The introduction of drug Arrest Referral schemes in London: A partnership between drug services and...

International Journal of Drug Policy 16 (2005) 343–352

The introduction of drug Arrest Referral schemes in London:A partnership between drug services and the police

Gillian Hunter∗, Tim McSweeney1, Paul J. Turnbull2

Institute for Criminal Policy Research (ICPR), School of Law, King’s College, 3rd/4th Floor,26-29 Drury Lane, London WC2B 5RL, UK

Received 14 March 2005; received in revised form 22 June 2005; accepted 28 June 2005

Abstract

The significant investment into developing criminal justice interventions to link drug-using offenders with drug treatment interventions,most specifically in the UK, Australia and North America, has instigated debate about the emphasis given to crime reduction vis-a-vis healthand harm reduction for drug users. Key to this debate is the extent to which health and criminal justice agencies are equal partners andcollaborate effectively in delivering drug interventions. Arrest Referral (AR) schemes, located in police stations, provide an opportunity for

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advice, information, assessment and referral to drug services at point of arrest. These form a first stage of intervention which cainclude court enforced community drug treatment orders and prison detoxification programmes. As part of an evaluation of ARin London that took place between 2000 and 2002, 84 police officers and 67 drugs workers involved in the schemes were inabout their working relationships and views on AR. Findings highlight practical difficulties of delivering a drug service in a police cenvironment, including how to establish the ‘credibility’ of the service among drug–using arrestees. Others issues raised included dbetween the police and drugs workers in their perceptions of the aims of AR and the fear among drug workers that their role in pharm reduction was being ignored by the funders of the schemes. More positively, data showed greater collaboration and improverelationships over time. The implications of these findings are discussed in the context of the introduction of Criminal Justice ITeams (CJIT) in the UK, which aim to integrate criminal justice and community drug treatment interventions and promote inter-agemanagement thus increasing the need for partnerships between health and criminal justice agencies at all points of the Criminal Jus(CJS).© 2005 Elsevier B.V. All rights reserved.

Keywords: Drugs interventions; Criminal Justice System; Arrest referral; Police; Partnerships

Introduction

The reduction of drug-related crime has been a centralaim of the UK drug strategy (HM Government, 1998, 2002).This has resulted in significant investment into the develop-ment of interventions for drug users located at key pointsin the Criminal Justice System (CJS): arrest, sentencing,prison and community (Kothari, Marsden, & Strang, 2002;

∗ Corresponding author. Tel.: +20 7848 1748; fax: +20 7848 1770.E-mail addresses: [email protected] (G. Hunter),

[email protected] (T. McSweeney), [email protected](P.J. Turnbull).

1 Tel.: +20 7848 1757; fax: +20 7848 1770.2 Tel.: +20 7848 1744; fax: +20 7848 1770.

Turnbull and Webster, 1998); and is consistent with deveopments in the US (Marlowe, 2003), Australia (Bull, 2003)and across mainland Europe (EMCDDA, 2003). In 2003, theDrug Intervention Programme (DIP) was launched in theto integrate these various CJS interventions and with a buof almost £0.5 billion over three years, to promote an inagency case management approach to dealing with drugfrom point of entry into the CJS through to ‘aftercare’ a‘re-settlement’.

The substantial investment in CJS interventionsintensified international debate about the focus of poapproaches to problem drug use. In recent years in theit has been argued that there has been too great aicy emphasis on crime reduction at the expense of puhealth strategies that promote harm reduction, health

0955-3959/$ – see front matter © 2005 Elsevier B.V. All rights reserved.doi:10.1016/j.drugpo.2005.06.008

344 G. Hunter et al. / International Journal of Drug Policy 16 (2005) 343–352

social gain for drug users (Hunt and Stevens, 2004; Stimson,2000).

Drug use and crime

In the UK the association between illicit drug use andcrime has sometimes been exaggerated, and is often over-simplified (Best et al., 2001a; Hough, 2001; MacGregor,2000; McSweeney and Hough, in press; Seddon, 2000;Simpson, 2003). The common failure, when discussing thelinks between drug use and crime, to differentiate betweentypes of drug user has also been criticised (Hough, 2001).Behavioural data collected from drug users entering treat-ment services in the UK (Best, Sidwell, Gossop, Harris,& Strang, 2001b; Inciardi and Pottieger, 1994; Parker andBottomley, 1996) show that problem drug users who aredependent on heroin and crack cocaine often commit crimeto finance their drug use. The National Treatment OutcomesStudy (NTORS) found that just over half the sample of1100 drug users had committed a crime (other than drugpossession) in the 3 months prior to entering drug treat-ment. The most commonly reported offence was shoplifting(Gossop, Marsden, & Stewart, 1998). Ten percent of thesample accounted for three-quarters of the total acquisitivecrimes committed. By contrast, half reported that they had notcommitted any acquisitive crime in the three months priort fe,2

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programmes; community prescribing; care planned coun-selling; and residential rehabilitation (Department of Health,1996; Holloway, Bennett, & Farrington, 2005; Hough, 1996;Marsden and Farrell, 2002). Methadone maintenance, inparticular, has been shown to offer a way of reducingdrug use and enabling improvements in physical and men-tal health, and personal and social functioning (Marsch,1998).

