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 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Introduction Objectives Key Targets Methodology Meetings with key Stakeholders RAPt CARAT Service – Pentonville Turning Point - Pentonville Pentonville Detox Voluntary Testing Unit Mapping of Treatment Pathways at HMP Pentonville HMP Pentonville Statistics and Monitoring Systems Race Relations and Diversity Workforce Planning issues in the Substance Misuse sector in London The RRAA 2000 and the BME Prison Population in Pentonville Conclusion Recommendations References & Literature Review Appendices 1 1 1–2 2 3 3-5 5-6 7-9 9 10 11 11 - 12 12 - 14 14 15 16 - 20 21 22 - 32

1. 1.1

Introduction 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’. 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. Objectives 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. 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 Key Targets Key Target 2 Review Area and DSU data collection on BME use of drugs services.

1.2

2. 2.1

2.2

3. 3.1

1

See Key Targets and Work Programme (Appendix 0.01)

1

3.2 • 3.3

Key Targets 3. Review and evaluate service diversity training for service, employed staff. Visit 6 named establishments; report on findings 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. Methodology. 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.

• •

4. 4.1

2 3

See letter of introduction (Appendix 0.02) See Equality Health Check Update

2

5. 5.1

Meetings4 with Key Stakeholders 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. RAPt CARAT Service – Pentonville 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. 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. 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. 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

6. 6.1

6.2

6.3

6.4

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
Asian Black Other White Oct 11 20 7 28 Nov 10 36 7 56 Dec 4 36 8 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. Turning Point - Pentonville 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 oneweek after-care programme provision. Access is for those who have at least 4 months left to serve and who have committed drug related offences. A meeting5 was held with 12 inmates. 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. However, most referrals come from other than the CARAT team. In December 2003 63% of referrals came from Turning point and selfreferrals while the rest were from the CARAT team. 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. 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.”

7. 7.1

7.2 7.3

7.4

7.5

7.6

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 8

6 4 2 0

White Black Asian Mixed Other

10 6 2 1 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. Turning Point also run Diversity groups for inmates and attend their own mandatory Diversity training.

7.9

6

8. 8.1

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

8.2 8.3

8.4

8.5

8.6

8.7

6

See Fig. 4

7

Fig.4
No. of Detox's started in December

160 140 120 100 80 60 40 20 0

% %

White Mixed Asian Black Other BME%

148 11 29 50 2 92

62 4.58 12 21 0.8 38

8.8 8.9

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

8.10

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

8.12

9. 9.1

Fig.5

December 2003 Voluntary Drug Testing/Unit 400 350 300 250 200 150 100 50 0

378 339

39 9 7

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. 11.1

HMP Pentonville Statistics and Monitoring Systems 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 BME prison Population BME as a % of the Total population Breakdown BME Remanders Non-UK Nationals Staff 1102 inmates 541 49% (Previous months up to 52%) Black: 36.38%; Asian 7.71%; White 50.91%; Other 4.9% 51% 31% 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. ‘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’. Race Relations and Diversity 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. 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.

11.3

12 12.1

12.2

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. 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’. Workforce Planning Issues in the Substance Misuse Sector in London 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”

12.5

13. 13.1

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. 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. 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

13.3

13.4

• • • • 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 9

Audit Commission – Changing Habits (2002) 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. 14.1 The Race Relations Amendment Act (RRAA2000) & the BME prison population in Wormwood Scrubs ‘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 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. 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. 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.

14.2

14.3

14.4

11 12

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

14

15. 15.1

Conclusion 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 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. 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. 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. 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. 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.

15.2

15.3

15.4

15.6

15.7

15

Recommendations________________________________________________ 1 1.1 Pentonville Drugs Strategy Meetings 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. 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. 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. RAPt CARAT Service – Pentonville Robust Monitoring (including ethnic monitoring) and evaluation systems must be put in place for group-work. 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. 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) prerelease planning to address employment and housing needs, and to establish ongoing contact with services outside prison”. p.6.

