Report on Drugs Strategy; Implementation & the BME

Prison Population (HMP Pentonville)

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

March 2004
 Contents
Page

1 Introduction 1

2 Objectives 1

3 Key Targets 1–2

4 Methodology 2

5 Meetings with key Stakeholders 3

6 RAPt CARAT Service – Pentonville 3-5

7 Turning Point - Pentonville 5-6

8 Pentonville Detox 7-9

9 Voluntary Testing Unit 9

10 Mapping of Treatment Pathways at HMP Pentonville 10

11 HMP Pentonville Statistics and Monitoring Systems 11

12 Race Relations and Diversity 11 - 12

13 Workforce Planning issues in the 12 - 14

Substance Misuse sector in London

14 The RRAA 2000 and the BME Prison 14

Population in Pentonville

15 Conclusion 15

16 Recommendations 16 - 20

17 References & Literature Review 21

18 Appendices 22 - 32
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)

1
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 stakeholders to consider culturally sensitive service
provision4 in order to consider the service provision in relation to BME
prisoners in Wormwood scrubs. 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 Wormwood Scrubs. 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

2
5. Meetings4 with Key Stakeholders

5.1 An initial meeting was held on the 10th December 2003. After this,
informal meetings with key stakeholders were held on, 20th and 21st
January followed by the 17th and 24th February 2004. Discussions took
place pertaining to the impact of drugs strategy and intervention in
relation to BME prisoners in Pentonville. The meetings were made as
informal as necessary to facilitate the exchange of varied perspectives held
by those concerned.

6. RAPt CARAT Service – Pentonville

6.1 The CARAT Manager informed the DDA that there are currently 15 staff
members including a Senior Crack worker who started work on the 18th
January 2003. It was stated that there was a time when there was an all
female staff team that included no BME workers. There are now 6 BME
staff members and a 50/50 male and female staff mix. The team includes 1
worker who is part of the NTA modern apprentice scheme.

6.2 The team receives approx. 300 – 400 referrals per month to what has been
described as “a skeletal service over the last few months.” The DDA was
informed that a needs assessment commissioned by Camden and
Islington NHS recommended that a BME stimulant worker should be
employed. This recommendation is currently being put into action after a
period of difficulty recruiting a specialist worker. During this period crack
groups were still carried out by existing staff once a week for 6 weeks and
will be taken over by the new Senior Crack worker. No additional funding
has been given for this. According to CARAT reports Crack groups have
been running at 50 – 76% BME. No information was available regarding
dropout rates for groups. Evaluation of the group was not available.

6.3 At the time of meeting the team acupuncture sessions were on hold
although it was said that up to 5 members of staff were acupuncture
trained. Harm minimisation groups (2 per week) were available until
November 2003. The CARAT service was seeking to provide this during
induction for all inmates. Staff levels and KPT pressures were said to
dictate the amount of group-work carried out.

6.4 The CARAT manager has had no Prison Diversity training. Race Relations
training was attended 3 years ago. The manager had attended the Identity
and Difference training organised by The Federation in 2003 and gave
excellent feedback. Prison Diversity training, according to reports from
staff, was described as poor with attendees making sexist and racist
comments and jokes. It was not clear whether this occurred during the

4
See list of meetings (Appendix 0.03)

3
 training or outside of it. The CARAT manager attends Race Relations
Meetings.

Fig.1

CARAT Initial Assessments

3rd Quarter

70
60
50
40
30
20
10
0
Oct Nov Dec
Asian 11 10 4
Black 20 36 36
Other 7 7 8
White 28 56 67

Fig.2

Month BME Initial Assessments Total Contacts

Dec 42% 42%
Nov 49% 48%
Oct 58% 56%
CARAT monthly stats show 0 counselling sessions.
2306 current active cases by the end of the 3rd quarter.

6.5 The CARAT Manager made the following observations:

• It was stated that what is needed is more intervention that is rolling and
brief rather than less variety for longer.

