Alcohol and Drug Partnerships (ADP) 2021/22 annual returns: summary report

3. Main findings

3.1 Demographics and response rates

Responses were received from 29 of the 30 ADPs in Scotland^[4]. It is important to note that ADP areas vary considerably by size, population and demographics. A breakdown of these areas by deprivation profile is provided in Appendix B, and an urban/rural breakdown is provided in Appendix C.

All but one ADP responses were signed off at ADP level^[5]. One ADP did not respond to the follow-up email sent to clarify the level of sign off received for the submitted survey responses.

3.2 Principle outcome: Reduce drug deaths

All ADPs reported that drug-related death review boards were held in 2021/22 (Figure 2). A number of ADPs reported attending their local Health and Social Care Partnership or Chief Officer meetings to review drug-related deaths. A minority of ADPs reported taking part in both groups where appropriate. Both of these groups involved the stakeholders that had been providing care to, or were aware of, the deceased individual (e.g. service providers, general practitioners (GPs), Police Scotland, Community Justice, and Scottish Ambulance Service).

A majority of ADPs (69%) reported having established early warning systems for drugs.

Fewer than half of ADPs reported having other measures in place. These varied somewhat across ADPs, but generally consisted of the establishment of multi-agency protection groups where ADPs and stakeholders – such as Police Scotland and community groups – pooled resources and intelligence to rapidly respond to community needs. Some ADPs also reported internal groups and sub-groups that had specifically been set up to review drug-related deaths.

These groups and boards were used to generate a shared and informed understanding of the circumstances of an individual’s death (after notification by Police Scotland or other agencies), further to which learning and good practice opportunities could be identified and shared with the relevant agencies and individuals. Where reported, meetings were often held on a quarterly or bi-monthly basis, although one ADP did report having monthly inter-agency meetings.

Some ADPs reported that they were developing or refreshing their audit processes at the time of the survey. This was typically to include lived and living experience perspectives alongside clinical reviews, to engage with all services involved in the deceased individual’s care, or to invest in dedicated posts to support the drug-related deaths review process and wider drug-related death prevention agenda.

3.3 Cross cutting priorities: Lived experience

The vast majority of ADPs (97%) reported offering specific volunteering and employment opportunities for people with lived and living experience (Figure 3). Nine in ten respondents (90%) offered peer support/mentoring, and there was also high rates of naloxone distribution and community/recovery cafes (both 86%). Two in three (66%) offered job skills support, and just over one in four (28%) offered psychosocial counselling.

All ADPs reported involvement of people with lived experience and family members affected by substance use within their services (Figure 4). The responses indicated that ADPs tended to prioritise the involvement of people with lived experience with family members being involved to a lesser extent.

The most common approach reported was the use of a feedback or complaints process, with the vast majority of ADPs (93%) reporting this being in place for both groups, and one ADP specifically mentioning offering service exit interviews. For people with lived experience, this was followed by questionnaires or surveys (79%); lived experience groups or forums (76%); and focus groups or panels (72%). There were comparatively lower proportions of representation on boards at ADP level (52% and 41% for people with lived experience and their families, respectively) and representation at board level within services (45% and 34%, respectively).

In open-text responses, a few ADPs reported having their own internal lived experience panels to provide feedback and advice. Some reported having people with lived experience in advisory roles within their ADP who were involved in service evaluation and design. A substantial number of ADPs reported collaborating with local community organisations, such as recovery cafes or family groups for those affected by substance use, in order to gather feedback.

The majority of ADPs (93%) reported having arrangements in place to involve people with lived experience in different areas of delivery (Figure 5). The two ADPs that did not report doing so specified that they were in the process of developing lived experience panels or forums.

A large majority of ADPs reported involving people with lived experience in the planning and implementation of services (69% and 79%, respectively). Around half of ADPs (52%) also reported involving people with lived experience in the monitoring and evaluation of services. There were also other means of involvement reported, such as assessing demand, mapping pertinent services and organisations, and developing networks to reach more people with lived experience.

