Can liaison and diversion services increase referral to drug and alcohol treatment?

Background

In 2009 the UK government made a commitment to improve Liaison and Diversion (L&D) services, which aim to identify people with a range of vulnerabilities as they pass through the criminal justice system to ensure their health and other needs are known about, and that they are referred to appropriate services – including services for drug and alcohol misuse. A research team from RAND Europe is currently undertaking a national evaluation of the new L&D services for the UK Department of Health and Social Care.

Methods

Between September 2016 and October 2017, people using L&D services in 28 areas of England were asked to participate in the RAND evaluation by agreeing (in line with consent processes authorised by the UK Health Research Authority) to share their name, date of birth and selected other identifiers with the research team.

RAND researchers applied to relevant national ministries and bodies to receive criminal justice, drug and alcohol treatment and health service use records for consenting service users.

At the mid-way point of this evaluation, these data have been subject to a descriptive analysis. The aim was to understand the history of L&D service users’ involvement in the criminal justice system, their experience of drug and alcohol treatment and their utilisation of mental health care and emergency health care services.

Results

Applications to gain access to data from the relevant public bodies took between one and three years.

Following data cleaning, the study achieved a sample of 8,729 individuals. 2,619 individuals were ‘matched’ to a record in the national drug treatment database; 5,763 individuals were matched in the national police computer; and 7,316 individuals were matched to health service use data.

Preliminary descriptive analysis suggests that referral to L&D services comes at a time of crisis for these individuals. Records from drug and alcohol treatment services show that self-rated quality of life and psychological wellbeing dropped in the two years before referral and utilisation of hospital emergency departments increased.

There is some evidence that L&D services may be effective in increasing referrals to drug treatment services in the months after an individual enters L&D. There is some suggestion that this translates into greater numbers of drug treatment episodes. There is heterogeneity in these findings across the country.

Conclusions

This ongoing evaluation offers a unique opportunity to link data from several sources to build up a picture of service use by a population of vulnerable service users across the criminal justice system, health and substance misuse services. However, ensuring that this is done in line with regulatory frameworks is a lengthy process. Preliminary results from the evaluation suggest L&D may have resulted in increasing the number of vulnerable people being referred to and accessing drug treatment services.