• There is no allocated group space and this was said to be a major problem
for the team.

• Unlocking inmates was said to be time-consuming, taking up inmate

group time.

4
 • It was admitted that there are not enough qualitative evaluations of
CARAT services in Pentonville.

• An example of a ‘bottleneck’ in service provision was said to be if 100

people were assessed and 70 wanted a Crack group.

• It was said that the Drug Strategy Team was “quite good” in Pentonville
but on the issue of Diversity they could be more pro-active.

7. Turning Point - Pentonville

7.1 Turning Point run a 10-week intensive Cognitive Behavioural Therapy

programme. This includes group-work, one to one’s and complimentary
therapy sessions. In addition there is a one-week pre-programme and one-
week after-care programme provision. Access is for those who have at
least 4 months left to serve and who have committed drug related
offences.

7.2 A meeting5 was held with 12 inmates.

7.3 The DDA was informed that, “the majority of referrals are supposed to
come from CARAT’s” and that there have been problems with BME
inmates coming through this route. As a result Turning Point employed a
referrals worker (June 2003 to 31st March 2004) who is able to bring in a
significant number of referrals. With other referrals coming from mainly
CARAT’s and self-referrals the team is now achieving their 40% BME
target. Before this BME figures were as low as 10% or less.

7.4 However, most referrals come from other than the CARAT team. In
December 2003 63% of referrals came from Turning point and self-
referrals while the rest were from the CARAT team.

7.5 The Service User Activity Report for December shows that 47% of referrals
were from BME inmates. The RRMT Report for the same period shows
that the Programme was 62% BME. Departures from the programme
showed an ethnic breakdown that was 80% BME. However, it was not
possible to work out within which category these BME departures linked
to, i.e. Completed Care Plan but failed drug test/Left at own request/Asked to
leave by TP staff/Released early/asked to leave by HMP staff/etc.

7.6 Inmates on the waiting list cannot access the programme once it has begun
even if there are dropouts. Attrition rates can be as high as 40% due to, it
was stated, “the politics of the wing, inmates falling out with officers and
transition.”

5
See (Appendix 0.05)

5
7.7 It was said that after completion of the Turning Point programme the
CARAT team don’t always fluidly continue the intervention. As a result,
some inmates are able to access certain aspects of provision such as
acupuncture.

Fig. 3

Turning Point
Referrals - December
2003
10

White 10
Black 6
Asian 2
Mixed 1
Other 0

7.8 All Turning Point staff have attended Diversity training. It was stated that
feedback from regarding this was poor and that they were squeezing 2
day training into 2 –3 hours. It was said that during training the
vocabulary used by officers highlighted their racist attitudes. Another way
to view this is that training is provided partly in order to hear such
vocabulary and challenge it with the aim of assisting change. However, it
was said that many officers do not want to change their perceptions and
language. Much of the training time is spent “arguing” and some
attendees walk out stating, “this is a waste of time”. The DDA had
discussions with the manager regarding what she thought would
constitute a good training programme.

7.9 Turning Point also run Diversity groups for inmates and attend their own
mandatory Diversity training.

6
8. Pentonville Detox

8.1 The Clinical Nurse Manager stated that she has a nursing background and
is trained in addiction. She has non-clinical line management from an
officer because the original Manager left in August 2003. The Clinical
Nurse Manager is effectively running the service but un-officially and
stated that she has not been informed whether or not she is the Acting
Head of Detox.

8.2 It was stated that there are 11 staff members all of whom comprise a
varied cultural mix. There is currently no admin worker.

8.3 It was said that the prison has, on average, 275 identified drug users
entering the prison each month. From this number it was said that 95 to
110 are BME drug users (excluding cannabis users). On a typical day 22
out of 36 identified drug users want a detox referral. In December there
were 239 referrals to detox. 35% of these were BME, hence the ‘TAKE
ACTION’ statement in Race Relation Monitoring Report. BME drug users
for that month who started a detox stand at 38%6. Although RRMT
meetings discuss this issue there is at present no strategy to address this
ongoing situation.

