Matrix Bite Drug Matrix Bites row 5: Reducing crime, protecting families
Concerns treatment intended to safeguard the community. A common theme is the potential contradictions involved in offering or imposing treatment centred on the patient’s welfare within a system which prioritises the wider community, and sees the patient essentially as a threat. That divide is regularly and productively bridged, but perhaps we should make coercion more of an exception by maximising the accessibility and acceptability of voluntary treatment.

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The five cells

A5. Interventions: Treatment reduces crime and protects children
Reminds us that coercion is not essential to crime reduction – that happens ‘naturally’ during voluntarily sought treatment – but a seminal US study from the 1970s showed that coercion can aid treatment. Ends by asking, Can it ever be safe to leave children with problem drug users?

B5. Practitioners: Are therapeutic relationships overshadowed by coercion?
Are therapeutic relationships overshadowed when treatment is coerced, or more important because “genuinely adopting and communicating [motivational] qualities is much trickier when the ‘client’ is not there because they want to be [and] when for them you may represent an oppressive authority”?

C5. Management: Reconciling the conflicts
How do you implement the patient-centred focus entailed in treatment within a system which centres not on the patient, but on reducing their impact on family and society? And how do you prioritise the child when their parent is your service’s client/patient?

D5. Organisations: How are they affected by criminal justice contexts?
How working in law enforcement contexts affects treatment agencies, and how this affects their relationships with and impacts on ‘clients’. Expert US review identifies key barriers and solutions – applicable to the UK?

E5. Whole systems: Maximise coercion or voluntary engagement?
Do coercion and collaboration with law enforcement undermine or amplify treatment’s crime-reducing impacts; should treatment systems be set up to maximise coercive treatment entry and compliance, or to maximise voluntary engagement?

More ways to appreciate the matrices
Visit the matrices page of the Effectiveness Bank web site for articles, presentations, and a video explaining their genesis and construction.