Mid Western Regional Drugs Taskforce Action Plan June 2005

Mid Western Regional Drugs TaskforceAction PlanJune 2005 1

Agenda • Chairperson’s Foreword • Background and Context • Consultation Process • Key Issues • Action Plan 2

A Statement from the Chairperson Drug misuse is a major issue in the Mid Western Area and is the source of significant social and personal problems for individuals, families and the community in general. We all must face up to the many issues and develop effective, practical actions to improve the lives of those impacted. This document, therefore, is critically important in establishing the prioirty actions needed within the Region to tackle the problem. The plan was developed in the context of a comprehensive consultation process involving all the key stakeholders including statutory agencies, community and voluntary groups and individuals from the Region. Their valuable insight was greatly appreciated and has led to the development of this plan. I would like to personally thank all of those that participated in the various consultation sessions and also thank the members of the Regional Drugs Taskforce that selflessly gave up so much of their time to produce this document. This plan will not be delivered without the close co-operation and partnership of all the stakeholders involved. The RDTF on it’s own does not have the capacity to tackle the issues single-handedly. Collectively, we have a duty and responsibility to ensure that we now work together to achieve the aims and objectives set out in this plan. I am confident that the taskforce can be a useful force of change and focus in how we tackle the problems. I call on all those involved to work with us to make the difference in the lives of those impacted. Tom Gleeson, Chairperson Mid Western Regional Drugs Taskforce 3

Background Context Mid Western Regional Drugs Taskforce • The Mid Western RDTF was convened in May 2003. • The formation of the Regional Drugs Taskforces was on foot of recommendations within the National Drugs Strategy 2001-2008 and was further supported by findings from a Health Research Board report which showed that drug abuse outside Dublin had increased three-fold over a four year period. • It is acknowledged that there are ‘huge gaps’ in service provision for drug users in the area. • With collaboration from the local community, voluntary groups, relevant agencies, and the public in general the Mid Western Regional Task Force hopes to develop an integrated plan to tackle the drugs problem and to identify the gaps in services to best provide care for drug users. 5

Structure of RDTF • The Mid Western RDTF is made up of representatives from the following local community, voluntary groups, and the statutory agencies: • Limerick City Community Reps • Limerick City Council • Limerick County Council • Limerick County Council Homeless Service • Limerick County Community Rep • Limerick Youth Services • NDST • North Tipperary County Council • Probation & Welfare • Talbot Grove Treatment Centre • Voluntary Rep • YPFSF, City of Limerick VEC • Aljeef • Bridgeland House • Bushypark Treatment Centre • Limerick City VEC • Clare County Council • Cuan Mhuire Bruree • Custom & Excise, Shannon • Mid-Western Regional Office, Dept of Education and Science • FAS • An Garda Síochána • HSE Mid-Western Area Regional Drug Co-ordination Unit 6

Consultation Process • The RDTF decided to consult with a variety of stakeholders in the Region in order to develop a detailed action plan. • These consultations sessions, facilitated by external consultants, were held over a period of three weeks across the region. • There were two primary methods of consultation: • 1. Public consultation sessions • Four public consultation meetings were held in Newcastle Western, Limerick City, Nenagh, and Ennis. In each location, meetings were also held with local community groups separate to the public meetings. In total, over 80 people attended these public consultation sessions and they contributed a large range of ideas and suggested actions for the plan. • 2. Sub-group meetings • A number of sub-group meetings were convened with specific special interest groups. For example, meetings were conducted with treatment & rehabilitation service providers, education & prevention workers including school representatives, youth workers, community representatives, Gardaí and a meeting was also held with service users. • Separate to this a number of individuals and groups provided submissions to the task force on their views with respect to the action plan. • Having gathered all of the inputs from these sessions three working groups were established within the task force to develop the detailed action plan itself. These groups meet on a number of occasions and a final draft action plan was developed by the task force. • This draft plan will be submitted to the National Drug Strategy Team (NDST) for assessment. • Recommendations on funding will then made to the Inter-Departmental Group on Drugs and the Cabinet Committee on Social Inclusion. • The taskforce would like to thank all those who attended the various meetings. The Action plan has been developed on the back of the valuable input provided by these individuals and groups. 8

