Rehabilitating our criminal justice system

It’s been hard to miss recent media attention given to the problem of drugs within our corrections system. Keriata Stuart outlines some of these problems and what the Drug Foundation believes are ‘best buys’ in addressing them.

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It is said up to 80 percent of New Zealand’s crime is alcohol and drug related, and about half of all offenders are using at least one drug at the time of their arrest. Some 210 convictions occur each week for drug offences alone.

Problems with alcohol and other drugs signifi cantly contribute to New Zealand’s increasing imprisonment rate, and we may need around 10,000 prison beds by 2011 if nothing is done to reduce current imprisonment rates.

The Drug Foundation has been actively looking at these issues since 2005, when we organised a forum featuring leading prison health researcher Michael Levy, but current interest from groups across  the political spectrum now presents an opportunity for the Drug Foundation and others to work towards real progress.

A 2006 visit by the Corrections Minister and community leaders to prisons in the United Kingdom, the Netherlands and Finland has helped bring fresh perspectives to decision making.

One key outcome is the government’s Effective Interventions project, launched last August. Effective Interventions’ focus includes reducing offending, tackling repeat offending, introducing more sentencing options and improving rehabilitation.

Another has been expansion in drug treatment in prisons. One new unit opened in Christchurch last year, another this year in Hawkes Bay, and two units are due next year, taking the number of drug treatment unit places from 160 to more than 500.

Against this background, the Drug Foundation is releasing its policy position this month. Our policy originates from a wide-ranging review of research on what works overseas, and what could be applied here to reduce offending and address the serious health needs of many prisoners. We have identified the ‘best buys’ for government – policies
and practices that could produce the biggest bang per buck.

• Best buy no. 1: Services across the criminal justice system

Interventions need to extend to police cells, courts and remand centres as well as prisons.

When people with alcohol and other drug problems are arrested, it often signals a crisis in their lives, prompting them to seek or be open to treatment. To exploit this window of opportunity, however, requires coordination between police, health providers, courts and corrections agencies. Resources need to be committed to screening and support in cells and in courts. If treatment is not there when the person is ready for it, they can quickly become demotivated, and the opportunity is lost.

New Zealand has had court-based screening pilots and is about to start two trial services working between cells, courts and prisons.

Similarly, to reach people with substance abuse problems where they are means services need to be available to those on community sentences, such as probation and home detention.

Research in a number of countries shows how important support after release (often called ‘aftercare’) is for maintaining treatment gains. This kind of support is usually the responsibility of health services, so needs to be closely coordinated with Corrections.

The best example of this intersectoral approach is the United Kingdom’s Tackling Drugs, Changing Lives initiative. The UK is implementing its approach gradually, evaluating pilots before extending services nationally. This has created a useful evidence base on what has and has not worked. Among the UK successes have been screening and brief intervention following arrest, and coordinated aftercare, including housing support.

• Best buy no. 2: Treatment works

Over the last few years, the United States National Institute on Drug Abuse (NIDA) has evaluated diversion to treatment and prisonbased treatment. Its conclusions were summarised in a Washington Post article by NIDA director Nora Volkow, bluntly headed ‘Treat the addict, cut the crime rate’.

Volkow, whose agency is not known for its liberal stance, argued comprehensive drug treatment “not only reduces drug use, but also curtails criminal behaviour and recidivism”.

NIDA estimates that every dollar invested in prison addiction treatment yields a return of US$4–7 in reduced drug-related crimes. For some diversion to out-of-prison treatment programmes, savings were as high as US$12.

Recent research on California’s Substance Abuse and Crime Prevention Act (SACPA) has supported other studies on diversion. SACPA – the result of a state referendum – provides for people convicted of non-violent, drug related offences to be sentenced to probation with drug treatment.

While there have been some diffi culties meeting needs and managing people who drop out of treatment, a 2006 University of California study found that, for every dollar invested in SACPA services, taxpayers saved nearly US$2.50. For people who completed their required drug treatment, savings were as high as 4:1.

