Report on Drugs Strategy; Implementation & the BME

Prison Population (HMP & YOI Feltham)

Abd Al-Rahman
Drugs and Diversity Advisor
HMPS (London Area)

January 2004
 Contents
Page

1 Introduction 1

2 Objectives 1

3 Key Targets 1–2

4 Methodology 2

5 Meetings with key Stakeholders 3

6 Feltham Drug Strategy Team 3

7 Healthcare – Substance misuse team 3-4

8 CARAT Service – Feltham 5 – 10

9 Other services – Feltham 10

10 Mapping of Treatment Pathways at Feltham 10 - 11

11 Feltham Prison Statistics and Monitoring systems 10 - 12

12 Race Relation and Diversity 12

13 Foreign Nationals 13

14 Workforce Planning Issues in the Substance Misuse Sector in London 13

15 The RRAA 2000 and the BME prison population in Feltham 14 - 15

16 Conclusion 16 - 17

Recommendations 18 - 21

References & Literature Review 22

Appendices 23 – 34

ii
1. Introduction

1.1 The Federation has been established as a national, membership body

actively supporting the needs of BME professionals in the drug and
alcohol field and their communities. The Federation also acts in a
consultant advisory capacity to central government, informing the
Updated Strategy (2002) from a culturally sensitive standpoint. The
Federation have established regional committees to support regional
government, other strategic partnerships and BME drugs & alcohol
professionals to address the aforementioned gaps and meet the targets
informed by the ten year drug strategy and updated strategy 2002, carried
forward through its key drivers (Drug Strategy Directorate, National
Treatment Agency, HM Prison Service, Drugs Action Teams, Crime
Reduction Partnerships etc). The Federation, through its regional
committees, will support the aforementioned stakeholders to deliver
joined up and inclusive services which meet the support needs of the
‘whole community’.

1.2 The regional structure is based on government models of best practice,

which allow for the step-organic model of change management as detailed
in the ‘Change Here’ booklet produced by the Audit Commission. The
Federation will ensure the drug and community safety related needs of
BME communities and wider communities are represented locally,
regionally and nationally.

2. Objectives

2.1 This report seeks to inform HM Prison Service (London Area) and The
Federation (London) Regional Management Committee (RMC) of the
contractual outcomes achieved to date. This report represents
performance of the Drugs and Diversity Advisor (London Area) in
relation to the contractual outcomes for the period October 2003 –
December 2003.

2.2 The Outcomes to date can be measured by the requirements of the Key
Targets agreed with between HMP (London Area) and The Federation, for
the period outlined above. 1

3. Key Targets

3.1 Key Target 2

Review Area and DSU data collection on BME use of drugs services.

1
See Key Targets and Work Programme (Appendix 0.01)
3.2 Key Targets 3.

Review and evaluate service diversity training for service, employed staff.
• Visit 6 named establishments; report on findings

3.3 Key Target 4.

Offer the contract drug services consultation and support their training
needs and operational considerations to assist complying with the prison
service duties and policies on diversity

• Produce and distribute letter of introduction to Service Managers of

contract agencies (1) explaining context of prison service work, rationale
and (2) offering Federation consultancy services2

• Make recommendations on any necessary systems improvements.

Highlight any indicated service shortfall or trends to be reviewed by
steering group.

• Equality Health Check Process Update3.

• Information gathered during the visit also pertains to the Prison service
Diversity training. This feedback will be included in a separate document
focusing on Prison Service Diversity training and training needs of
CARAT service providers after conducting a training needs analysis.

4. Methodology.

4.1 a). Meetings with key stakeholders4 to consider culturally sensitive service
provision in order to consider the service provision in relation to BME
prisoners in Feltham. b). A mapping exercise to establish existing
pathways and services available to drug using inmates (i.e. throughcare).
c). Review of HMPS (London Area) prison statistics and monitoring
systems. d). Consideration of workforce planning issues across the
substance misuse sector; recruitment, retention and training of BME
professionals. e). Consideration of the implications of the Race Relations
Amendment Act (2000) in respect of the BME prison population in
Feltham. Culminating in a set of recommendations, which aim to assist the
process of developing equitable, and quality service provision for BME
inmates alongside the HMPS (London Area) Equality Health Check
process and findings from the national CARAT service review.

2
See letter of introduction (Appendix 0.02)
3
See Equality Health Check Update
4
See list of meetings (Appendix 0.03)

2
5. Meetings with Key Stakeholders

5.1 Informal meetings with key stakeholders were held during the 5th – 8th
January 2004. Discussions took place pertaining to the impact of the drugs
strategy and intervention in relation to BME prisoners in Feltham. The
meetings were made as informal as necessary to facilitate the exchange of
varied perspectives held by those concerned.

6. Feltham Drug Strategy Team

6.1 The Drug Strategy Co-ordinator stated that everyone is treated the same
within services and the focus is on the personality of inmates. Seeking to
identify, analyse and rectify issues specific to BME inmates was itself
mistakenly seen as creating inequalities. Furthermore, it was stated that as
services are open to everyone, BME inmates were already being properly
catered for.

6.2 The DDA was informed that there have been cases where inmates will use
cannabis because if they are tested this would show a positive reading. A
positive reading for cannabis means that they will not be tested again for
30 days (the approximate time that cannabis takes to come out of the
system) according to procedure. The reason for this is the cost associated
with testing. Within the 30 day period inmates would then be free to use
crack of heroin without fear of being tested.

6.3 It was said that at one stage mostly White inmates signed up for voluntary
drug testing. Changes in the induction process alongside the IEP scheme
then brought in more BME inmates.

6.4 The DSC said that there is a proposal to develop a VTU that would have a
treatment aspect to it. The criteria for entry would be drug free and for
those who have earned the right to be there, i.e. enhanced prisoners. The
DSC said that he would like to see at least 50% of the wings on the A & B
side to be drug free. They would, in his vision, be Lifestyle units that have a
focus that is wider than merely substance misuse.