All ADPs reported taking steps to respond to the feedback received from people with lived and living experience and family members affected by substance use. All ADPs reported that the feedback received was considered internally and shared with relevant services and individuals. Most ADPs reported that the feedback was used to inform future service improvement and design.

A substantial number of ADPs reported using a “You Said, We Did” model whereby the ways in which the feedback had been responded to was outlined and communicated back. Other approaches mentioned included conducting post-bereavement interviews with the families of people who had died while engaged with the service in order to identify areas of improvement.

However, some ADPs outlined a number of challenges associated with including people with lived and living experience. Where these individuals were included as community representatives, the issues of training, role conflict, and remuneration were highlighted by a few ADPs as challenges. It was felt training was needed to help empower people with lived experience to take part and to support them in understanding their role and remit. Also mentioned was the need to address issues arising from role conflict, where an individual’s official role with an ADP could clash with their membership of the wider community of people with lived experience. In addition, engaging people who were no longer involved with services was noted as a specific challenge.

A number of ADPs were concerned with the challenge of making the inclusion of people with lived and living experience proportionate and effective. Cited barriers included practical considerations such as time constraints and both ADP and Scottish Government processes. A few ADPs noted that serving a largely remote and rural area brought its own challenges in reaching out to those with lived and living experience. They noted that declining populations spread over a large area meant that it was difficult to raise and maintain the motivation for face to face groups. Also mentioned were inequalities with regards to the use of digital technology affecting the viability of organising remote and online alternatives to face to face.

3.4 Fewer people develop problem drug use (outcome 1)

All ADPs reported having provided information on local treatment and support services to the general public (Figure 6). The most common media used were websites or social media (100%), leaflets or take home information (90%), and posters (72%). However fewer than half of ADPs (41%) reported communicating this information in accessible formats (e.g. in languages other than English).

All ADPs reported carrying out some form of education and prevention campaign or activity (Figure 7). The most common type of campaign overall related to overdose awareness, with ADPs reporting targeting this at an international level (28%), national level (62%) and local level (90%).

At a national level, the next most common campaigns reported related to reducing stigma (41%) and mental health (38%). At the local level, over three in four ADPs (76%) reported carrying out mental health campaigns, while the third most commonly reported theme was ‘seasonal campaigns’ (66%). Excluding ‘other’, the least-common type of campaign at both the national and local levels was criminal justice (3% and 31%, respectively).

ADPs reported carrying out a number of activities with regards to education and prevention (Figure 8). The majority of ADPs reported carrying out naloxone promotion activities (90%), peer-led interventions (79%), stigma reduction (69%) and providing teaching materials (69%). However, less than half of ADPs reported providing counselling services (48%) and youth activities such as sports or arts (45%).

Activities were most commonly delivered via third sector or community partners (83%) (Figure 9). This was followed by formal settings such as schools (76%). There was also a high proportion of services being delivered online or by telephone (72%). Other reported settings included accident and emergency departments, workplaces, recovery cafes and hostels.

3.5 Risk is reduced for people who take harmful drugs (outcome 2)

ADPs were asked to report on the availability of four key harm reduction services: naloxone supply, Hepatitis C testing, injecting equipment provision and wound care. The heat map below (Figure 10) describes the distributions in the availability of these harm reduction services across a range of settings. This shows that most harm reduction services were reported to be available through NHS drug services.

Naloxone supply was reported as being by far the most commonly available service to the public across a range of settings. All ADPs reported that NHS drug services supplied naloxone. It was also reported as being most commonly offered through third sector drug services (93%) and mobile or outreach services (86%). Naloxone supply was also reported as being offered in women’s support services and mental health services by a third of ADPs (both 34%).

The vast majority of NHS drug services also offered Hepatitis C testing (93%), the provision of injecting equipment and wound care (both 86%). Hepatitis C testing was next most commonly reported as being available through third sector drug services and general practitioners (both 52%). The provision of injecting equipment was reported by the majority of ADPs (83%) as being offered in community pharmacies. Finally, wound care was most frequently said to be available to the public through general practitioners (59%) and accident and emergency (A&E) departments (52%).

Of the 13 ADPs that reported having a prison in their area, the majority (85%) reported that people in prison had access to non-fatal overdose pathways upon release.