8.4 It was said that Pentonville detox’s more drug users than all the London
prisons put together. C wing is allocated to detox, the 2’s and 3’s
(landings), while the 4’s and 5’s being allocate to those almost finished
detox/waiting list for Turning Point. However, in January C wing is 1 of 2
wings (out of 8 including the Health care unit) that has been identified to
TAKE ACTION within the RRMT report.

8.5 The DDA was informed that there is no translated drug related
information within the prison. At times this has caused problems with
assessments especially as 30% of the population are non-UK Nationals.

8.6 It was said that there is not a lot of time available for after-care and there
was no health promotion. CARATs were said to be unable to do much
group-work due to their workload. Turning Point was viewed more
positively and able to meet the needs of inmates. In general it was felt that
more focus needs to be placed on needs and some staff in the prison may
not be able to see this.

8.7 The lack of adequate staff training was seen as a major issue for the team.
Training courses had to be taken out of annual leave and the team had no
training budget. As well as this there was no clinical supervision for the
Acting Manager.

6
See Fig. 4

7
 Fig.4

No. of Detox's started in

December
160

140

120

100

80

60

40

20
0
%

%
White 148 62
Mixed 11 4.58
Asian 29 12
Black 50 21
Other 2 0.8
BME% 92 38

8.8 The DDA has accessed no information regarding completion of detox that
can be cross-referenced with fig. 4.

8.9 When asked how the nurse/Doctor determines who is referred to the
substance misuse team the reply came that they often refer all new drug
users.

8.10 There is disagreement within the team in regard to drug users ‘slipping
through the net’. It was stated that first timers within the prison system
may do so but word soon gets around regarding the benefits of making
contact with services, i.e. time out of cells and becoming drug free. It was
stated that stronger links are needed between services within the prison.
This has been raised during meetings but it appears that the opportunity
was not taken up by services. The detox team state that they have access to
very little information after inmates leave their care.

8
8.11 The observation was made that Pentonville’s drug related provision
works as separate units and resources would be better used if a strategy
were put in place to help services work more whole-istically.

8.12 Detox staff also felt that there should be substance misuse and advice
drop-in ‘s on the wings.

9. Voluntary Testing Unit

9.1 The DDA found the following information of interest:

• The capacity of the VTU; 39, compared to the figures for those
signed up to a VDT compact; 378.
• There is no ethnic breakdown of those on a VDT compact.
• The VTU is 54% BME.
• There are no structured interventions for those on the VTU. Some
inmates have called for a whole will to be designated as a VTU.

Fig.5
December 2003
Voluntary Drug Testing/Unit

400 378
339
350
300
250
200
150
100 39 9
50 7
0
0

Total signed up to VDT

Total signed up to VDT but not in VTU
Total VTU Places available
Total number of new inmates placed on VTU
Number left the VTU
VTU waiting list

9
10. Mapping of Treatment Pathways at HMP Pentonville

10
11. HMP Pentonville Statistics and Monitoring Systems

11.1 The figures below are drawn from data gained from the Race Relations
Liaison Officer and Represent the month of January 2004.

Fig.3.

Total Pentonville prison population 1102 inmates

BME prison Population 541
BME as a % of the Total population 49% (Previous months up to 52%)
Breakdown Black: 36.38%; Asian 7.71%; White
50.91%; Other 4.9%
BME Remanders 51%
Non-UK Nationals 31%
Staff 29.92% BME

11.2 The RRLO monitors drug related intervention within the Prison. The
month of January saw the first ‘TAKE ACTION’ remark on the traffic light
monitoring system for the CARAT team this financial year.