6.5 The view was expressed that the Drug Strategy Team should operate like
a service with Drug Strategy reps working with contract services to ensure
a fully co-ordinated approach.

7. Healthcare – Substance misuse team

7.1 The Deputy Head of Healthcare stated that at reception everyone is

screened for their state of health. The substance misuse team was said to
be diverse in terms of race and gender. At present there exists an
outpatient detox facility. However, from March it was said that there
would be an in-patient facility that would include provision for crack

3
 users. There was mention of a series of plans for future developments to
Healthcare and the CARAT team including changes to the management
structure and staff expansion.

7.2 Referrals to the detox were low (see Fig.1 & 2) in terms of BME uptake
with ‘Take Action’ often showing on the traffic light system. In November
2003 Feltham had a total BME population of 56%. At that time the A-side
was 50% BME while the B-side was 61% BME. An assessment has not been
conducted in regard to how the proposed changes to the substance misuse
team and the treatment process might impact upon BME inmates.

Fig. 1
Detox referrals Oct. 2003

10

9
8
7
6
5
4
3
2
1
0

A side B side
Asian 3 0
Black 2 2
Other 0 0
White 10 6

Fig. 2
Detox Figures Nov. 2003

18
16
14
12
10
8
6
4
2
0
A-Side B-Side

A-Side B-Side

Asian 0 4

Black 0 5

Other 0 1

White 11 18

4
7. CARAT Service – Feltham

8.1 The DDA was informed that the CARAT team at Feltham is contracted to
South Staffordshire NHS Trust. The CARAT team on the A and B-side
have a total KPT of 1200 assessments per year. This includes release plans
for those on remand or with 1-year left to serve.

8.2 The CARAT team is made up of 9 staff (A-side 15 – 17 year olds, 3 workers
and B-side18 –21 year olds - 6 workers), one of which is Male. There is 1
Black female worker – the only staff member who is from a BME
community. It was said that 4 more workers are required in order to have
a full team but advertising has brought in no applications from BME
communities. The predominance of female staff was not seen as a problem
but, it was said, “it would be helpful if there was a BME worker.”

8.3 At 9am every morning during induction the CARAT staff see all those
who have newly arrived at Feltham. During induction every inmate is
given a pack containing information on health, the CARAT service,
general drug related info. and a referral form. Most inmates are referred
while at the induction stage. At induction a list of individuals who speak a
variety of languages is available.

8.4 Inmates from a Caribbean background were said to have more of an issue
admitting to heroin use than crack use because heroin is seen as a drug for
‘junkies’. A crack specific support group is facilitated for those on the B-
side once per week for 9 sessions, 2.5 hours each. As well as this there is a
pre-release drugs awareness group and a drug awareness session that is
part of the Healthy Living Programme. It was said that the A-side is
awaiting space to run groups and at present no such groups are carried
out. It was said in relation to these groups that ethnicity and retention is
not monitored.

8.5 It was stated that Feltham A side has ongoing concerns regarding the low
numbers of BME inmates accessing the service5. Two years ago nearly all
clients came under the category of W1, W2 or W9 and at this time the
CARAT team was passive, waiting for referrals. Also at that time there
was 1 Male Black worker, 1 mixed Female and 1 White Female, it was
stated that this too made no difference to the figures. As a result, it was
said, the following changes were made with the aim of increasing BME
uptake:

a) January 2003 - The CARAT team made stronger links with other
staff/organisations within the prison so that more referrals
would be made to CARAT’s if drug use was identified.

5
see figures 3, 4 & 5

5
 b) April 2003 - Officers, as part of induction, conducted brief
interviews on inmate needs and level of drug use.
c) July 2003 - The CARAT team began seeing every new inmate
and conducting an initial screening. Inmates were then offered a
service.

8.6 However, as illustrated in figure 3, 4 and 5, low BME service uptake

remains on the A side and is highlighted within quarterly reports6. At
quarterly meetings staff seek out ways to address this issue. It was said
that it seems as if they have run out of ideas.

Fig. 3

Referrals: Breakdown of Ethnicity Feltham A July - Sept 2003

60

50

40

% 30
20
10
0
White Irish
White Br.
Other

Mixed other

Mixed Af.

Mixed Car.

Black other
African

Asian other
Caribbean

Indian

BME uptake

BME Asian Black Mixed White

Indian Caribbean African Mixed Car. Mixed Af. Other White Br.
uptake other other other Irish

Ethnic Groups 36.26 2.12 1.05 12.75 6.37 1.05 3.18 2.12 5.5 2.12 59.5 2.12

8.7 According to a CARAT 2nd quarter report the average total Feltham
population over the stated quarter consists of Asian 7.5%; Black 43.12%;
Other 4.09%; and White 45.13%. It was stated in the same report that:

“the biggest disparity is between Black and White individuals. The

CARAT team sees 63.82% of White individuals compared to 25.53% of
Black trainees. It is difficult to determine the best method in
encouraging Black individuals to come forward, particularly in light of
the new procedure of CARAT workers seeing all new trainees.”

6
3rd Quarter figures were not available at the time of visiting the prison

6
7.8 Initial assessment figures for the previous quarter, April – June, had the
following percentages: White 60%; Black 27.5%; Other 8.7%; and Asian
3.75%. When compared to July – Sept., as illustrated in figure 4, there was
an increase in White clients and a drop in BME clients. According to the
CARAT Quarterly report there was also a drop in contacts with BME
inmates from 8.75% to 7.45%.

Fig.4
Ethnicity of initial assessments
A Side, July - Sept 2003
70

60

50

40

% 30

20

10

BME uptake
Asian Other
Black
White

White Black Other Asian BME uptake

63.82 25.53 7.45 3.2 36.18

8.9 It was stated that there were on-going issues of pressures between, on the
one hand, meeting KPT’s (initial assessments, release plans) and
developing the work of the CARAT team in terms of equalities, quality,
process’s and relationships.