The Mid Western Region – A Unique Geography … The Mid Western region is unusual for the fact that whilst it is largely rural it is also dominated by a major urban centre Implication Issue • The Mid Western Region covers the counties of Limerick, Clare and North Tipperary. The region is relatively rural – 57 per cent of the population live in rural areas in comparison to the national average of 40 per cent. • Limerick City, however, accounts for over one quarter of the region’s 240,000 population. The city dominates the region with a population almost four times that of the next largest centre, Ennis. • The population in Limerick and its environs is growing rapidly and is the second highest among the country’s five major urban centres. The population growth rate in Clare is relatively high also. It is possible based on current projections that the population of the region could reach 280,000 by 2020. • As a result, integrated care within the region is viable only if practical solutions are sought to ensure that services are fully connected and inclusive of outlying rural areas. Services must be flexible and adopt an holistic user-led approach. • However, smaller populations limit the range of possible services and there may be issues in relation to staff skill shortages. This makes an integrated care approach more expensive and difficult to provide equitable services across the urban/rural divide. Because of the mix of Rural and Urban there is a need to ensure that the response to the issues of drug misuse are sensitive to the local needs. The responses required for Limerick City are different to those needed in smaller rural settings. 10

The Mid Western Region – Disparity in affluence/deprivation … The Mid Western region displays considerable differences in socio-economic status Implication Issue • There are considerable disparities between communities and areas in Limerick, in terms of access to employment opportunities and levels of income and consumption. There is a strong degree of polarisation with respect to disadvantage and affluence. • Limerick is a highly segregated city in which communities living in different areas enjoy very different lifestyles and standards of living. There are a number of suburbs and other areas within the city that are relatively affluent. • At the other end of the scale there are many areas that exhibit high levels of disadvantage. For example, the rate of occurrence of lone parent families in these areas is significantly above the national average. • Limerick City has consistently ranked as the second most dis-advantaged of the 34 local authority areas (i.e. Cities and Counties) in Ireland. • Rurally, there are also significant areas of disadvantage in some of the outlying areas of Limerick, Clare and North Tipperary. • Overall, in comparison to other Regions, the Mid Western displays possibly the largest disparity between affluence and deprivation. The scale of socio-economic disadvantage in the Region means there are a number of high priority areas that require significant investment and support to combat the related issues. The bulk of support provided through the RDTF and other agencies should be concentrated in these areas of most need. 11

The Mid Western Region – Significant drug-related issues … The Mid Western region has relatively higher drug-related issues to deal with in comparison to other Regional Drugs Taskforce areas Implication Issue • Gardaí figures show that outside of the Dublin Metropolitan Region, the Southern Region (which includes Limerick) has the highest rate of drug related offences in the country. For example, cocaine related offences in the Southern Region are, at 17%, higher than any other region outside of Dublin Metropolitan (62%). • There is a high level of demand for treatment services within the region. For example, the Mid Western area has the second highest number of patients in the methadone treatment programme outside of the Dublin areas. • An NDTRS research study showed that in the Region the mean age of initial drug use was relatively young, at 15 years of age, in comparison to other areas. • Outside of the areas that currently are served by the Local Drugs Taskforces (in Dublin and Cork City), the Limerick area has the highest level of drug-related issues in the country. Relative to other areas in the country, the Mid Western and Limerick in particular require significantly greater levels of resource to tackle drug-related issues. 12

The Mid Western Region – An overview of the issues identified through the consultation process … Limited support for parents Continuum of care not always clear Clients not put at the centre (key worker approach) Not enough investment in youth services and facilities Residential detox facility required RDTF not effective to date Infrastructure and resources inadequate to tackle the issues Limited services making accessibility to services difficult Poor service accessibility Need for pre- and post- treatment support Lack of co-ordination across service providers Inconsistent sentencing Intimidation of local communities Significant areas of disadvantage Lack of resources No support for families Mid Western Region - The Issues Limited resources for Gardaí Little research into scale & nature of issue Not clear where to go for support or where to refer to Little or no support for alternative treatments Alcohol – biggest problem drug Need for effective education & prevention programmes Methadone seen as a long-term solution – no pathway off methodone maintenance No needle exchange programme Denial and unwillingness to accept the drug problem Lack of service for Under 18s Lack of community/statutory co-operation & collaboration Lack of volunteers Limited investment in the Region over the years Comprehensive range of services not in place to service scale of demand 13

