CHAPTER EIGHT: CONCLUSIONS
INTRODUCTION
8.1 As indicated in Chapter One of this report, the objectives of the pilot Drug Courts are to:
- reduce the level of drug-related offending behaviour
- reduce or eliminate offenders' dependence on or propensity to use drugs, and
- examine the viability and usefulness of a Drug Court in Scotland (in the case of Fife in a non-urban centre) using existing legislation and to demonstrate where legislative and practical improvements might be appropriate.
8.2 In this final chapter we summarise the key conclusions that can be reached on the basis of the evaluation and the implications if Drug Courts are to be extended in Scotland beyond the original pilot sites.
ACHIEVING OBJECTIVES
8.3 Drug Courts cannot provide a panacea for the problem of drug-related crime. However there is evidence that a sizeable proportion of clients made subject to Drug Court Orders were able to achieve and sustain reductions in drug use and associated offending behaviour. Moreover, completion rates (at around 30% and 44% across the 2 schemes) were commendable in view of the histories of offending and prior drug use among the Drug Court client group. Evidence for reductions in use came from the analysis of drug tests over the course of Orders, from individual assessments by social workers, from self-report by clients and from the impressions of the sentencers who came into regular contact with clients through the system of regular reviews. Drug court participants also commented on the significant impact that a Drug Court Order had had on their lives, enhancing relationships with their families and resulting in considerable improvements in their health and appearance.
8.4 Evidence for reduced recidivism is, perhaps, more tentative given the relatively short-follow-up period that was possible. However, despite their histories of persistent drug-related offending prior to appearing before the Drug Courts, half of those given Drug Court Orders remained free of further convictions for at least 12 months and almost 3 in 10 had not been reconvicted after 2 years. Successful completion of an Order was associated with a lower frequency of reconviction in the 2 years from the date of an Order being made than in the 2 years before. Social workers' assessments of progress and client self-report also pointed to reductions in drug-related offending while clients were subject to Orders.
8.5 The establishment of the Drug Courts was achieved primarily on the basis of existing legislation, though provisions were subsequently introduced in the Criminal Justice (Scotland) Act 2003 to enable solemn cases to be dealt with in the Drug Courts and to provide them with interim sanctions (in the form of short prison sentences and periods of community service) to respond to instances of non-compliance. Although these measures were regarded as a useful addition to the options available to deal with non-compliance, in practice little use had been made of them to date.
8.6 In most other comparable jurisdictions (such as Canada and Australia) where Drug Courts have been introduced, they have been piloted in cities and their suburbs. When it was established, the Fife Drug Court was unique in terms of its location (a non-urban centre) and its implementation across 2 courts (Dunfermline and Kirkcaldy). Although there were particular challenges to be faced in operating a Drug Court under these circumstances, many positive features of the Fife Drug Court were apparent, not least of which was the commitment and enthusiasm of those involved in its operation. Some of the difficulties that were encountered in Fife related less to the non-urban setting than to competing philosophical standpoints of different professional groups.
8.7 Given the difficult client group with whom they were engaging and the challenges of providing a co-ordinated multi-professional response, the pilot Drug Courts can be deemed to have been a success. While operational difficulties were encountered during the establishment and operation of the pilots, there was widespread support for the Drug Courts both from those working within them and from other criminal justice professionals, such as Sheriffs sitting in other courts. Although some concern was expressed about the implications of increasing specialisation in courts (in terms of the erosion of the traditional role of Sheriffs and the administration of justice) the Drug Courts were regarded as offering benefits over and above those associated with DTTOs.
8.8 Although Drug Court orders are a relatively expensive way to respond to persistent drug-related offending, they are unlikely - even given the most pessimistic cost estimates - to be more expensive than imprisonment. In addition, there is some cause to be optimistic - on the basis of DTTO reconviction data (McIvor, 2004) - that the comparatively low rates of reconviction found among Drug Court participants will be sustained over a longer period of time. The most pessimistic interpretation of the data suggests that the initiatives have come close during the pilot period to matching the savings generally estimated in cost-effectiveness studies of more established treatment modalities. A more generous assessment would suggest that they have achieved considerably more.
STRENGTHS OF THE DRUG COURT APPROACH
8.9 Before considering some of the issues that will require attention if Drug Courts are to be introduced in other parts of Scotland, it is worth highlighting what appear to be the main strengths of the Drug Court approach.
8.10 The main strengths of the Drug Court can be summarised as: the 'fast-tracking' of offenders (in Glasgow); the existence of a trained and dedicated team with regular contact with participants; and the system of pre-court review meetings and reviews. The dialogue between the bench and Drug Court participants was viewed almost universally as a central component of the Drug Court process. The Drug Court Sheriffs reported being better informed about drug use and therefore better able to respond appropriately to those appearing before the Court.
