Official Report 1069KB pdf
The next item of business is a members’ business debate on motion S6M-15657, in the name of Elena Whitham, on a report on alcohol use disorder in the justice system. The debate will be concluded without any question being put.
Motion debated,
That the Parliament notes the publication of the Scottish Health Action on Alcohol Problems’ paper, Alcohol (In)justice: Position on people with an alcohol use disorder in the justice system; is concerned that it is estimated that almost two-thirds, 63%, of people in prison have an alcohol use disorder, with almost half of those, 31%, possibly dependent on alcohol; is further concerned that the risk of death from alcohol causes is three times higher in men and nine times higher for women who have been in prison than for the general population; understands that the paper sets out why and how people with alcohol use disorders who come into contact with the justice system should have the best opportunities to access treatment and support, and that this could reduce reoffending and pressures on the justice system, tackle inequalities, improve the health and lives of the people concerned and the lives of their families and wider communities; believes that there are examples of innovative practice across Scotland, including Glasgow’s Alcohol Court; acknowledges that the paper further sets out several potential standards that could be implemented across the justice system, and understands that accountability for such standards is required in order to make a difference to the health and lives of people in Carrick, Cumnock and Doon Valley and across Scotland with alcohol problems who are being dealt with by the justice system.
12:48
I thank colleagues from across the Parliament for supporting my motion, which has enabled me to bring to the Parliament’s attention the recent report “Alcohol (In)justice—Position on people with an alcohol use disorder in the justice system” by Scottish Health Action on Alcohol Problems. I welcome representatives from SHAAP to the chamber.
The play on words in the title of this critical report is in itself a lightning rod that we should all be coalescing around. Alcohol is a recurring feature in our justice system and the link between alcohol and crime is well understood. That, in turn, highlights the injustice that is faced by many when alcohol use disorder impacts on the individual, the family and their community.
Inequality is at the heart of the issue, and the human cost is staggering, but it goes wider than that—it impacts on all public services, and the cost to the public purse is considerable. Repeated interaction with the criminal justice system, driven and exacerbated by alcohol use, creates impacts that ripple through every area of life, such as repeated contact with police and courts, repeat periods of incarceration, repeat homelessness, social work interventions, loss of employment or employment opportunities and poor health that results in increased need for national health service interventions, including costly unscheduled care.
I believe that the case for change that is set out in the report is clear. The number of people with alcohol use disorders in our Scottish justice system is disproportionately high compared with the figure for the population at large and, although we are working hard on our imprisonment rate, we still have the highest rate in western Europe. We know that 63 per cent of people in prison have an alcohol use disorder, with 31 per cent of those individuals possibly being alcohol dependent. The risk of death from alcohol causes is three times higher in men who have been in prison, and a staggering nine times higher for women who have been in prison, than it is for the rest of the general population.
If we consider adverse childhood experiences and trauma, we find that 25 per cent of people in Scottish prisons are care experienced, 47 per cent have experienced physical abuse in childhood, and around a third lived with someone who was a problematic drinker during childhood. Inequality and disadvantage are pervasive in the justice system. I saw that over and over again when I worked in front-line homelessness services.
If we think in resourcing terms, we find that the overall estimate for the yearly cost to public services of alcohol-specific and alcohol-related offences is between £462.5 million and £991.7 million, with a midpoint of £721.1 million. It is important to note that those figures have not been re-estimated since 2007-08 and that the true figure is likely to be much higher.
The SHAAP report calls for a system that truly integrates health and justice; that provides treatment options and community disposals instead of incarceration, where appropriate; and that offers support at every stage of an individual’s journey, from arrest to sentencing and beyond. That is not just a humane approach—it is an effective one.
We know that addressing the root cause of problematic alcohol use through targeted interventions can reduce offending and lead to better outcomes for individuals and for society as a whole. However, the reality is that the 2019 Scottish prisoners survey showed that
“only 22% of participants reported that they had been given the chance to receive treatment for an alcohol use disorder during their sentence.”