Fig. 5 CARAT A side figures, Dec. 2003 - Initial Assessments

12

10

W1 W2 W9 M1 M2 M3 M9 A1 A2 A3 A9 B1 B2 B9 O1 O9

Total 11 2 0 1 0 0 1 0 0 0 1 1 3 1 0 0

7
8.10 The DDA was informed that there is no counselling on the A-side, instead
there is advice and support. One-to-one work is carried out by AA/NA
but with a negligible number of BME inmates.

8.11 It was said that many Asians wouldn’t admit to problematic drug use. The
Imam stated to the CARAT manager that this was due to religious issues
and the fear of information getting back to family members because the
YOT would often inform parents; parents might even know about the
drug use but not everything that goes with it. The main thing, according
to the CARAT team, is that they are aware that the team exists.

8.12 The DDA posed a question in relation to inmate consultation on services

provided and what their thoughts were on why BME inmates shy away
from the service. As a reply it was stated that inmate feedback is gained
during assessments where they were informed of what CARATs offer and
they stated what they would like from this. The DDA explained that this is
giving inmates a choice rather than engaging with them through a
strategy and process that allows inmates to inform what is offered and
how it is offered. It was stated that the CARAT team is a culturally
sensitive service but admitted that without inmate feedback “how will we
know?” When asked how it is known whether the work of the team is
effective it was stated that there is no way of knowing except if an inmate
returns to Feltham as a result of re-offending.

8.13 Feltham B were said to not be experiencing the type of uptake problems
that exist in Feltham A.

Fig. 6 Feltham B-Side Referrals 2003

350

300

250

200

150

100

50

Total Total BME BME %

Referrals

Total
Total BME BME %
Referrals
1st 313 156 50
2nd 269 137 51
3rd 225 109 48

8
8.14 The DDA was informed that all of the CARAT team, except for a new
worker (who started in Nov. 2003), have attended Prison service Diversity
training. A log is kept of all those who have attended Diversity training.
The team gave good feedback of this training and generally felt it was a
positive experience.

8.15 The work of the CARAT team was said to be crisis focused since the
average stay in the prison was 17 – 19 days. As a result the DDA was
informed that a programme such as RAPt would not work in Feltham.
Short programmes were seen as the way forward in regard to expanding
service availability. As well as this greater links with a wider range of
community organisations was seen as necessary.

8.16 The CARAT manager felt that every new inmate should be given an
assessment along with harm minimisation information whether they are a
drug user or not. It was also said that the Youth Justice Board would like
to see a ratio of 1 CARAT worker to every 30 inmates. This would mean
that an extra 7 workers would be required.

Fig. 7
Feltham B-Side Initials 2003

300

250

200

150

100

50

0
Total Initials Total BME BME %

Total Initials Total BME BME %

1st Qtr 257 131 51

2nd Qtr 195 105 54
3rd Qtr 167 80 48

8.17 The DDA was informed that from the end of January 2003 until July 2003
there were more BME inmates accessing the B-side CARAT’s than at any
other time before. Earlier, if CARATs were seeing 20% BME then this
would have been a lot. After a TV documentary, “Feltham Sings”
showcased the work of a few staff members, BME uptake rose to 60% –
65%.

9
8.18 The Traffic light system reporting overall prison activity is split into A and
B side activity. However, It appears that CARAT team A and B side
figures are put together in an A side report and the same occurs with B
side reports. This oversight allows CARAT figures to then appear as ‘OK’
on the traffic light system.

8.19 The following five areas were cited as the most pressing for the CARAT
team:

a. Proving that they are doing a good job.

b. The team needs to develop along with the changing profile and
needs of inmates.
c. More staff are needed.
d. There needs to be more room in the prison available for groups.
e. There is an ongoing issue in regard to escorting inmates.

9. Other services – Feltham

9.1 There were no figures available for AA/NA attendance. However,

anecdotal evidence indicates that BME uptake of such provision is
minimal.

10. Mapping of Treatment Pathways at Feltham

10.1 Figure 8 below was put together from discussions with the Drug Strategy
Co-ordinator and CARAT team. Mapping services and the process in this
way allows for ease in understanding what is available, to what level, for
whom it is available and for ease in assessing where problems areas
occur/are likely to occur.

11. Feltham Prison Statistics and Monitoring Systems

11.1 Feltham utilises ethnic monitoring system codes that are in line with the
last census. The system used, termed the ‘traffic light system’ allows
disproportional representation in all areas of prison work to be
highlighted for action, as such this system is effective.

10
Fig. 8

Fig.9

November 2003 Total

Total Feltham prison population 635

BME prison Population 358

BME as a % of the Total 56.38%

population
Breakdown Asian 8.98%; Black 43.15%;
Other 4.25%; White 43.62%;

Un-convicted population Asian 8.90%; Black 51.25%;

Other 3.20%; White 36.65%

Staff Asian 9.35%; Black 6.88%;

Other 1.65%; White 82.12%

Feltham A-side BME 50%

Feltham B-side BME 61%

11
11.2 Contained in Fig.9 is information gained from the Race Relations Liaison
Officer and represents figures for November 2003. There is no particular
significance of the specific month used for the figures aside from the fact
that the Race Relations Liaison Officer was seen on that day and it was
said that the figures are representative of the usual breakdown.

12. Race Relations and Diversity

12.1 Feltham has 2 full-time staff focusing on Race Relations and Diversity. It
was said that this area of work is high profile at Feltham and there are
approximately 31 race related complaints per month. This was seen as an
indication that there was confidence in the complaints process.

12.2 The DDA was informed that when new policies or initiatives are
launched, such as RESPECT they are not explained well to ground staff.
The biggest problem occurs if staff feel that they can’t express their
feelings openly because they may be called racist and if they suppress
their feelings this can lead to more racism. As a result there is great
emphasis on training. Diversity training aims to encourage honest
discussion and debate in order to counter suppression.

12.3 In the past Nacro had conducted some training but the feedback was
negative. In-house training was said to be more productive due to
facilitators having more knowledge of the prison, its culture and history.

12.4 The prison service training package was said to be as good as the
knowledge, experience and confidence of the trainer. At Feltham the 2
staff members dealing with this area stated that their training is very
effective.

