Some of the most interesting things about alcohol and other drugs in 2017

Andrew Brown

andrewbrown365

Prevalence

Estimated prevalence of dependence in England

257000

183000

595000

0

100000

200000

300000

400000

500000

600000

700000

Opiate Crack Alcohol

Estimated number of opiate andor crack cocaine users by age in England in 201112 and 201415

32628

109124

152127

30190

91808

178785

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

200000

15 to 24 years 25 to 34 years 35 to 64 years

201112 201415

Source Estimates of the Prevalence of Opiate Use andor Crack Cocaine Use 201415 Sweep 11 report (LJMU 2017)

Prevalence

Estimated prevalence of dependence in England

257000

183000

595000

0

100000

200000

300000

400000

500000

600000

700000

Opiate Crack Alcohol

Estimated number of opiate andor crack cocaine users by age in England in 201112 and 201415

32628

109124

152127

30190

91808

178785

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

200000

15 to 24 years 25 to 34 years 35 to 64 years

201112 201415

Source Estimates of the Prevalence of Opiate Use andor Crack Cocaine Use 201415 Sweep 11 report (LJMU 2017)

Estimated prevalence of dependence in England

257000

183000

595000

0

100000

200000

300000

400000

500000

600000

700000

Opiate Crack Alcohol

Estimated number of opiate andor crack cocaine users by age in England in 201112 and 201415

32628

109124

152127

30190

91808

178785

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

200000

15 to 24 years 25 to 34 years 35 to 64 years

201112 201415

Source Estimates of the Prevalence of Opiate Use andor Crack Cocaine Use 201415 Sweep 11 report (LJMU 2017)

Estimated number of opiate andor crack cocaine users by age in England in 201112 and 201415

32628

109124

152127

30190

91808

178785

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

200000

15 to 24 years 25 to 34 years 35 to 64 years

201112 201415

Source Estimates of the Prevalence of Opiate Use andor Crack Cocaine Use 201415 Sweep 11 report (LJMU 2017)

Estimated number of opiate and crack users in England in 201112 and 201415 by region

169

35

46

337

36270

24

08

5

3432

9

219

52

549

85

329

35 26

051 17675

48

814

366

62

25057

34822

25910

524

87

32734

26

622

-

10000

20000

30000

40000

50000

60000

North East NorthWest

Yorkshireand theHumber

EastMidlands

WestMidlands

East ofEngland

London South East SouthWest

201112 201415

Source Estimates of the Prevalence of Opiate Use andor Crack Cocaine Use 201415 Sweep 11 report (LJMU 2017)

Nationally there was a 2 increase in

the estimated number of OCUs but this

change was not statistically significant

The number of OCUs in the East of

England increased by 18 from 21952

in 201112 to 25910 in 201415 and this

increase of 3958 was statistically

significant (95 CI 270 to 7606) There

was an increase in the point estimate in

the North West of 2477 ndash an increase of

5 - but this was not statistically

significant All other regions saw

increases in the point estimate apart

from a small fall in the South East and a

larger (but still not statistically

significant) fall in London

Estimated number of children who live with opiate users by region

-

5000

10000

15000

20000

25000

30000

East of England East Midlands London North East North West South East South West West Midlands Yorkshire andthe Humber

Female Opiate Users

Male Opiate Users

Source Estimates of the number of children who live with opiate users England 201112 (PHE 2017)

Estimated proportion of the population who are alcohol dependent by upper tier local authority

000

200

400

600

800

1000

1200

Wo

kin

gh

am

Su

rrey

Wes

thellip

Ham

psh

ire

Lei

cest

ershellip

Wilt

shir

e

Bro

mle

y

Eas

thellip

Ess

ex

So

lihu

ll

Bex

ley

Her

efo

rdshellip

Dev

on

Sh

rop

shir

e

Bat

h a

nd

hellip

En

fiel

d

Ken

t

Sta

ffo

rdsh

hellip

Ho

un

slo

w

No

rfo

lk

Su

tto

n

Ch

esh

irehellip

Eal

ing

Der

bys

hir

e

Cal

der

dal

e

Gre

en

wic

h

Wal

tham

hellip

Bu

ry

Co

rnw

allhellip

So

uth

end

-hellip

Bar

kin

ghellip

To

rbay

Du

dle

y

No

rth

hellip

So

uth

hellip

Der

by

Dar

ling

ton

Co

un

tyhellip

Red

carhellip

Bo

lto

n

Old

ham

Hac

kne

y

Po

rtsm

ou

th

Bar

nsl

ey

Wir

ral

San

dw

ell

Islin

gto

n

Tam

esid

e

Kin

gst

on

hellip

Sal

ford

Bla

ckp

oo

l

D

ep

en

de

nce

ra

te

Source Estimates of alcohol dependence in England including estimates of children living in a household with an adult with alcohol dependence supplementary tables (PHE 2017)

Health and drug and alcohol treatment services

Types of identified substance misuse support for women in England and Wales

337

337

120

108

96

00 100 200 300 400

Womenrsquos group in generic service

Substance misuse midwife

Women-only residentialrehabilitation facility

Other type of substance usesupport

Women-only non-residentialsubstance misuse service

N = 83Data from the National Drug Treatment

Monitoring System (NDTMS) indicates that

currently around a third of people

accessing drug treatment services are

women with the figure rising to almost

40 in alcohol only support services

As such finding that only around half of all

local authority areas in England (n=74

490) and five unitary authorities in Wales

(227 of all authorities in Wales) are home

to localised support specifically for women

experiencing substance use problems is

disappointing

Source Holly J (2017) Mapping the Maze Services for women experiencing multiple disadvantage in England and Wales London Agenda amp AVA

Types of identified substance misuse support for women in England and Wales

337

337

120

108

96

00 100 200 300 400

Womenrsquos group in generic service

Substance misuse midwife

Women-only residentialrehabilitation facility

Other type of substance usesupport

Women-only non-residentialsubstance misuse service

N = 83Data from the National Drug Treatment

Monitoring System (NDTMS) indicates that

currently around a third of people

accessing drug treatment services are

women with the figure rising to almost

40 in alcohol only support services

As such finding that only around half of all

local authority areas in England (n=74

490) and five unitary authorities in Wales

(227 of all authorities in Wales) are home

to localised support specifically for women

experiencing substance use problems is

disappointing

Source Holly J (2017) Mapping the Maze Services for women experiencing multiple disadvantage in England and Wales London Agenda amp AVA

Number of adults in community drug and alcohol treatment in England 2013-14 to 2016-17

