Bibliography and Literature Review

National Centre for Cultural Competence – ‘Conceptual Frameworks/Models, Guiding

Values and Principles’

Audit Commission – Change Here, Managing Change to improve Local Services (2001)
DSD – Updated Drug Strategy 2002

Substance Misuse Advisory Service – Commissioning Standards - drug and Alcohol

treatment and care

NTA - Commissioning definitions and frameworks

NTA – Models of Care

NTA – ‘RRAA 2000 – Implementing good practice’

Home Office Online Report 33/03 – Differential substance misuse needs of women, ethnic
minorities and young offenders in prison

CRE – Public Procurement and Race Equality, Guidelines for public authorities

Abd Al-Rahman – ‘Report on Drugs Strategy; Implementation & the BME Prison Population

Audit Commission – ‘Change Here’

Task Force to Review Services for Drug Misusers – Report of an independent review of drug
treatment services in England (1996) DoH

Sangster, et al – ‘Delivering drug services to Black and ethnic-minority communities.

P. Lamour – Equality Health Check, HMPS London Area

Home Office guidance The Development and Practice Report

Julie Clouder (DSD) - Diversity Manual; How to embed equality issues into the delivery of the
national drug strategy

CRE/HMPS – Implementing Race Equality in Prisons

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 (Appendix 0.01)

Estimates of numbers of BME drug users being identified/month entering

London Area Prison Establishments:
The table below is based on figures requested by the Federation’s Drug & Diversity Adviser from
Healthcare or DSC’s from 5 London prison establishments for the month of December 2003.

Latchmere House is not included below because inmates enter the prison drug free. There are a small
number of relapses but, because the contract drug service did not monitor its clients for a protracted length
of time, no data is available. Feltham was unable to supply figures so conservative estimates are included
based on CARAT initial assessments.

The total average and average new BME drug user/month figure was gained from Healthcare or Prison
Drug Strategy Co-ordinators. These figures do not account for the following:

• Those who start using whilst in prison.

• Users who are able to get past the first hurdle (initial drug screen).
• Those who have recently stopped using then re-start in prison
• Cannabis users.

Calculations for Brixton have been based on the assumption stated by Healthcare “that 85% of new inmates
have a Substance misuse problem”. It has also been said that “Many of those who use only Crack are most
probably not being identified at reception”

Pentonville Brixton W. Scrubs Wandsworth Feltham Total

Total Pop. 1105 795 1168 1404 635 5107
Total BME 47% - 52% 50 –55% 66% 44.16% 56.38% 2666 (52%) –
(Monthly 7.51% Asian 5.66% Asian 10.27% Asian 48% excluding overall 2760 (54%)
variance) 35.29% Black 40% Black 48% Black Vulnerable Persons
4.89% Other 1.89% Mixed 7.53% Other Unit. 36.68% Black, A-side 50%
52.31% White 5.53% Other 34% White 5.64%Asian B-side 61%
46.04% White 6.49% Other.

VPU 30.53% BME.

Average total 275 - 300 295 84 - 121 130 150 – 200 934 - 1046
drug users Estimate
identified at
reception/month
Average new 95 - 110 90 - 110 36 – 50 32 - 43 35 – 45
BME drug Estimate
uses/month at
reception
(Monthly
variance)

Total new BME Drug users entering 5 High 358 per month 4296 per yr
London prisons/month/year (From Low 288 per month 3456 per yr
available figures)

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 (Appendix 0.02)

The Following is taken from The Home Office Briefing Paper No.16 by Deborah
Sangster, Michael Shiner, Kamlesh Patel and Noreen Sheikh - ‘Delivering Drug Services to
Black and Ethnic-Minority Communities’.

“Good Practice Points.

The report says that while there is a place for specialist services, it is crucial for
mainstream providers to develop accessible and appropriate services. It outlines the
basis of good practice in developing drug services for Black and Ethnic-Minority drug
users.

Cultural Ownership and Leadership within a service, including a team made up of

people from different ethnic backgrounds and Black and ethnic-minority representation
within its management structure.

Symbols which clearly show than an agency is there to meet the needs of a wide range
of users.

Familiarity with and ability to meet the distinct needs of communities. Services must
be supported by an understanding of the norms, history, codes of conduct and beliefs
within communities.

Alternative forms of help for users that go beyond a narrow medical approach to drug
treatment and which understand that drug use may be an escape from social
deprivation.

Creating different services to break away from services which are heavily focused on
opiate use.

Black and ethnic-minority workers employed as part of an ongoing process and not just
a ‘one-off’.

Services that are in and for the community, including education and training for
community members.