12.5 The changes brought in over the last couple of years are as follows:

a. Two full-time race relations officers. (Governor and S.O.)

b. Introduction of colour coded ethnic monitoring system.
c. Regular prisoner focus groups chaired by the Governor.
d. Introduction of transparent complaints system for prisoners.
e. Appointment of full-time Imam with full-time assistants.
f. Dedicated Mosque.
g. Over 500 Feltham staff have attended diversity training.
h. Pro-active local RESPECT group.
i. Foreign Nationals Co-ordinator.
j. Introduction of support groups supported by outside agencies: Eastern
European group, Irish group, Somali group, African prisoners,
k. Large selection of library books and newspapers in different
languages.
l. Appointment of two ESOL teachers.
m. Piloting of the Nat. Probation Service course “Racially motivated
offenders” for prisoners convicted on racially motivated offences.

12
13. Foreign Nationals

13.1 The DDA received figures for foreign national prisoners from November
2003. From these figures foreign nationals totalled 141 inmates (A and B-
side). This is 22.2% of the total prison population. On the received form
that illustrated the figures Jamaican foreign nationals stood out with a
total of 19 (A and B-side). This was followed by Somali 14; Turkish 12;
Romanian 8; Yugoslavian 7. Other foreign nationals scored significantly
lower.

14. Workforce Planning Issues in the Substance Misuse Sector in London

14.1 Much of the information gathered throughout the process of this visit
suggests that workforce developmental issues, present a significant
challenge to Feltham in relation to the successful implementation of its
drugs strategy. As a consequence of this exercise, it has been established
that HMP & YOI Feltham should not consider the implications of
equitable drugs treatment and service provision in isolation, but within
the broader context of challenges faced across the substance misuse sector
as a whole within the capital. Health Works UK’s6 findings regarding the
recruitment and retention of staff in the substance misuse field also
supports this view. They describe the issue of recruitment and retention
as,

“A national problem, largely due to overall shortages across the health and social
care professions…the rapid development of the drug treatment sector – with new
criminal justice interventions developing alongside the expansion of drugs
commissioning and policy – has exasperated these pressures. Many agencies
reported difficulties retaining staff due to new opportunities elsewhere. Such
pressures are unlikely to diminish… Estimates suggest that the number of drug
treatment specialists will need to increase by up to 50 per cent in the next five
years to meet demand7”

14.2 It should be noted that London demonstrates consistently higher rates of

drug use than any other region in the U.K7 The Mayor for London
established the Greater London Drug and Alcohol Alliance (GLADA)8
who in 2001 agreed that the crisis in recruitment, retention, training and
workforce planning faced by the sector in London should be addressed as
a matter of priority. As a first step, GLADA commissioned the Cranfield

6
Health Works (UK) is a National Training Organisation for the health sector. They are currently
developing national occupational standards for people working in the drug and alcohol sector.
7
Audit Commission – Changing Habits, Page 9 (2002)
8
GLADA is a London based partnership alliance established to provide a mechanism to tackle London
wide problems and to promote better co-ordination of policy and commissioning of drug and alcohol
service

13
 School of Management to undertake a systematic assessment of workforce
requirements. The information generated by the assessment is being
utilised to develop a human resource action plan for the specialist drug
and alcohol sector in London. The Federation are members of GLADA.

14.3 London and the South East of England have long been “hotspots” for
recruitment difficulties and for pressures on all aspects of employment.
Therefore, an important aspect of the research programme was to form an
overall demographic profile of the sector in London. The Training Needs
Analysis has generated a reliable profile of age, gender and ethnicity for
different areas of the workforce population, its findings are as follows.

14.4 In the area of service delivery (TNA A) the workforce population of

London (in terms of the alcohol sector) breaks down broadly as:

• 69% White, 16% Black and 7% Asian

• For managers (TNA B) the same three broad groups break down as
75% White, 13% Black and 7% Asian
• There is a small disparity between the practitioner ratio and
manager ratio that implies ethnic minority workers, particularly
from a black background, may have more difficulty progressing to
management levels
• Ethnicity profiles for commissioners indicate an entirely White
sample
• The community care assessors profile is 78% White
• Gender profiles for practitioners reveal a majority of Female
workers, the ratio being 61% Female and 39% male
• In the managers sample there are 45% Male and 55% Female

14.5 The National Treatment Agency has committed to recruiting an extra 3000
practitioners into the drugs treatment workforce, a significant number of
which will be recruited from BME communities. Between 1991 and 1993 a
much smaller increase in BME employees in the drugs field led to a 30%
increase in disciplinaries involving BME staff. It is generally recognised
that the majority of services have not developed the polices, processes,
structures and professional competencies to deal with the challenges that
will come with an increasingly diverse workforce10 and the communities
within which they serve.

15. The Race Relations Amendment Act (RRAA2000) & the BME prison
population at Feltham

15.1 ‘Institutional racism consists of the collective failure of an organisation to provide

appropriate and professional service to people because of their colour, culture or

10
Federation Equality Health Check (2002)

14
 ethnic origin. It can be seen or detected in processes attitudes and behaviours
which amount to discrimination through unwitting prejudice, ignorance,
thoughtlessness and racist stereotyping which disadvantage minority ethnic
people’. MacPherson

15.2 The Task Force Review Report, NTA HR Strategy; Developing Careers,
Updated Drug Strategy (2002), and National Scoping Study11; Delivering
Drug Services to Black and Minority Ethnic Communities (Home Office),
state clearly that the drug related needs of BME communities and BME
professionals in the drugs field have not been met by drugs service
commissioners and drug service providers.

15.3 Lack of cultural competence (absence of culturally sensitive treatment

modalities, lack of competent management support and developmental
opportunities for BME staff), ineffective needs assessment/consultation
with BME communities, inadequate HR/Performance Management
Frames, inadequate data collection systems (ethnic monitoring is
particularly poor), research gaps in relation to the specific needs of BME
drug users and inadequately trained staff, particularly in relation to
diversity, have been sighted as key areas in need of development if BME
communities are to experience equitable access to drugs services and
equal opportunity in the appointment to and development in professional
roles within the drugs field12.

