Enlightened times

The shift away from locking up drug misusers to treating them in
the community has major implications for social workers. Here
Adrian Rhead and Luke Clements outline the legal position for
practitioners working with this client group.

Tony Blair famously announced that he would be tough on crime
and tough on the causes of crime. The new government has clearly
identified drug addiction as a major cause of crime and it is soon
to announce the appointment of a ‘drug tsar’, who is expected to
emphasise the link between drugs and crime. One person tipped for
the job is Keith Halliwell, West Yorkshire’s chief constable and
the Association of Chief Police Officers’ spokesperson on
drugs.

Nevertheless, there has been a shift away from locking up
addicts to treating them in the community, as this is seen as a
more effective way of dealing with the problem of addiction. There
is a growing recognition that jailing offenders only temporarily
suppresses the underlying causes of their addiction. When offenders
are released back into the community they remain caught in the
revolving door of drugs, offending and prison.

Home Office research, to be published later this year, estimates
that one in five offenders are heroin users, with some estimates
putting the cost of drug-related crime as high as £5 billion
per year. Even prisons now have their own drugs problem and have
introduced compulsory random testing.

Ironically this is turning many drug misusers away from ‘soft’
drugs like cannabis, which can still be detected after three weeks,
towards heroin, traces of which disappear after 72 hours. Many
researchers argue that a prison system that deals with the
fundamental problems posed by deep-seated addiction merely by
random testing and then punishment is bound to fail.

This more enlightened approach to drugs and crime is in many
ways following the same path as the treatment of mentally
disordered offenders. Many of the initiatives which have proved
successful with mentally disordered offenders – such as
inter-agency co-operation and diverting funds from punishment to
rehabilitation – are now gradually being tried on drug-addicted
offenders.

If this community-based, non-custodial residential treatment is
pursued with vigour it will have dramatic consequences for social
workers, both in terms of resources and multi-agency working. The
cost of treating drug offenders will be, to some extent at least,
transferred from the Home Office – which is responsible for prisons
– to social services departments, which will have to provide
treatment out of their community care budgets.

Field social workers can expect a parallel increase in their
workloads as well as more joint working with the probation and
health services. They can expect an increase in referrals for
community care assessments for drug misusers, as solicitors and
others in the criminal justice system seek alternatives to custody.
These referrers will be looking beyond the usual probation or
community service orders; they will want quick responses and
expedited assessments which can be incorporated into sentencing
packages.

Although this is a change in government policy, the legislation
and guidance are already in place. Social workers will be familiar
with the duty imposed on social services to carry out community
care assessments for any person who appears to be both:

· Someone for whom they may provide or arrange for the
provision of community care services, and

· In need of such services.

The need for a multi-agency approach to the problem of drug
addiction has been emphasised in a number of important government
policy documents. In 1995, the government White Paper Tackling
Drugs Together,¬ in referring to the role of health services,
stated: ‘The government’s aim is to provide a comprehensive range
of choice of local services to help drug misusers give up drugs and
maintain abstinence. Such services also promote better health and
reduce the risk of drug misuse, including infections associated
with sharing injecting equipment such as HIV and hepatitis.

‘The services include residential detoxification and
rehabilitation, community drug dependency services, needle and
syringe exchange schemes, advice and counselling, and after care
and support services.’

Specific guidance on community care and housing ­ insists
on versatile strategies for dealing with misusers effectively. It
says housing authorities should acknowledge that a care plan ‘may
include a planned progression from some form of residential care to
a more independent lifestyle, possibly away from their original
areas of residence’.

This emphasis on providing a wide range of services is repeated
in the community care policy guidance ® which stresses the
‘high priority’ given by the government ‘to tackling the problems
associated with the misuse of alcohol and drugs, and to ensuring
the provision of a comprehensive network of services for alcohol
and drug misusers’.

Another government circular ¯ lays further emphasis on a
multidisciplinary approach, dealing specifically with the
relationship between offending and community care assessments. It
draws attention to the special circumstances surrounding the
provision of services for people who misuse drugs or alcohol and
says that social services departments must be able to respond
effectively and offer a programme of care that will help misusers
change their lives for the better.

The circular also calls on departments to remember that people
who misuse alcohol and drugs may, among other things, need to be
provided with services several times before they succeed in
bringing the problem under control.

Residential treatment and rehabilitation should be a choice
available to clients who, it should be acknowledged, may sometimes
behave unpredictably and may not fit easily into assessment
management systems designed to meet the needs of other client
groups.

The multidisciplinary aspect of dealing with drug misusers, and
the recognition that they will frequently be involved in the
criminal justice system, is made explicitly clear in circular
(93)2: ‘There are a range of organisations and professionals who
deal frequently with alcohol and drug misusers. A great many of the
services are provided by the independent sector. There is,
therefore, within the independent sector a substantial reservoir of
experienced professionals with skills to undertake assessment in
this field. Local authorities should consider involving independent
sector agencies in the assessment process.’

Social workers are expected to work particularly closely with
probation officers, as they will often share the same client
groups. Guidance points out that the probation service is likely to
seek a range of services, involving both residential and
non-residential care, and that it is up to local authorities to
liaise with the agency to ensure that these needs can be considered
within community care arrangements.

Joint assessment and common assessment procedures are expected
to be placed centre stage in any concerted programme for drug or
alcohol misusers. The guidance urges local authorities to bear in
mind that requests for care will be made for those whose misuse
comes to light through offending or through an appearance in
court.

It finishes with a reminder of the emphasis of the Criminal
Justice Act 1991, that it is ‘preferable for offenders who misuse
alcohol or drugs to be dealt with in the community rather than in
custody’.

The shift from punishment to treatment and rehabilitation will
increase the burden on already overstretched social services
departments. How will they respond to this new challenge in dealing
with this difficult client group?

Social services departments will be expected to be the lead
agencies in arranging a co-ordinated response for the assessment of
clients and provision of community care. They will not be able to
respond on an ad hoc basis but will have to put in place strategies
for fast-track assessments and out-of-area referrals, as well as
having a bank of community-based and residential services at their
disposal. Finally, joint working will have to be backed up by
multi-agency planning meetings to agree respective
responsibilities.

¬ Department of Health, Tackling Drugs Together,
HMSO, 1995

­ LAC(92)12, Department of Health, 1992

® Department of Health, Community Care into the Next
Decade and Beyond, HMSO, 1990

¯ LAC(93)2, Department of Health, 1993

Adrian Rhead is a solicitor and visiting fellow at the
department of applied social studies, Warwick University. Luke
Clements is a solicitor and research fellow at the Cardiff Law
School, University of Wales

Key points

· Section 47 (1) of the NHS and Community Care Act 1990
obliges social services departments to carry out community care
assessments. The duty to assess is triggered when a person appears
to be in need of services.

· Circular LAC (93) 2 gives guidance to local authorities
on the provision of community care services for drug and alcohol
misusers.

· It sets out both local authority and health authority
responsibilities.

· It reminds local authorities that addicts present special
problems and eligibility criteria for community care should be
sensitive to their needs. Addicts will often respond half-heartedly
to treatment programmes and those who provide them with help must
persevere.

· Addicts will often need ‘a fast-track assessment’ and
emergency action. Procedures must be set up to achieve this, and
also to deal with and act upon out-of-area referrals.

· Attention should be given to establishing joint
assessment or common assessment procedures, in particular with the
probation service and other specialist agencies.

· Local authorities can obtain information about
residential service provision from national voluntary organisations
Alcohol Concern and the Standing Conference on Drug Abuse.