The survey also revealed that
“40% of prisoners involved reported being drunk at the time of their offence”
and that nearly
“one fifth ... of prisoners who took part in the survey were worried alcohol would be a problem ... when they got out.”
Encouragingly, however,
“Forty one percent of participants said that if they were offered help for their alcohol use disorder (both inside and outside of prison) ... they would take it.”
The key recommendations from SHAAP that are outlined in the report are that, at each stage of a person’s interaction with the justice system, alcohol issues should be recognised, properly assessed and acted on, with key agencies having accountability. Accountability is key. In police custody centres,
“There should be a standard in place for the identification and treatment of people with an alcohol use disorder ... for the police and NHS ... staff.”
That would include referral to healthcare or addiction services, appropriate tools being used for alcohol use screening and appropriate actions being taken, including alcohol brief interventions or arrest referral for alcohol treatment and support.
The report says that, for alcohol brief interventions in justice settings,
“delivery sits at about 29% in prison and 3% in police custody”.
Those figures urgently need to rise. Those who are identified as needing support should be flagged so that their support needs are known throughout their journey in the criminal justice system. If fulsome information was provided on the standard prosecution report, that would also help to support the procurator fiscal when looking at suitability for diversion from prosecution.
We know that referrals to drug and alcohol specialist treatment have fallen in Scottish prisons in recent years, and work is under way by Public Health Scotland to understand why that is the case. That is part of wider work on overall reductions in referrals to alcohol services in general. The Scottish Government is also working on a national service specification for alcohol and drugs. That represents an ideal opportunity to publish a clear specification for justice settings, as well as to develop standards for alcohol treatment and support at each stage of the justice system, which will help to embed treatment and recovery communities across the justice sector.
Recent broader approaches to justice, such as Public Health Scotland’s health and justice programme strategy and the Bail and Release from Custody (Scotland) Act 2023 demonstrate that there is a will to change, but the separation of powers and the independence of decision making between the organisations and bodies that are involved in the justice system can pose a challenge for the overall co-ordination of care and support. We need enforceable standards with clear lines of accountability so that those recommendations can be implemented and so that people do not continue to fall through the cracks.
Planning for release should happen when someone arrives in custody, so that we can ensure that they have been linked with recovery services and support as well as housing and welfare provision well ahead of their release. We should also seek to maximise the role of recovery communities and Alcoholics Anonymous, which can help people to work through those issues. Reports suggest that, with consistent access to AA meetings, attendees have reduced cravings, stronger coping strategies and improved engagement with other rehabilitative programmes. Participants who continue with AA after release credit it with helping them to secure employment, rebuild family relationships and remain sober in the community.
The same can be said when people are proactively linked into recovery communities once they have returned home. When I was a minister, I was privileged to visit the Glasgow drug and alcohol courts and watch them in action. I was mightily impressed by the problem-solving attitudes of those sheriffs and their shared desire to drive systems change. I also spoke to other sheriffs right across Scotland who shared the problem-solving ethos and a desire to understand what drives offending and what interventions, diversions and community justice disposals could deliver better outcomes.
That attitude must become the default if we want to sever the link between alcohol and crime. It is not soft justice—it is smart justice. I look forward to hearing from colleagues across the chamber and from the Cabinet Secretary for Justice and Home Affairs, who I know is as passionate about the issue as I am.
12:56
I am pleased to speak in this important debate, and I thank my colleague Elena Whitham for securing it. I congratulate her on her long-standing commitment to tackling the problem of alcohol and drug abuse and thank her for her customary informative and inspirational opening speech.
Alcohol abuse and addiction is a significant and pressing issue in the justice system in Scotland—indeed, the rate is disproportionately high. Almost two thirds—63 per cent—of people in prison have an alcohol use disorder, with almost half of those possibly dependent on alcohol. The risk of death from alcohol causes is three times higher for men who have been in prison and nine times higher for women who have been in prison than for the general population, as Elena Whitham articulated. All deaths due to alcohol are a tragedy but, as convener of the cross-party group on women, families and justice, that statistic really concerns me.