15.4 The Federation Equality Health Check currently being carried out on
behalf of London Area will recommend any necessary training, policy
and/or procedural development that is required including a full race
equality specific training needs analysis. The EHC uses an assessment tool
that is DANOS and QuADS compliant and designed to compliment the
RRAA(2000) related audit tools developed by local authorities, PCT’s and
Criminal Justice Services across the country. The findings will be
consolidated in a confidential report to HMP London Area.

10
Federation Equality Health Check (2002)
11
Sangster D, Shiner M, Patel K and Sheikh N (2002)
12
Ahmun V, 2000

15
16. Conclusion

16.1 HMP & YOI Feltham has, to some extent, varying issues between the A &
B side. The B-side is quite effective in terms of referrals and attracting
BME inmates for initial assessments. It was more difficult to determine,
however, the level of BME uptake and retention of groupwork. The A-side
has ongoing issues with BME uptake but the critical factor is that the team
have explored at length possible ways to remedy the situation. The
Substance Misuse Team (Healthcare) has plans to expand its staff and
service provision. This is a positive development but bearing in mind the
present low BME detox figures the team must actively seek to ensure that
plans for expansion include how they will seek to address issues specific
to BME inmates and increase BME uptake of detox facilities. Overall,
Feltham has an atmosphere of transition and appears to have developed
in terms of race relations over the last few years partly due to a strong
Race Relations team.

16.2 However, the information gathered suggests that the CARAT team within
Feltham A-side, despite effort, lacks the required culturally sensitive
approach to meeting effectively the drug treatment needs of its juvenile
BME prison population.

16.3 Findings suggest the nature of provision does not provide the BME prison
population with an effective response, particularly with regard to
stimulant users. (see Appendices 0.05 & 0.06).

19.4 The HM Prison Service and in particular CARAT providers should

encourage greater levels of diversity in teams. Diversity is a gateway to
being more effective. Belbin (1981)13 talks about balance in a team,
ensuring that a whole range of individual differences in areas such as
skills, attitudes, attributes and personality is taken into account. The more
diverse the team is in terms of interests, attitudes and backgrounds, the
more potential for increased productivity and practice; thus fostering a
more cohesive force.

19.5 Recruitment, retention and training of appropriately skilled staff and in

particular professionals from BME communities are workforce challenges
currently reflected in the wider community. For example, the Audit
Commission’s review of the sector; Changing Habits (2002) states that
workers in the sector experiencing problems with delivery of treatment
may be doing so as a consequence of “low levels of staff training and
expertise…as staff in the sector are drawn from a wide variety of
professional backgrounds”.

13
Organisational Behaviour p.96

16
19.6 Whilst this report acknowledges it is still early day in the life of the HMPS
drugs strategy more can be achieved by utilising examples of best practice
as they exist within the wider community i.e. Nafas, the Federation,
Blenheim Project etc. These can be adapted and tailored to suit the
changing needs of the prison environment. Thus, supporting HMP & YOI
Feltham’s aim to provide more equitable service provision in relation to
drugs treatment and intervention for those from BME and marginalised
communities.

17
Recommendations________________________________________________

1. Feltham Drug Strategy Team

1.1 Issues pertaining to Cultural Competence, Diversity and BME inmates are
often seen as confusing to discuss within Drug Strategy Meetings due to a
lack of knowledge of just how these areas play a role. This is especially so
if the attendees are themselves unrepresentative of the prison population.
As a result Diversity and BME inmates, if agenda items, usually translate
into a brief look at statistical data coupled with the statement, “our
services are open to everyone”, meanwhile gaps and service provision
related shortfalls go unnoticed. There needs to be a mainstreaming of the
Diversity agenda within Drug Strategy meetings as a standing agenda
item or within service updates to be evidenced within minutes. However,
before this can occur in a meaningful way consultation needs to occur
with those involved in drug strategy to assist them in a better
understanding of what to look for and options for change.

1.2 Within Drug Strategy Meetings services need to address the question:
“How might services evolve in order to meet the needs of BME inmates,
Crack users and poly-drug users utilising independent consultants who
have expertise in this area to assist the process wherever necessary.

1.3 Training on Cultural Competence theory and practice is required for the
Drug Strategy team. This would assist in achieving the points raised in 1.1
and 1.2 above. Training. Provision of training on drug related issues
would also be of benefit to prison officers as a whole.

1.4 CARAT A & B side statistical data needs to be separated on the traffic
light reports in order to give a realistic impression of what is occurring on
the ground within the CARAT team.

1.5 Feltham would benefit from the presence of a race relations/diversity lead
on the Drug Strategy Team. This would assist Race Relations in
developing drug related knowledge as well as assisting the link between
drugs and diversity.

2. Healthcare – Substance Misuse Team

2.1 In light of the proposed changes to the substance misuse strand of

Healthcare the team must seek to address the shortfall in BME uptake of
detox facilities. The must be asked, “how can we ensure that the changes
assist in increasing BME uptake.” Proposals aimed at achieving this
increase need to be clearly documented.

2.2 An impact assessment should be carried out in regard to the proposed

changes.

18
3. CARAT Service Feltham

3.1 Home Office guidance The Development and Practice Report, states, “Further
developments in CARAT teams should concentrate on (1) increasing the
number of places on therapeutic programmes and (2) pre-release planning
to address employment and housing needs, and (3) to establish ongoing
contact with services outside prison”. p.6. Employment and housing are
said to be the most pressing issues for inmates, particularly from BME
communities, leaving prison. Closer working ties with services outside of
the prison need to be established in order to work more effectively,
realistically and to document the specific areas of difficulty and need.