155852

25570

28

871

916

51

1529

64

25025

28

128

89

107

149

80

7

25814

28

187

85035

146

536

24

561

28

24

2

80

454

-

20000

40000

60000

80000

100000

120000

140000

160000

180000

Opiate Non-opiate only Alcohol and non-opiate Alcohol only

2013-14 2014-15 2015-16 2016-17

There has been a fall in the

number of adults in treatment

in the community (3 down

on last year)

This has been particularly steep

in those in treatment for

alcohol alone (5 down from

2015-16) and prevalence

estimates suggest 4 in 5 people

who are alcohol dependent

arenrsquot having their treatment

needs met

The number of individuals

presenting with crack cocaine

problems (not being used

alongside opiates) increased

by 23 (2980 to 3657)

Source Substance misuse and treatment in adults statistics 2016 to 2017 (PHE 2017)

NHS hospital finished admission episodes with a primary or secondary diagnosis of drug related mental health and behavioural disorders in England

819

0474

80

1

68

5976114

2

57852

5135344

585

42

170

40

42

1

38170

380

05

0

10000

20000

30000

40000

50000

60000

70000

80000

90000 There were 81904 hospital admissions with

a primary or secondary diagnosis of drug-

related mental and behavioural disorders

This is 9 more than 201415 and over

double the level in 200506 ndash though the

increase from 200506 will be partly due to

improvements in recording of secondary

diagnoses

The North West had the highest rate of

admissions per 100000 population for both

males and females at 326 and 141

respectively The South East had the lowest

rates at 139 for males and 61 for females

Source Statistics on Drugs Misuse England 2017 (NHS Digital 2017)

Numbers of people admitted to hospital in England recorded as having a diagnosis of withdrawing from alcohol (broad measure)

10730

12620

14430

1634017960

19800

21590 2203022970 22900

2427025040

26810

1270 1290 1390 1400 1210 1220 1230 1130 1220 1230 1100 1210 1300

0

5000

10000

15000

20000

25000

30000

200304 200405 200506 200607 200708 200809 200910 201011 201112 201213 201314 201415 201516

Withdrawal state

Withdrawal state with delirium

Source Alcohol-related hospital admissions ndash Statistical tables for England (PHE 2017)

Admission episode rates for alcohol related conditions and healthy life expectancy at birth for males in Englandrsquos Upper Tier local Authorities

50

55

60

65

70

75

450 650 850 1050 1250 1450 1650

Ma

le h

ea

lth

y li

fe e

xp

ect

an

cy a

t b

irth

Admission episode rates for alcohol related conditions

ldquoA proxy measure for the harmful effects of drinking is the number of occasions where acute healthcare is required as a result which can be measured through Hospital Episode Statistics The national rate of alcohol-related admissions in England for males and females combined during the financial year ending (FYE) 2015 was 6347 per 100000 but there were large differences in the rate of admission for alcohol-related conditions across the countryhellip

For example by comparing the extremes the rate of admission episodes among males was more than three times greater in Blackpool (15440 per 100000) compared to Wokingham (4936 per 100000) These areas are starkly contrasting in terms of male HLE at birth men in Wokingham were expected to live 142 more years in good health compared to men in Blackpool in 2013 to 2015rdquo

Source An overview of lifestyles and wider characteristics linked to Healthy Life Expectancy in England June 2017 (ONS 2017)

Admission episode rates for alcohol related conditions and healthy life expectancy at birth for males in Englandrsquos Upper Tier local Authorities

50

55

60

65

70

75

450 650 850 1050 1250 1450 1650

Ma

le h

ea

lth

y li

fe e

xp

ect

an

cy a

t b

irth

Admission episode rates for alcohol related conditions

ldquoA proxy measure for the harmful effects of drinking is the number of occasions where acute healthcare is required as a result which can be measured through Hospital Episode Statistics The national rate of alcohol-related admissions in England for males and females combined during the financial year ending (FYE) 2015 was 6347 per 100000 but there were large differences in the rate of admission for alcohol-related conditions across the countryhellip

For example by comparing the extremes the rate of admission episodes among males was more than three times greater in Blackpool (15440 per 100000) compared to Wokingham (4936 per 100000) These areas are starkly contrasting in terms of male HLE at birth men in Wokingham were expected to live 142 more years in good health compared to men in Blackpool in 2013 to 2015rdquo

Source An overview of lifestyles and wider characteristics linked to Healthy Life Expectancy in England June 2017 (ONS 2017)

Number of admissions and bed days for those diagnosed with alcohol related mental and behavioural disorders associated with dependence and withdrawal in hospitals in England in 2015-16

1300

26810

320

52970

1970

0 20000 40000 60000

Withdrawal state with delirium

Withdrawal state

Psychotic disorder

Dependence syndrome

Amnesic syndrome

Admissions (broad measure)

6579

74921

4731

55581

19275

- 20000 40000 60000 80000

Withdrawal state with delirium

Withdrawal state

Psychotic disorder

Dependence syndrome

Amnesic syndrome

Number of finished consultant episodes bed days

Source Hospital Admitted Patient Care Activity 2015-16 (NHS Digital 2016)Source Alcohol-related hospital admissions ndash Statistical tables for England (PHE 2017)

Number and proportion of patients who have an emergency alcohol-specific readmission to any hospital within 30 days of discharge following an alcohol-specific admission

2116122016

2334124036

1112

1213

0

2

4

6

8

10

12

14

0

5000

10000

15000

20000

25000

30000

April 2011 - March 2014 April 2012 - March 2015 April 2013 - March 2016 April 2014 - March 2017 (Provisional)

Source Clinical Commissioning Group Outcomes Indicator Set (NHS Digital 2017)

Provisional rate (per 100000 registered patients) of emergency admissions to hospitals for alcohol related liver disease in 2016-17 by CCG