It is, however, important not to over-simplify the effects oftreatment on drug use or offending behaviour (Gossop, 2005;Gossop, Marsden, & Stewart, 2001) or to under-play the vari-ous difficulties involved in engaging and retaining drug usersin treatment. Clearly, the quality of treatment and the contextin which interventions are delivered are critical determinantsof outcome. For example, recent analysis of data from theUK National Drug Treatment Monitoring System noted that“the strongest predictor of retention or completion of treat-ment was not the characteristics of the client, but related tothe agency they had attended” (Millar, Donmall, & Jones,2004, p. 4).

TheAudit Commission (2004)and others (Gossop, 2005)have stressed that clinical intervention alone is unlikely tobe effective and needs to be accompanied by social care andsupport; an issue that the UK Drugs Intervention Programmeis designed to address via the development of ‘through-care’ and ‘aftercare’ services. The often short-term natureo cerna rugu kelyte id-u mple,C -g d byt eten-t out-c

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ruga thatt idera 4;S vet acto ,T ta nyr serss( ec ing,s aboutt theC

o starting treatment (Stewart, Gossop, Marsden, & Rol000).

Drug use is common among arrestees in the UK.EW-ADAM (Arrestee Drug Abuse Monitoring) surv

Bennett, 1998, 2000; Bennett, Holloway, & Williams, 2001;olloway and Bennett, 2004) involved drug-testing and inteiewing samples of arrestees in England and Wales. Itsweep interviewed 3091 arrestees in 16 locations – equivo around 28% of the estimated 11,000 arrestees proceshese sites and half of those who were eligible for entry totudy – (arrested for acquisitive and drug related offenhirty-eight percent tested positive for either or bothtes and cocaine (Holloway and Bennett, 2004). The averageekly expenditure for those using opiates and crackocaine was £323; with the main sources of illegal incoming from property crime followed by undeclared eangs while claiming social security benefits and drug deaeroin and crack/cocaine users had an average annual

ncome of around £24,000 – compared to almost £600on-drug using arrestees.

he role of drug interventions in reducing crime

Reductions in criminal activity have been repormong drug users receiving treatment for substanceCoid, Carvell, Kittler, Healey, & Henderson, 2000; Gossopt al., 1998; Strang et al., 1997; Turnbull, McSweeneyough, Webster, & Edmunds). Several UK reviews o

he international evidence have examined the effecess of the main types of treatment in the UK: inpat

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f funding for many interventions has also been a connd not easily reconciled with the fact that problem dse is a chronic and relapsing condition that is unli

o be dealt with by a single period of treatment (Kotharit al., 2002). There are also factors related to an indival’s readiness to address problem drug use. For exaahill, Adinoff, Hosig, Muller and Pulliam (2003)have sugested that external forms of pressure like that exerte

he CJS might increase treatment entry and short-term rion but appears to have little impact on longer-termomes.

xploiting the coercive potential of the CJS

The expansion of drug services as part of a dnd crime reduction policy agenda raises concerns

reatment provision and the relationship between provnd client may be distorted (Barton, 1999; Parker, 200timson, 2000). Criticism of CJS drug interventions ha

ended to focus on the ethics of ‘coercion’ and its impn treatment processes and outcome (De Leon, Melnickhomas, Kressel, & Wexler, 2000; De Miranda, 1989; Hunnd Stevens, 2004). There is often the assumption that aeferral from the CJS will be coercive and that all drug ueeking help in the community will do so voluntarily.Bean2001, p. 63)andFarabee et al. (1998, p. 8)by contrast, havriticised the voluntary/coerced dichotomy as misleadtressing the need to examine the views of drug usershe extent to which they feel ‘coerced’ into treatment viaJS.

