Speech and language therapy at Feltham Young Offenders Institution

In this episode we talk to Christian Boakye an SLT as Feltham Young Offenders Institution. It's a fascinating look into how speech and language therapy can help young offenders deal with custodial sentences and improve their chances of rehabilitation upon release. We also talk about prison abolition, diversity in the workforce and other issues related to criminal justice. 

The interview is conducted by Jacques Strauss, freelance digital producer.

Please be aware that the views expressed are those of the guests and not the RCSLT.

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Transcript

Speaker Key:

H:            HOST (Jaques)
 
CB:         CHRISTIAN BOAKYE


H - 0:00:00
Oh, that face you pulled!  I forget you can see me, my camera… I need to sort this out so that…
[FADES OUT]

0:00:08 -  MUSIC PLAYS -

H - 0:00:22
Welcome to another RCSLT podcast.  Today’s guest is Christian Boakye.  I'm really excited to talk to him, because I think he represents the future of the profession, which is more diverse.  He’s a young guy, he’s a person of colour and he works in criminal justice. 

He’s had an interesting career trajectory, in that he started off in a secure forensic psychiatric unit before moving to Feltham Young Offenders Institute. 

I think as much as the public are aware of the excellent work that SLTs do in clinical and educational settings, the work that is done in criminal justice is less well known.  Given that so many young offenders have language and communication difficulties that are often a contributing factor to the situation in which they find themselves and can often exacerbate the situation, it’s such important work in terms of prevention and rehabilitation.

I should just mention from the outset that the views expressed in this podcast are Christian’s and not necessarily those of the Central and North West and London NHS Foundation Trust. 

I'm going to start by asking you the question that I ask everyone who comes on the podcast: how did you get interested in speech and language therapy?


CB - 0:01:32
How did I get interested?  I’ve always wanted to work in healthcare, and I think it comes from… my mum’s a nurse and dad a carer, so I always was intrigued about healthcare, helping people, etc. 

Actually, initially – if I'm being very truthful – I wanted to do medicine, so I went down the road of biology, chemistry, physics and French at A Level, but didn’t quite work out, Jacques [over speaking].  And so I was like, actually, what am I good at?  I quite enjoy the biology side of things, I like how things work, the anatomy, etc., but I also really loved English and history, so that’s all languages. 

And actually, how I came across SLT was, at the time, I was also just doing some odd jobs and I was actually working at a rehab centre, so it’s almost like a halfway house, where people have… discharged from hospital.  If they’re not well enough to go home they go to this halfway house.  And there they had a range of… a multidisciplinary team.

Cleaning a room one day, I came across a little exercise – just a piece of paper.  Looking back on it now, I know what it was.  It was like a semantics… trying to strengthen the person’s semantic system.  So I think it was [inaudible 0:02:58] and they have to find the appropriate category.  And I was like, right, that’s really intriguing.  So I was just like, okay, what’s speech and language therapy?  I went to a few talks on it, but the more I read about it, the more I was like, wow, what a great area. 

I also had the opportunity to shadow a little bit some local community speech and language therapists and, yeah, I never looked back, really.


H - 0:03:26
Again, we spoke about something which has come up quite often, which is that most SLTs encountered an SLT first before they decided to train in the profession.  But Christian raised an interesting point that I hadn't considered.


CB - 0:03:40
For me, I think that shows the power of SLT in a way, because people see how it works and how it affects people’s lives.  Then they say, actually, I want to be part of this, and then pursue a career in SLT.

I work with colleagues who perhaps were OT assistants and saw those enjoyment sessions with SLTs and thought, actually, this is a viable option for me.


H - 0:04:06
Yes, let’s actually get to the reason why we really wanted to talk to you.  I wonder if you could just tell us where you work and what it is you do?


CB - 0:04:14
I work in HMYOI Feltham.  It’s a Young Offenders Institute in London.  And Feltham is unique in the sense that it does have kids who are under 18, so you have one section which is from 15 to about 17 and 11 months, and you’ve got the young adult section, which is there from 18 until about 21/22 [they should be moving on 0:04:38].  That’s where I work.