NHS Tower Hamlets CCG 42

All registered patients in England 277

NHS South Sefton CCG 933

00

100

200

300

400

500

600

700

800

900

1000

NH

S T

ow

er H

amle

ts C

CG

NH

S P

ort

smo

uth

CC

GN

HS

So

uth

Glo

uce

ster

shir

ehellipN

HS

Bat

h a

nd

No

rth

Eas

thellipN

HS

Wes

t H

amp

shir

e C

CG

NH

S B

arn

et

CC

GN

HS

Ch

ilte

rn C

CG

NH

S Ip

swic

h a

nd

Eas

t S

uff

olk

hellipN

HS

No

rth

Ham

psh

ire

CC

GN

HS

Eas

t R

idin

g O

f Y

ork

shir

ehellip

NH

S H

igh

Wea

ld L

ewes

hellipN

HS

Eas

t an

d N

ort

hhellip

NH

S C

royd

on

CC

GN

HS

New

bu

ry a

nd

Dis

tric

t C

CG

NH

S K

ing

sto

n C

CG

NH

S O

xfo

rdsh

ire

CC

GN

HS

Ho

un

slo

w C

CG

NH

S D

artf

ord

Gra

vesh

amhellip

NH

S N

ott

ing

ham

Cit

y C

CG

NH

S E

alin

g C

CG

NH

S S

hro

psh

ire

CC

GN

HS

Ho

rsh

am a

nd

Mid

hellipN

HS

So

uth

Lin

coln

shir

e C

CG

NH

S C

ove

ntr

y an

d R

ug

by

CC

GN

HS

Bri

sto

l CC

GN

HS

Lee

ds

No

rth

CC

GN

HS

Win

dso

r A

sco

t an

dhellip

NH

S H

eref

ord

shir

e C

CG

NH

S S

ou

th E

ast

Sta

ffo

rdsh

irehellip

NH

S N

orw

ich

CC

GN

HS

Bar

kin

g a

nd

Dag

enh

amhellip

NH

S C

entr

al M

anch

este

r C

CG

NH

S N

ene

CC

GN

HS

Wyr

e F

ore

st C

CG

NH

S E

ast

Sta

ffo

rdsh

ire

CC

GN

HS

Du

rham

Dal

eshellip

NH

S B

rad

ford

Dis

tric

ts C

CG

NH

S O

ldh

am C

CG

NH

S N

ort

h W

est

Su

rrey

CC

GN

HS

Sca

rbo

rou

gh

an

dhellip

NH

S V

ale

Ro

yal C

CG

NH

S W

alsa

ll C

CG

NH

S H

ard

wic

k C

CG

NH

S S

wal

e C

CG

NH

S H

artl

epo

ol a

nd

hellipN

HS

New

cast

le G

ates

hea

d C

CG

NH

S S

ou

th C

hes

hir

e C

CG

NH

S B

lack

bu

rn W

ith

Dar

wen

hellipN

HS

Gre

ater

Pre

sto

n C

CG

NH

S K

no

wsl

ey C

CG

NH

S R

edd

itch

an

dhellip

NH

S S

un

der

lan

d C

CG

Source Clinical Commissioning Group Outcomes Indicator Set (NHS Digital 2017)

Number of attendances at AampE in England recorded as having social problems (including chronic alcoholism and homelessness)

3950740867

4399346197

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

2013-14 2014-15 2015-16 2016-17

Source Accident and Emergency Attendances in England for 2014-15 2015-16 and 2016-17 NHS Digital

It is estimated that the following proportion of a GPrsquos practice (with 2000 patients) will havehellip

176

04

60 60

30

88

0

2

4

6

8

10

12

14

16

18

20

Common mental healthproblems

Psychosis Below diagnositicthreshold for psychosis

Alcohol dependency Drug dependency Personality disorder

Source Mental health in the West Midlands Combined Authority (Centre for Mental Health and University of Birmingham 2017)

LGA survey of local authorities about providing naloxone in the community

99

25 2521

1812

6 5

25

0

10

20

30

40

50

60

70

80

90

100

Drugtreatment

service

Hostels Outreachworkers

Pharmacyneedle and

syringeprogramme

Peers (otherpeople whouse drugs)

Primarycare

Communitypharmacies

AampE Other

Which services or organisations provide take-home naloxone Nine in ten respondent local authorities (90 per cent) currently made available take-home naloxone Six of the fourteen respondents which did not currently make naloxone available subsequently commented that they were either considering planning or about to make it available

ldquoAll service users accessing our local drug treatment services are offered take home Naloxone - We have piloted the distribution of take home naloxone in 3 community pharmacies providing high level of needle exchange and are looking to expand this provision across all needle exchange pharmacies over the coming year subject to ratificationrdquo (West Midlands)

ldquoNaloxone saves lives and is a very important tool in tackling DRDs in our areardquo (South East)

n = 121

Source Naloxone survey 2017 (LGA 2017)

High risk behaviours and multiple needs

Characteristics people who inject drugs in 2016

70

91

68

75

13

0

10

20

30

40

50

60

70

80

90

100

Currently in treatment Ever used a needle exchange Ever been in prison Ever been homeless Ever traded sex for moneygoods or drugs

Source People who inject drugs HIV and viral hepatitis monitoring (PHE 2017)

Characteristics people who inject drugs in 2016

70

91

68

75

13

0

10

20

30

40

50

60

70

80

90

100

Currently in treatment Ever used a needle exchange Ever been in prison Ever been homeless Ever traded sex for moneygoods or drugs

Source People who inject drugs HIV and viral hepatitis monitoring (PHE 2017)

Proportion of people who inject drugs (who had injected in preceding four weeks) who reported injecting crack powder cocaine and amphetamine

35 35 35

29 2932

36 3740

46

53

1619 18 17 18

23 22 23 24

17 17

12

12 11

8 79 9

7 810 10

0

10

20

30

40

50

60

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Crack Amphetamine CocaineldquoInjection of crack increased in recent years with 53 (95 CI 50-55) of those who had injected in the preceding four weeks reporting crack injection as compared to 35 (95CI 33-37) in 2006rdquo

ldquoCrack injection also increased among the recent initiates with 50 (95CI 40-59) of those who had injected in the preceding four weeks reporting crack injection in 2016 vs 28 (95CI 22-33) in 2006rdquo

ldquoThere was no significant change in the injection of cocaine (10 95CI 9-12 in 2016 vs 12 95CI 10-13 in 2006) or amphetamine (1795CI 15-19 in 2016 vs 16 95CI 14-18 in 2006) among those who had injected in the preceding four weeksrdquo

Source People who inject drugs HIV and viral hepatitis monitoring (PHE 2017)

Prevalence of blood borne viruses amongst people who inject drugs in England Wales and Northern Ireland