G. Hunter et al. / International Journal of Drug Policy 16 (2005) 343–352 345

Further, the benefits of drug treatment are incremental andthus retention in treatment is a key predictor of positive out-come. It has been noted (mainly by North American studies)that initial ‘coercion’ can help keep drug users in contact withservices longer, particularly during the difficult first stagesof treatment and is no less effective than treatment enteredinto ‘voluntarily’ (Anglin, 1988; Barton, 1999; Farabee,Prendergast, & Anglin, 1998; Hser, Maglione, Polinsky, &Anglin, 1998). However the lack of any long-term outcomestudies, particularly in the UK and European context, on theeffects of ‘coerced’ versus ‘voluntary’ treatment make it dif-ficult to draw any firm conclusions at present (seeStevenset al. (2005)for a recent review).

The basis of CJS drug interventions, and indeed the devel-opment of the Drug Intervention Programme, is collaborationbetween the CJS and health services, which in effect hasmeant forging a union between agencies with different agen-das and perspectives on drug use and drug users (Barton,1999; Hough, 1996; Turnbull et al., 2000). A multi-agency‘partnership’ approach to dealing with drug use has been pro-moted by the UK government since Tackling Drugs Together(Home Office, 1995). It was this document that instigatedthe formation of local Drug Action Teams (DATs). Thesewere established to bring together various statutory author-ities to assess the nature and extent of local drug problemsand implement a co-ordinated plan to tackle these. Increas-i ntactw e) toe ever,k equalp llab-o s thed oalsa rimer ofb s onew gelyb rac-t Osg s thec f thet ulle

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was achieved. Annual monitoring data for the period October2000–September 2001 showed that 48,810 individuals werescreened by an AR scheme and, of those, over half were vol-untarily referred to a drug service (Drug Prevention AdvisoryService, 2002).

The schemes did not offer an alternative to prosecution ordue process and participation was voluntary; arrestees wereunder no obligation to be assessed or referred by a drugworker. They functioned in much the same way as peripateticoutreach, an intervention that has been encouraged since thelate 1980s as a way of ‘reaching out’ to ‘hidden’ drug usersto reduce drug-related harms and encourage entry to drugtreatment (Ball, 1998; Rhodes and Stimson, 1998). Discus-sion between an arrest referral worker and an arrestee wasconfidential, except in instances where the arrestee mightdisclose information about harm to self or others or aninvolvement in a serious crime that police were unawareof. The parameters of the confidentiality policy were to bemade clear to the arrestee prior to any interview with the ARworker.

In this paper, we take the introduction of Arrest Refer-ral schemes in London as an example of the “meeting” ofhealth services and the CJS, and review the extent to whichthis initiative functioned as a partnership at ‘grassroots’. Bythis we mean between operational police officers and drugsworkers rather than at senior management level. By April2 perate2 prox-i livert stip-u ichi cus-t unitytP ,T n,1

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ng communication between the agencies that have coith drug users (including health services and the policnsure a more concerted response seems sensible. Howey issue is the extent to which agencies are genuinelyartners. The most unsatisfactory outcome of such coration would be one where the CJS agency is alwayominant partner, so that harm reduction and health gre always subservient to those of enforcement and ceduction.Bean (2004: 91)has described the experienceringing together health and CJS agencies in the USA ahere compromise on working style and agenda is lareing made by health agencies with little change in p

ice from the CJS. In the UK, practice guidelines for DTTive the CJS the ultimate power in treatment decisions aourts and probation service can override the advice oreatment provider (Falk, 2004; Kothari et al., 2002; Turnbt al., 2000).

rrest referral

Arrest Referral (AR) schemes are intended as partnenitiatives between police and local drug services thathe point of arrest within custody suites (at police statios an opportunity for drug-using offenders to be assey an independent drugs worker who can then refer t

o drug treatment services. AR schemes have been in uarious forms in the UK since the 1980s (Dorn, 1994; Drugrevention Advisory Service, 2002). Their introduction intovery custody suite in England and Wales was an objecthe Government drug strategy (1998) and by 2002 this t

a

000, 14 drug services had been awarded contracts to o5 schemes in police stations across London and ap

mately 100 drugs workers had been employed to dehis service. A number of service requirements werelated, including using the proactive model of AR, wh

nvolved having dedicated drug workers on-site at theody suite and all arrestees were to be offered the opporto see a drugs worker (hereafter arrest referral worker) (Drugrevention Advisory Service, 1999, 2002; Edmunds, Houghurnbull, & May, 1999; Edmunds, May, Hough, & Hearnde998).

ethod

The way in which the AR scheme functions in the potation (e.g. how drugs workers make contact with arreshat services they can offer at point of contact, whaters service delivery) is explored by reference to intervith AR workers and custody sergeants; the latter areolice officers responsible for the management and carrestees. These interviews examined the views of both

ies on working practice and working relationships, perion of the aims of AR and its usefulness and effectiveneroviding help to drug users. The findings formed partK Home Office-funded evaluation of AR (Drug Preventiondvisory Service, 2002; Kothari et al., 2002; Oerton et002).