H - 0:04:39
What interested you in this particular area?


CB - 0:04:44
My interest in forensics was stoked from training in Birmingham when I first realised, actually, this is a specific area you could train in, my interest was stoked straight away.  And I had the good fortune of having a placement in a forensic mental health hospital and I really liked the forensic aspect to it, but particularly how my placement supervisor… her name was Jan Cape, who is retired now, but I really liked how functional it was.  I really like how you worked with the multidisciplinary team to make a real difference.  And also the people are interesting.  I’ve always been intrigued by people and their journey. 

I, from qualifying, had the opportunity to work in another forensic mental health hospital, which was St Andrews.  And then the last year or so of that, I worked predominantly with adolescents, so I loved working with young people.  Again, they had difficulties such as learning disability, autism, mental health difficulties.  I guess this was the next step up, really, in terms of working with this population in a secure setting. 

But yeah, I'm fascinated by their stories, and I think particularly in custody these are people who are going through a tough time, but the journey is so fascinating.  If you’ve got an opportunity to make a difference in one of these people’s lives, I think it’s just such a precious opportunity to take and support them in any which way we can.


H - 0:06:21
What sort of crossover do you then see between having worked in a mental health hospital and now in a secure unit?  How different is it?


CB - 0:06:35
Again in Feltham, I think there’s quite a bit of resource there.  Again, I have the opportunity to work with occupational therapists, psychologists, we’ve got psychiatrists.  Actually, we’re recruiting for an art therapist.  I think we’re thinking creatively of how to support young people. 

In terms of comparison, I think it really stood me in good stead.  Bar the security aspect of things; obviously, prisoners, it’s more secure, but in terms of the approach, you often adopt a multidisciplinary approach.  What you’re trying to do is understand person’s journey, so, you know, what’s happened to you?  What’s happened along the way?  And where does everyone’s roles fit in in terms of supporting this person to achieve the best possible outcomes.


H - 0:07:27
I guess, generally, people would ask, what exactly is the role of an SLT when you’re working in a secure setting?  Is it about rehabilitation before release, or what is the overall strategy?  What are your main goals?


CB - 0:07:43
Of course.  I would describe my goals as to highlight the communication needs of our patient and make recommendations in terms of how to support that so they’re able to engage whilst they’re in custody.  So whether they’re engaging with interventions, they’re engaging in the regime, actually following instructions. 

But also beyond that, giving them the skills to be able to feel able to make and maintain relationships, for example, or being confident in their communication skills so they’re more confident to go through the process of getting a job. 

In terms of actual custody, the evidence shows that at least 60% of our young people we work with will have some sort of speech, language and communication issue.  And if we recognise that, we’re able to support them. 

For example, in prison, there’s a load of jargon that is flying your way.  What is IOP?  What is canteen?  What’s a regime?  These are words you take for granted, but for a young person who’s just come to custody, it might be really difficult to really understand and follow what’s going on. 

So I try to highlight that and in my training to staff and colleagues, prison staff, I always say, look, let’s always check for understanding in terms of has this young person fully understood the instructions they’ve been given?  In terms of my colleagues who deliver interventions, actually, are the words I'm using too complex, for example?  Are there too many people in this group?  How well is the person able to pay attention and follow the content of the session?  Helping them to engage in the regime and beyond.


H - 0:09:28
So you’re actually playing a critical role in helping them to cope with what must be a very frightening and traumatising experience, but giving them the skills, the support that’s available at least can be utilised, I guess you’re saying?


CB - 0:09:41
Yes, and as a speech and language therapist you do help them in different parts of their journey.  For example, I was working with a young man who was on remand in custody.  His trial for murder was coming up, but this young man also had a stammer and he was incredibly anxious about giving evidence and is my stammer going to stop me being able to present myself in the best way I can? 