3.2 The Federation should support HMP & YOI Feltham to develop specific
means by which the needs of BME inmates can be adequately explored in
terms of the way in which services are delivered. Focus Groups already
exist with the prison. However, drug specific focus groups focusing on
access issues, how the CARAT team is perceived and what inmates feel
the team need to do in order attract BME inmates could be utilised to
communicate with a significant number of BME inmates, particular from
the A side. The Audit Commission states that:

“Without knowing anything about the people who use your service, how can
you begin to understand their needs? Without hearing what they want from
you, how can you focus on the areas that really matter to them? Without an
accurate picture of their experiences, how can you be sure that you fully
understand what works and what needs fixing, especially where your
contribution is part of an extended process involving other agencies as well as
your own?” p.64

These inmates can then become more involved in the development of the
service and part of the change process that aims to increase BME uptake of
services.

3.3 South Staffordshire NHS Trust recruitment and retention policies need to
be reviewed and made live to ensure recruitment process and procedures
for staff are designed to appeal to a wider audience and therefore are able
to successfully attract professionals from BME communities. The NTA
states that:

“There is clear evidence that issues of anti-discriminatory practice in

employment and issues of equity in service provision for diverse communities
are, and should be considered as, related and not as separate issues”. p.7

19
3.4 The KPT’s need to include information from groups, i.e. numbers
involved and ethnic breakdown. As well as this there needs to be a
qualitative aspect to KPT’s that seek to measure the effectiveness of the
service. Without this information it will not be possible to assess in real
terms how effective the CARAT team is. The NTA states in Models of Care:

“There is an increasing central imperative to monitor the activity, cost

and outcomes of substance misuse treatment and care services. Structured
community and specialist substance misuse service providers are now
expected to report at least some information about how effective they are at
helping people who present for treatment. This reflects a desire to gauge
the return on national investment in treatment services and to ensure that
resources are directed to treatments that are effective.” P.196

3.5 There appears to be some confusion, on the part of inmates, in regard to

how the CARAT team is accessed and the process through which the team
accesses inmates (see appendix 0.05). The Reception Screening process
needs to be re-evaluated.

3.7 Groups such as The ID and Difference Process have proved to be highly
effective in facilitating change within young people from the BME
communities. Group-work of this nature should be utilised in order to
address the broader, underlying issues that often inform the misuse of
drugs. A recent Home Office development and practice report
recommends that:

“Educational programmes for young offenders need to adopt a broad

educational approach to cover the wide range of substances used. At the
same time, it should be acknowledged that much of their recreational drug
use is determined by social settings and drug-using peer groups, and may
only be successfully addressed by changes in lifestyle or environment. A
concentration on drug use in isolation is unlikely to be successful”. p. 5

4. Workforce & Cultural Competence

See 1.1 and 3.3 above

5. Workforce Planning

5.1 Carry out Equality Health Check to consider implications for Prison
Service, BME professionals and Communities.

5.3 Work with The Federation to develop Diversity Manual – ‘Identity &
Difference’ for bespoke diversity training programme for service staff and
providers.

20
5.4 Provision of leadership and management training for service staff and
providers working with BME communities.

21
References & Literature Review

NTA for Substance Misuse – a) RRAA 2000 – Implementing good practice

b) Models of Care (2002)

Home Office - development and practice Report – ‘The Substance misuse treatment needs of minority
prisoner groups: Women, young offenders and ethnic minorities’ (2003)

DOH - ‘Drug Misuse and Dependence – Guidelines on Clinical Management’ (1999)

Audit Commission – ‘Change Here!’ (2001)

Select Committee on Home Affairs Second Special Report - ‘Drugs and Prisons’ (2000)
http://www.publication

The MacPherson Report

Belbin – ‘Organisational Behaviour’ p.96 (1981)

1) Home Office – ‘Findings 186. Prisoners’ drug use and treatment: seven studies’
2) Home Office – ‘Prison Population Brief’
3) Home Office online report 33/03 – ‘Differential substance misuse treatment
needs of women, ethnic minorities and young offenders in prison: prevalence of
substance misuse and treatment needs’.
4) Home Office DSD – Updated Drug Strategy 2002
5) Home Office – ‘Tackling Crack – A National Plan’
6) NTA/COCA – ‘Treating crack and cocaine misuse - A resource pack for
treatment providers’
7) NTA – ‘Models of Care’.
8) CRE – ‘Race equality in prisons’ (2003).
9) CRE – ‘The duty to promote race equality. Performance guidelines
10) CRE – ‘Public procurement and race equality’.
11) CRE/HM Prison Service – ‘Implementing Race Equality in Prisons’.
12) HM Prison Service performance rating system. 2nd Quarter 2003/04.
http://www.hmprisonservice.gov.uk/corporate/dynpage.asp?Page=950
13) a. Prison Drug Strategy – detailed initial impact assessment (CARATs).
b. Prison Service impact assessment (Reception).
http://www.hmprisonservice.gov.uk/life/dynpage.asp?Page=807
14) Sangster D, Shiner M, Patel K and Sheikh N (2002) – ‘National Scoping Study’
15) Audit Commission – ‘Changing Habits’

22
 Appendix 0.01

The Federation

Abd Al-Rahman – Diversity & Drugs Adviser (London Prison Service)

Work Program (21st October 03 – March 04)

Key: Area Drugs Coordinator (ADC) Chief Executive Officer (CEO), Head of
Consultancy (HC), Drugs & Diversity Advisor (DDA), National Training
Officer (NTO).