Interviews were conducted at two points (Time1: October000–February 2001 andTime2: November 2001–Februa


2002) to review changes or developments in collaborationand working practice. Sixty-seven interviews were conductedwith AR staff from 11 of 25 AR schemes in London, 35 atTime1 and 32 at Time2. In total, 13 managers and 38 ARworkers were interviewed (16 AR staff were interviewed atboth times). In addition, three focus groups were conductedbetween May and December 2001, two with workers and onewith managers, to discuss further some of the issues raisedin the individual interviews.

Eighty-four interviews were conducted with custodysergeants from 24 police stations (linked to the 11 ARschemes), 52 at Time1 and 36 at Time2. Four respondentsinterviewed at Time1 were re-interviewed at Time2. AtTime2, no effort was made to exclude those sergeants whohad been interviewed before. The relatively small numberof repeat interviews was, in part, indicative of police staffturnover.

A semi-structured interview schedule was used for ARstaff. The interviews took approximately 1 h and were tape-recorded and transcribed. Interviews with custody staff wereconducted while they were on duty and for that very prac-tical reason, tape recording interviews was not viable anda semi-structured questionnaire was used instead. Commontopics were covered in both interviews, although clearly theAR workers had opportunity to discuss in greater depth theirviews on AR.

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Information and training about AR and the CriminalJustice System

Given their central role, it is important that custody offi-cers were clear about the aims of AR and their responsibilitiesfor the AR process. However, introducing the concept ofAR to custody staff was done on a rather ad hoc basis.Less than a third of respondents (16/52) reported partici-pating in a formal training session about AR prior to itsimplementation at their station. At Time2, similar propor-tions reported receiving introductory information from boththe police (13/36) and the AR schemes (11). Informationabout AR for police officers often came in the form of amemo (Time1 14/52), via a chat with a senior officer (3),through contact with a scheme at a previous station (11) or‘by picking up information from colleagues’ (4 at Time1, 8at Time2).

Only a quarter of respondents at Time1 (13) and one-thirdat Time2 (12) reported receiving more general training fromthe police authorities on drug awareness with many describ-ing their knowledge about drug users as being picked upon the job. Their stated training needs regarding drug useincluded information on infectious diseases (9), an overviewof drug use issues (6), the effects of different drugs (5), healthimplications of drug withdrawal in custody (3), and moreinformation about policy and practice of AR schemes (3).

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Questionnaire data were analysed using SPSS. Structured interviews and focus group discussions wereecorded and transcribed. Qualitative data were analyshe assignment of codes to collate the data under keyories. These ‘first level’ coding categories reflected the autlined above. Within each ‘first level’ code, a numbe

second level codes’ were also identified and these forhe basis for further analysis and interpretation.

indings

Our findings present interview data on the extentature of information and training about AR for polnd AR workers, their understanding of working proures, views on working relationships, their perceptio

he aims of AR and the factors that made it effectneffective.

Drug agencies provided the AR service, although poustody officers were involved in the process in a numbmportant ways. It was the custody sergeant who first an arrestee if s/he wanted to meet with a worker. Theas made as part of a risk assessment interview (compuestions on physical and mental health) before being

o a cell. The officer could also inform AR workers abotential contacts when they are off-site. Importantly it isustody sergeant who served as gatekeeper to the arn that the AR worker required police permission to visitrrestee in a cell or to take the arrestee out of a cell to codrug use assessment.

e

AR workers also noted a lack of knowledge among sfficers about the aims and working procedures of ARescribed below:

“It was difficult from the start, because it’s partly a polproject but the policemen didn’t seem to know. It’s sticase of some people don’t have a clue, even after somonths.” [Time1, ARW 7: Scheme 2]

In turn AR workers had to feel confident about wong in the police station. Just under two-fifths had prevxperience of working in the CJS, including for otherchemes and the probation service. While almost all woeported receiving an induction to AR, a common compas that it did not prepare them for working in a police c

ody environment. For example, one worker describedack of familiarity with criminal justice ‘jargon’ as an initiaroblem:

“Being new to it, criminal justice, there is a lot of jargand especially the people you are talking to [arresteesto have been in the system before so they’re talking a‘remand’ and ‘licence’ and stuff. You can get a bit confuin there.” [Time1, ARW 11: Scheme 1]

Others requested guidance about the working ‘etiquf the custody suite:

“There was nothing in any of our books when we startedor when you’re in the custody suites, whether or not yoallowed to take them into the doctor’s room, absolu


nothing about any of that kind of staff stuff and it changesfrom station to station.” [Focus Group 1: ARW 02]

AR working procedure – making contact with arrestees

Co-operation between custody sergeant and AR schemestarted with the initial offer made to arrestees to meet an ARworker. In practice custody staff reported making judgementsabout the appropriateness of offering the scheme to arrestees.For example, exceptions were made by some officers for juve-niles, ‘old people’ those who were drunk or violent, thosearrested for ‘white collar crime’, anyone who required aninterpreter, those who were deemed to be mentally unfit andwhen it was thought that such a question might cause offence.Overall, police respondents at Time1 were more likely to statethat the scheme was offered to every arrestee (43/52) thanrespondents at Time2 (22/36).

Almost without exception, AR workers considered this tobe an inadequate means of introducing the service. A keyissue was the ‘context’ of the offer in that it was the last ofmany questions, which tended to elicit an automatic ‘no’. Asdescribed below:

“I’m satisfied they’re made aware, I’m not satisfied in themanner that they’re made aware and that’s something Iwill confront police with. That’s got to be re-addressed,

ht athing.3:

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onting

vicew esent( t them t thatc

“There’s times where I don’t think the co-operation is seenas important. If someone has asked to see a drug worker,and I’m not there at the time. I don’t think they see it asimportant to get back to me. They might be busy and askme to come back. . .. I come back an hour later and they’ve[arrestee] gone.” [Time1, ARW 5: Scheme 1]

“There are a couple [of sergeants] that do contact us but ahuge percentage of them don’t, so you know they’ll tick thebox [stating request for AR service] but they won’t call”.[Time2, ARW 2: Scheme 6]

The interviews with custody staff confirmed this view. ByTime2 even fewer sergeants were likely to make an effort tocontact workers if they were not present when the servicewas requested. While over three-quarters (45/52) of policerespondents at Time1 reported contacting the AR workerby telephone, this fell to over half (21/36) of respondentsat Time2. By this stage police respondents were more likelyto pass on the arrestee’s contact details to the worker the nexttime s/he attended the station or simply give the arrestee thenumber for the AR scheme and leave it to them to contact theservice. Although, custody staff justified this by stating thatAR workers were attending the police station daily and thusit was easy for them to pick up messages.

AR workers believed that the most successful way ofe y thew ctivew

omathe

ell

us-t pon-d py toa ownb con-c beenr clearp orki e2,s eantsu

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dys ntialt kers

because all these questions, it’s ‘no, no, no, no’, and rigthe end is the drugs question, and it doesn’t mean anytI’m sure there must be some other way.” [Time1, ARWScheme 1]

There was also concern among AR workers thatolice were not promoting the scheme because of their n

ive opinions about drug users and the view that arreould consider the scheme to be something to do

he police and therefore be unlikely to request theice:

“I get the feeling that only one or two sergeants actubelieve in the service and actively are selling it. I getfeeling that the perception of drug users as incorrigibthere and I think it’s going to be really hard to break tdown”. [Time1, ARW 8: Scheme 1]

“There is the relationship with the police and how thevice is sold by the police. Whether or not they trustpolice, whether or not they trust that we are an indedent service. I fear that an awful lot of people are fallingthe other side of that mistrust barrier. It’s the more truspeople that will see us.” [Time1, ARW 4: Scheme 1]

Co-operation from police was also required if the seras requested at a time when the AR worker was not pr

no scheme offered 24 h cover). Some workers felt thaany other responsibilities of custody sergeants mean

ontacting them was not a priority:

ncouraging arrestees to take up the offer of AR was borkers visiting the cells to introduce the scheme (proaork).

“Most of our referrals are proactive, we get very little frthe police. . . they do refer to us,. . . they refer a coupleweek but most of our referrals come from going round[cells].” [Focus Group 01, 03]

“It’s probably 75% we get from knocking on the cdoors.” [Time2, ARW 8: Scheme 2]

To do this, AR workers required permission from the cody sergeant. Over three-quarters (40/52) of police resents at Time1 and almost all at Time2 (35/36) were hapllow workers access to the cells. The initial reticence shy a minority of sergeants at Time1 (10), was related toerns about prisoner rights if the offer of the service hadefused on the risk assessment form (4), a lack of anyolice procedure for allowing workers to do proactive w

n the custody suite (1), and safety concerns (5). By Timuch concerns seemed to have abated with only two sergnhappy for AR staff to conduct proactive work.