11.3 ‘TAKE ACTION’ was said to be an ongoing feature of the Detox service’s
figures as was the case during January 2004. Cross-referenced with this
were the figures for C-wing (detox/treatment), which also shows ‘TAKE
ACTION’.

12 Race Relations and Diversity

12.1 HMP Pentonville has a full-time RRLO. As already stated The RRLO
stated that Detox figures were an ongoing issue in regard to BME up-take.
On the traffic light system ‘TAKE ACTION’ means that the particular
service or aspect of provision will be looked into to identify reasons rather
than, in the case of ‘TAKE ACTION’ in regard to inmate enhanced status,
simply moving more BME inmates onto that status. It was said that Detox
figures are discussed within Race Relations Meetings but for years the
situation has been the same. The DDA was shown evidence of this from
past minutes where every meeting had a reference to detox figures.
January’s Minutes stated that, “Some prisoners with a drug habit may not
wish to be detoxed and there is still no detox for crack cocaine users.”
However, there is no evidence of a specific strategy drafted on the back of
an identification of specific reasons for the shortfall.

12.2 The RRLO felt that more crack users fall through the net than is admitted
or known and this was seen as the main cause for the low BME detox
figures.

11
12.3 Other issues identified were:

• Problems with allocation of space for groups.

• Lack of drug related information.
• Lack of communication with inmates.

12.4 It was stated that there are two facilitators for Diversity training. The DDA
met briefly with one of the facilitators who explained the training
resources and the way in which training was carried out. Feedback was
said to be “good/OK” but there has not been the opportunity to assess the
full impact of training sessions. The key was said to be the confidence and
experience of facilitators. This discussion was in contrast to the discussion
held with CARAT staff on the subject of Diversity training.

12.5 While looking at the RRMT Report for December 2003 it was noticed that
there were what appeared to be anomalies in the system. For example,
under the heading ‘Use of Control & Restraint’ (number of times C & R
used), the following figures were cited; Asian 0, Black 12 (52%), Other 1
(4%), White 10 (43%) yet the system showed ‘OK’. In other words, Control
and Restraint can be used a disproportionate number of times on one
particular Race and the system shows ‘OK’.

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

13.1 Much of the information gathered throughout the process of this visit
suggests that workforce developmental issues, present a significant
challenge to Pentonville in relation to the successful implementation of its
drugs strategy. As a consequence of this exercise, it has been established
that HMP Pentonville 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’s7 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”

7
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.

12
13.2 It should be noted that London demonstrates consistently higher rates of
drug use than any other region in the U.K8 The Mayor for London
established the Greater London Drug and Alcohol Alliance (GLADA)9
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
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.

13.3 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.

13.4 In the area of service delivery (TNA A) the population 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

13.5 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,

8
Audit Commission – Changing Habits (2002)
9
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
services.
10
Federation Equality Health Check (2002)

13
 structures and professional competencies to deal with the challenges that
will come with an increasingly diverse workforce10 and the communities
within which they serve.

14. The Race Relations Amendment Act (RRAA2000) & the BME prison
population in Wormwood Scrubs

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

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

14.2 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.

14.3 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.

14.4 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.

11
Sangster D, Shiner M, Patel K and Sheikh N (2002)
12
Ahmun V, 2000

14
15. Conclusion

15.1 Pentonville is much like other London prisons in terms of service

provision in as much as the provision is not able to meet the demand and
to be effective while doing so. This appears to be the most critical feature
of feedback with staff and inmates. Even so, the Turning Point programme
seems to be effective and is able to attract a significant number of BME
inmates

15.2 The CARAT service staff mix is refreshing to see and is positive in
comparison to other establishments. The CARAT team have also taken on
a staff member as part of the Modern Apprenticeship Scheme and taken it
upon themselves to employ a BME senior crack worker both of which are
highly positive developments in their service.