44 43 43

47 47

43 43

4749 50

53

28

2018 17 16 16 17 16

14 13 14

13 11 16 15 11 12 13 11 10 10 09

0

10

20

30

40

50

60

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Hepatitis C Hepatitis B HIV ldquohellipdata from the main Unlinked Anonymous Monitoring Survey of PWID which is targeted at people who inject psychoactive drugs indicate that the proportion ever infected with hepatitis B has declined and that the prevalence of HIV remains stable and low Hepatitis C remains the commonest infection among this group and overall prevalence is currently stablehellip Whilst the vast majority of those with HIV were aware of their status half of PWID with antibodies to hepatitis C remain unaware of their infection even though four-fifths reported having been tested for hepatitis C infection After increasing during the previous decade the uptake of testing for hepatitis C infection has changed little over the last few years Services should aim to have testing for blood-borne viruses available for patients at first assessment Repeat testing of people who inject drugs is recommended and when risk is assessed as high testing may be carried out up to once or twice a yearrdquo

Source People who inject drugs HIV and viral hepatitis monitoring (PHE 2017)

Symptoms of an injection site infection (swelling containing pus (abscess) sore or open wound at an injection site) among those who injected during the preceding year

15

20

25

30

35

40

45

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Sh

ort

ened

axi

s

Under 25 25 to 34 35 and over Symptoms of a possible injection site infection are common among PWID across England Wales and Northern Ireland In 2016 36 (95 CI 34-38) of PWID who had injected during the preceding year reported that they had experienced an abscess sore or open wound at an injection site ndash all possible symptoms of an injection site infection - during the preceding year This is a similar level to 35 (95 CI 33-37) in 2006 but an increase from 28-29 reported in 2011-2013 The levels of possible injection site infection were particularly high among the under-25 year age group at 43 (95CI 30-58) which is higher than the 27 reported in 2006 (95CI 22-32)

Source People who inject drugs HIV and viral hepatitis monitoring (PHE 2017)

Proportion of participants in the Unlinked Anonymous Monitoring Survey (who had injected in preceding four weeks) who reported injecting in their groin

35

32 32

35

34

35 35

38 38 38

40

25

27

29

31

33

35

37

39

41

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

ldquoInjecting into the groin has been associated with a number of health problems including damage to the femoral vein and artery infections and circulatory problems The proportion of current PWID who reported injecting into their groin during the preceding four weeks varied across England Wales and Northern Ireland By country the proportion injecting into the groin in 2016 was as follows England 40 (95 CI 38-43) Wales 39 (95 CI 31-48) and Northern Ireland 60 (95 CI 39- 79) Across England there are differences in the proportion reporting injecting into their groin ranging from 47 (95 CI 40-54) in the South West to 33 in the East of England (95 CI 25-42)rdquo

Source People who inject drugs HIV and viral hepatitis monitoring (PHE 2017)

Non-fatal overdoses amongst people who inject drugs

15

1718

19

0

2

4

6

8

10

12

14

16

18

20

2013 2014 2015 2016

Among the participants who took part in the main Unlinked Anonymous Monitoring Survey across England in 2016 who had injecting during the preceding 12 months (recent injectors) 19 reported overdosing in the preceding year which has increased significantly from 15 in 2013

Self-reported overdose in 2016 was lowest among those who were currently in treatment for their drug use (ie those being prescribed a detox or maintenance drug regime 16) Self-reported overdose was 21 among PWID who had never been in treatment in 2016 and was especially high among those who had previously been in treatment but were not currently (31)

Source Non-fatal overdose among people who inject drugs in England 2017 report (PHE 2017)

Annual public spending for those with three severe and multiple disadvantage profiles per person 2016-17 prices

pound1916

pound6047

pound1957

pound1235

pound5075

pound3108

pound325

pound3108

pound-

pound1000

pound2000

pound3000

pound4000

pound5000

pound6000

pound7000

Physical health Criminal justice Mental health Prison Rough sleeping Hostels Benefits Substance usetreatment

Source Faulty by design The state of public-service commissioning (Reform 2017)

Multiple needs of people entering domestic abuse services and captured by the SafeLives database between April 2014 to March 2017

6

12

45

0

5

10

15

20

25

30

35

40

45

50

Drug misuse Alcohol misuse Mental health problems

Needs experienced within the last 12 months In the period April 2014 to March 2017 caseworkers submitted 974 intake forms for clients entering 11 health services across England and Wales which used the SafeLives Insights outcome measurement service

Where a referral route was recorded(n = 811) 1 (6 cases) were from drug and alcohol services and 6 (47 cases) were by mental health services

Of clients accessing support (n = 515) 28 (143) engaged with mental health services 9 (48) with drug services and 14 (72) with alcohol services

Source Insights National Dataset Health 2016-17 (SafeLives 2017)

Mental health

Proportion of patients treated in general hospitals with serious mental illness identified as having coexisting drug and alcohol misuse problems

15

12

8

26

17

11 11

30

0

5

10

15

20

25

30

35

Schizophrenia Otherpsychosis

Bipolaraffectivedisorder

Personalitydisorder

Drug misuse Alcohol misuse

n = 204 n = 57 n = 142 n = 43

Source Mental Health in General Hospitals Treat as One (NCEPOD 2017)

Proportion of patients treated in general hospitals with serious mental illness identified as having coexisting drug and alcohol misuse problems

15

12

8

26

17

11 11

30

0

5

10

15

20

25

30

35

Schizophrenia Otherpsychosis

Bipolaraffectivedisorder

Personalitydisorder

Drug misuse Alcohol misuse

n = 204 n = 57 n = 142 n = 43

Source Mental Health in General Hospitals Treat as One (NCEPOD 2017)

There were 27428 appointments made with drug and alcohol treatment for people who used adult secondary mental health and learning disabilities services between April and November 2015

781

156

37 26

00

100

200

300

400

500

600

700

800

900

Attended Did not attend Appointment cancelledpostponed byprovider

Invalidmissing data

n = 27428

Source Mental Health Bulletin 2015-16 Annual Report (NHS Digital 2016)

Estimated excess deaths per year below age 70 in England for people with diagnosed mental health disorder by diagnosed disorder

-

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Substance usedisorder

Alcohol usedisorder

Schizophrenia Depressivedisorder

Opioid usedisorder

Bipolardisorder

Personalitydisorder

Schizoaffectivedisorder

Stress-relateddisorders

Anxietydisorder

Unnatural

Source On the State of the Publicrsquos Health Baby Boomers Fit for the Future (Department of Health 2016)

Use of section 136 in England 201112-201516 health and police based places of safety