orking relationship between the police and the ARorkers

Developing a good working relationship with custotaff was considered by many AR workers to be esseo establishing an effective scheme. In the main, AR wor


considered their relationship with police to be good. How-ever, this had not been immediate as the following interviewextracts show:

“I’d describe it [working relationship] as very good. That’sbeen through persistent hard work and being in the cus-tody suite and making my presence known, and engagingwith them on a personal and professional level. Right atthe beginning they were very frosty and very sceptical.”[Time1, ARW 6: Scheme 3]

“I think it’s individual rapport. If you do go in guns blazing,‘I’m the Arrest Referral worker, get them out of the cellnow’ you’re going to build a bad rapport. We are workingwith different agendas. The more I’ve been there, the moreI’ve been accepted.” [Time1, ARW 11: Scheme 1]

Of note, however, was that problems in working with thepolice reported by workers at Time1 had often reduced byTime2, as illustrated below:

“There were teething problems and I think there have beenpretty much nationally, and I think most of those havebeen about the cultural difference between the police andthe way drug workers work. It seems to me that if nothingelse, if referrals are anything to go by, that’s really fine

er:

edewe2,

ork-i ragea

ingdesowbit

d are2:

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d/orb flu-

enced by how much additional work it creates for them, theirviews on the aims of the schemes and whether or not theythink the schemes can achieve these aims.

Over three-quarters (41/52) of police respondents atTime1 believed that having the AR scheme in the custodysuite had no additional impact on their work, however, atTime2 this had decreased to just over half (21/36) of respon-dents and a number of issues were mentioned, including theresponsibility of supervising AR workers (11/36); of trying toaccommodate AR work with the needs of other professionalssuch as solicitors and medical staff (7); the paper work theAR process created (4) and that it involved moving prison-ers about more often (e.g. taking them to and from interviewrooms to speak to AR worker) (4).

At both Time1 and Time2, police respondents most com-monly noted the key aim of AR to be crime reduction (openquestion) (40/52 at Time1 and at 21/36 at Time2). Under half(24) at Time1 and over one-third at Time2 (21) mentioned‘helping people get off drugs’ or into drug treatment. Otherkey aims, noted by a minority included the promotion of amulti-agency approach to dealing with drug users, identify-ing people who need support and improving the health ofdrug users.

When asked how likely they thought it was that ARschemes would achieve such aims, most police respondents(40/52) at Time1 did not know or felt that it was too soon tos ely.Y andT ARs r thisi k top thatA singo wasa 3 atT offero 1 atT

bec ent,a is tob tiva-t ssedb

ackeekcausents

eeopleyouing

hen

and we’re working well together”. [Time2, AR managScheme 8]

“I would say that it [working relationship] has improvoverall. I mean there’s still a bit of distance from a fof the old stalwarts but mostly it has improved” [TimARW 2: Scheme 4]

AR workers perceived a positive aspect to improved wng relations was that the police were more likely to encourrestees to take up the offer of the AR scheme:

“I think, for us it’s gotten a lot better, just through us bethere all the time, getting used to us, and their attituaren’t quite as hard and that’s sort of rubbing off on hthey introduce it to clients, they’re selling the service amore.” [Focus Group 1, 02]

“The sergeants are used to seeing us every day anfriendly. Attitudes have really changed.” [Time2, ARW05]

The vast majority of police respondents’ at both Timnd Time2 considered their working relationship withtaff to be very/fairly good (44/52 and 29/36, respective

erception of the aims and effectiveness of AR schemes

The extent to which custody staff will co-operate anecome more involved in the AR process is likely to be in

ay; by Time2 over two-thirds (25/36) considered it unliket despite this, nearly three-quarters at both Time1ime2 (37/51 and 26/36, respectively) considered thechemes to be useful. A range of reasons were given foncluding the view that arrest was a good point to speaeople about drug use (15 at Time1 and 20 at Time2),R was a good resource for the police to offer to drug-uffenders in custody (10 at Time1 and 8 at Time2) that itn example of multi-agency working (4 at Time1 andime2) and that even if only a few arrestees took up thef the scheme it could still have an impact on crime (ime1 and 3 at Time2).