3.6 People at most risk have access to treatment and recovery services; and, People receive high quality treatment and recovery services (outcomes 3 and 4)

3.6.1 Recovery communities

Every ADP reported undertaking activities to support the development of recovery communities in their area. A number of different groups were said to have been provided with support by the ADPs, including mutual aid groups, Self-Management And Recovery Training (SMART) groups, recovery cafes, recovery support groups, family support groups, and kinship care support. In addition, some ADPs specifically reported providing support to groups focussing on people engaged with Medication Assisted Treatment (MAT) and youth or gender specific services. The groups were organised by a variety of organisations, including delivery partners, churches, community interest companies and third sector organisations.

Many ADPs highlighted the negative effect that the COVID-19 pandemic and associated restrictions had on the provision of face to face activities. The support ADPs said they had offered ranged from providing staff to facilitate meetings, to offering direct funding to various recovery-based projects within their area. The projects encompassed a broad range of activities, from health promotion to encouraging more active lifestyles. Also mentioned was the provision of support for the peer volunteers involved in assisting with running the groups. Examples given included providing access to training (including naloxone) and developing employability skills.

3.6.2 Children and young people

The majority of the ADPs (83%) reported that they had specific treatment and support services for children and young people (Figure 11)^[6]. These were most often aimed at children and young people aged between 16 and 25 across a range of settings, the most commonly reported being third sector settings (79%), family support services and diversionary activities (both 72%), and mental health services (69%).

The most commonly reported settings for services aimed at children aged 16 and younger were diversionary activities, third sector services and family support services, with 72% of ADPs indicating availability of each of these services. For services aimed at children and young people aged between 16 and 25, the most commonly reported settings were third sector services (79%), family support services (72%) and diversionary activities and mental health services (both 69%).

Over half of ADPs (57%) reported that their services for children and young people with substance use improved in 2021/22, while 43% said that they stayed the same^[7]. No ADP reported either scaling back or removing the services they offered for these age groups.

3.7 Quality of life is improved by addressing multiple disadvantages (outcome 5)

3.7.1 Mental health

The vast majority of ADPs (92%) reported that mental health support was routinely available for people who use drugs or alcohol but do not have diagnosed co-occurring mental health problems^[8].

The majority of ADPs reported they did not have protocols in place to refer people with co-occurring problem drug use and mental health problems, or did not answer the question. Of those that did not have protocols in place, the majority reported that they were in the process of developing these.

Some of the ADPs that reported not having formal protocols in place specifically detailed alternative joint working or referral procedures that operated on a formal or informal basis. These included co-locating or sharing a management structure with mental health services and utilising a case management approach across services, with regular meetings to discuss the individual’s treatments and to develop and maintain good working relationships across teams and services; and establishing a team leaders’ forum.

ADPs were further asked to describe their local arrangements with mental health services to enable support for people with co-occurring drug use and mental health problems. Several ADPs reported multi-disciplinary team working as the main way they supported people with co-occurring problem drug use and mental health problems. This was typically described as mental health professionals, such as community mental health nurses, being located within (or working closely with) substance use services. However, there appeared to be various arrangements in place as other ADPs also reported that mental health teams would take the lead in most cases of co-occurrence or noted that their staff were trained in in providing low intensity mental health interventions such as Cognitive Behavioural Therapy.

All ADPs reported having at least some services where a trauma informed approach to substance use has been adopted. Fewer than a third of ADPs (31%) said that a trauma-informed approach to substance use had been adopted across “all services”, a slightly higher proportion (38%) reported it has been adopted in “the majority of services”, and an additional 31% in “some services”. Once again, ADPs listed a variety of examples illustrating the progress made towards integrating this approach across all services, such as training, recruiting new staff and engaging with third sector and community partners. Many also said that they had established working groups and sub-groups to ensure a trauma-informed approach was effectively embedded across their ADP area.

3.7.2 Justice

Of the 13 ADPs with a prison in their area, the majority (85%) reported having arrangements in place with community justice partners to ensure people in prison identified as at risk are issued naloxone upon on release. Moreover, ADPs also reported working with community justice partners at both operational and strategic levels (Figure 12).