8.11 Multi-professional working is a key feature of Drug Courts. Having dedicated staff had resulted in the creation of teams that, according to one sheriff, " work well together and know what they're doing". In Glasgow, the Co-ordinator was also regarded as having a pivotal role in ensuring that the wider team worked together effectively. Perhaps for this reason the issues around multi-disciplinary team working within the Supervision and Treatment Teams that were evident in the early stages of both pilots appeared to have been more successfully resolved in Glasgow.
8.12 It appeared that Drug Court Orders were being imposed upon offenders who would otherwise be at risk of a custodial sentence. Drug Court Sheriffs believed that sentencing decisions were better informed than in the Sheriff Court because assessment reports for the Drug Court were more comprehensive and focused. They also expressed satisfaction with the range of disposals available to them at the sentencing stage, with deferred sentences affording some flexibility in sentencing and the implementation of sanctions and rewards.
8.13 Drug testing was seen as a positive element of Drug Court Orders by professionals and participants. Almost all Drug Court participant respondents considered drug testing to be an important part of their Order and one that was necessary to help them reduce or end their use of illicit drugs.
THE IMPLICATIONS FOR A WIDER ROLL-OUT OF DRUG COURTS
8.14 The pilot Drug Courts have generally met their objectives, though some - such as reducing reconviction - have been more difficult to assess within the timescales and wider limitations of this research. Whether it is appropriate to develop further Drug Courts in other parts of Scotland will require balancing the costs with the potential benefits of such a development. It is unlikely that Drug Courts would be viable in all or even most parts of the country: even though a Drug Court has proved to be workable in a non-urban location, having a Drug Court operating in smaller courts is not likely to be feasible in practical terms. In Glasgow it appeared that the impact of the Drug Court on Sheriff Court workloads was probably neutral: the Drug Court Sheriffs were not available to assist with jury courts, but the Drug Court probably increased the incidence of guilty pleas and therefore resulted in fewer cases going to trial. In Fife, however, the Drug Court consumed a higher proportion of available court time and this had implications for the scheduling of other court business. If further Drug Courts are established, then the experiences of the pilots have highlighted some issues that will require attention. It should also be bore in mind that the pilot Drug Courts were developed from already well-established DTTO schemes: developing a Drug Court without that base on which to build would be an even more challenging undertaking.
Achieving sufficient appropriate referrals
8.15 Prior to the establishment of the Drug Courts estimates had been made of the number of Orders that were likely to be imposed. In Glasgow the number of referrals was disappointingly low throughout the pilot, with the level of police-initiated referrals much lower than expected. The broadening of the referral process to encompass solemn cases and court-initiated referrals succeeded in increasing the numbers referred in the third year, though they remained below initial expectations. It is to the credit of the Drug Court Team that they resisted the temptation to 'widen the net' and accept offenders who did not fully meet the Drug Court criteria. Given that other sheriffs in Glasgow have the facility to impose DTTOs it is likely that the level of appropriate referrals to the Drug Court has been achieved. The Supervision and Treatment Team were, in any case, working to full capacity with the Drug Court Orders and non Drug Court DTTOs that had been imposed and it is difficult to see how, without additional resources, a higher caseload could have been sustained.
8.16 In Fife, a slightly different issue was in evidence. Here the number of referrals to the Drug Court was uniformly high, but the proportion that resulted in the making of Drug Court Orders was relatively low. This would suggest that having a wider referral route from the outset had increased the flow of referrals but that many of these were inappropriate for the Drug Court. Undertaking these assessments did, however, absorb a significant amount of staff time which might be reduced if an initial screening of cases could be undertaken to eliminate those who are clearly unsuitable prior to proceeding to a full assessment.
8.17 Another issue that was a cause for some concern in the early stages of the pilot was the acknowledgement that those being assessed for the Drug Court were likely to continue to offend during the assessment period. Over time, however, it was apparent that a full and detailed assessment involving several appointments with different professionals from the Supervision and Treatment Teams could not be undertaken within a shorter timescale. In Fife, a related concern centred on the fact that Drug Court clients were further assessed by the medical staff after being placed on an Order, delaying their access to treatment. Swift access to treatment is likely to be critical to ensure that Drug Court clients engage with their Orders.