Strategic Action Plan Framework (1) Projected Costs The Vision The Goals RDTF Structure: Past and current circumstances with regard to the lack of clarity on the function and supports required by the RDTF to develop as a cohesive structure in its own right, and the subsequent work expected of the R.D.T.F. in developing its Action Plan requires that the commitment, infrastructure and framework are compatible. It is with this in mind that the Mid-Western RDTF have clearly identified the need for the committed resource allocation of Co-ordinator, Project Worker and Administrative Support. This action is to be supported and facilitated by the N.D.S.T. prior to the implementation of all other Actions identified within the Mid-Western RDTF Plan. Considering the diversity of the region and the specific nature of the issues related to Limerick city it is strongly recommended by the RDTF that a local drugs task force is established for Limerick city. This requires pre-development seed funding as was made available to the RDTF structure. The local drugs task force would work in parallel to and in close co-operation with the RDTF. • We believe that freedom from drugs and alcohol related problems requires investment in education and prevention, reduction of supply, and appropriate supported treatment and rehabilitation for all living in the mid-Western area. • Our vision is a future where individuals can access excellent services, developed and supported by community, voluntary and statutory agencies in their own communities 2005 : €961,700 2006: €1,702,200 2007: €1,752,200 15

The Actions Strategic Action Plan Framework (2) The Objectives The Vision The Goals Ensure parents are informed, educated, aware and supported We believe that freedom from drugs and alcohol related problems requires investment in education and prevention, reduction of supply and appropriate supported treatment and rehabilitation for all living in the mid-Western area. Our vision is a future where individuals can access excellent services, developed and supported by community, voluntary and statutory agencies in their own communities Support a broad range of interventions, to improve the awareness levels and knowledge of all key stakeholders within the Region To create a two-way learning and support Mechanism with service providers In the region Ensure effective outreach services are in place within the Region Create effective links with youth & communities within the Region that encourages communication and identifies alternatives to drug use/misuse Ensure appropriate education and awareness Programmes are provided within and outside the school structure Support and work in partnership with law enforcement within in the Region Support the reduction of supply within the Region Establish a co-ordinated and concerted drugs initiative in partnership with entertainment venue owners and staff Ensure that there is an adequate and appropriate level of treatment and rehabilitation services provided to respond to the needs of people within the region Carry out practical and process focussed research to inform and direct responses 16

The Actions Strategic Action Plan Framework (3) The Objectives The Vision The Goals We believe that freedom from drugs and alcohol related problems requires investment in education and prevention, reduction of supply and appropriate supported treatment and rehabilitation for all living in the mid-Western area. Our vision is a future where individuals can access excellent services, developed and supported by community, voluntary and statutory agencies in their own communities Support and deliver a broad range of interventions, to improve the awareness levels and knowledge of all key stakeholders within the Region Provide a range of accessible treatment and rehabilitation programmes appropriate to meet the needs of those experiencing difficulties with drugs and alcohol, from pre-treatment to rehabilitation Establish progression routes to Holistic treatment and rehabilitation Take meaningful action to support the reduction of supply within the Region Ensure adequate funding to enable access to appropriate treatment and rehabilitation services Ensure that there is an adequate and appropriate level of treatment and rehabilitation services provided to respond to the needs of people within the region Establish partnership models, close working relationships and efficient co-ordination between all agencies (statutory, voluntary & community) Carry out practical and process focussed research to inform and direct responses Monitor, review, evaluate and inform stakeholders of alcohol and drugs issues in the Region on a regular basis, in a practical manner 17

Goal 1: Education and Prevention (1) Support and deliver a broad range of interventions, to improve the awareness levels and knowledge of all key stakeholders within the Region Objectives Key Actions • Parental Support Initiatives • Pilot a parent education pack with the SPHE co-ordinators to be given to all parents, at home, as their children are covering the ‘Drugs’ Module on the SPHE programme. • Provide support to the Family Resource Centres to deliver support programmes to families affected by drug misuse issues • Review the capacity within the family support structures and highlight areas where there are inadequate services and prioritise support in these areas. A. Ensure parents are informed, educated, aware and supported 18

