As the Chairman said in his introduction, the focus of special report No. 64 is on drug addiction treatment and rehabilitation. A previous meeting in July considered the role of the HSE and the co-ordinating role of the Department of Community, Rural and Gaeltacht Affairs. This session examines drug treatment and how drug treatment and rehabilitation is handled in the criminal justice system.
Within the criminal justice system there are three main institutions which have an input into addiction treatment and rehabilitation: the Irish Prison Service which provides addiction counselling, methadone maintenance treatment, detoxification and rehabilitation for persons in custody; the probation service which assists the courts at sentencing stage in those cases where community based sanctions incorporating drug treatment are contemplated and, in instances where they are actually imposed, monitors their implementation; and the drug treatment court which operates for offenders resident in two Dublin postal districts in the north inner city who have committed non-violent offences. The aim of the court is to maintain offenders in the community on condition that they manage their addiction.
The key findings of the audit were as follows. In the case of the Prison Service, methadone maintenance facilities are available in eight prisons that accommodate three quarters of the prison population. Around 12% to 15% of the persons committed to prison between 2003 and 2007 were placed on methadone programmes. Only Mountjoy Prison provides a rehabilitation facility which is capable of treating around 72 prisoners each year. During the years participation and completion rates in the programme have varied, perhaps influenced by the availability of methadone maintenance programmes. However, after 2006, the completion rate of the programme began to rise.
All prisons offered addiction counselling services, with the exception of Arbour Hill Prison. Since September 2008, most counselling services in prisons have been outsourced and will now be provided by Merchants Quay Ireland. The audit concluded that more information needed to be captured and shared about those treated in prisons, as well as the outcome of the treatment provided. Full utilisation of the computer-based medical record system and integrating prison treatment information into the national drug treatment recording system appeared to be the solution to this. In addition, more continuity of care was desirable as prisoners moved from and back into the community.
The second arm in the criminal justice system is the Probation Service and it was involved in the planning and funding of drug treatment services for individuals. In 2007, it provided €2.7 million for voluntary and community bodies for these kinds of programmes. However, it is reviewing these arrangements in light of the improved general access to addiction services in the community generally and has found there is scope for improvement in the information captured by the Probation Service, especially that pertaining to access to treatment places for those offenders where community-based sanction is being considered. It is also reviewing them in light of the outcomes in court ordered treatments that it supervises.
The Dublin Drug Treatment Court, which was put on a permanent footing in 2006, has a low participation and completion rate. The examination found that just over half of the cases referred to the drug treatment court were found to be eligible and suitable for inclusion on the programme. It also found the throughput of cases was low. Between 2002 and 2008, some 22 offenders a year were admitted to the programme, which is approximately one fifth of the target envisaged at its inception. Only 17% of programme participants completed the programme to the satisfaction of the court. The remit of the drug treatment court was to be expanded to include the entire city of Dublin, but this has not yet happened. The Courts Service has stated the expansion has not happened because other agencies, in particular the HSE, have not been in a position to provide the necessary support services.
Overall, there is a need to evaluate the effectiveness of the Drug Treatment Court in comparison with community-based sanctions that provide for treatment. This would preferably be done by making a comparison with areas of similar socioeconomic profile.