1. Drug-related deaths among young people: a social, structural and systems autopsy

Scotland has the highest rate of drug-related deaths (DRD) in Europe: deaths that are contextualised by high levels of social and health inequalities. In the Highland region, almost twice the level of DRD occurs among young people compared to the national average. This study traces the lived experience of young people and their interactions with state systems and institutions prior to their death in order to inform policy and practice on DRD prevention

Existing health, social work, police and post mortem records (both paper and electronic) of young people aged 16-25 who had died of a DRD between 2012 to 2019 (n=22) in the Highland region. A data record template was created to extract information from the records. Summary narratives, chronologies and descriptive statistics were produced using Excel and NVivo. Bronfenbrenner (1977) and Rhodes (2002) concepts of ecological systems and risk environments informed the data analysis.

Almost all the young people had experienced numerous significant adversities in their lives such as poverty, loss of a loved one, family breakdown, insecure housing, poor mental health, and educational difficulties. At a young age, they came into contact with state systems (such as education, health, drug treatment, social care and criminal justice) which struggled to respond to their multiple and complex needs.

Young people experienced a complex and fragmented system of care that focused on addressing their capacity and motivation for behavioural change. Their capacity for such change was constrained by the systems lack of capability to meet their broader needs.

This work was supported in part by a grant from the Corra Foundation, Scotland