Medical Interventions
INTERVENTIONS PROVIDED BY MEDICAL AND NURSING TEAM ON THE DRUG MISUSE UNIT AT HMP BELMARSH, SOUTH LONDON AND HMP WOODHILL, MILTON KEYNES
Our service provides access to safe, appropriate, humane detoxification for all prisoners with drug dependencies.
We offer individualized and evidence based treatment for prisoners with drug dependencies, including alcohol related problems.
All our treatments are implemented in line with the Department of Health Guidelines (1999) and HM Prison Service standards.
In 2003 the substance misuse service (sms) opened its doors in HMP Belmarsh and HMP Woodhill to provide a comprehensive service for all prisoners whose lives are affected by their substance misuse, on average we assess 100 prisoners per month.
How we started?
Prior to the sms prisoners with heroin addiction were treated with an analgesic medication that is not recognised as an affective treatment and along with diazepam was given out once a day unsupervised in bags. This practice in turn promoted bullying, dealing, taxation, self harm and aggression on the wings, and did not address the cause and effects of the individuals behaviour on themselves, their families, their communities or the prison. In the year preceding the unit opening there was a high level of suicides and self-harm directly linked to prisoners with drug and alcohol problems.
Who are we?
The team comprises of a governor, P.O, S.O and 4 discipline officers (who are responsible for the unit and MDT, VDT). A programme coordinator/ facilitator, a probation officer and 1 admin staff.
There is also a full time doctor and 2 nurses employed by Seagrave Trust.
We liase closely with carats, resettlement, education, psychology, healthcare, all departments within the prison and multiple outside agencies and GPs.
Seagrave Trust was awarded the contract to set up the unit, devising and implementing protocols in line with evidence based practice and ensuring high standards of care, education, intervention and treatment.
What are the aims of the service?
v To provide access to safe, appropriate and humane detoxification for all prisoners with drug dependency through flexible and appropriate referral.
v To complete comprehensive client centred assessment, planning, implementation and evaluation of care.
v To provide effective management of withdrawal symptoms for prisoners with drug dependency undergoing treatment with the service.
v The provision of education and training to prisoners in relation to the health and social implications of drug misuse.
v Promote effective working partnerships with both prison and community services.
v Provide support, training and advice to staff at HMP Woodhill.
Commit to ongoing staff development to promote continued high standards of care and evidence based practice.
How do we achieve this?
On arrival at the prison healthcare staff complete a screening (F2169) which will highlight anyone one with a drug/ alcohol problem, they are then referred through to the sms.
We see all referrals the next day – those who arrive Friday or Saturday are covered by a comprehensive interim prescribing regime and seen the following Monday.
On their initial session at the sms an assessment is carried out, a care plan opened, medical and discipline compacts signed, urine drug screen taken and if appropriate a treatment plan drawn up. If the prisoner states they are already receiving treatment from an outside prescriber (i.e. methadone) this is confirmed and will influence the treatment plan.
The main drugs prescribed for detoxification are
v Opiates = Buprenorphine or methadone.
v Alcohol = Chlordiazepoxide and Thiamine.
v Benzodiazepines = Chlordiazepoxide.
We also prescribe a comprehensive list of symptomatic relief as required.
On completion of an opiate detox all prisoners are offered the opportunity of starting Naltrexone (the opiate blocking drug).
Do we offer anything else other than medication?
Whilst attending the service everyone has the opportunity to access the programme, which includes:
v Education
v Yoga
v Acupuncture
v Gym
v Art
v Music appreciation
v Discussion Groups (blood borne viruses, harm minimisation, tolerance / overdose prevention, drug awareness and personal development.
All of this is recorded on the care plan, which is given to the prisoner on completion of detox.
PRIMARY INTERVENTIONS
• Medical and Nursing Assessment
• Explanation of treatment options.
• Urine screening.
• Investigations (blood tests).
• Liaison with appropriate outside agencies.
• Titration
• Care planning.
• Case reviews.
• Dispensing of medication.
• Detoxification of Opiates, Alcohol and Benzodiazepines.
• Daily treatment.
• Advice and support to prisoners.
• Brief interventions
• Education and health promotion.
• Naltrexone prevention therapy.
• Discharge planning and liaison with DATs, GPs and other agencies.
SECONDARY INTERVENTIONS
• Training to staff in Belmarsh.
• Advice and support to staff in Belmarsh.
• Attending multidisciplinary meetings.
• Development and review of procedures and protocols.
• Documentation.