It is estimated that as many as 90 per cent of women in custody in Scotland have addiction problems, whether that involves alcohol or drugs. It is further estimated that 80 per cent of women in prison have brain damage due to head injuries that have been caused by domestic violence, and that a similar number suffer from mental illness to some degree. Whether those women should be in prison at all is for another debate, although I am certain that we should have that debate soon. I submit that prison is entirely the wrong place for women whose addiction and chaotic life experience have led them down the wrong path.
I am grateful to SHAAP for its research, which shows that, of the 12,000 people who had community payback orders imposed in 2021-22, only 1 per cent received alcohol treatment as part of their order. I know that there can be complex reasons for that but, on the face of it, we must do better. Forty per cent of prisoners reported that they were drunk at the time of their offence, and almost one fifth were worried that alcohol misuse would be a problem for them on their release. However, 41 per cent said that, if offered help for their alcohol use, inside or outside prison, they would take it.
In addition, people with fetal alcohol spectrum disorder, which is an entirely preventable condition, are overrepresented in the justice system. Turning Point Scotland, which is an excellent third sector organisation, delivers a range of harm reduction approaches in relation to problematic alcohol use across our services. It believes that its programme of harm reduction should be incorporated into the justice system to help identify and act on a risk of alcohol-related harm. Time does not allow me to detail the organisation’s initiatives, but it is well worth having a look at its excellent website.
To an extent, people coming into the justice system provide an opportunity to recognise and, crucially, address alcohol use disorders by offering treatment and support. Alcohol brief interventions, which Elena Whitham mentioned, are a good example of that approach, but that could be strengthened through more consistent delivery and by improving options for diversion to appropriate services.
It is abundantly clear that alcohol misuse disorders in the justice system are a significant problem that has been overlooked for too long. Our prisons are overcrowded, and hard-working prison staff are dealing with a multitude of problems. A targeted programme of support and of treatment for alcohol abuse—of course, that should include prevention in wider society, where Scotland’s drinking culture has been a long-standing problem—should be available to reduce the pressure on our justice system.
13:00
I am pleased to be able to contribute to this afternoon’s important debate, and I thank Elena Whitham for bringing it to the chamber.
How alcohol use disorders interact with the Scottish justice system is still not very well understood. Elena Whitham’s motion lays out the key statistics, including the fact that nearly two thirds of people in prison have an alcohol use disorder. However, this issue goes beyond mere numbers. Far too much of the current legislation on the problem focuses entirely on alcohol use in prisons. In reality, alcohol use disorders affect individuals who are at all stages of the justice system. That includes during initial police contact, in custody centres and court settings and during liaison and diversion and throughcare.
It is clear that the current approach to alcohol and drug use is not working in prison settings. At His Majesty’s Prison Glenochil in Clackmannanshire in my region, 35 inmates were found to be under the influence of drugs on Christmas day. Although prison staff reportedly seized the articles that were causing the problem, the indication is that the issue is far reaching, so it is only fair that drugs and alcohol be considered when we are dealing with situations in our prisons.
The Scottish Prison Service was forced to introduce a policy to deal with influences on individuals as a result of that incident, but it is only one example of the disruption that can be caused in prisons and to the wider system. The Scottish prison healthcare network previously published guidance on the misuse of drugs in prisons and in custody settings; unfortunately, that guidance is no longer in use, and our prisons are often worse off as result.
As members from across the chamber will agree, further action is needed to tackle the attitude to alcohol in the wider justice system. Today’s motion mentions the solutions that are being created to support individuals who require treatment in the justice system, but it is disappointing that some approaches are not being considered. More guidance might need to be ascertained from the cabinet secretary in that respect, and I look forward to hearing about that in her summing up.
The Scottish Government is in the process of creating a national service specification for alcohol and drugs services, following the publication of UK-wide alcohol treatment guidelines. That could provide an opportunity to ensure that effective standards are in place in the justice system as a whole. I hope that, in summing up, the cabinet secretary will give an update on the Scottish Government’s progress on that, because it is a complex issue that requires bold solutions.
We have heard about the number of individuals—men, in particular—who were drunk during their offending, about the number of women who have suffered as a result of alcohol-related domestic abuse and violence and about the number of individuals in our custody and our systems who are suffering. That should have an impact on what we do.