Action Target Date Comment

.
Identify Mentor/Coach for external support and supervision 28th November Essential
03 requirement
(1) Support/advise steering group in relation to issues
pertaining to diversity and drugs in prisons

• Organise, coordinate and minute meetings,

disseminate information TBA – after DDA/Prison Service
second meeting (PA)
with Huseyin
• Produce quarterly reports
(December, March) 17th Dec 03
and 29th March
DDA
04
) Review all existing area and DSU data collection
on BME use of prison drugs services

• Review transcripts of Focus groups and produce 31st Oct. 03

report of key findings
DDA/HC
st
• Review findings and responses to Action 31 Oct. 03
Research questionnaire.
DDA/HC
• Visit HMPS London Area Office and access Week
intranet (1 full day). commencing
DDA
3rd Nov.03

• Highlight any indicated service shortfall or trends. 31st October

Report findings (plus Focus groups, Action 2003/ongoing
DDA,
Research) to ADC, Steering Group, FSC, FCEO

(3) Evaluate Training needs and develop training

pack for service employed staff

• Develop, disseminate, evaluate training needs January 2004

questionnaire. February

23
 questionnaire. February DDA, HC,NTO

• Make recommendations to steering group February 2004

DDA, CEO, HC

(4) Review and evaluate service diversity training for service

employed staff

• Organise Federation Diversity Training Session February 2004

“Identity & Difference” for prison drug service DDA, HC
staff

• Disseminate Evaluation forms, collate and February 2004

feedback DDA, HC

• Make recommendations for further training. February/March

2004 DDA, CEO, HC
(5) Offer the contract drug services consultation and support
their training needs and operational considerations to assist
complying with the prison service duties and policies on
diversity

• Produce and distribute letter of introduction to

Service Managers of contract agencies (1) 7th November
explaining context of prison service work, 2003 DDA, CEO, HC
rationale and (2) offering Federation consultancy
services

• Visit 6 named establishments on at least two

occasions each. by 9th January
2003 DDA
• Make recommendations on any necessary
systems improvements. Highlight any indicated 19th January
service shortfall or trends to be reviewed by 2004 CEO, HC, DDA
steering group

• Follow up letter to Chief Executives of contract

agencies in conjunction with ADC to arrange 15th January
meetings with Contractors CEO’s & CEO, HC 2004 DDA, CEO, HC
following completion of the Equality Health
Check Process

• Inform development of audit tool to

establish awareness and practice pertaining TBA
to prison service duties and diversity DDA, CEO, HC

Notes – Abd Al-Rahman, as discussed -

fortnightly supervision is an essential criteria as
well as your identifying an appropriate individual
to provide you with professional mentoring and
coaching

24
coaching

This template will work in conjunction with your London

HMPS Outcomes.doc and Rationale.doc. In addition to your
supporting Federation activities as specified by the CEO.
This document will be reviewed monthly and any
adjustments made.

25
 (Appendix 0.02)

Dear ,

I am writing to inform you of work that is taking place within the London Area prison
service in relation to drug strategy/intervention and BME inmates.
The Prison Service London Area Office has funded The Federation of Black and Asian
Drug and Alcohol Professionals for the post of Drugs and Diversity Adviser. The
Federation is a national organisation established to support the needs of Black and
Minority Ethnic (BME) professionals in the drugs, alcohol and related sectors, and their
communities. The Federation acts in a consultant advisory capacity to central
government; Drug Strategy Directorate (DSD) Drugs Prevention Advisory Service
(DPAS), National Treatment Agency (NTA) etc. Informing the updated, National Drug
Strategy, from a culturally sensitive standpoint.

The role of Drugs and Diversity Adviser entails the following:

1. Support and advise the Area Drugs Co-ordinator, the Federation and the HMPS
(London Area) Diversity steering group in relation to issues pertaining to
diversity and drugs within the London area prisons.

2. SAMPLE
Review Area and DSU data collection on BME use of drugs services.

3. Review and evaluate diversity training for service employed staff.

4. Evaluate Training needs and develop training pack for service employed staff

5. Offer contract drug services within the London area prisons, consultation and
support with their training needs and operational considerations to assist
compliance with prison service duties, race equality and diversity policies

In order to carry out these responsibilities I have been visiting HMP’s Wormwood
Scrubs, Wandsworth, Latchmere House, Pentonville, Brixton and Feltham to meet with
service providers and others to gain insight into what services are available, to what
extent BME inmates access them and how these services work with these inmates. The
task is one that aims to advise and assist services wherever necessary in order to
further enhance the quality of practice.

I have already attended after which I had a chance to briefly

introduce myself to . I am now booked to attend various meetings at
between the .

If you require any further information regarding this work please call me at The
Federation.

Yours Sincerely,

Abd Al-Rahman
Drugs and Diversity Adviser

26
 (Appendix 0.02i)

The letter overleaf was sent to the following Area Managers/Directors of Drug
services within London area prisons

HMP Brixton

Adrian Davies
Area Manager
CRI
1st Floor Lorenzo Street
Kings Cross
London
WC1X 9DJ

CARATs Brixton and Wormwood Scrubs

Peter O’Loughlin
Area Manager
Cranstoun Drug Services
112 – 134 Broadway House
The Broadway
Wimbledon
SW19 1RL
______________________________________________________________________

HMP Feltham/Latchmere house (South Staffordshire – CARATs)

Alistair Sutherland Director of Inclusion, Drug and Alcohol Services

20 Mill Lane
Yately
Hants
GU 46 7TN
alistair.sutherland1@ntlworld.com

______________________________________________________________________

HMP Wandsworth

Joe Bernadello
Director of Operations South
RAPt
Riverside House
27 – 29 Vauxhall Grove
London
SW8 1SY
0207 582 4677
0207 820 3716 fax
info@rapt.org.uk
www.rapt.org.uk

27
CARAT
Peter O’Loughlin
Cranstoun Drug Services
112 – 134 Broadway House
The Broadway
Wimbledon
SW19 1RL
______________________________________________________________________

HMP Wormwood Scrubs

Andy Hillas
Area Manager
Turning Point
100 Christian Street
London
E1 1RS

0207 265 2010

andrew.hillas@turning-point.co.uk

HMP Pentonville

Andy Hillas
Area Manager
Turning Point
100 Christian Street
London
E1 1RS

0207 265 2010

Andrew.hillas@turning-point.co.uk

28
 (Appendix 0.03)

Name Position Date visited

2 x CARAT workers 5th January
A & B side

Ian Grange CARAT Admin (A-Side) 5th January

Lynne Parkings CARAT Admin (B-Side) 5th January

Barry McRae-Adams Drug Strategy Co-ord. 6th January

Allison Jones Dep. Head of Healthcare 6th January

Jackie Bird CARAT Manager - A/B 8th January

side.