15.3 However, the monitoring and evaluation of some aspects of service

provision is lacking particularly in relation to group-work. In other words,
if the question is asked, “how effective are drug related groups in the
prison?” there is a lack of information to prove effectiveness. Another area
that is lacking is the identification of causes for low BME up-take, where
they occur, and actions to address these shortfalls. This applies in
particular to the Detox provision.

15.4 There appears to be a strained relationship between The CARAT service

and Turning Point focused around the fact that 63% of referrals come from
other than the CARAT team. As well as this there are no reported
counselling sessions to date (03 – 04). Inmates highlighted this point
during discussions and saw this as a major issue. The pressures on the
CARAT team to meet KPT’s around initial assessments and the ‘politics of
the wings’ as outlined within this report have been cited as the reasons
behind this. Alongside this the Team built up 2306 current active cases by
end of 3rd Quarter, a workload that is far too great.

15.6 As was the case in HMP’s Wormwood Scrubs and Wandsworth, findings
suggest that the nature and level of provision does not provide the BME
prison population with an effective response, particularly with regard to
stimulant users and remand prisoners.

15.7 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, The
Blenheim Project etc. These can be adapted and tailored to suit the
changing needs of the prison environment. Thus, supporting HMP
Wormwood Scrub’s aim to provide more equitable service provision in
relation to drugs treatment and intervention for those from BME and
marginalised communities.

15
Recommendations________________________________________________

1 Pentonville Drugs Strategy Meetings

1.1 Issues pertaining to Diversity and BME inmates within Drug Strategy
Meetings are often seen as confusing to discuss due to a lack of knowledge
of just how the 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 Prison Officers in general should be trained in drug related issues and
recovery in order for them to work alongside and as part of the prison
drug strategy.

1.3 Measures need to put in place to transform the VTU into a genuine drug
free wing with full access to a range of Relapse Prevention/aftercare
intervention.

2 RAPt CARAT Service – Pentonville

2.1 Robust Monitoring (including ethnic monitoring) and evaluation systems

must be put in place for group-work.

2.2 Access to structured counselling is an important aspect of treatment11 for

drug users and those seeking to maintain abstinence. The CARAT team
and Drug Strategy Group must work together to find a solution to the lack
of structured counselling in the prison. This is within the remit of the
CARAT team and constitutes a critical feature in drug related recovery.

2.3 Home Office guidance, The Development and Practice Report, states that:

“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 to establish
ongoing contact with services outside prison”. p.6.

11
NTA – Models of Care

16
 a) Alongside the crack awareness group there is a need for a rolling,
intensive training/support group that targets (but not exclusively) those
on remand or short sentences. These programmes need to be deeper than
simply cognitive behavioural and broader than a focus on ‘the drug’
enabling participants to explore who they are. Such groups need to be
facilitated by experienced, credible and confident workers.

Extensive focus on longer-term inmates occurs to the detriment of Short-

term/remand inmates who are all too often excluded from provision. An
alternative would be to put in place group-work that is specific to the
needs of those who will very soon be out in the community. The Drugs
and Prisons Report by The Select Committee on Home Affairs stated back
in 2000:

59 “Drug treatment in prisons has focused on longer-term prisoners. The

same attention needs to be paid to remand and short-term prisoners. They are
more likely to be in prison for drug-motivated crime and treatment is more
urgent because they will be released sooner. They are the greatest challenge if
the cycle of addiction, crime and imprisonment are to be broken. We
recommend that the Prison Service should make more drug rehabilitation
programmes available to remand and short-term prisoners beyond what is
currently envisaged under the CARAT service.”

b) Offending behaviour groups should be provided for those who all as a

preparation for leaving the prison.

c) It is essential that through-care/pre-release planning is reviewed in

order to put forward a more realistic view of what can be done for
inmates. Also, contract services need to be better informed of what
community-based services are currently available and ensure that time is
allocated to assisting inmates with planning for their release.

