Public Health England (PHE) produce a suite of tools to support the understanding of drug and alcohol need at a local authority and NHS Clinical Commissioning Group level. Their Co-existing substance misuse and mental health issues profiles highlights a significantly higher proportion of Derby’s population with risk and related factors such as socio-economic deprivation, children in poverty and violent crime. It also reveals a high level of local need, since the prevalence of opiate and/or crack cocaine use is significantly greater in the city than the national and regional averages. The rate of hospital admissions for mental and behavioural disorders due to alcohol follows a similar pattern. The proportion of drug and alcohol clients with concurrent contact with mental health services is currently below the national average. However, it is important to remember that this group is more vulnerable to mental health problems and therefore require comprehensive support with recovery.
The latest ‘Healthier Lives’ alcohol and drugs profile for Derby shows that the percentage of clients who successfully complete treatment for non-opiate and alcohol use was comparable with the national average in 2016. However, Derby ranks significantly worse than England in relation to the proportion of the population waiting more than three weeks for drug and alcohol treatment.
The National Drug Treatment Monitoring System’s adult drug headline information indicates a gradual increase in the number of clients in treatment since 2005/06, although this has recently fallen. The proportion of clients waiting less than three weeks has consistently remained higher than 97% since 2008/09. The latest adult alcohol headline information shows a gradual decline in the number of clients in treatment since 2013/14, although this recently increased in 2016/17. The percentage of clients waiting less than three weeks has gradually increased from 80% in 2010/11 to 97% in 2016/17.
The Local Alcohol Profiles for England (LAPE) are a resource to support local, sub-national and national alcohol policies. Derby’s latest alcohol profile shows a significantly higher rate of deaths from alcohol-specific conditions than the national and regional average. This is reflected in the higher rates of people admitted to hospital for alcohol-specific conditions, and hospital admissions for alcohol-related conditions. When broken down by causal group, Derby performs significantly worse than the national average for admission episodes for mental and behavioural disorders due to alcohol and intentional self-poisoning. Amongst females, the rate of admissions due to alcoholic liver disease is significantly higher than the national average. The broader societal impact is reflected in the significantly higher rate of claimants due to alcoholism, and a comparable rate of alcohol-related road traffic accidents.
“Deaths from liver disease are increasing in England. This is in contrast to most EU countries where liver disease deaths are falling. In 2014 the number of people who died with an underlying cause of liver disease in England rose to 11,597. This rise is in contrast to other major causes of disease which have been declining. Liver disease is largely preventable. Whilst approximately 5% is attributable to autoimmune disorders (diseases characterised by abnormal functioning of the immune system), most liver disease is due to three main risk factors: alcohol, obesity and viral hepatitis” (Public Health England, 2016).
In Derby, the under 75 mortality rate from liver disease was 25.0 per 100,000 in 2014-16. This is significantly higher than the national and regional average, and has gradually increased from 18.5 per 100,000 in 2001-03. The rate of alcohol-specific hospital admissions in 2016-17 in Derby was significantly higher than the national and regional averages for both males and females. Obesity is strongly linked to non-alcoholic fatty liver disease (NAFLD). In Derby, the proportion of overweight or obese adults was significantly higher than the national average in 2016-17. The percentage of overweight or obese year 6 children was also significantly higher than the national and regional average in 2016-17. Hepatitis B is a virus which is transmitted through contact with infected blood or other body fluids, and is a risk factor for liver disease. The latest data for 2012/13-14/15 indicates that the hospital admission rate for hepatitis B related end-stage liver disease is comparable with England but significantly higher than the national average. The hepatitis C virus is mainly transmitted through contact with infected blood. In Derby, the hospital admission rate for hepatitis C related end-stage liver disease was significantly higher than the national average between 2012/13-14/15. Further exploration of the data can be made in PHE’s Liver Disease Profiles.
Public Health England also produced a blog on preventable liver disease in September 2014.
Derby’s Integrated Drug and Alcohol Service
From April 2016 Derby’s integrated drug and alcohol service encompasses family support; recovery focused family interventions including support for people affected by someone else's drug/alcohol use. This places greater emphasis on building family and social recovery capital to maintain positive treatment outcomes. There is a commitment to continued partnership working to improve access to wider support for drug and alcohol clients to maintain recovery and improve wellbeing; maintaining links with sport and leisure, housing, welfare and debt advice, employment and education and opportunities to engage in mutual aid groups, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), and other peer support activities. Services are accessed through a single point of entry and assessment process, reducing artificial barriers through the development of a person centred approach to care. Clients may access ‘step down’ provision at St Peters Churchyard and other community venues. The ongoing commitment to reduce re-offending in the city is maintained through custody suite activities, court assessments and support for the effective delivery of court orders to tackle offending which is driven by drug and alcohol use.
For more information about the level of need for treatment and support in Derby, including Derby’s new integrated drug and alcohol treatment service, please refer to the Needs Assessment.