Can prison and police custody offer a new setting to target those misusing alcohol?

“Without a doubt, we still have a problem with alcohol in terms of public health here in Scotland,” says Dr Lesley Graham, associate specialist in public health within the Information Services Division of NHS National Services Scotland.

“We saw the dramatic rise in the early 90s of alcohol-related harm, particularly mortality, and although it would appear that the rates are now falling – particularly from about 2003 for men and 2005 for women – we are still at rates nearly twice as high compared to 30-40 years ago.”

As is often the case, the problem is magnified in custody. Men imprisoned in Scotland are nearly three times more likely to die an alcohol-related death compared to the general population, a probability nearly ten-fold where women are concerned.

With the NHS now responsible for healthcare in prisons and throughout police custody suites, trying to deal with alcohol misuse outwith hospitals and GP surgeries is attracting greater attention.

Two reports – one setting out a number of indicators to assess the impact of healthcare services delivered in police custody, the other making a series of recommendations to tackle drug, alcohol and tobacco use among prisoners – were being finalised this month. Part of the impetus will be to encourage wider adoption of alcohol brief interventions (ABIs), a measure primarily delivered in A&E, primary care and antenatal care up until now.

In NHS Greater Glasgow and Clyde, for example, ABIs have been embedded within a police custody setting. “We know that on some occasions a lot of people won’t go on [to other services], but we work on the principle of saturation,” says Grant Scott, professional nurse adviser for prison healthcare and healthcare in police custody suites across the health board.

“We might have to repeat this on a number of occasions before an individual actually says, ‘I think what they’re saying is quite accurate, I’m seeing the fact that I have now been arrested four times in the last two months and alcohol plays a part in it, maybe I should listen to what is being said and look at the options round about me’,” he adds.

Of course, there are complexities. For the individual, the daily prison regime can be taxing and even if progress is made in custody, making a seamless transition back into the community can prove problematic.

“They can go from having links to an alcohol nurse, care and support group work, and individual tailored care needs in a prison setting to being released and having to work with a new set of people,” says Scott. “While we’ve tried to do the throughcare process and introduce them pre-release, it can be a staging process and that can cause some difficulty.”

A willingness to engage with services, of course, cannot be guaranteed. That said, latest figures from the Scottish prisoner survey indicate fewer people are being offered help and fewer treated. Completed waits for specialist alcohol treatment services in prison also fell 12 per cent in the last year on record.

“You’ve got a treatment gap of about one in five,” says Graham. “For every five people in need, one is being entered into specialist alcohol treatment services in the prison setting.”

Holyrood is hosting an event ‘Alcohol Interventions in Justice Settings’ on March 22.