Tackling Drug Misuse in Prisons A qualitative study into the lived experience of drug testing and Incentivised Substance Free Living wings (ISFLs) in three prisons

Final Report RAND Europe with research support from Rosie Meek, Kirsty Hudson, Sarah Senker and Charlotte Scott

RAND Europe was commissioned by the Ministry of Justice in 2022 to conduct a study exploring the lived experiences of two interventions in prisons in England and Wales: drug testing regimens and incentivised substance free living (ISFL) wings. Mandatory drug testing is routinely conducted in prisons to monitor drug trends, deter drug consumption (through sanctions), and identify individuals in need of further support. ISFLs are dedicated wings for prisoners who want to live in a drug-free environment, whether that be free from the consumption of drugs, the violence related to drugs, or the culture of drug use. Drug testing regimens and ISFLs feed into the delivery of His Majesty’s Prisons and Probation Service’s (HMPPS) drug policy for prisons, which is guided by three key aims: restrict supply, reduce demand and build recovery. This study aimed to understand how drug testing regimens are delivered, experienced, and perceived. Findings will shape the ISFL model by understanding the lived experience of staff and prisoners both on existing ISFL wings and elsewhere in the prison. Findings from this report will also be used to inform the design of a randomised controlled trial and process evaluation on ISFLs and a larger qualitative piece of work on implementation of drug testing. Data collection consisted of interviews and focus groups with prisoners, interviews with prison staff, and observations of drug testing suites and ISFL wings. Fieldwork took place in March and April 2023 in three prisons: a category C men’s prison in the North of England; a category B/C men’s prison in Wales; and a closed women’s prison in the South of England. Key findings on drug testing regimens Drug testing regimens appear to be designed with limited consideration of the variation and uniqueness of each prison and its population. The research identified practical limitations for prisoners on remand or serving short sentences in accessing support services. Female prisoners experienced the process of being tested as degrading due to the different way that they provide a sample in comparison to men. The illicit use of prescription medication, sourced through the prison’s medication hatch and traded among prisoners, was reported to be prevalent in all three sites. There was no immediate way for prison staff to know whether a positive result was the result of misuse or legitimate prescription use. The process for confirming this, via medical records, was described as lengthy and, at times, inappropriately punitive to prisoners legitimately taking prescription medication. Several staff and prisoners commented that the regimens were testing for substances that were widely understood not to be consumed in the sites. Drug testing regimens were not always seen to be effective as a therapeutic tool to support prisoners or address underlying needs that drive drug use. Generally, prisoners were either indifferent to, or supportive of, drug testing itself. The punitive responses to positive drug tests were felt to do little to deter drug use, in the absence of support being offered. Most participants, particularly in the men’s prisons, felt that drug testing was currently ineffective at deterring drug use in part due to inconsistent implementation. Additionally, for some at the South of England prison the ‘benefit’ of taking drugs to help deal with mental health issues and prison life, outweighed the ‘cost’ of getting caught. Key findings on ISFL wings There were mixed perceptions about the value of ISFL across the prison population. In the North of England and Welsh prisons, staff and prisoners were generally positive about the operation of the ISFL and attributed this to a calm atmosphere, positive and supportive relationships with staff and other prisoners, extended time out of cells and additional support services to help prisoners address their mental health needs. At the South of England prison, the ISFL was struggling to differentiate itself from other wings which staff and prisoners attributed to a lack of incentives specific to the ISFL. ISFLs were described by both staff and prisoners as having ‘a bad rep’ and creating ‘ill feeling’ among prisoners on other wings. This was put down to jealousy and resentment about the additional privileges and a perception that prisoners on ISFLs were colluding with management. ISFL referral processes differed significantly in implementation across the three prisons. All three wings used some form of referral criteria for recruiting participants. However, how referral worked in practice seemed ad hoc, informal and varied from site to site. The process for being able to reside on the wing was also unclear to many prisoners. Approaches to dealing with positive drug test results from ISFL residents also differed across the sites. In the North of England prison, a ‘two strikes’ approach to excluding prisoners from the wing appeared to be implemented consistently, while in the Welsh prison there was more flexibility for prisoners who volunteered information that they had used drugs. In the South of England prison no such penalty was applied. Talking therapies and purposeful activities were important in supporting recovery. The peer-led component of therapies and the opportunities to build supportive relationships with other residents through additional time out of cells and in shared spaces was felt to be effective in helping prisoners to understand the drivers of their drug use and how to address their mental health needs. The importance of a stable, safe environment and providing activities tailored to the needs of the population was highlighted by interviewees. Many believed that an ISFL should primarily be a settled environment where prisoners can access help to support their needs, and that a mix of prisoners, with and without histories of drug use, was beneficial in creating this environment. However, the environment in the ISFL at the South of England prison was described as ‘disruptive’ as it included prisoners who had not chosen to be on the ISFL, and other wings were described as offering a more therapeutic, communal environment. At this prison, staff also reported that the incentives on offer were typically more popular in a male, rather than female, prison (e.g., gym weights or pool tables) and female prisoners described different motivations for taking drugs. Findings underlined that the types of drugs consumed, reasons for drug consumption, and mental health and other needs vary by sex.

London: Ministry of Justice, 2024. 106p.