These are just as important in planning and commissioning as in delivering services”

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 (Appendix 0.03)

Key Recommendations extracted from

six London Area Prison Reports

Workforce and Cultural Competence

• There is a need for experienced drug workers who have the ability to effectively
engage and relate with BME inmates at the reception stage allowing inmates to
familiarise themselves with providers and to become motivated to seek further
assistance. This earlier contact with drug services will aim to lower the number
of drug users, in particular crack users, refusing to see the CARAT team. Also,
this will help to rectify what was highlighted within the focus group earlier in
the year re: confusion in regard to how the CARAT team is accessed and the
process through which the team accesses inmates.

• There needs to be provision of leadership and management training for service

staff and providers working with BME communities.

• Prison Officers in general should be offered training in drug related issues and
recovery in order for them to work alongside and as part of the prison drug
strategy. Training on Cultural Competence theory and practice is required for the
Drug Strategy team.

Race Relations and Foreign Nationals

• The lack of drug related information in a variety of languages has been an

ongoing issue within the substance misuse field in general. Although this was
not raised within the focus groups and given that the overall prison population
of foreign nationals is over 11% and rising the provision of drugs and various
other information in languages other than English needs to occur.

• The Diversity Officer receives data from all areas of the prison except data
related to drugs intervention. Although to date it has not been standard practice
to do so, the Diversity Officer should be supplied with full drug related data.
Perhaps the most important reason for this is in order to bring together the areas
of Drug strategy/intervention and diversity/BME inmates.

• 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.

• Contract service recruitment and retention policies need to be reviewed and

made live to ensure recruitment process and procedures for staff are designed to
appeal to a wider audience and therefore are able to successfully attract
professionals from BME communities.

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Monitoring and Evaluation

• Programme evaluation and inmate feedback processes need to be put in place in

order to make better sense of high attrition rates and to assist Turning Point in
meeting the diverse needs of inmates.

• 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.

• At present assessing the work of CARATs revolves around numbers. These

numbers need defining and definitions need to be made clear so that
interpretation can occur accurately. For example, CARAT counselling sessions in
one month can be as high as 140, but how many individuals (as opposed to
sessions) does this correspond to and what constitutes a ‘counselling session’ in
terms of time and setting? KPT’s need to include information from groups, i.e.
numbers involved and ethnic breakdown. As well as this there needs to be a
qualitative aspect to KPT’s that seek to measure the effectiveness of the service.
Without this information it will not be possible to assess in real terms how
effective the CARAT team is.

• Steps need to be taken to ensure that the CARAT team along with other services
within Wormwood Scrubs operate as one service with elements managed by
contractors. At present there is no uniformity in terms of care standards, no
equity in service provision for various drug usage and no robust qualitative
evaluation process for counselling sessions or group-work.

• 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 CARAT team needs to monitor the ethnicity of those participating in groups.
The team also needs to evaluate group-work as standard practice.

Treatment Provision

• Extensive focus on long-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.

• There is a need for crack specific workers – 49% of reception tests are positive for
crack. Crack users also benefit from structured talk therapy and groups – this is a

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 gap that needs to be filled if the Prison is to make significant progress in treating
BME inmates and inmates as a whole and preparing inmates for life outside.

• 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.

• The Federation, Blenheim project or other organisation with a track record of

running crack groups for BME communities needs to be approached with the
view to developing a programme as part of service provision open to those on
short and longer sentences as well as on remand.

• There needs to be stronger evidence gathered for BME take up of groups and
evidence of the effectiveness of such groups.

• It was stated that there is a BME short-fall even though the Pathways Project sees
66% BME ex-inmates and 80% primary crack users. The Blenheim Project stated
that they see 340 out of 750 inmates. This, in the DDA’s opinion, is due to ‘detox’
being inappropriate for crack users.

• 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.

• 85% of the prison is said to be drug users or those with a Dual Diagnosis. With
drug users spread over a number of wings and two detox staff to cover the work
more staff are needed. To further compound the situation there is no admin
support. If Detox staff are expected to increase the number of BME inmates
accessing their service then they will need the staff to do so.

• 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.

Drug Strategy

• 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.

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• Mainstreaming of issues specific to BME drug users within the Prison through
inclusion on the agenda within Drug Strategy meetings as a standing agenda
item &/or within service updates to be evidenced within minutes.

• The role of SMTCO would make an effective addition to provision in other

prisons such as Wormwood Scrubs.

• In order to assist the process of bringing together the areas of drugs and diversity
a Diversity Officer should attend drug strategy meetings.

• Leaflets about specific issues raised by inmates, i.e. MDT and moving from one
drug to another that has less days for detection could be provided as a way
seeking to prevent such cases.

• The Federation, Blenheim project or other organisation with a track record of

working with BME communities needs to be approached with the view to
developing a crack specific programme as part of overall service provision open
to those on short and longer sentences as well as on remand.

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