I hope that, in tackling the issue, the Scottish Government will follow the advice and evidence from other areas on how to manage it. The justice system needs to be equipped to support hard-working staff with the tools that they need to do their job effectively, to support themselves and to support those going through the justice system.
13:04
I thank Elena Whitham for securing this important debate and congratulate her on her speech, which sets out the direction that we should all support in Scotland. I am very supportive of the motion, and I welcome SHAAP to the public gallery.
Excessive drinking of alcohol poses a significant public health challenge globally. However, the Scottish culture of high alcohol consumption levels and binge drinking has created what can only be described as a crisis. We need to be honest about that if we hope to reverse the current trajectory and help people, families and communities. It is our responsibility in this Parliament to do what we can to support those communities.
Office for National Statistics figures released only yesterday reveal that alcohol-specific deaths in Scotland have reached a 15-year high and that our country continues to have the highest rate of alcohol deaths in the United Kingdom. As we have heard from Elena Whitham, inequality is embedded in Scotland, so some of the problems with alcohol feel almost built into the lives that people are going to have. We have to be honest about that and seek to change that direction.
Although rates have remained steady compared with 2022, Scotland still has some of the highest rates of alcohol-related harm in Europe. Not only does harmful drinking impact people’s physical and mental health, but, as we have heard, it has a profound antisocial impact and can be detrimental to individual and societal wellbeing. It affects us all, so it is the responsibility of all of us to do something.
We are here today because, as we have heard, there is a strong link between alcohol and criminal behaviour. The “Alcohol (In)justice” report, which we are discussing today, expertly highlights that and provides crucial insight into the extent to which alcohol can fuel violence and criminality, and how we can respond to that.
As we have heard, the number of people with alcohol use disorders is disproportionately high in the Scottish justice system, compared with the rest of the population. A reported 63 per cent of people in prison have an alcohol use disorder, and almost half of those people are possibly dependent on alcohol. The report also highlights findings from the 2019 Scottish prison survey, which found that 40 per cent of prisoners who were surveyed
“reported being drunk at the time of their offence”.
The link between harmful drinking and criminal behaviour is clear. I emphasise that we must work together not only to provide better support for those who are suffering from alcohol problems, but to tackle the root causes of alcohol dependency and alcohol use disorders. It is important that we take that public health approach. By offering treatment and support to people who come into contact with the criminal justice system, we can do some of that work and provide individuals with the opportunity to recognise and address alcohol use disorder.
I have heard a little about the Glasgow alcohol court, which I hope to visit at some point. I hope that the cabinet secretary will agree that some of its positive approaches, which we have heard about, are useful. Intervening in that way would not only improve the health and lives of the individuals affected; it has the potential to reduce reoffending rates, thus helping to alleviate the immense pressures that we feel across Scotland and in the justice system.
Economic and social disparities are also prevalent factors in an individual’s choice with regard to alcohol, as I and others have mentioned. We know that the risk of alcohol-related harm is greater for those who are most disadvantaged in our society. It is important to make the point that they are often the people who are very hard to support; they do not readily come forward to services, and therefore we have a responsibility to go to them and see what we can provide.
I welcome the steps, such as minimum unit pricing, that the Government has taken to address alcohol harm. However, does the Cabinet Secretary for Justice and Home Affairs agree that we need to do some cross-portfolio work on this matter? I have asked the Minister for Public Health and Women’s Health for an update on the delivery of alcohol market reform. If we work together on those issues, we might see beneficial outcomes.
I am aware of the time, so I will close there. I thank members for their contributions, and I particularly thank Elena Whitham for securing this important debate today.
13:09
I, too, thank Elena Whitham for raising this report in the Parliament. I know how important the issue is to her and how much work she has done to tackle harmful alcohol and drug use. The Parliament will be poorer for losing her insightful and empathetic contributions.
