Agenda item

The meeting will consider evidence on taking a Public Health approach to Anti-Social Behaviour.

Camden and Islington NHS Foundation Trust has been invited to attend to present on their mental health and addiction services and how best to support their clients that may be perpetrators of ASB.

Miriam Bullock, Deputy Director of Public Health, together with Liz McGrath,  Clinical Director, and Jane Palmer, Criminal Justice Pathways Coordinator, of Camden and Islington NHS Foundation Trust (C&I), presented to the committee on taking a public health approach to ASB, and in particular on the links between mental health, drug and alcohol needs, and ASB issues.

The following main points were noted in the discussion:

·       C&I’s drug and alcohol services worked closely with council services, including the Street Population team, the Cuckooing Team and Housing Officers. The service offered outreach work that sought to engage people in treatment and offered rapid prescription of opiate replacements. C&I also worked closely with council officers through the MARAC process, as well as with GP surgeries, voluntary sector partners and others.

·       Following a question on the impact of austerity on drug and alcohol services, it was advised that additional investment had been made into the service in recent years, including extra investment to develop new pathways into treatment for those in the criminal justice system. Outreach services had continued to be funded despite the financial challenges facing public services. The most significant challenge was getting people to engage in treatment and stay in treatment. There were no waiting lists in drug and alcohol services.

·       Outreach work had developed over recent years by targeting outreach at hard to reach groups, including women and those in the criminal justice system.  

·       It was asked if the provision of supervised injection facilities in Islington would allow for better opportunities for intervention.  In response, it was commented that this could be considered a harm reduction approach, however there were already opportunities for intervention through needle exchanges and other services. Services were proactive in engaging with clients and welcoming them into treatment services.

·       In relation to mental health, a member commented on the need to consider the mental health of those experiencing ASB, as well as that perpetrators of ASB may have mental health issues.

·       It was commented that mental health services could recommend rehousing to housing providers if they are aware of ASB issues affecting the mental health of their clients.

·       Following a question on barriers to accessing drug and alcohol services, it was commented that women tended to have increased complexity off need and face stigma in accessing services. Addiction services were now linking with other women’s services to make them easier to access.

·       It was reported that some of those accessing addiction services had positive outcomes. This was particularly the case when addiction issues were not intergenerational. When there was a history of addiction in families, then issues could be much more entrenched.

·       Councillors welcomed the holistic approach to viewing ASB through a public health lens, as detailed in the report, and queried how a public health approach to ASB could have a wider impact on policy. Officers emphasised that housing was a strong determinant of health; roughsleeping, homelessness and insecure housing tenure could have a significant impact on both physical and mental health, as could overcrowding and damp and mould issues.

·       A member commented on common mental health issues such as stress, anxiety and depression, how these could manifest as ASB issues, and the need to address the drivers of these issues, including the housing crisis, housing density, cultural issues around alcohol misuse, and other factors. Islington had one of the highest rates of mental health prevalence in London. An early intervention approach would focus on determinants of poor mental health before needs escalate.

·       It was confirmed that drug and alcohol services worked with the police on joint patrols as part of their outreach work.

·       Following a question on drug-taking in parks and public concerns about needles, it was confirmed that there were various pharmacies and other sites that operated needle exchange schemes. C&I worked with council services to encourage those taking drugs in public to enter treatment, but building trust was key to drug-users choosing to engage in treatment.

·       There were challenges around obtaining accurate data on the level of need among drug users.

·       A member commented on Islington’s diversity and the need for services to be culturally competent to best meet the needs of the borough’s communities. It was advised that there was a specific drug treatment pathway for men from a Black African background, and both mental health and addiction services employed key workers from a range of different backgrounds. It was intended for drug and alcohol support services to be culturally aware. The services also engaged with community leaders, community centres, and had provided training to community groups with relatively lower levels of engagement to encourage take-up. There were also two workers who specialised in working with the LGBT+ community.

·       In response to a question on early intervention approaches, it was noted that those with drug and alcohol dependency had typically experienced trauma, poverty, and instability in their lives. Early intervention approaches would need to consider wider determinants, including housing, education, and support for families.

·       Drug and alcohol education was provided in schools as a way of engaging with young people.

·       The Committee considered the difficulty of getting those with complex needs to engage with drug, alcohol and mental health support services. Unless someone was exhibiting behaviours significant enough to require them to be sectioned under the Mental Health Act, then there was no power to compel people to engage in treatment and support.

·       Recently there had been increased investment in mental health services for less severe problems; it was intended to offer more community based mental health support for those with lower needs. The service offer was still being developed, but it was intended to be easier to access.

·       A member asked, if the officers and representatives of C&I could do one thing to improve ASB outcomes, what it would be. In response, all agreed that addressing the housing crisis would make the biggest impact on people’s wellbeing.

The Chair thanked the witnesses for their attendance.