservices,targeteddrugeducationandcriminaljusticeagenciesaddressingoffendingissues.

TierThreeServicesdemonstratingathresholdofexpertiseandcompetencethatiscapableofcomprehensiveassessmentandformulationofanoverallplanforsubstanceuseandvariousotherproblems,includingoutcomedomains.Theservice(s)willdealwiththecomplexandoftenmultipleneedsofthechildoryoungperson,includingsubstanceproblems.Theaimistoreintegrateandincludethechildoryoungpersonintohis/herfamily,communityandschool,trainingorwork.ExamplesofsuchservicesmaybestandaloneserviceseitherwithinthevoluntaryorstatutorysectororspecialistservicesintegratedacrossCAMHS.

TierFourVeryspecialisedchildrenandyoungpeople'sservicesusedforparticularinterventionsorfocusedworkand/orshort/temporaryperiods.Thismightconsistofinpatientadolescentservicesorforensicunitscomplementedbyspecialistyoungpeople'saddictionstaff,paediatricbedsorintensivedaycentresfordetoxification,crisisplacements,specialisthousingorfostering.Theaimwouldbetoprovidespecialistinterventionsandasettingforaparticularperiodoftime,andforaspecificfunction,asanadjunctto,andabackstopfor,theservicesforothertiers.Continuityofcarepre,during,andpostadmissionisimportant.


Appendix2:ListofAbbreviationsUsedintheText

‘3Z’drugs Zalepon,ZolpidemandZoplicone

A&E AccidentandEmergency

AA AlcoholicsAnonymous

AAIS AdolescentAlcoholInvolvementScale

ADTS AddictionDayTreatmentServices

AEPs AlternativeEducationProviders

ASB AntiSocialBehaviour

ATP AdolescentTransitionsProgramme

ASCERT ActiononSubstancesthroughCommunityEducationandRelatedTraining

Benzo(s) Benzodiazepines

BCAS BelfastCommunityAddictionService

BCC BelfastCityCouncil

BCSP BelfastCommunitySafetyPartnership

BDAWG BelfastDrugandAlcoholWorkingGroup

BELB BelfastEducationandLibraryBoard

BHDU BelfastHealthDevelopmentUnit

BHSCT BelfastHealthandSocialCareTrust

BRO BelfastRegenerationOffice

CAMHS ChildandMentalHealthService

CARAT Counselling,Assessment,Referral,AdviceandThroughcare

CASE CitizenshipandSafetyEducationprogramme

CAT CommunityAddictionTeam

CBT CognitiveBehaviouralTherapy

CDSCNI CommunicableDiseasesSurveillanceCentreforNorthernIreland

CHILL CounsellingHelpandInformationforLifestyleandLiving

CHNI CouncilfortheHomelessNorthernIreland

CODA CommunityDrugAwarenessProject

comm community

COPAH CounsellingforOlderPeopleatHome

CSPs CommunitySafetyPartnerships

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DAAMHS DrugandAlcoholMisuseMentalHealthService