14902 14053

17008

19403

22965

8667 7761

6028

3996

1764 -

5000

10000

15000

20000

25000

201112 201213 201314 201415 201516

where PoS was health-based ie a hospital

where PoS was policecell or custody suite

The use of section 136 of The Act (under which people

were brought to hospital as a lsquoplace of safetyrsquo)

increased by 18 per cent since last year to 22965

The increase in uses of Section 136 to take people to a

hospital as a place of safety should also be viewed in

the context of a fall by a similar number in the use of

section 136 where the place of safety is a police cell

Data released by the police in 2016 and previous years

shows the number of uses of section 136 where the

place of safety was a police cell in England reducing

from just under 9000 in 201112 to 1764 in 201516 a

fall in number of 6903 (80) across that four year

period

Source Inpatients formally detained in hospitals under the Mental Health Act 1983 and patients subject to supervised community treatment (NHS Digital 2016)

Associations between diagnosis and being re-detained or admitted following being detained under Section 136 of the Mental Health Act

[Across the cohort the] most common primary diagnosis was F20ndash

F29 schizophrenia schizotypal and delusional disorders (n=52 21)

F60ndashF69 disorders of adult personality and behaviour (n=50 21)

and F10ndashF19 mental and behavioural disorders due to psychoactive

substance use (n=48 20) Fifty-two per cent (n=126) had either a

primary or secondary diagnosis of psychoactive substance use (F10ndash

F19)

In the year following their original S136 detention 41 individuals

(17) were detained again by the police

Patients with personality disorder were the most likely to be re-

detained under S136 and those with a primary or secondary

diagnosis of substance use were also more likely to be re-detained

multiple timeshellip in around half of the repeat detentions the

individual had been using substances Substance use should

therefore be a target for interventions to reduce crisis contacts with

health services and police

36

50

27

1713

75

6

64

2

30

0

10

20

30

40

50

60

70

80

Re-detained in follow-up period Admitted in follow-up period

Personality disorder Substance misuse Schizophrenia

Affective disorder Other diagnosis

Burgess JL White SJ OrsquoBrien A Retrospective cohort follow-up study of individuals detained under Section 136 British Journal of Psychiatry Open 2017 Nov 13(6)281-4

Characteristics of patients who died by suicide and had been in touch with mental health services in the 12 months over the last 10 years

68

22

45

33

73

27

63

43

68

25

58

46

70

25

49

38

0

10

20

30

40

50

60

70

80

History of self-harm History of violence History of alcohol misuse History of drug misuse

England Northern Ireland Scotland Walesn = 13576 n = 778 n = 2652 n = 817

Source National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Annual Report 2017

Number of patients in contact with mental health services in the 12 months prior to death by suicide with a history of alcohol or drug misuse in England

544

466501

561524

560

624598

575

515486

375356

337

391357

377

475

431 442413

389

0

100

200

300

400

500

600

700

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Alcohol DrugThe number of suicides in patients with a history of alcohol or drug misuse has fallen since a peak in 2011 Between 2011-2015 375 (7) patients who died were under drug services 389 (7) were under alcohol services and 612 (11) were under either drug or alcohol services

The most common substances misused in the 3 months prior to suicide were alcohol (59) cannabis (21) stimulants (15) and heroin (13) The number of patients misusing alcohol or heroin fell between 2011 and 2014

Source National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Annual Report 2017

Behavioural characteristics of patients with mental ill health homicide offenders in England (2005-2015)

5053

7773

7871

80

88

100

89

58 58

8691 92

61

46

75 74 74

0

10

20

30

40

50

60

70

80

90

100

History of self-harm History of violence Any previous convictions History of alcohol misuse History of drug misuse

England Northern Ireland Scotland Walesn = 641 n = 18 n = 137 n = 39

Source National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Annual Report 2017

Homelessness

Estimates of the number of households experiencing core homelessness in Great Britain by type in 2011 and 2016 (rounded)

61

00

59

00

79

00

47

100

100

00

42

90

0

91

00

89

00

121

00

42

20

0

193

00

68

30

0

-

10000

20000

30000

40000

50000

60000

70000

80000

Rough Sleepers Car tent publictransport

Squatting Hostels refugesetc

UnsuitableTemporary

Accommodation

Sofa Surfers

2011 2016

Source Homelessness projections Core homelessness in Great Britain (CrisisHerriot Watt University 2017)

ldquoThe scale of core homelessness has

increased significantly across Great

Britain (33 between 2011 and 2016)rdquo

ldquoAt any one point in time core

homelessness in 2016 stood at around

1600002 households in Great Britain

(143000 in England 5100 in Wales

11800 in Scotland)rdquo

ldquoWe estimate that core homelessness

contains 57000 lsquofamilyrsquo households

(couples or lone parents) containing

82000 adults and 50000 children so

that the core homeless lsquopopulationrsquo is

236000rdquo

Estimates of the number of households experiencing core homelessness in Great Britain by type in 2011 and 2016 (rounded)

61

00

59

00

79

00

47

100

100

00

42

90

0

91

00

89

00

121

00

42

20

0

193

00

68

30

0

-

10000

20000

30000

40000

50000

60000

70000

80000

Rough Sleepers Car tent publictransport

Squatting Hostels refugesetc

UnsuitableTemporary

Accommodation

Sofa Surfers

2011 2016

Source Homelessness projections Core homelessness in Great Britain (CrisisHerriot Watt University 2017)

ldquoThe scale of core homelessness has

increased significantly across Great

Britain (33 between 2011 and 2016)rdquo

ldquoAt any one point in time core

homelessness in 2016 stood at around

1600002 households in Great Britain

(143000 in England 5100 in Wales

11800 in Scotland)rdquo

ldquoWe estimate that core homelessness

contains 57000 lsquofamilyrsquo households

(couples or lone parents) containing

82000 adults and 50000 children so

that the core homeless lsquopopulationrsquo is

236000rdquo

Proportion of people seen rough sleeping in the year in London with alcohol drug andor mental health support needs

41

31

45

28

43

31

46

26

44

35

47

23

0

5

10

15

20

25

30

35

40

45

50

Alcohol Drugs Mental health No alcohol drugs or mental healthsupport needs

2014-15 2015-16 2016-17

Source Chain Annual Report (Greater London Authority)

Rough Sleeping Statistics Autumn 2016 England

-

500

1000

1500

2000

2500

3000

3500

4000

4500

2010 2011 2012 2013 2014 2015 2016

England London Rest of England

Rough sleeping counts and

estimates are single night snapshots

of the number of people sleeping

rough in local authority areas Local

authorities decide whether to carry

out a count or an estimate They are

encouraged to gain intelligence for

street counts and estimates from

local agencies such as outreach

workers the police the voluntary

sector and faith groups who have

contact with rough sleepers on the

street

Source Rough sleeping in England autumn 2016 (DCLG 2017)