Goal 1: Education and Prevention (2) Support and deliver a broad range of interventions, to improve the awareness levels and knowledge of all key stakeholders within the Region Key Actions Objectives • In priority communities, support and fund children to attend crèche facilities, to enable and facilitate parents to attend treatment or re-habilitation related to Drugs and Alcohol use. This service to be delivered in partnership with local community structures. • In non-priority communities support parental skills building programmes/initiatives delivered through local community groups. • Mainstream current pilot parents support initiatives and roll out this initiative to 15 community based parent groups Parental Support Initiatives A. Ensure parents are informed, educated, aware and supported 19

Goal 1: Education and Prevention (3) Support and deliver a broad range of interventions, to improve the awareness levels and knowledge of all key stakeholders within the Region Key Actions Objectives • GPs, Pharmacists, Practice Nurses • Develop and resource an education and support network for all GPs, Pharmacists, and Practice Nurses in partnership with the HSE, Education Officers and the RDTF. • Addiction Studies Training • Continue to support and develop the existing Community Addiction Studies Course and NUI certificate courses in the region. • Fund the development and delivery of a locally based Diploma in Addiction studies in conjunction with local service providers, University of Limerick and Limerick Institute of Technology. • Fund and support students to attend diploma course B. Provide education and support to service providers 20

Goal 1: Education and Prevention (4) Support and deliver a broad range of interventions, to improve the awareness levels and knowledge of all key stakeholders within the Region Key Actions Objectives • Education & Prevention Service Providers Support • Carry out a review of current training provided to Education & Prevention service providers. • Identify good existing programmes and look to build on these and roll-out to other service providers in a targeted manner. Additionally, make available specific drug prevention training to all service providers as part of their vocational training programmes (e.g. teachers, youth workers, counsellors, GPs, law enforcement workers, judiciary, welfare officers etc.). • Ensure there is a regular (at least quarterly) forum for service providers to come together and share experiences, learnings and information at county level and annual regional forum. • Information • Publish and distribute a comprehensive list of supports available to all service providers (statutory, community and voluntary) e.g. list of facilitators, training courses, education material etc. • RDTF • Provide a series of training events to RDTF members, increasing the capacity of the RDTF from both an operational and subject-focused basis. B. Provide education and support to service providers 21

Goal 1: Education and Prevention (5) Support and deliver a broad range of interventions, to improve the awareness levels and knowledge of all key stakeholders within the Region Objectives Key Actions • Outreach Service • Appoint 8 additional community based outreach staff, with a specific substance misuse information and services focus for users, their families, and communities that will form a “drugs” outreach team (supervision arrangements to be included). • Dovetail all outreach support workers with local community groups. • In particular, support the capacity building of “peer” outreach support by providing training and financial support to community workers/individuals to ensure that capacity to reach hard to reach communities/ individuals (e.g. homeless, travellers, ex prisoners, high risk communities) is developed.. • Develop and support the outreach workers forum to network and information share linking with the Drugs Education Workers Forum (DEWF) as a model. C. Ensure effective outreach services are in place within the Region 22

Goal 1: Education and Prevention (6) Support and deliver a broad range of interventions, to improve the awareness levels and knowledge of all key stakeholders within the Region Objectives Key Actions • Consultation • Engage in a consultation process, specifically with young people, in all areas in the Region to get their views on what is needed and what they believe should be put in place. • Use the output of these consultations to help inform decisions on funding and support (especially within the RDTF). D. Create effective links with youth & communities within the Region that encourages communication and identifies alternatives 23

Goal 1: Education and Prevention (7) Support and deliver a broad range of interventions, to improve the awareness levels and knowledge of all key stakeholders within the Region Objectives Key Actions D. Create effective links with youth & communities within the Region that encourages communication and identifies alternatives • 2. Events • Fund, support and encourage alcohol and drug free events – one per year. • 3. Targeted projects for individuals with Drugs & Alcohol issues • Identify, fund and support special projects for people in early recovery e.g. employment, training and education programmes through FAS. • 4.Small Grants Fund • Allocate a specific fund for small first-off grants to support and encourage initiatives that will complement the aims of our plan. 24