He also had a lot of witness of trauma.  This young person also had been stabbed before.  Actually, he was also very impacted by the index offence.  We did obviously a disfluency intervention, but I also worked with my colleague who was a psychologist and we did some joint sessions.  So she was working on grounding techniques, techniques to manage anxiety.  So we might do some breathing techniques before a session, some visualisation, but also he was being encouraged to utilise those therapeutic techniques in his one-to-one sessions with the psychologist as well in terms of how quickly he’s speaking, but also the knowledge of the modification techniques to get through stammering moments a little bit easier. 

You might be working with someone at that stage in their journey in the criminal justice system.  You might be working with someone who has been sentenced, but is going to do some, say, anger management intervention as well, but you recognise that they’ve got language difficulties so the best thing to do is let people, education, know that actually this person might need more support, they might need some other content adapted, or you’re double-checking for understanding. 

On the other side, one of the young adults was going through parole hearing.  For some people, they’re not actually released until we have a parole hearing and you prove that you’re actually safe to be released. 

He had some communication difficulties so we made the parole board aware of that, and gave some strategies actually when you’re answering questions, give them enough time to process that.  You might offer him the opportunity to write down his answers, to prepare his answers.  I also worked with him on a one-to-one basis in terms of social communication.  How do I sit?  How am I presenting myself?  Good eye contact, good pace of speech. 

Actually, he was able to present himself in a better light in that meeting and there was a positive outcome in that he got his parole. 

But it’s so varied in terms of the journey are young people are on in custody and where speech and language therapy can help them.


H - 0:12:31
How are your patients?  How responsive are they to you?  I guess that’s varied too.  But when you say, I'm an SLT, what do they say?


CB - 0:12:42
What’s that?!


H - 0:12:44
Yeah, right, okay!


CB - 0:12:45
Probably more responsive than you think, really.  Partly because it gets them out of the room.  They’re like, why not?!  It’s going to get me out of my room for a little bit.  But also I think it’s about how you approach it and it’s about them seeing value in what you’re offering. 

So I always start with: what two things do you want to achieve whilst in prison?  What two things do you want to achieve whilst you get out?  And then we talk about their communication skills and what part of their communication they want to work on. 

And we say, okay, do you think working on these things will help you achieve these goals?  More often than not, the answer is, yes, I think working on my language skills or speech or being confident enough to hold interactions well in terms of being assertive, that’s going to help me to get a job, that’s going to help me to engage in my interventions. 

So yeah, it can be… they’re actually more receptive than one might think.


- 0:13:52  - MUSIC PLAYS -


H - 0:13:58
Many years ago, I was working on a literacy project and I had to do some work in a medium security prison.  I have to admit that I was pretty anxious. In part, it was about the inmates, but the environment certainly doesn’t help.  I asked Christian about his thoughts on working in a prison.


- 0:14:15 - MUSIC PLAYS -


CB - 0:14:19
I think it can be anxiety-provoking.  It is a different environment – even although I came from working from secure units, etc., prison’s different.  Very hierarchal, you’ve got different rules.  Obviously you’ve got bars, you’ve got keys, you’ve got radios going on, sometimes you’ve got alarms. 

It can be quite… it takes you a few weeks to settle and ground yourself.  The environment can be quite intimidating and there is so much to get your head around.  But everyone works together to keep everyone as safe as possible so things can run smoothly.  No doubt the environment can be a little bit intimidating.


H - 0:15:06
Can you talk me through your typical day?  Monday morning, you get up and what sorts of things might you do throughout a day?


CB - 0:15:16
I mean, no day is [over speaking].


H - 0:15:16
[Inaudible 0:15:17] no typical day.  Okay, fair enough.  But…


CB - 0:15:19
I mean, I could be doing any one of the things.  For example, on Monday morning, I run a social communication group on our inpatient unit and that group is really fun, it’s really dynamic because, actually, you don’t know who you’re going to have in there.  Some people stay there for weeks, months; some people are there for a few days, so you always have to adapt the group content and make it relevant to the young people on their unit. 