Proportion of local authorities reporting how the provision of specialist support andor accommodation for the groups of homeless peoplethose at risk of homelessness changed since 2010

21

11

32

2130

14

2417 16

20

10 1321 22

28 31 3338 39

44

-50

-40

-30

-20

-10

0

10

20

30

40

Migrants Women DV survivors Care leavers 16-17s Ex-prisoners 18-24s Substanceabusers

Alcohol abusers Mental illhealth sufferers

Increased Reduced n = 162

Source The homelessness monitor England 2017 (JRF and Crisis 2017)

The number of offences charged and reaching a first hearing at a Magistratesrsquo court in England under section 3 of the Vagrancy Act 1824

1510 1465

1763 1825 1889

1573 1626

2771

3071

2365

-

500

1000

1500

2000

2500

3000

3500

Source Rough Sleepers and Anti-Social Behaviour (England) (House of Commons Library 2016)

ldquoBegging is an offence under section 3 of

the Vagrancy Act 1824 (as amended) It is a

recordable offence The maximum

sentence is a fine at level 3 on the

standard scale (currently pound1000) Other

provisions also criminalise begging

behaviour wilfully blocking free passage

along a highway is an offence contrary to

section 137 of the Highways Act 1980 (as

amended) punishable by a level 3 fine

Using threatening or abusive words or

behaviour is an offence under section 5 of

the Public Order Act 1986 which also

carries a level 3 finerdquo

Projections for the number of people sleeping rough in England Wales and Scotland

-

5000

10000

15000

20000

25000

30000

35000

40000

45000

2011 2016 2021 2026 2031 2036 2041

England Wales Scotland

Source Homelessness projections Core homelessness in Great Britain (CrisisHerriot Watt University 2017)

ldquoA sub-regional housing market model has been

adapted to forecast future levels of homelessness

which has modelled 15 additional variables The

model depends on many assumptions but for the

purpose of this analysis it has been fixed on a

relatively neutral benign scenario for the economy

and labour market and current policy settings

including planned welfare reformsrdquo

The 15 variables used are rough sleeping hostel residents

unsuitable temporary accommodation sofa surfers total

core homelessness homeless acceptances total homeless

applications total in temporary accommodation people

asked to leave household evictions wider homelessness

relative low income poverty after housing costs crime rates

welfare reform cuts impact (from Beatty amp Fothergill)

households in financial difficulty

Criminal justice system

Numbers of adults receiving treatment for drug and alcohol use disorders in prisons and other secure settings in England in 2015-16

29146

10259

12298

8551

0

5000

10000

15000

20000

25000

30000

35000

Opiate Non-opiate only Non-opiate andalcohol

Alcohol only

Source Adults and young people in secure settings in England data for 2015-16 (PHE 2017)

In all 60254 adults were in contact with

drug and alcohol treatment services within

secure settings during 2015-16 and most

(56803) of these were within a prison

setting with 3124 within YOIs and 327

within IRCs [Immigration Removal

Centres] Just under half (48) of those in

contact with treatment in adult settings

presented with problematic use of opiates

a further 37 presented with problems with

other drugs (non-opiates) and 14

presented with alcohol as their only

problem substance

Numbers of adults receiving treatment for drug and alcohol use disorders in prisons and other secure settings in England in 2015-16

29146

10259

12298

8551

0

5000

10000

15000

20000

25000

30000

35000

Opiate Non-opiate only Non-opiate andalcohol

Alcohol only

Source Adults and young people in secure settings in England data for 2015-16 (PHE 2017)

In all 60254 adults were in contact with

drug and alcohol treatment services within

secure settings during 2015-16 and most

(56803) of these were within a prison

setting with 3124 within YOIs and 327

within IRCs [Immigration Removal

Centres] Just under half (48) of those in

contact with treatment in adult settings

presented with problematic use of opiates

a further 37 presented with problems with

other drugs (non-opiates) and 14

presented with alcohol as their only

problem substance

Numbers of adults in secure settings (prisons Youth Offending Institutions and Immigration Removal Centres) in England being treated for use of NPS by type

2163

1156

296

83

80

41

0 500 1000 1500 2000 2500

Predominantly cannabinoid

Other

Predominantly stimulant

Predominantly hallucinogenic

Predominantly sedativeopioid

Predominantly dissociative6 of all adults in treatment cited New Psychoactive

Substances (NPS) as one of their problem substances

or their only problem substance This figure represents

the number of adults presenting for treatment with

problem NPS use and not necessarily a reflection of

overall NPS prevalence in adult secure settings

Source Adults and young people in secure settings in England data for 2015-16 (PHE 2017)

Prisoner survey responses on drugs alcohol medicines and mental health

65

31

7

76

4247

23

53

0

10

20

30

40

50

60

70

80

Do you feel you have anyemotional well beingmental

health issues

Is it easyvery easy to getillegal drugs in this prison

Is it easyvery easy to getalcohol in this prison

Are you currently takingmedication

Women MenldquoThe proportion of new

[male adult] prisoners with

a drug andor alcohol

problem remained very

high most noticeably

among those reporting a

mental health problemrdquo

ldquoOur survey showed an

increase in the proportion

of women arriving in

prison with drug and or

alcohol problemsrdquo

Source HM Chief Inspector of Prisons for England and Wales Annual Report 2016ndash17

Responses by adult male prisoners in England and Wales about drugs and alcohol by ethnicity

21

12

40

20

96

32

21

49

24

139

0

10

20

30

40

50

60

Did you have aproblem with

drugs when youcame into this

prison

Did you have aproblem with

alcohol when youcame into this

prison

Is it easyvery easyto get illegal drugs

in this prison

Is it easyvery easyto get alcohol in

this prison

Have youdeveloped a

problem withdrugs since you

have been in thisprison

Have youdeveloped a

problem withdiverted

medication sinceyou have been in

this prison

BAME prisoners

White prisoners

Source HM Chief Inspector of Prisons for England and Wales Annual Report 2016ndash17

ldquoDuring the course of the past year I

have seen many prisons and other

institutions operating under

extreme pressure The challenges

thrown up by the prevalence of

illegal drugs and other contraband

increasing violence too many

prisoners suffering from mental

health issues an ageing prison

population and a prison estate that

in many places is not fit for any

purpose let alone the decent

detention of human beings are

stretching hard-working and well-

intentioned staff to their limits

Reform is overduerdquo

Number of community and suspended sentence orders requiring drug or alcohol treatment by year

Drug Treatment

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Suspended Sentence - Drug treatment