Capacity and resources
8.18 It became apparent during the Drug Court pilots how resource-intensive Drug Court Orders are as a result of the high levels of contact with participants and the regular reviews. In both pilots there were times when the Supervision and Treatment Teams were under considerable pressure because of the volume of work. In Glasgow, despite the availability of additional central government funding, the local authority did not initially commit resources up to the level stipulated in the Drug Court Manual which meant that for the first 2 years of the pilot the team was significantly under-resourced. This was compounded by high levels of staff turnover. In Fife, problems were experienced in relation to the recruitment and maintenance of staff. There were particular difficulties in recruiting criminal justice social workers, largely due to the higher workloads of Drug Court social workers in comparison to those involved in more mainstream criminal justice work.
Multi-disciplinary work
8.19 For Drug Courts to operate effectively requires a co-ordinated and integrated approach by the different professionals who comprise the Supervision and Treatment Team. Whilst multi-professional teamwork presents challenges in itself, in the Drug Courts this was compounded by the fact that professionals were also required to step beyond their traditional roles and to do so within a criminal justice framework. In both pilot sites tensions had developed as a result of lack of clarity regarding roles and responsibilities. In Glasgow this was addressed through the provision of training aimed at fostering multi-professional teamwork and over the course of the pilot a strong sense of team identify became apparent. Similar difficulties were encountered in Fife where they appeared to be more difficult to resolve. In Fife the sectorisation of the Supervision and Treatment Team by geographical area and strong leadership within the team had done much to strengthen team identity and to clarify the professional capabilities of the various disciplines involved. However fundamental differences in professional orientation remained which were reflected, for example, in the withdrawal of prescriptions by the medical providers. The threat of having prescriptions withdrawn was a source of concern to many clients and was often viewed as an overly punitive measure non-medical professionals. The appointment from the outset of a Co-ordinator with sufficient seniority to negotiate with other senior professionals may have helped to resolve some of the difficulties that arose.
8.20 It should also be noted that the development of practice within the Drug Courts benefited from the extensive networking that professionals from both Courts undertook in Scotland and through the links they established with international Drug Court networks. This ensured that practice continued to be informed by wider international developments.
Changing patterns of drug use
8.21 In both Drug Courts the majority of those given Orders were using heroin and the most common approach to treatment was methadone substitution. Once clients were stabilised on methadone (the approach to which differed in Glasgow and Fife) reductions in drug-related offending and illicit drug use usually occurred. However it was apparent, particularly in Glasgow, that a growing number of individuals made subject to Orders through the Drug Court were also using cocaine. Accessing treatment services for substances other than heroin - including residential facilities - will present the Drug Courts with an additional challenge.
Random testing
8.22 In Fife there was some concern that, while the existing approach to drug testing was adequate, the introduction of random drug testing would be a further improvement. Without the use of fully random tests there was always a possibility that clients could conceal ongoing drug use. Random tests were said to be difficult to institute in practical terms: having clients make themselves available at short notice was not feasible in view of the other commitments required by their Orders and wider commitments such as employment. However they had been introduced successfully in Glasgow, being seen as particularly useful towards the latter stages of Orders.
8.23 A further concern in relation to urinalysis centred on the fact that the tests were unable to detect changes in the amount or frequency of substances consumed, making it impossible to tell whether even if clients were detected as still using illicit substances their drug use had reduced. Although there are tests available that can measure concentration levels they are costly and their accuracy is open to question.
Providing longer term support
8.24 With the exception of a few clients who expressed dissatisfaction, most were positive about the services and support they received from the Supervision and Treatment Teams and from other agencies to which they were referred. However, the limited availability of wider resources to address aspects of the social exclusion experienced by drug-misusing offenders, especially in Fife, is likely to have impacted upon the potential effectiveness of Drug Court Orders in the longer-term. There was also a concern, again more specifically in Fife, that once Drug Court Orders had ended, clients would be unable to access a continued methadone prescription from their GPs and would start using again as a result. More attention therefore needs to be given to how clients can be supported beyond their Orders so that the benefits gained during their involvement with the Drug Court can be sustained in the longer term.
Effective monitoring systems
8.25 There was an expectation from the outset that the pilots would establish IT systems for monitoring purposes and to furnish data for the evaluation. Some progress was made in this respect but there was still an over-reliance on manual records and the nature and amount of information held on databases was variable. This impacted upon the evaluation but, more importantly, will have limited the usefulness of the information available for internal monitoring and management purposes. Experience in other jurisdictions suggests that the establishment of a shared database to which different team members have varying levels of access is crucial for maintaining up-to-date records and facilitating the efficient exchange of participant-based information at different stages in the Drug Court process. If further Drug Courts are established, early investment in a national IT system would enhance administrative efficiency and ensure a consistent approach to the monitoring of the work of the Courts