You might be seeing a boy who stammers.  You might be offering training.  You might be doing accessible information, for example, I'm really pleased because the more SLT has been in the prison, the more people have seen our value. 

For example, people know that if I'm presenting information to boys, let me run it past the speech and language therapy.  So I might get emails saying, actually, Christian, can you have a look at this?  Will that be okay for our young boys to access?  And what’s really rewarding is when you see people, like officers and stuff, take the initiative to do that themselves and making sure that the information they’re presenting the boys is accessible.

A recent example was the prison wanted to make a document for young people who might be restricted status.  So that’s a status that is… they have more restrictions on them, basically, because their risk level is assessed to be quite high, so they don’t have the same amount of privileges that an ordinary prisoner might have, and it can be quite confusing.  So the prison thought, actually, we need to explain this. 

My colleagues thought, let’s run this past Christian, and I gave a template.  Because of the caseload, because it’s so high, I'm not able to do absolutely everything, but I said, look, these are the things that need to change; there’s so much jargon in this, perhaps consider changing the layout.  But what’s really warming was they took that on board and they actually, on their own accord, made those changes and ended up producing a really, really good document.


H - 0:17:27
This is what leads me to the next question is: are you the only SLT at Feltham?


CB - 0:17:31
Yes.  So I’ve been at Feltham for three-and-a-half years.  But – exciting news – three years of advocating and saying, look, there is the need here and with more resource we could do so much more, I did some interviews, I think it was two weeks ago now, and we should be welcoming a band 6 on board very soon.  Another colleague.  So I'm really excited about that. 


H - 0:18:00
How many inmates are there currently?


CB - 0:18:01
Feltham can have up to 500 young men and I think at the moment it’s about 400 and something. 


H - 0:18:09
Right, and if you’re saying 60% of them have speech and communication issues then that’s an enormous caseload you have. 


CB - 0:18:20
Yeah, I’ve always got the biggest waiting list.  It does throw up: where do you focus on?  Where can you make the most impact?  That’s something I'm always juggling.  Is it through training?  So if staff are aware – for example, the Youth Custody Service is trying to move towards a trauma-informed way of working with people, trying to understand: what happened to you, as opposed to: what’s wrong with you? 

Part of that is training existing staff and new staff, and I'm lucky enough to be involved in that training, so we’re making the officers aware of… recognising any speech, language and communication needs – what might that look like?  What barriers may that pose?  And what can I do to support that? 

That’s one big part in terms of: where do I focus my resources?  Training, obviously, you’re doing some one-to-one, you’re doing group work…
[FADES OUT]


- 0:19:18  - MUSIC PLAYS -


H - 0:19:28
We spoke about the support that’s available for offenders when they leave the institution and there is a great deal more available for those under the age of 18, which is ridiculous.  We have so much evidence that the brain continues to develop for several more years, that young men, in particular, are bad at risk assessment. 

And even so, Christian pointed out that not providing more support for older offenders is bad socially, morally, economically.  Which led us to a controversial but increasingly prominent movement: prison abolition.  It’s a network of groups and activists who are working to significantly reduce or perhaps eliminate prisons altogether.  Like calls to defund the police, there is a spectrum of views.  Some people say that, for the vast majority of offences which are non-violent, like drug offences, we should end custodial sentences.  But others are calling for the complete abolition for all offences. 

What’s certainly true is that there are tremendous inequities in the current system.  White collar criminals are incarcerated at pretty low rates, which certainly points to systemic failings in the justice system. 

I started by asking Christian if he had thoughts on prison abolition.


- 0:20:44 - MUSIC PLAYS -


CB - 0:20:51
I do and I also subscribe to the notion that I don’t think prison should be the dominant mode of punishment in society.  If we’re being realistic, if we look at the reoffending rates, it’s not effective.  Just to be putting someone in custody is not effective.  Let’s look at what’s going on in society that’s making this possible. 