Most AR workers also noted the ‘official’ aim of AR torime reduction via channelling drug users into treatmlthough they considered their capacity to achieve the restricted by various structural factors and the mo

ion of individuals to address problem drug use, as discuelow:

“We are up against it. We’re not in a position to fast tr[quick entry to drug treatment services]. Six to eight wwaiting list for assessment and that really sets us up bewe’re offering everything and delivering nothing. Cliecan’t wait that time.” [Time1, ARW 6: 04]

“The frustrating thing is. . . the waiting lists. If you arassessing people and they are quite vulnerable and pthink that arrest referral doesn’t require many skills butare dealing with people who are vulnerable, often comdown from crack, or heroin. You do work hard and t


people don’t turn up for treatment, or there are waiting listsand they lose their motivation and that does get to you.”[Time2, ARW 2: 05]

A common concern of AR workers was that while muchhad been invested into setting up AR schemes, there had beenlittle focus on how AR services would be integrated into drugservice provision more generally:

“It’s been very good in terms of cementing a much moreproductive working relationship with the police. Ten yearsago we were very wary of the police and would not havethought about having shared initiatives .. . . It’s difficult tosay how successful I think it is in terms of diverting peopleinto treatment.” [Time2, AR manager: Scheme 7]

“It seems to have come the wrong way around, getting allthose workers generating new referrals or re-generatingold referrals and not having anywhere to send them, that’sjust mad.” [Time2, ARW 8: Scheme 2]

Because of this, AR workers were keen to stress the moreimmediate aspects of their work and there was a commonemphasis on the importance of using the AR encounter asbrief intervention to provide harm minimisation informationto drug users as illustrated in the following quotes:

pos-boution.onof

rds.”

asrugsosted

y doomeger:

ucha rdosew ders( pecto esea

hathatunt

on,tely

ignored by government and the police and it’s a big part ofour work. [Time2, ARW 6: 05]

Discussion

A number of issues are raised by these findings about ARand the nature of partnership between police and AR workersat ‘grass roots’ level. These include the sometimes poor com-munication between AR workers and the police, the lack oftraining and preparation for both parties about the running ofthe schemes in the custody environment, the perceived lackof emphasis given to the harm reduction role of AR workersand the isolation of the schemes from community-based drugservices.

The integration of the various CJS and community drugtreatment interventions is a key aim of the Drug InterventionProgramme in the UK and therefore, these issues need to beaddressed in laying the foundations for the effective deliveryof Criminal Justice Integrated Teams (CJITs).

In some areas the expansion of drug testing arrangementsin custody has already become an important mechanism foridentifying potential CJIT clients (ICPR & CRDHB, 2004).This involves compulsory testing for Class A drugs for allthose arrested for acquisitive and drug-related offences. Inmost cases, however, arrestees who have been tested consti-t tingo refer-r r thane illb giesf ents

ossi-b inga pos-i ndert kera ARr andd ealthw

licec offi-c tiesa ingr ever,w rshipo ble.

inE mit-m ptakea f anA fer-r eent

“The aim of my scheme is to see as many people assible. To give them as much information as possible awhat’s available, what’s going on about harm reductI think that’s probably more important and to advisevarious things from Hep C to overdose. Irrespectivewhether these clients go on to see anyone afterwa[Time1, ARW 8: Scheme 1]

“The intervention of the AR worker, why not see thatimportant. Bear in mind how many people come to dservices anyway, they wait until they’re in real crisiswhy you’d think that just because someone’s been arrethey’ll attend the service the next day. I mean they mabut if you’ve done some good work and passed on sgood advice then that’s great too.” [Time2, AR manaScheme 10]

Yet their capacity to promote public health strategies ss safer drug use practices and prevention of drug oveas perceived by workers to be largely ignored by the fun

Home Office and Metropolitan Police) because this asf their work was not being monitored routinely by thgencies:

The main focus is getting people into treatment, that’s wthe Met [Metropolitan police] want to hear and that’s wthe Home Office want to hear. They don’t take accoof the information and advice giving, harm minimisatithat’s not counted as a result. Stuff like that is comple

uted a small number of those engaging with DIP. Tesn charge appears to be a key problem with arrestees ping to leave the police station as soon as possible rathengage with AR (ibid). A key challenge for CJITs then we to develop and implement a number of different strate

or improving take-up and engagement rates with treatmervices.

Restriction on bail measures (which introduces the pility of withdrawing access to court bail for those refusdrugs assessment and any follow-up treatment after a

tive test) and the expansion of drug testing provision uhe Drugs Act 2005 will make meeting with a CJIT wor

mandatory requirement for bail. Consequently, theoute will remain a key part of the overall CJIT processemand even greater cooperation between police and horkers.In terms of the practical operation of AR schemes in po

ustody, it is possible to say that in general police custodyers did not obstruct AR workers in conducting their dund over time often a ‘rapport’ and constructive workelationship was achieved between these parties. Howhether the AR process could be described as a partnef equals between police and drug workers is questiona

Dorn (1994), in his research on fledgling AR servicesngland in the early 1990s, discussed how police coment to these schemes was often undermined by low umong arrestees. In London, in 2000, the routine offer oR service by custody officers continued to yield few re

als and thus police perception of AR may well have bainted by this lack of interest among arrestees.