The statistics in the report speak for themselves: almost two thirds of people in prison have an alcohol disorder and the best part of a third are possibly dependent. However, many of them are willing to take help. That is the important point, because, as we have just head from Carol Mochan, that is not always the case. A huge opportunity has been presented to us to support those people.
There is undoubtedly an issue with stigma that will drive not only addiction but the severity of addiction in those who are in prison or who are reintegrating into society afterwards. Some of the rhetoric that we heard during First Minister’s question time is unlikely to help matters. Trying to make prison as punitive as possible will not reduce prison numbers or crime, and it will not make the lives of victims, families or anyone else any better. As Elena Whitham put it,
“It is not soft justice—it is smart justice.”
It serves absolutely nobody to keep people stuck in a cycle of addiction and crime, when we know what is causing it.
We have a lot to learn yet about addictions and about the societal impact both ways—in other words, how the negative impacts of the treatment of people with addictions are felt not only by that person but by all of us. Failing to support people costs us money and time, and it costs us fellow members of society who could be more functioning, happier and active contributors to our communities, rather than likely to return to prison after they are released.
On my recent visit to HMP Inverness, I was struck by comments from prison officers, who said that they really get to know a lot of their prisoners; they get to build trust, and they understand and see the cycle that many people are caught in. They see how the poor treatment and judgment that those whom they have supported inside often go on to receive outside, even from those who should be offering them support, make them far more likely to return to the behaviours and the people who led them to their convictions in the first place. Unable to get the support that they really need, they return to the harmful support networks that they are used to, and they return to alcohol and drugs and to committing more crime.
We heard from Elena Whitham that people’s experiences, disadvantage and trauma often seem to write their future for them. It is clear from the report that people are suffering something that they have no control or influence over. When people are in the justice system, we have the opportunity to recognise the high likelihood of their developing illness and to give them preventative treatment inside. There is no excuse for somebody who is dependent on alcohol and who is in the justice system not to have that dependency addressed.
13:12
I pay tribute to Elena Whitham for securing this important debate. She brings to every debate that she participates in or leads her insight, her experience and her eloquence in advocating for the causes that she champions. She is quite correct to talk about the pervasiveness of inequality in our justice system and for the people whom we seek to serve and rehabilitate for the safety of our communities.
We should remember that, although we must have a real focus on every step and stage of the justice system and on what we can do differently to divert people and to support them to turn their lives around, we must also focus on what happens upstream in health, education and other public services. As Carol Mochan said, it must be cross-portfolio work.
I am grateful to all members who have participated in the debate. It has been a measured and thoughtful debate, and I hope that we can take its spirit forward as we continue to wrestle with our high prison population, for example.
Emma Roddick spoke powerfully about how we need to have a different debate—a mature debate that, ultimately, focuses on what will work to help people to turn their lives around and to make our communities safer.
Rona Mackay asked the fundamental question on our use of custody, in respect of which we have a lot of questions to ask as well as to answer.
Alexander Stewart spoke about the importance of standards and of those standards being applied consistently across the system.
I am grateful to Scottish Health Action on Alcohol Problems for what I consider to be a very well-thought-out position paper, and I welcome the SHAAP representatives who are in the public gallery. I would be happy to meet Ms Whitham along with SHAAP, as well as Ms Minto, if that would be of assistance.
It is worth repeating the core statistics that Ms Whitham and others have narrated from the important SHAAP report, including that two thirds of people in prison have an alcohol use disorder. That certainly gives me, as the Cabinet Secretary for Justice and Home Affairs, a mandate for action. When we read that the Scottish prisoner survey, as others have outlined, found that 41 per cent of prisoners said that they would accept help for their alcohol disorder but that only 22 per cent said that they had been offered help, it is clear that action is required across portfolios.
The inequality in the prisoner population—men who have been in prison are three times more likely, and women who have been in prison are nine times more likely, than those in the general population are to die as a result of their use of alcohol—speaks to the need for the strength of the actions that we have taken through the women in custody strategy. Those actions include the establishment of community custody units—one in Glasgow and one in Dundee—and the additional investment in health to support the opening of HMP Stirling.
