Bucharest, 11-12 October 2007                                                                                            

P-PG/CJ (2007) 19 EN

Conference on quasi-coerced treatment and

other alternatives to imprisonment

11-12 October 2007, Bucharest

www.coe.int/pompidou/fr

QCT and other alternatives to imprisonment: conclusions and recommendations

Tim McSweeney
Senior Research Fellow
 Institute for Criminal Policy Research
King’s College, London

What we’ve covered

•      Rationale for QCT

•      Evidence for effectiveness of QCT

•      Use of QCT in Europe

•      Recovery, desistance & the role of QCT

•      Ongoing ethical and practical issues

•      Recommendations

Rationale for QCT

•             Rising prison population – large proportion drug-related.

•             Relative ineffectiveness of other sanctions in deterring drug use and related crime.

•             Community-based treatment more cost effective than imprisonment and have fewer adverse effects.

•             Only need to affect behaviour of a few to be cost-effective. Good economic/social case for QCT.

Evidence for the effectiveness of QCT

•       ‘Coerced’ treatment can be effective in reducing substance use, risk and offending behaviours, and improving social integration.

•       ‘Coerced’ treatment can be as effective as ‘voluntary’ treatment - if received in the same treatment services – (QCT Europe) and regular detention (SOV).

•       More improvement observed among QCT groups - reflecting their poor prognosis at intake. 

•       The message is not that ‘coercion works’, but that treatment can be a viable alternative to imprisonment.

Use of QCT measures in Europe

•             QCT endorsed by UN and EU - most countries utilise the approach (though nature and extent of use unclear)

•             Completion rates vary considerably within and between countries.

•             Factors that might explain variations in outcomes include:

–           Differences in the profile of those exposed to QCT.

–           Variations in treatment quality, availability and delivery.

–           Setting (community-based vs residential).

–           Treatment orientation (abstinence-based vs harm reduction).

–           Enforcement practices (how we respond to non-compliance).

Recovery, desistance & QCT

•             Recovery and desistance are processes not events

•             People’s readiness to change varies

•             Need to continually generate & sustain motivation

•             Agency is important in promoting/inhibiting change

•             Tackling social problems important too

•             Provide opportunities to use new skills

Recovery, desistance & QCT

Recovery and desistance are processes not events

–           Of 126,000 users - 71% failed to complete drug treatment in 03/04.

–           NTORS – 40% still using heroin 3-4 years later

–           DORIS – only around 8% had attained abstinence after 3 years

•             Limited impact of conventional CJ responses – two-year reconviction rates for England & Wales:

–           All prisoners (65%) and probationers (51%)

–           Users in treatment via NTORS (74%)

–           Misusers supervised by the correctional services (74%)

–           Prolific users sentenced to QCT (82%).

•             More about managing expectations than lowering them

Recovery, desistance & QCT

People’s readiness to change varies

•             Complex interaction, making it difficult to predict receptiveness to narratives of change or those likely to do well.

•             Compounded by many (72%) feeling ‘coerced’?

        - 65% of the ‘volunteers’ reported some external pressure or duress to enter treatment.

        - 78% for the QCT group.

•             A link between legal status and perceived pressure but this does not reduce people’s motivation to change (Stevens et al., 2006).

•             People reported feeling less coercion during follow-up than at intake.

Recovery, desistance & QCT

Generate motivation & sustain change

•             A human process or ‘craft’ as much as a technology.

•             Practical assistance helps foster trust, moral obligation and a working alliance (Burnett & McNeill, 2005).

•             Is there sufficient scope for flexibility within QCT to respond constructively to lapses and relapses?

•             Too much emphasis on punishment of non-compliance & not enough incentives/rewards (positive reinforcement and/or contingency management)?

Recovery, desistance & QCT

Agency is important in promoting or inhibiting change

•             Behaviour influenced by thinking as well as circumstances.

•             Encouraged to embrace opportunities to adopt alternative, desired and socially approved personal identities or narratives.

•             Instil a belief that the offender has begun to take control (using PSM, MI).

•             Undermine recidivist narratives which cast offenders as victims of circumstance who cannot help re-offending (‘offender responsibility’ versus ‘opportunity deficit’ models).

Recovery, desistance & QCT

Tackling social problems important too – provide opportunities to use new skills

•             Limited capacity of QCT to tackle wider social and environmental factors (e.g. housing & ETE needs).

•             Limited access to suitable housing stock and poor links with employers or understanding of labour market needs.

•             Aftercare too often just an afterthought.

Ongoing ethical issues

•             Are we observing the principles of distributive justice (avoid displacing non-CJ clients or creating perverse incentives to offend)?

•             Important to distinguish between coercive and compulsory forms of treatment (the latter falls foul of ethical standards)

•             There must be opt-outs to conventional punishment

•             Participation in proven treatment that meets the needs of different user types

•             Principles of proportionality - not too intrusive or excessive

•             Ensure appropriate/graduated responses to inevitable lapses (rather than jail/revocation for non-compliance)

Ongoing practical issues

•      System capacity (Is QCT feasible? Can current systems absorb additional demand?)

•      Clarify treatment objectives (harm reduction or abstinence)

•      How best to target and identify those most likely to benefit?

•      Promoting and monitoring compliance (testing, reviews, contingency management)

•      Ability to sustain partnerships (knowledge, capacity & commitment)

•      Ensuring effective integrated support (housing, ETE, mental health)

•      Monitoring and evaluation (well resourced, comparison groups & qualitative)

•      Educate the public & stakeholders about the ‘chronic, relapsing nature’ of dependency. Be pragmatic/realistic about what can be achieved.