Community Orders - Drug treatment

Alcohol Treatment

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Suspended Sentence - Alcohol treatment

Community Orders - Alcohol treatment

Source Offender Management Statistics quarterly October to December 2016 (MoJ 2017)

Average custodial sentence (months) in England for drug offences(shortened axis)

326 325 323

315

306

299296

316

335 337

353

26

27

28

29

30

31

32

33

34

35

36

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Ave

rag

e c

ust

od

ial s

en

ten

ce (

mo

nth

s)

Source Criminal justice system statistics quarterly (MoJ 2017)

ldquoThe requirements for courts to

follow the wide overall offence

guidelines rather than the

narrower category ranges within

them mean that the Council can

report high rates of compliance

In 2014 for drug possession

offences 84 per cent of

sentences imposed fell within the

guideline offence range for Class

A drugs over 99 for class B and

89 for Class Crdquo

Source The Sentencing Council for England and Wales brake or accelerator on the use of prison(Transform Justice 2016)

New sentencing guidelines

Prison population in England and Wales under immediate custodial sentence for drug offences by sentence length

88 139

548

3552

1399

1920

1404

877711

11

30257

0

500

1000

1500

2000

2500

3000

3500

4000

Source Hansard 2017

Prison population under an immediate custodial sentence for drug offenses

9987

59341

55

10582

49332

450

2000

4000

6000

8000

10000

12000

Trafficking in controlled drugs Other drug offences Possession of controlled drugs(excluding cannabis)

Possession of cannabis

30-Jun-15 30-Jun-16

Source Hansard 2017

What did people who had a previous conviction for drug offences get reconvicted for if they reoffended during the period July 2014 to June 2015

964

87

211

6079

118

9211

767

706

2873

287

7804

3815

498

0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000

Violence Against the Person

Sexual

Robbery

Theft

Criminal Damage and Arson

Drug

Possession of Weapons

Public Order

Miscellaneous Crimes Against Society

Fraud

Summary Non-motoring

Summary Motoring

Other

Source Proven reoffending statistics July 2014 to June 2015 (MoJ 2017)

Positive drug tests carried out by Liverpool police on arrest by drug type (2014-15 vs 2015-16

0

500

1000

1500

2000

2500

2014-15 2015-16

Cocaine only

Opiates only

Both cocaine amp opiates

The number of attempted drug tests conducted in

Liverpoolrsquos custody suites halved between 2014-15 and

2015-16 while the number of individuals testing positive

decreased by around two-fifths (41) The rationale for

targeted testing was to reduce the number of negative

tests in order to reduce police time Although the positive

drug test rate has increased it is only by a small proportion

(6) There are substantially lower numbers of offenders

being imposed with an RA and therefore lower numbers of

drug using offenders coming into treatment This is where

there is considerable concern by treatment services

commissioners and the Police themselves This concern is

greater still for opiate drug users in Liverpool who are not

coming into the treatment system

Source Criminal Justice Project Impact of targeted drug testing on drug using offenders coming into treatment in Liverpool (PHI 2017)

Reduction in re-offending in the two-years following the start of treatment by substance group

-31

-59

-44 -44 -44

-21

-49

-36 -35-33

-70

-60

-50

-40

-30

-20

-10

0

Opiates Alcohol onlyAlcohol amp non-

opiates Non-opiates only Total

Offenders Offences

44 of clients did not reoffend in this period [two years following the start of treatment] and this resulted in the number of recorded offences decreasing by 33 Opiate clients had the lowest percentage change in recorded offenders and offences (31 and 21 respectively) while the alcohol only client group experienced the greatest reduction in both offenders and offences (59 and 49 respectively)

There was a 55 reduction in clients with one offence recorded against them a 45 reduction in clients with two offences recorded against them and this decreasing trend generally continues There was a reduction of only 03 in the number of clients with 15 or more offences recorded against them

Source The impact of community-based drug and alcohol treatment on re-offending (MoJ and PHE 2017)

Over a quarter (27) of all shoplifting incidents involved food and grocery items in 2016 one in seven (14) involved alcohol

0

3

3

3

4

4

6

7

14

14

16

16

27

0 5 10 15 20 25 30

Electronics toysDVDstoysgames

Toiletries

Watches belonging to the business

Personal possessions belonging to employees or customers

Money

Jewellery belonging to the business

Home accessories

Electrical or electronic equipment

Alcohol

Parts components or small equipment

Clothing

Cosmetics

Food or groceries

There were 35 million incidents of shoplifting in 2016

The 2016 CVS also included new questions for respondents who said the most commonly stolen items in shoplifting incidents were food or grocery items Respondents were asked whether the food or groceries typically stolen were high value luxury items (eg expensive cuts of meat) lower value day-to-day items (such as bread or milk) or a combination of these Responses shows that the majority of premises (71 for all incidents and 80 for the most recent incident) typically had low value goods stolen in shoplifting incidents involving food and grocery items

Source Crime against businesses findings from the 2016 Commercial Victimisation Survey (Home Office 2017)

Number of offenders issued a Penalty Notice for being drunk and disorderly aged 16 and over

43556

4699644411 43570

37119 36001

32648

27907

23679

17973

13860

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Source Criminal Justice System statistics quarterly December 2016 (MoJ 2017)

Young people

The number of young people entering treatment with a primary problem with cannabis or alcohol in comparison with all other drugs

1278413200

13581 13659 1345412863

7054

5884

4704

37763133

2556

20211549 1495 1668 1747 1651

0

2000

4000

6000

8000

10000

12000

14000

16000

2010-11 2011-12 2012-13 2013-14 2014-15 2015-16

Cannabis Alcohol All other drugs

ldquoSince 2005-06 young people have been

increasingly likely to seek help for

problems with cannabis compared to

other substances During 2015-16 12863

presented to specialist services with

cannabis as their primary substance (75

of all those receiving help during the

year) Although there was a 7 fall in the

number of young people in treatment in

2015-16 the proportion of young people

citing primary cannabis use increased

slightly (from 73 in 2014-15 to 75 in

2015-16)rdquo

Source Young peoplersquos statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2015 to 31 March 2016 (PHE 2017)

The number of young people entering treatment with a primary problem with cannabis or alcohol in comparison with all other drugs