3 Turning Point - Pentonville

3.1 In light of attrition rates that can be as high as 40% new inmates would
benefit from more flexibility with inmates accessing the programme after
it has begun with, perhaps, a cut-off point of 2 weeks into the core
programme.

3.2 There is a need for a closer working relationship with the CARAT team in
order for the services to have a more unified approach to meeting the
needs of inmates.

3.3 There is a need for clearer ethnic monitoring in relation to inmates at

various stages in the process of treatment. For example, discharges. The
NTA states in Models of Care:

17
 “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

4 Pentonville Detox

4.1 The Drug Strategy Team require expert assistance in identifying the
specific issues regarding low BME up-take of the service and an action
plan for implementing change. The case is the same for most other
establishments. In the DDA’s assessment of the available information the
problem arises due to the way in which a detox is viewed within a prison
context and what a detox is in reality. When this is analysed, particularly
in relation to crack, a significant aspect of the problem becomes clear. In
short, detox is concerned with Opiate users, Alcohol addiction and other
substances than illustrate prominent and apparent physical withdrawal
symptoms that can be managed, to a large extent, by medication. So what
is happening is that an inmate is being physically detoxed from a
substance. With crack the situation is, to some degree and depending on
the level/length of time of use, different. Crack detox for most would be
therapeutic groups and talk therapy. This is why the crack group in
Brixton was so successful. Inmates do not detox from crack in the same
way that an alcoholic or heroin user would detox from their drug of
choice. Therefore, an analysis should be conducted into the level BME
crack users within the prison in order to:

a. identify whether this is in fact the central feature to low up-take.

b. find out what inmates have to say on why they don’t access the
provision in sufficient numbers.
c. find out what inmates think needs to be done about the situation
d. use this information to assist the drafting of action points for the
required change.

4.2 Detox staff have highlighted the absence of a training budget as a major
obstacle to their ongoing development as well as morale. As well as this
access to training is further hindered due to the stipulation that annual
leave is used in order to attend. If the prison is to retain quality staff, keep
them motivated and raise levels of morale this concessions need to be
made.

5 Voluntary Testing Unit

5.1 In light of an increasing drug user population, the number of inmates

signed up to VDT compacts and (in comparison) the present capacity of

18
 the VTU discussions need to commence regarding how the unit can be
expanded and what provision could be included to upgrade the unit.

6 Race Relations and Diversity

6.1 Diversity training needs to be properly evaluated with opportunities to

discuss issues after the training so that concerns are not left to fester. Good
practice would be to hold one or two open groups at monthly intervals
after such training. There is a need for training across the estate that assists
facilitators in bringing to life the Diversity training package.

7 Workforce & Cultural Competence

7.1 Services as a whole would benefit from a survey as well as ongoing

feedback groups that allow inmates to express what they want from a
drug service and their perceptions of current services. As well as
informing the evolution of provision this would include inmates in the
change process. 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

7.2 The Drug Strategy needs to, as part of its vision, map out what constitutes
a service matrix that will ensure the most effective equality based
treatment provision. This could be drawn up on the back of consultation
with inmates and with assistance from specialists in the drug treatment
field.

7.3 Drug related information (Harm Reduction, Information on dangers

associated with various drugs, changing from one drug to another to try
and avoid MDT positive results, etc.) in various languages would be
beneficial for those at reception and within services on the wings.

7.4 Consultation should take place across the board in order to develop a
culturally sensitive model of working suited to the prison service.

8. Workforce Planning

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

19
8.2 Work with Federation to develop Diversity Manual – ‘Identity &
Difference’ for bespoke diversity training programme for service staff and
providers.

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

20
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’

21
 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

22
 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

23
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.

24
 (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

25
 (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

26
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

27
 (Appendix 0.03)

Name Position Date visited

Amy Williams Clinical Nurse Manager 10th December/24th
Feb.