Some of the savings came from taxes paid by those able to stay in or re-enter the workforce. This supports the contention that diversion from prison not only reduces costs, it also benefi ts families.

These findings are paralleled in the UK where a 2005 report on the National Treatment Outcome Research Study (NTORS) found “substantial reductions in crime at all follow-up points after treatment”. After five years, drug related crime had reduced by about 75 percent among the highrisk group targeted.

Compulsory treatment – a surprising success

One surprise finding in the US review was strong evidence supporting compulsory treatment. While it has been used for many years, there have been concerns that compulsion may violate human rights or result in resistance to treatment.

Contrary to expectations, however, offenders mandated to treatment had drug use outcomes and crime reductions similar to, or sometimes better than, those achieved by voluntary patients.

• Best buy no. 3: Get the treatment right

A systematic review of international research found that treating imprisoned drug users could not only reduce alcohol and other drug use, it could also reduce recidivism by as much as 20 percent.

The review found that not all treatment programmes were equal, however. ‘Boot camp’ style programmes were found to be ineffective in reducing either usage or recidivism. Counselling had some effectiveness in reducing recidivism but little in reducing drug use.

The good news from New Zealand’s perspective is that the most effective services were therapeutic communities, which are already the main type of residential treatment in our prisons. Corrections’ research has found that, over two years, people who complete the programmes have reconviction rates 13 percent lower than people who do not receive treatment.

• Best buy no. 4: Meet treatment needs in full

While New Zealand provides highquality treatment under present policy and funding regimes, the system’s ability to meet needs is less than satisfactory. Estimates are that less than a quarter of people needing treatment receive it.

Current policies also mean that many prisoners can only access treatment if they are in prison long enough to attend a treatment programme and have already stopped using drugs. This excludes most prisoners on short sentences, a large proportion of whom are women. With a few exceptions, prisoners cannot get treatment until two-thirds of the way through their sentences. This policy does not fi t with best practice, and has been subject to criticism.

Treatment programmes that begin in prisons and commit the person to continue after release, as used in other countries, could eliminate such gaps.

• Best buy no. 5: Harm reduction in prisons

“The current situation of judicial authorities is paradoxical. They have to find a solution to a problem that is not supposed to exist: drugs in prisons.” (World Health Organization, in Health in prisons: A WHO guide to the essentials in prison health, 2007.)

Unlike many other countries, New Zealand has responded to the dilemma described above by taking a clear harm minimisation approach. This means that, as well as taking action to reduce the entry of drugs into prisons, Corrections supports some services to reduce harm to prisoners who do manage to access drugs.

Many harm reduction initiatives have been well evaluated, especially in Australia. There is particularly strong evidence on the benefits of making opioid substitution therapies, such as methadone, available to prisoners with injecting drug use problems.

New Zealand recently changed its policy so that all prisoners receiving opioid substitution therapies before entering prison can continue their treatment. However, existing prisoners cannot access this therapy.

New areas for harm reduction and treatment include smoking cessation support. In the UK, nicotine replacement pharmacotherapy and smoking cessation programmes have been available in prisons for some time and have had higher than expected uptake.

• Best buy no. 6: Follow through

International evidence emphasises the importance of well-planned and long-term support for people released from prison. Aftercare, including community-based treatment, housing, and support to fi nd work, helped maintain reduction of or abstinence from alcohol or other drugs, and reduce recidivism.

New Zealand is trialling coordinated reintegration teams, but we have yet to see how intensive that support will be, or if those services will be available over the three to five years recommended by researchers.

There’s no reason why New Zealand cannot replicate the same successes seen overseas and extend on our own experiences of reducing reoffending. It is clear that well planned and resourced services, and programmes delivered across the criminal justice system, will go a long way towards reducing offending and addressing prisoners’ health needs.

The challenge facing decision makers now is to introduce new and effective policies while confronting a political opposition scoring easy hits on failures in the system, and selling new ideas to a public, who might perceive that prisoners are receiving too much support and not enough punishment.

• Keriata Stuart is the Drug Foundation’s Senior Policy Analyst.