While many custody staff considered the AR schemes tobe a useful resource and arrest to be a key point for inter-vention with drug users, officers were sceptical about thesuccess of AR at getting drug users to engage with treat-ment services and therefore the likely effectiveness of AR atreducing crime; the key aim of AR as identified by the policeofficers we interviewed. Their level of cooperation in passingon details of those arrestees who had requested the service toAR workers had declined by second interview stage and theircomplaints about the additional work generated by hostingthe schemes had increased.

The potentially conflicting viewpoints of CJS staff andhealth professionals about drug users and the goals of druginterventions is raised by a number of authors as a key prob-lem for joint initiatives (Barton, 1999; Beyer, Crofts, & Reid,2002; Hough, 1996; Kothari et al., 2002; Lough, 1998). Forexample Lough, writing about CJS interventions in Aus-tralia, noted the general conservatism of police about ways ofresponding to drug use and drug users as an inhibiter to part-nership working.Kothari et al. (2002)have stated that all staffwithin the CJS need to be educated about the various methodsfor treating and rehabilitating drug-using offenders, includ-ing the more immediate priorities of reducing drug–relatedharm.

At the time of this study, there was certainly some short-fall in the training of custody staff specifically about AR, withm thert wella ryingo tiono avec thec tionsi sur-i andd ouldc duc-t drugt cussa ectiver form n toA suess com-m

ioni uses ga s typeo or-i sucha bornei gni-t thatt pec-t red.

However, the latest drug strategy (HM Government, 2002)does actually mention the words ‘harm minimisation’ and itseems crucial to ensure that the new CJIT maintain a clear rolein reducing drug-related harm alongside helping drug usersget into treatment services and others forms of intervention.For example,The Hepatitis C – Action Plan for England(Department of Health, 2004) makes clear recommendationsfor strengthening local harm reduction services for hepati-tis C prevention and this could involve brief intervention atthe police station by AR workers, including the distributionof up-to-date information on safer injecting practices. Thereis certainly some scope for involving police partners in thisharm reduction role.

For the AR workers, alongside the practical obstacles ofnegotiating the custody environment, there was some worrythat the credibility of their service among drug-using offend-ers was being undermined by an association with the police,as well as concern about the ability of AR to get drug usersinto treatment. While one key factor was the motivation ofthe drug user, there was also a range of structural difficul-ties, including waiting lists and service capacity and of notewas the common view among health professionals that ARhad been developed in isolation and not as part of a sys-tem of drug treatment. Furthermore, theAudit Commission(2004)recently noted that despite the significant expansionin drug treatment provision and capacity during recent years,a nessa sult ofe

ve ton ly ofd rain-i ge oft cityt ando osei ner-s rvices

R

A ng

on

A

B epi-s, &

B new

B

any of our police interviewees reporting the need for furraining about the aims and operation of the schemes ass on more general drug-related issues. This was a worversight for the Metropolitan Police, given the proporf problem drug users who police officers are likely to hontact with in their day-to-day work and in the light ofontinued development of CJS drug treatment intervennvolving the police. It demonstrates the importance of enng an adequate and ongoing training package for policerugs/CJIT workers is developed and delivered. This cover drug use issues including the rational for harm reion and the evidence for the effectiveness of differentreatments. However, it could also provide a forum to disnd agree the aims of CJS interventions and the respoles within that process, including developing protocolsaking contact with potential clients and referring theR services. Further, meetings to review procedural ishould be scheduled on a regular basis to foster goodunication between police and AR workers.AR workers considered providing harm minimisat

nformation to be a key aspect of their role, and a way tokills effectively, particularly in light of difficulties of gettinrrestees into drug treatment programmes. However, thif information was not collated in routine activity monit

ng and thus the promotion of public health strategiess safer drug use practices and the prevention of blood-

nfections and drug overdose received no ‘official’ recoion by funders. This suggested to many health workersheir work was being marginalised and a particular persive on responding to problem drug use was being igno

lack of integrated support often hampers its effectivend threatens to undermine any progress made as a rengagement with treatment services.

These are just some of the hurdles that CJITs will haegotiate if they are to successfully integrate the panoprug, alcohol, mental health, housing and education, t

ng and employment support for drug users at each stahe criminal justice continuum. However, increasing capao promote a more joined up system of drug treatmentther support for drug users, and better training for all th

nvolved may help to foster a greater sense of joint owhip of these interventions between police and health setaff.

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