1278413200

13581 13659 1345412863

7054

5884

4704

37763133

2556

20211549 1495 1668 1747 1651

0

2000

4000

6000

8000

10000

12000

14000

16000

2010-11 2011-12 2012-13 2013-14 2014-15 2015-16

Cannabis Alcohol All other drugs

ldquoSince 2005-06 young people have been

increasingly likely to seek help for

problems with cannabis compared to

other substances During 2015-16 12863

presented to specialist services with

cannabis as their primary substance (75

of all those receiving help during the

year) Although there was a 7 fall in the

number of young people in treatment in

2015-16 the proportion of young people

citing primary cannabis use increased

slightly (from 73 in 2014-15 to 75 in

2015-16)rdquo

Source Young peoplersquos statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2015 to 31 March 2016 (PHE 2017)

Substance use of all young people in treatment in secure settings in England in 2015-16

91

51

19

19

9

8

8

4

2

1

1

0 20 40 60 80 100

Cannabis

Alcohol

Nicotine

Cocaine

Amphetamines

NPS

Ecstasy

Other

Opiates

Solvents

CrackThere were 1541 young people in specialist

substance misuse treatment in a secure setting in

2015-16 The majority (69) of young people in

treatment in secure settings reside in YOIs with a

further 16 residing in Secure Childrenrsquos Homes

(SCHs) 12 in Secure Training Centres (STCs) and

3 in Welfare Only Homes (WOHs)

Cannabis was the most commonly cited problem

substance amongst young people in treatment in

secure settings (91 of all in treatment) Around half

cited problematic alcohol use (51) Other

substances reported by young people included

nicotine (19) cocaine (19) amphetamines (9)

ecstasy (8) and NPS (8) Two percent of young

people cited problematic opiate use

n = 1541

Source Adults and young people in secure settings in England data for 2015-16 (PHE 2017)

Diagnosis of alcohol abuse or dependence by age of onset of alcohol use amongst adolescents who had consumed alcohol in the past 3 months visiting Emergency Departments in England (n=609)

247

221

94

23

0

50

100

150

200

250

300

Age of onset before age 15 Age of onset age 15+

No diagnosis Diagnosis

Among adolescents who had consumed

alcohol in the past 3 months 15

screened positive for alcohol abuse or

dependence (using MINIKID)

ldquoThe prevalence of a diagnosis of

alcohol abuse or dependence was

considerably higher among participants

who started drinking before the age of

15 years with almost 1 in 3 meeting the

criteria for alcohol abuse or

dependencerdquo

Source Donoghue Kim et al Alcohol Consumption Early-Onset Drinking and Health-Related Consequences in Adolescents Presenting at Emergency Departments in England Journal of Adolescent Health

Number of looked after children aged 16 to 17 years identified with substance misuse needs and the proportion refusing intervention

760 750790

450 480510

0

10

20

30

40

50

60

0

200

400

600

800

1000

1200

1400

2014 2015 2016

Pro

po

rtio

n r

efu

sin

g in

terv

enti

on

Nu

mb

er id

enti

fied

wit

h s

ub

stan

ce u

se n

eed

Male Female Refused intervention Any young person who is at increased risk of

substance misuse including those who are

leaving care should be provided with

targeted prevention support which focuses on

reducing risks and strengthening resilience

Through commissioning of public health

services local councils should ensure they

have clear referral pathways into specialist

substance misuse services for those young

people who are assessed as requiring

structured drug and alcohol interventions

Source Healthy futures Supporting and promoting the health needs of looked after children (LGA 2016)

Source Children looked after in England including adoption 2015 to 2016 (DfE 2016)

Selected individual vulnerabilities identified among all young people starting treatment in England in 2015-16

-

500

1000

1500

2000

2500

3000

Affected byothers

substancemisuse

Affected bydomestic

abuse

Mentalhealth

problem

Self-harm Sexualexploitation

Pregnantandorparent

Injecting

Female Male ldquoYoung people do not develop substance misuse

problems in isolation The 2015-16 data shows that a

significant proportion of young people who entered

specialist treatment services also had other multiple

problems or vulnerabilities that were linked to their

substance misuse

ldquoFor some young people these wider issues may be

the cause of their substance misuse problems and

for others a consequence So it is vitally important

that young peoplersquos treatment services are working

closely with a wide range of other children and young

peoplersquos health and social care services to ensure

that vulnerable young people have all their needs

supportedrdquo

Source Young peoplersquos statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2015 to 31 March 2016 (PHE 2017)

Age and gender breakdown of young people starting treatment in England in 2015-16 who reported sexual exploitation

0

20

40

60

80

100

120

140

160

180

200

Under 14 14-15 15-16 16-17 17-18

Female Male

Source Young peoplersquos statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2015 to 31 March 2016 (PHE 2017)

ldquoOverall 6 of young people (704) reported

sexual exploitation However the proportion

is much higher among females (14) than

males (just over 1) Although these figures

suggest a large difference between sexual

exploitation experienced by boys and girls

research from Barnardorsquos has highlighted

difficulties in identifying sexual exploitation

of boys and young men because they often

do not disclose abuse The median age of

young people reporting sexual exploitation

was 15 compared to 16 for all new

presentations reflecting the high proportion

who were femalerdquo

Distal risk indicators of child sexual exploitation

50

34

26

24

23

20

16

16

16

15

14

13

11

10

5

3

0 10 20 30 40 50 60

Criminal prosecutions prior to 2013

Living in care

Truancy disruptive behaviour at school

Neglectful parents

Unrelated sexual assault

Mental health issue learning disability

Physical emotional abuse from family

Domestic violence within family

Family links to OC

Parents drug and or alcohol abuse

Links to gangs or OCGs (not family)

Sexual abuse within family

Physical emotional abuse by adult (not family)

Aggressive behaviour

Excluded from services

Has contracted STIs

Source The impact of organised crime in local communities (Police Foundation 2017)

ldquoThe victims of CSE are some of the most

vulnerable children in society With an

average age of 15 most come from highly

dysfunctional families half have a

criminal record and a third live or have

lived in care Some are repeatedly

abused by multiple perpetrators over long

periods of time The multiple risks they

are exposed to are not dissimilar to those

experienced by adult sex workers they

include physical psychological and

emotional trauma sexually transmitted

diseases educational failure and

problematic substance misuserdquo

Selected Antecedents of Suicide In Under 20s And 20-24 Year Olds

22

34

43

52

57

16

119

42

51

47

41

55

108

3

0

10

20

30

40

50

60

Excessivealcohol use

Illicit drug use Academicpressures overall

Previous self-harm

Suicidal ideas Family history ofmental illness

Family history ofsubstance

misuse

Witness todomesticviolence

Under 20 (n=285)

20-24 (n=106)

Source Suicide by Children and Young People (NCISH 2017)