As Carol Mochan mentioned, the number of such deaths is at a 15-year high. Even with minimum unit pricing having been introduced seven years ago, it is clear that we still have an emergency and that individuals are slipping through the net. What do we need to do with regard to treatment and rehabilitation for individuals? The report found that individuals said that they would accept support in custody, but it does not seem to be being provided.
I will come on to speak in more detail about the action that the justice system is taking on that matter. Mr Stewart and others have made the point that there is no silver bullet. I am a great advocate for minimum unit pricing and would never detract from it, but there is never just one solution—there are always many solutions. That is particularly so for the work that my colleagues are taking in pursuing a public health approach to the issue.
Ms Minto and other health ministers are waiting on further work that is being done on what we can do, within our devolved competence, in relation to the advertisement of alcohol. There is no easy solution to that issue.
I convey to Mr Stewart and others that everyone, irrespective of their abode—whether that is in the community or at His Majesty’s pleasure—has the same right to access treatment. Our national health service does not and should not discriminate against people on the basis of their past life, what they have or have not done or, indeed, where they are housed—whether they are at liberty or in custody. I have understood that to my very core since I was a prison social worker quite a few decades ago.
On the action that is under way, I am proud that one of my last actions before I left drugs policy to become the Cabinet Secretary for Justice and Home Affairs was to update the prison-to-rehab pathway. Through that work, some important learning was undertaken on how we can prepare people who are leaving custody to go into rehabilitation. We also removed the 12-week limit on the rehabilitation period. Although the renewed focus on residential rehab came as a result of our drug deaths crisis, the investment in residential rehab actually benefits more people with an alcohol disorder. I was very pleased to do that work.
One of the cultural and operational changes is the presence of the recovery movement in our prisons. The Scottish Recovery Consortium’s work has grown. It started in 2021 with 10 residents in HMP Perth, where I used to work a number of years ago. That grew to HMPs Edinburgh, Addiewell, Glenochil, Polmont and Cornton Vale. Now, there is a recovery presence in all prisons, with the option of prisoners accessing mutual aid groups.
That speaks to the creation and building of relationships that serve people well in custody and prepare them for liberation. However, it is important that all that work aligns with the medication assisted treatment standards. Access to treatment, medicine and interventions is crucial, but so is broader holistic support, including financial, welfare and psychological support.
On consistency and the cross-Government angle, I chair a cross-Government ministerial oversight group on prisoner healthcare, which has been considering, for example, the Scottish Prison Service alcohol and drug strategy and the recruitment and retention of band 5 and 6 nurses in the prison system. The group has also been looking at a target operating model for prisoner healthcare. That might sound technical and not the most exciting aspect of policy, but we have to get into the nuts and bolts if we want to see standards, access and consistency. I also pay tribute to the national prison care network.
The arrest referral work is expanding. It is about contactable moments. Groups have been established across most local authority areas.
On alcohol and drug courts, I am very supportive of problem-solving courts, which are tailored to change and monitor individual behaviour. There is strong evidence that supports them. Ultimately, it is the decision of the judiciary and the Scottish Courts and Tribunals Service whether to create specialist divisions in the system. I will certainly discuss the matter further with the new chief executive of the service and the new Lord President.
The core of the SHAAP report was about a standard approach. Others spoke about the importance of the national treatment specification for alcohol and drug treatment in Scotland and the need for it to connect to MAT standards. We will use the national service specification to promote the good practice that exists in some areas of Scotland and ensure that that work is incorporated into standard practice.
My final point—it is, I promise, my final point, Presiding Officer—is about accountability. I speak about that often in the chamber, because we are accountable to ourselves and to one another as parliamentarians. Services are also accountable to themselves and other services. Accountability is not about blame. It is about answers, actions, people working together and proactively seeking to make a difference to prevent crises from becoming a catastrophe. It is about always seeking to take a preventative approach as well as responding when life goes terribly wrong. I am sure that everybody who has participated in the debate wants that different debate and different outcomes.
That concludes the debate. I suspend the meeting until 2.30 pm.
13:24 Meeting suspended.Air ais
First Minister’s Question TimeAir adhart
Portfolio Question Time