Recommendation

•             How can we disseminate our findings beyond the conference audience?

Is there scope for:

–          A network to develop guidelines on good practice as it relates to QCT?

–          Training on QCT issues for stakeholders?

•             Recommendation: that the PG CJ platform further explores the possibility of developing these guidelines/training.

Finally, thanks to:

The conference hosts and organisers – Romanian National Anti-Drug Agency and the Pompidou Group, Council of Europe.

Email: [email protected]

http://www.kcl.ac.uk/icpr

Conclusions of Workshop I

Eligibility criteria and engaging ‘hard-to-reach’ groups

Tim McSweeney
Senior Research Fellow
 Institute for Criminal Policy Research
King’s College, London

Issues we wanted to explore

•      In devising this workshop we sought to explore two issues:

1. How do QCT systems target and identify suitable offenders?

2. How responsive is the drug treatment component of QCT to the needs of different types of drug using offender?

–    women

–    young people

–    BME groups

–    stimulant/poly drug users and

–    co-morbid users

•      Experiences from Switzerland, Portugal, Germany, Ireland and Romania.

Anticipated themes/issues

•      Are certain offenders targeted for QCT by the nature of their offence (burglars, shoplifters) but others excluded (possession/dealing offences; offence too serious or not serious enough)? Could this explain why certain groups may be under-represented in QCT?

•      What impact do other issues have on eligibility for QCT: i.e. homelessness, lack of community support (family, non-using friends, etc), mental health issues, previous offending history (risk assessment), previous ‘failed’ treatment or non-compliance with the courts?

Anticipated themes/issues

•      Related to this is how do services/professionals identify those likely to benefit most from QCT? How do they assess motivation (and all its associated problems) in the context of QCT?

•      Residential or community-based treatment?: What criteria are used when deciding?

•      Exploratory informal discussions gauging the extent of such problems rather than proposing solutions.

Themes/issues that emerged

Targeting, eligibility & suitability

•      Crime must be drug-related

•      Linked to severity of offence and length of likely sentence

•      Exclusion of violent offenders by some

•      Consistent and timely information exchange between health and CJ important

•      Complexity of assessing motivation

•      Delays in custody waiting for court date damages motivation

•      Starting treatment prior to sentence as a measure of motivation

Themes/issues that emerged

Engagement with QCT

•      No obvious issues re: treatment suitability for different groups

•      Social exclusion (housing, ETE, healthcare) bigger barrier to engagement

•      Only ‘hard-to-engage’ groups in QCT are the stakeholders!

•      Treatment availability limited – residential support not available to all

•      Preference for residential treatment by courts because of surveillance aspect; outpatient treatment considered a greater risk.

•      Financial restrictions determine QCT length (not nature of offence/clinical need)

Conclusions of Workshop II
Partnership and information sharing

Lidija Vugrinec

Head of National Drugs Information Unit and International Affairs Department

Office of the Croatian Government

for Combating Narcotic Drugs Abuse

Definition of partnership

A partnership is a relationship between two or more parties working to achieve common interests and goals. It is characterized by mutual cooperation and responsibility

Introductions

•      Mr. Lars Siggelin, Hassela Gotland, Sweden

•      Mr. Benjamin Bernard, Comunita Incontro, Italy

•      Mr. Dimitru, Penal Reform International, Romania

Discussion points 

•      How do we facilitate cooperation?

•      Is clear legal base essential to initiate a partnership?

•      How is partnership being realized (official correspondence, regular meetings etc.)?

•      What are the mechanisms for information exchange?

•      Role of NGOs in QCT and other alternatives of imprisonment?

Key elements 

•      Cooperation between judicial, health, social services/institutions, including NGOs

•      Different levels: local, national, international

•      International partnership in a sense of translation of good practices between countries

•      Continuity

•      Information sharing – issue of personal data protection

•      Promotion

•      Financial preconditions

Conclusion

If we want to achieve successful social reintegration of drug addicted offenders as the final goal of QCT and other alternatives to imprisonment, we have to ensure joint actions of all relevant stakeholders. 

[email protected]

Platform Co-ordinator / Coordonateur de plateform

Speakers / Orateurs

Austria / Autriche

Bosnia and Herzegovina/ Bosnie Herzegovine

Belgium / Belgique

Bulgaria / Bulgarie

Croatia / Croatie

Cyprus / Chypre

Czech Republic / République tchèque

Denmark / Danemark

Estonia / Estonie

Finland/Finlande

France

Germany / Allemagne

Greece / Grèce

Hungary / Hongrie

Iceland / Islande

Iran

Mehrzad TASHAKORIAN

Health & Treatment Manager

Iran Prisons Organisation-Health & Treatment Office

Ireland / Irlande

Italy

Latvia / Lettonie

Lithuania / Lituanie

Moldova

Montenegro

Netherlands / Pays-Bas

Norway / Norvège

Pakistan

Portugal

Romania / Roumanie

Russian Federation / Fédération de Russie

Mrs Olga KAVERINA

Mr Sergey MURAVIEV 

Deputy Head of Legal Directorate

San Marino / Saint-Marin

Slovak Republic / Republique Slovaque

Slovenia / Slovenie

Spain

Sweden / Suède

Turkey / Turquie

Ukraine

United Kingdom / Royaume-Uni

WHO GENEVA / OMS GENEVE

Pompidou Group / Groupe Pompidou

Interpreters / Interprètes