In relation to working with community justice partners, over 9 in 10 ADPs indicated having mechanisms in place for information sharing (97%) and providing advice or guidance (93%). The lowest reported figure was for joint funding of activities, but nearly 7 of 10 ADPs (69%) had systems in place for doing this.

The percentages were similar for ADP contributions to community justice strategic plans.

* ‘Access to not-fatal overdose pathways upon release’ not applicable for ‘Community justice strategic plan input’.

ADPs reported a range of available pathways and protocols to address the treatment needs of people with problem substance use at various stages of their involvement with the criminal justice system (Figure 13).

Upon arrest, well over half of ADPs (59%) said the individuals had access to community workers and 83% reported pathways being in place to divert the individual from prosecution.

Nearly 9 in 10 ADPs (86%) reported providing naloxone upon release from prison^[9]. ADPs indicated that ongoing support was provided to people leaving prison, including access to community workers (66% of ADPs) and peer workers (62%).

Exercise and fitness activities were the least commonly offered forms of support reported, both upon arrest (28%) and release from prison (34%).

* ‘Naloxone’ was an option for ADP responses on pathways and protocols available upon release from prison only.

3.8 Children, families and communities affected by substance use are supported (outcome 6)

The vast majority of ADPs (90%) reported having specific treatment and support services for children and young people affected by a parent or carer’s substance use (Figure 14)^[10]. In general, a slightly greater proportion of services were available for those aged 16 and over, with family support being the most common service across the age groups. The next most commonly reported services by age group were diversionary activities and mental health services for 16 to 25 year olds (both 66% of ADPs), and diversionary activities (66%), school outreach (66%) and carer support (62%) for children aged 0 to 16 years.

Every ADP reported contributing toward the integrated children’s service plan. Many ADPs noted that they are represented on the relevant working and planning groups, and there is evidence of a high degree of engagement with this work. Moreover, 57% of ADPs reported that services for children and young people affected by a parent or carer’s substance use improved in 2021/22^[11]. An additional 43% felt that they had stayed the same. No ADP reported either scaling back or removing the services they offered for these age groups.

The vast majority of ADPs (96%) also reported having specific support services in place for adult family members (Figure 15)^[12]. Over 9 in 10 ADPs said there was signposting (93%) and naloxone training (90%), and there were also high percentages of ADPs reporting one-to-one support (86%) as well as support groups (83%). Once again, many ADPs reported working with third sector and community partners to ensure these services were delivered. Just under half of ADPs (48%) said that their adult family member services improved in 2021/22, while 52% felt they stayed the same. No ADP reported either scaling back or removing the services they offered for this group.

ADPs offered a variety of services to adults with the aim of supporting family-inclusive practice (Figure 16). This involved people with family members both in and not in treatment. Across both categories, advice was the highest-reported service, with over 9 in 10 ADPs (93%) providing this. Overall, a slightly greater proportion of services were reported to be offered to people with family members in treatment compared to those who were not.

Over half of ADPs (52%) reported that they had not completed an audit of their service provision for families within the 2020/2021 reporting period. However, most of these ADPs reported that audit work was in progress. For some ADPs this was also in parallel with recruitment for new posts to assist with the development of services taking a whole family approach and further audit work. Most intended to have this audit work complete by the end of 2022 or early 2023.

A similar proportion reported that some form of audit activity had taken place and detailed how Scottish Government funding had been spent. This included the funding of new posts; either to expand or develop pre-existing services, to employ a family wellbeing worker, or to create new coordinator posts for women’s and young people’s services. Other ADPs said they had partnered with carer support organisations to offer support to people caring for someone with problem substance use or taking over the care of children with a parent or carer with problem substance use. Also mentioned was the using the funding to “formalise” the partnership model that existed between third sector delivery partners, creating a more joined up and integrated service for young people. One ADP outlined ways in which the audit had been used to map service provision within their area and using the funding for a small scale test of change, with the intention of gathering learning to inform the future delivery of whole family inclusive approaches.