1.2

1.3

2 2.1 2.2

2.3

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 Shortterm/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 3.1 Turning Point - Pentonville 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. 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. 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:

3.2

3.3

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 4.1 Pentonville Detox 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. Voluntary Testing Unit In light of an increasing drug user population, the number of inmates signed up to VDT compacts and (in comparison) the present capacity of

5 5.1

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 6.1 Race Relations and Diversity 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. Workforce & Cultural Competence 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. 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. Consultation should take place across the board in order to develop a culturally sensitive model of working suited to the prison service. Workforce Planning Carry out an Equality Health Check to consider implications for Prison Service, BME professionals and Communities.

7 7.1

7.3

7.4

8. 8.1

19

8.2

Work with Federation to develop Diversity Manual – ‘Identity & Difference’ for bespoke diversity training programme for service staff and providers. Provision of leadership and management training for service staff and providers working with BME communities.

8.3

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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’

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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 28th November 03 .

Comment Essential requirement

Identify Mentor/Coach for external support and supervision (1) Support/advise steering group in relation to issues pertaining to diversity and drugs in prisons

Organise, coordinate and minute meetings, disseminate information

• Produce quarterly reports (December, March) ) Review all existing area and DSU data collection on BME use of prison drugs services • Review transcripts of Focus groups and produce report of key findings Review findings and responses to Action Research questionnaire. Visit HMPS London Area Office and access intranet (1 full day). Highlight any indicated service shortfall or trends. Report findings (plus Focus groups, Action Research) to ADC, Steering Group, FSC, FCEO

TBA – after second meeting with Huseyin

DDA/Prison Service (PA)

17th Dec 03 and 29th March 04

DDA

31st Oct. 03 DDA/HC 31 Oct. 03 DDA/HC Week commencing 3rd Nov.03 31st October 2003/ongoing DDA
st

DDA,

(3) Evaluate Training needs and develop training pack for service employed staff • Develop, disseminate, evaluate training needs questionnaire. January 2004 February

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questionnaire. • Make recommendations to steering group

February February 2004

DDA, HC,NTO DDA, CEO, HC

(4) Review and evaluate service diversity training for service employed staff

Organise Federation Diversity Training Session “Identity & Difference” for prison drug service staff Disseminate Evaluation forms, collate and feedback Make recommendations for further training.

February 2004 DDA, HC February 2004 DDA, HC 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) explaining context of prison service work, rationale and (2) offering Federation consultancy services Visit 6 named establishments on at least two occasions each. Make recommendations on any necessary systems improvements. Highlight any indicated service shortfall or trends to be reviewed by steering group Follow up letter to Chief Executives of contract agencies in conjunction with ADC to arrange meetings with Contractors CEO’s & CEO, HC following completion of the Equality Health Check Process

7th November 2003

DDA, CEO, HC

by 9th January 2003 19th January 2004

DDA CEO, HC, DDA

15th January 2004

DDA, CEO, HC

Inform development of audit tool to establish awareness and practice pertaining to prison service duties and diversity

TBA 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

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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.

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(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. Review Area and DSU data collection on BME use of drugs services. Review and evaluate diversity training for service employed staff. Evaluate Training needs and develop training pack for service employed staff 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

2. 3. 4. 5.

SAMPLE

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 introduce myself to between the after which I had a chance to briefly . I am now booked to attend various meetings at .

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

Yours Sincerely,

Abd Al-Rahman Drugs and Diversity Adviser

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(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

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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

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(Appendix 0.03)

Name
Amy Williams Alan Ding Peter Rodriguez Wally Adegun Ali Young Diane Newton 12 inmates 3 Turning staff Point

Position
Clinical Nurse Manager Substance Misuse & After-care Nurse Deputy Manager RRLO CARAT MAnager Turning Point Manager

Date visited
10th December/24th Feb. 20/1/04 24th February 5th December 1stDecember/ open access 17th February 24th February

2 x Officers

17th Februay

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(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?


• • • • • • • •

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(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

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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.”

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(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.”

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