DAISY DrugandAlcoholInterventionServiceforYouth

DARS DrugArrestReferralScheme

DE DepartmentofEducation

DES DirectedEnhancedService

DEL DepartmentofEmploymentandLearning

DHSSPS DepartmentofHealth,SocialServicesandPublicSafety

DMD DrugMisuseDatabase

DOJ DepartmentofJustice

DOT DrugOutreachTeam

DPPO DesignatedPublicPlacesOrder

EDACT EasternDrugsandAlcoholCoordinationTeam

FASA ForumforActiononSubstanceAbuseandSuicideAwareness

FPNs FixedPenaltyNotices

GP GeneralPractitioner

HAZ HealthActionZone

HepC HepatitisC

HMP HerMajesty’sPrison

HSC HealthandSocialCare

HSCB HealthandSocialCareBoard

HSCT HealthandSocialCareTrust

ICAP InterChurchAddictionProject

ISP IntensiveSupportPilot/Programme

IV intravenous

LCG LocalCommissioningGroup

LGBT Lesbian,Gay,BisexualandTransgender

LGD LocalGovernmentDistrict

LHSCG LocalHealthandSocialCareGroup

LIFT LinkingtheInterestsofFamiliesandTeachers

LST LifeSkillsTraining

MARC MakingARealChange

N&W NorthandWest


NA NarcoticsAnonymous

NBPB NorthBelfastPartnershipBoard

NEETS NotinEducation,Employment,TrainingorSchool

NI NorthernIreland

NIACRO NorthernIrelandAssociationfortheCareandResettlementofOffenders

NICAS NorthernIrelandCommunityAddictionService

NICE NationalInstituteforClinicalExcellence

NIDA NationalInstituteonDrugAbuse

NIHE NorthernIrelandHousingExecutive

NIHSCIMS NorthernIrelandHealthandSocialCareInequalitiesMonitoringSystem

NIO NorthernIrelandOffice

NIPS NorthernIrelandPrisonService

NISRA NorthernIrelandStatisticsandResearchAgency

No. Number

np-SAD NationalProgrammeonSubstanceAbuseDeaths

NRPs NeighbourhoodRenewalPartnerships

NSD NewStrategicDirection

NSDAD NewStrategicDirectionforAlcoholandDrugs

NTE NightTimeEconomy

OCN OpenCollegeNetwork

PACE PoliceandCriminalEvidenceAct

PHA PublicHealthAgency

PHIRB PublicHealthInformationandResearchBranch

PND PenaltyNoticesforDisorder

PSNI PoliceServiceofNorthernIreland

QUB QueensUniversityBelfast

RADICAL ResponsestoDrugsandAlcoholinCommunitiesandLives

RATSDAM RapidAssessment,TreatmentandSupportforDrugandAlcoholMisusers

RIAT RegionalInitialAssessmentTool

RIMT RegionalImpactMeasurementTool

RPA ReviewofPublicAdministration(inNorthernIreland)

RVH RoyalVictoriaHospital

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S&E SouthandEast

SDR StandardisedDeathRate

SEHSCT SouthEasternHealthandSocialCareTrust

SEBSAN SouthandEastBelfastSubstanceAbuseNetwork

SF StrengtheningFamilies

SHAHRP SchoolHealthandAlcoholHarmReductionProgramme

SPT SubstitutePrescribingTeam

SSDP SeattleSocialDevelopmentProject

stat statutory

TATI TalkingtoyourChildrenaboutToughIssues

UK UnitedKingdom

USA UnitedStatesofAmerica

vol voluntary

WHO WorldHealthOrganisation

YJA YouthJusticeAgency

YOC YoungOffendersCentre


Appendix3:MembershipofBDAWG

BrianAllen,TheRISE Foundation

LindaArmitage,East Belfast Partnership

ClaireArmstrong, Addiction NI

AnneBill,Forum for Action on Substance Abuse and Suicide Awareness

FrancesBlack,TheRISE Foundation

[MaryBrannigan,Youth Justice Agency]

JustineBrown,North Belfast Partnership Board

EdeleCleary,BCC-Belfast Community Safety Partnership[replacedStevieLavery]

ClaireCrainey,Northern Ireland Housing Executive

AlisonCrawford,BCC-Belfast Health Development Unit

TomCrossan,BCC-Belfast Health Development Unit

KellyGilliland,PHA-Eastern Drugs and Alcohol Coordination Team

MaireadGilmartin,Holy Trinity Family Centre

BillyHutchinson,Mount Vernon Community Development Association

UnaLappin,South Belfast Partnership Board

[StevieLavery,BCC-Belfast Community Safety Partnership]

BennyLynch,Falls Community Council

AndrewMacQuarrie,YouthJusticeAgency[replacedMaryBrannigan]

ElaineMcCarthy,PHA-Belfast Health Development Unit

MichaelMcKay,Lisburn YMCA

JohnMcGeown,Belfast Health and Social Care Trust

AidanMcGoran,Belfast Regeneration Office

GaryMcMichael,Action on Substances through Community Education and Related Training

BrendanNellis,Barnardos

BryanNelson,Belfast Health and Social Care Trust

BrianO’Kane,Northern Ireland Housing Executive

OwenO’Neill,PHA-Eastern Drugs and Alcohol Coordination Team

BriegeQuinn,Belfast Health and Social Care Trust

IreneSherry,Bridge of Hope/Ashton Community Trust

AlanSwann,Police Service of Northern Ireland

CarolineWilson,Police Service of Northern Ireland [replacedJonathanWilson]

[JonathanWilson, Police Service of Northern Ireland]

*PleasenotethattheCODAProjecthassincefoldedandthatSEBSANhasnotmetinsometime

Appendix4:OverviewofservicesinBelfastcurrentlyfundedbyEDACT/PublicHealthAgency


Report produced by the Belfast Drug and Alcohol Working Group on behalf of the Public Health Agency.

For more information, or to request a hard copy of this report, please contact Kelly Gilliland in the Public Health Agency T: 028 9031 1611 orE: [email protected]

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