Goal 1: Education and Prevention (8) Support and deliver a broad range of interventions, to improve the awareness levels and knowledge of all key stakeholders within the Region Objectives Key Actions • SPHE Pogramme • Develop and deliver policies to enable schools within the region, to deliver the SPHE modules, that address substance misuse issues to a high standard. • Provide support to the schools to assist in the delivery of the relevant SPHE modules. E. Ensure adequate education and awareness programmes are provided within and outside the school structure 25

Goal 2: Supply Reduction (1) To take meaningful action to support the reduction of supply within the Region Objectives Key Actions • District Drug Units • The community demands that dedicated officers be assigned to Garda districts within areas of identified drug use. • A networking system to be established in each Garda district where all relevant community, statutory and voluntary personnel working/residing in the area can create a forum for pro-active actions. • Conduct an assessment of resource requirements (manpower, equipment) for law enforcement officers within the Region and lobby through the RDTF for the adequate resource support of Gardaí. • Community Policing • Support the establishment of estate management programmes in at-risk communities/estates. These programmes will be driven by the local residents and will highlight practical and positive interventions to improve the environment within the estates e.g. fix the street lights. • Education programme for Judiciary • Offer, at least once a year, an education/training day for all the judiciary on substance misuse issues and distribute relevant information appropriately and promptly. • Funds from seizures • To assess current level of seizures and consider the allocation of all or part of the financial seizures back to the communities/areas of high priority. A. Provide adequate support and work in partnership with law enforcement officers in the Region 26

Goal 2: Supply Reduction (2) To take meaningful action to support the reduction of supply within the Region Objectives Key Actions Joint initiative Establish and support a joint initiative with law enforcement agencies, health services, education officers and vintners/hotel/restaurant/entertainment venue owners. The initiative would provide training and education for venue owners and staff on substance misuse issues and how to handle incidents. All participating venues would actively promote it’s participation in the initiative. B. Establish a co-ordinated and concerted drugs initiative in partnership with entertainment venue owners and staff 27

Goal 3: Treatment and Rehabilitation (1) Ensure that there is an adequate and appropriate level of treatment and rehabilitation services provided to respond to the needs of people within the region Objectives Key Actions • 1. Prison Substance Misuse Programme • Appoint a full-time addiction counsellor to work within Limerick Prison as part of an integrated counselling/service provision within the context of an Addiction Treatment programme for prisoners. • Ensure that all programmes adequately address: pre-treatment support, provision of the treatment itself, follow-up care post-treatment, preparation for release, and post-release support for all participants on the programme. • Provide an integrated and cohesive plan for each prisoner (with multi-agency involvement). Provide a range of accessible treatment and rehabilitation programmes and services to meet the needs of clients and their families from pre-treatment to rehabilitation stages Establish progression routes for clients entering the treatment and rehabilitation phase to ensure a holistic treatment model is available Ensure adequate funding provision to enable people to access treatment and rehabilitation services 28

Goal 3: Treatment and Rehabilitation (2) Ensure that there is an adequate and appropriate level of treatment and rehabilitation services provided to respond to the needs of people within the region Objectives Key Actions Provide a range of accessible treatment and rehabilitation programmes and services to meet the needs of clients and their families from pre-treatment to rehabilitation stages Establish progression routes for clients entering the treatment and rehabilitation phase to ensure a holistic treatment model is available Ensure adequate funding provision to enable people to access treatment and rehabilitation services • 2. Detox Services • Provide a dedicated, appropriate residential detoxification facility within the region. • 3. Harm Reduction Programme • Research and deliver a broad range of harm reduction interventions e.g. Hepatitis C awareness, Needle exchange, Safe sex. • 4. Out of Hours Service • Ensure there is a crisis support/point of contact service available at all times, preferably delivered through existing structures. Explore this with existing helpline providers and other appropriate agencies with a view to meeting Drug & Alcohol needs. 29

Goal 3: Treatment and Rehabilitation (3) Ensure that there is an adequate and appropriate level of treatment and rehabilitation services provided to respond to the needs of people within the region Objectives Key Actions • 5. Day Treatment Programme • Develop and deliver a structured and comprehensive day treatment programme, offering an holistic range of services, operating on an inter-agency model and focusing on providing pre-treatment support and out-patient treatment services. • Provide support and resources for existing and potential centres for respite and halfway houses within the Region. Ensure that these facilities offer a broad range of appropriately structured services to users and are accessible to vulnerable communities and individuals (e.g. homeless). Provide a range of accessible treatment and rehabilitation programmes and services to meet the needs of clients and their families from pre-treatment to rehabilitation stages Establish progression routes for clients entering the treatment and rehabilitation phase to ensure a holistic treatment model is available Ensure adequate funding provision to enable people to access treatment and rehabilitation services 30