John Bird RRLO 8th January

Sonia Aluk Deputy RRLO 8th January

29
 (Appendix 0.04)

Questions asked during meetings

The following questions acted as a guideline and directional prompt They were
asked within the framework of a semi-structured discussion. Questions asked
were based on relevancy to the staff member and their role.

• What is the nature of the drug treatment offered? (Detox, groups, one-to-one’s,
models used, etc.)

• Is there Information in various languages?

• What is the ethnic breakdown of those referred?

• Are there mechanisms for inmate feedback?

• What are the drug related outcome targets?

• What are the output targets?

• How are inmates assisted at the prison exit stage? (links with outside
agencies,etc).

• What has been done previously to address any BME unmet needs /shortfall in
service uptake?

• Treatment service policies – On Diversity and Eq. Opps. How are they made
live?

• What has been the feedback in relation to Diversity training?

• Do services feel that they meet BME inmate diverse needs? If so, how?

• How do they assess how well they are doing in relation to the above?

• How does the Race/Diversity agenda play a role in the Drug Strategy Group?

• Does a Race Relations Officer/Diversity lead attend Drug Strategy meetings?

30
 (Appendix 0.05)
1. Inmate perspectives

The following is from a focus group held in Feltham in September 2003.

Interviewer 1: A
Interviewer 2: B
5 Participants: C

…….

A: You have been once, to see a CARAT worker. Did you go from your own free will or
did they come to see you or what?

C: No they came to see me.

A: OK, they came to see you. You said you went to see one once as well?

C: Yeah, Yeah, they came to see me as well. When you first come in here they ask if you
want to see a CARAT worker, if you want you just say yeah and put your name down
and then a couple of weeks later they come to your wing, get you out and talk to you.

C: They have to see every new person that comes in don’t they, so you don’t have to put
your name down, they have to see whoever comes in.

A: So I ask the question again,

C: We seen one but it’s not that they come to see every single person, you have to put
your name down innit.

C: I didn’t put my name down they just come to see me.

C: We put our name down for CARAT workers to come and see us.

A: OK right, If I’ve got it clear……..OK, can I ask a second question. Are you getting any
benefit from the drug treatment inside the prison?

C: They don’t give you nothing in here, nothing at all, just bang us up inside and give us
paracetamol for sleeping and paracetamol for everything that’s all.

C: With CARATs you’re just talking and that’s just counselling. So that’s the most you’re
getting, you’re not getting any treatment innit. I heard the CARAT worker talking about
acupuncture yesterday but that’s it. You’re not getting no other medical treatments in
here.

A: …What happens if someone comes in and they are clearly on withdrawal and really
shows signs of…

C: If you can’t sleep yeah, he tells you the night Governor will keep an eye out for you
for 3 days and if you still can’t sleep then you be able to see a doctor but 3 days later
when you tell a nurse that you can’t sleep then they don’t do nothing about it.

31
C: Once someone come in and they just left him in the cell and he just vomited, you
know that’s what they do innit, just vomit and the Governors made him lie down on the
pool table while they cleaned the cell and just put him back in. I’m not joking.

B: You’re not aware of anyone seeing him?

C: There is no treatment. You just can’t get anything in jail. They should give you
something like methadone to ease you up innit but there is nothing. They just let you get
on with it, cold turkey and stuff, it’s deep man.

C: There is no treatment, they just don’t care, they don’t care. They’ve got a job to do,
they deal with 50 inmates in the wing, they don’t care about one sick one…You got a
buzzer on your wall and that’s for emergencies only and if you press it they come in
about 20 minutes and say, “what? You’re gonna get nicked for that”, that’s all.

C: Yeah this boy called Paddy in the wing, he looks like he smokes brown but he ain’t
getting no treatment. They don’t care, just bang him up in his cell. He starts kicking
down the door because he is depressed and they just nick him. Take all his stuff so he
gets even more depressed.

C: Going back to about 2 years ago I was here and I got banged up with this boy and like
he couldn’t sleep for the whole night and he kept on waking me up. I asked him what
his problem is and so he had used heroin and that. So I pressed the buzzer for him and
try telling him that the guy needs help and that but they just left it. For a week he was
like that, for the whole week no sleep, nothing.

A: …so lets start thinking about what support you need to stop using drugs and we are
gonna look at CARAT workers, prison officers and your families.

C: It’s not so much here but it’s when you go outside. You need to keep yourself busy
like get a job or something, or start college, then maybe you got a good chance for not
going back to using drugs. In here they can’t help you, you have no choice…

C: …In here you just get to see your CARATs worker and that’s about it. That’s the only
treatment you getting…

A: So how long do you talk to a CARAT worker?

C: Bout half an hour, once a week and maybe not even that, I’ve only seen one 3-4 times.
…..
B: Have any of you been offered, maybe not this time but before, a DTTO?

C: No.

32
 (Appendix 0.06)

Aware of Feltham Use of Feltham

CARAT CARAT
service? Service
Yes 11 Yes 5
no 8 no 16
Never 3 Unknown 2
heard of
them
Unknown 1 Total 23
Total 23

Satisfied Feltham Effectiveness Feltham

with of CARAT
CARAT
Very 2 Yes 2
Useful
Useful 4 no 7
Satisfactory 0 Unknown 14
Useless 1 Total 23
Unknown 16
Total 23

Drug Feltham Used Feltham

User? Drugs
in the
past
Yes 10 Yes 17
no 10 no 4
Unknow 3 No 2
n respons
e
23 Total 23

On Feltham Want Feltham

Remand? treatment
on
release?
Yes 13 Yes 6
No 7 no 14
No 3 No 3
Response response
Total 23 Total 23

33
 (Appendix 0.07)

1 Staff perspectives

1.1 “Diversity training just gets the boxes ticked…During training some were
perhaps afraid to ask or speak…The training is more policy driven than
focused on individual needs.”

1.2 “A motivational programme is needed for the Juveniles. Maybe a 3 month

course. Their time could be better used, instead of school which doesn’t
motivate them.”

34