Alan Ding Substance Misuse & 20/1/04

After-care Nurse

Peter Rodriguez Deputy Manager 24th February

Wally Adegun RRLO 5th December

Ali Young CARAT MAnager 1stDecember/

open access

Diane Newton Turning Point Manager 17th February

12 inmates 24th February

3 Turning Point 2 x Officers 17th Februay

staff

28
 (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?

• How many BME inmates are referred to the service?

• 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?

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

• Can you outline staff training in relation to Diversity?

• Do services feel that provision is sensitive to cultural differences?

• 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?

29
 (Appendix 0.05)
1. Inmate perspectives

A group was held with 12 inmates in order to gain their thoughts and
feelings on drug related intervention. Notes were taken during this group.

“The CARAT team are supportive but they need more staff to deal
properly with inmates. They can’t do one-to-ones when their supposed to.
On Turning Point the 12 week groups should be longer. 20 come then 20
go. They’ve stayed away from drugs then they go to the general
population. I think that at least half of one wing should be a VTU.”

“More needs to be done for inmates leaving prison. I’ve known some
people who plead guilty just so they can get a rehab in jail.”

“Too many people leave prison NFA and this leads to continued
offending. I want to integrate back into society, I don’t want drugs
anymore, I want to change, we are ready.”

“Some prison officers are on a humiliation tip. They’ll say that so and so is
on the ‘Junkie wing’ but they should see this as positive because inmates
are changing. Some of them like to play mind-games. Officers need
training on how to handle inmates who are in recovery.”

“Officers don’t have training in rehab and drugs etc yet they are working
around people in recovery.”

“Officers take it upon themselves to remove inmates from Turning Point

without discussion. Inmates on Turning Point are seen as in a privileged
position so some inmates seek to intimidate them. Officers sometimes take
your letters and delay giving them out and this is not a one off.”

“Officer let professional status and personal feelings around drug users
collide.”

“We used to have NA and AA in the prison but not anymore. We wanted
to facilitate our own NA type group, like on a Sunday morning, but this
was refused.”

“There are officers in the jail who can be paid to do anything, they bring in
some of the drugs.”

“We’ve had no input from probation whatsoever. I’ve been waiting to see
them for months…..(another inmate) – I’ve been here since May and not
seen them.”

There were reports of many incidents where inmates get out of prison and
probation don’t know who is assigned to them. Ex-inmate goes from office to office
trying to sort this out then 3 weeks later there is a warrant out for his arrest. The

30
ex-inmates licence is then recalled for failing to comply with regulations and they
do not receive licence recall appeal papers are not received.

“The chances of getting proper through-care is slim because co-ordination

is lacking.”

“I’ve been to Scrubs, etc. but Pentonville is incompetent. Some cells barely
have hot water, you wait four months for a dentist…”

“Racism is not the root of the problem here it is the way the prison is run.
They’re gonna get a riot happening here the way things are going.”

“I’ve seen a lot of racist incidents in C wing towards Black officers and
other nationalities.”

“In one incident a white inmate was being racist over a period of time
against a Black guy who had mental problems, he slashes his arms and
stuff. The White guy threw something at the Black guy so he hit him. The
officers then all jumped on the Black inmate and dealt with him and then
took a statement from the White inmate.”

31
 (Appendix 0.06)

1 Staff perspectives

It was stated that there is a need for a quadrupling of resources to meet

the needs of all inmates added to this was the statement, “Why identify
drug users if (due to long waiting lists) no service is available for them.”

“Turning Point’s drop-out rate is too high and the programme is not
effective or intense enough.”

“Healthcare has many Black workers but the Management is White. Many
issues are present in Healthcare.”

“There is a big balancing issue between Supply of drugs, Security,

resources and treatment services.”

“Good practice is on paper but being ignored. Inmate needs are not really
being met.”

“As far as human resources and finance is concerned there is no priority

for drug users. Finances are shifted from allocated places.”

“There should be stats on crack groups, i.e. ethnic breakdown, but this
doesn’t exist.”

32