Goal 3: Treatment and Rehabilitation (4) Ensure that there is an adequate and appropriate level of treatment and rehabilitation services provided to respond to the needs of people within the region Objectives Key Actions Provide a range of accessible treatment and rehabilitation programmes and services to meet the needs of clients and their families from pre-treatment to rehabilitation stages Establish progression routes for clients entering the treatment and rehabilitation phase to ensure a holistic treatment model is available Ensure adequate funding provision to enable people to access treatment and rehabilitation services • 6. Treatment for Under 18s • Assess the need/demand for residential and other treatment services targeted at Under 18s within the region and ensure that these services are made available and adequately resourced. • 7. Family Support • Ensure that all treatment services address and provide appropriate family support for parents and other family members of users. • Consider the provision of child-care facilities in/around treatment and rehabilitation centres. 31

Goal 3: Treatment and Rehabilitation (5) Ensure that there is an adequate and appropriate level of treatment and rehabilitation services provided to respond to the needs of people within the region Objectives Key Actions • Funding Pool • Ensure that people who want access to treatment are not prohibited from doing so due to financial restrictions by creating a central pool of funds for education/training/treatment/rehabilitation purposes for people within the region. Provide a range of accessible treatment and rehabilitation programmes and services to meet the needs of clients and their families from pre-treatment to rehabilitation stages Establish progression routes for clients entering the treatment and rehabilitation phase to ensure a holistic treatment model is available Ensure adequate funding provision to enable people to access treatment and rehabilitation services 32

Goal 3: Treatment and Rehabilitation (6) Ensure that there is an adequate and appropriate level of treatment and rehabilitation services provided to respond to the needs of people within the region Objectives Key Actions • Multi-Agency Working Model • Encourage all agencies to work closely together in an integrated and co-ordinated way by hosting bi-monthly multi-agency meetings to take place to share information and co-ordinate action and responses. • Establish a treatment and rehabilitation service providers forum, to meet quarterly, to share learning's, information, experiences, best practice and to share training. • Conduct a pilot project of multi-agency co-operation on a case-based approach to address client needs in a specific area. Upon evaluation, if this model proves to be successful extend to all areas within the Region. • Specifically, invite a GP and Pharmacist onto the RDTF to address a current gap in the make-up of the taskforce. D. Establish partnership models, close working relationships and efficient co-ordination between all agencies (statutory, voluntary and community) E. Develop more efficient co-ordination mechanisms between communities, the community and voluntary sector and the statutory sector 33

Goal 4: Research (1) Carry out practical research to inform and direct responses Objectives Key Actions A. Evaluate, Review, Monitor and Inform stakeholders of the issues and nature of the problem in the Region on a regular basis, in a practical manner • 1. RDTF Bulletins • The RDTF will produce a regular bulletin - at least two per year. • 2. Research impact of initiatives • Conduct action research on the impact of four initiatives from the RDTF Plan, one from each pillar of the NDS Plan. • Monitor and review all aspects of the Plan. • Negotiate the development of systems for ongoing monitoring to ensure qualitative and quantitative information is gathered in such a way as to influence ongoing development of policy and practice in relation to drug misuse. • Undertake a review of the RDTF Plan each year to ensure it’s on track and up to date. 34

Goal 4: Research (2) Carry out practical research to inform and direct responses Objectives Key Actions • Facilities • Review the range of facilities in place, particularly for young people, throughout the Region and highlight areas with inadequate facilities. • Identify and support positive, accessible programmes (through arts, culture, sport, youth schemes) in priority areas (either where there are inadequate facilities and/or areas where drug misuse is most prevalent). • The RDTF will lobby on behalf of the Region to increase the level of funding provided through the Youth People Facilities and Services Fund (YPFSF) and extend to other areas in the mid-Western. A. Evaluate, Review, Monitor and Inform stakeholders of the issues and nature of the problem in the Region on a regular basis, in a practical manner 35

Mid Western Regional Drugs Taskforce Action Plan June 2005