If someone has good access to education, if they have good access to opportunities in terms of job prospects.  I actually say to the boys, look – because money’s usually an issue – so if you were to be in a different environment and you had the money, do you think you’d be doing what you were doing?   Actually, the answer is usually, no, I don’t think I would. 

They’re going to come out one day and you’re going to probably end up with more of a broken society because these people are... Jail is not sometimes a nice place.  You’re risking re-traumatising people, potentially coming out more distrustful of people or more violent, and also their prospects are hugely reduced in terms of employment prospects. 

A lot of the young people say, I want to go into construction.  And you find that partly because quite a lot of the young people are better with their hands, or they think they’re better with their hands and fixing things.  But also they don’t really see that many avenues open to them because people [inaudible 0:22:28] once you say you have a criminal record. 

I think you risk criminalising a whole generation and prospects are reduced.  I think, as a society, we could probably think of ways of addressing those things that drive people to criminality, because criminality doesn’t happen in a vacuum, it’s a lot of different things that make people turn to criminality.  That would be my opinion there.

 
H - 0:23:01
It’s interesting what you’re saying.  What’s you’re basically saying is that if we’re sending a young person to prison, we’ve really failed.  I mean, if we’re sending anyone to prison we’ve really failed them in some really fundamental way, really. 


CB - 0:23:13
Yeah, and I think that’s a good summary of what it is.  I think, as a society, let’s have a look at our education system, as I said, job prospects.  How are we supporting families?  They could be single families who are struggling.  Kids witnessing domestic violence, lack of role models.  The list goes on. 

And actually, one of the more challenging aspects of the role is witnessing the impact of adverse childhood experiences.  Some of the young people have been through unimaginable horrors.  And you just think, gosh, what chance did you have growing up in a community like that, or an environment like that, or having a family structure like that? 

It’s much more complex than this person’s committed this crime.  I think we have to do better to understand what came about to make that happen.   


H - 0:24:20
It’s so important to have a more representative profession.  What do you think we can do to change the gender balance in SLT? 


CB - 0:24:29
That’s a good question and I think that RCSLT would probably have me on the board if I had the right answers to that!  What can we do to change the balance?

I think one is to do with visibility and actually proving to males whether young, old, that actually this is a viable option for them.  If you want to help people, if you’re interested in people, if you’re interested in communication, why not? 


H - 0:25:00
Do you think it’s important that you’re a guy working in Feltham?  Do you think it’s easier for a guy?


CB - 0:25:07
My predecessors were all female and I have a student [inaudible 0:25:10] who are all female and they do a fantastic job. 

But I do think, on some level, actually being a black male is a bit of an advantage because sometimes the boys can relate a little bit better to you as a male, or as a person of colour.  I do think it does make a little bit of difference, yeah.  Because we work with a diverse group of people.  We’re a diverse population, so you do need a diverse workforce because people are going to be able to relate to different people at different points. 

And it just so happens I work with a group of young men so sometimes they’re easier to relate to me, whether it’s through trainers, or popular culture or hairstyles.  Sometimes it helps to break the ice.


- 0:25:58 - MUSIC PLAYS-


H - 0:26:02
We then moved onto the question of race and increasing the ethnic diversity within the profession.  We touched on the same areas as we did in terms of gender diversity – in particular the role that social media can play in bringing more attention to male SLTs and SLTs of colour and so forth. 

But then Christian told me a very interesting story.


- 0:26:24 - MUSIC PLAYS -


CB - 0:26:30
I’ll give you a personal example.  So I told you I worked in St Andrews and that was in Northampton, my working career so far everything was fairly white and straightforward.  But when I was actually doing my interview for Feltham, I was interviewed… the Head of Healthcare – actually the Deputy Head of Healthcare – was a black male.  For some reason, I didn’t really… that really struck me.  I walked into the room and I was just really surprised. 


H - 0:27:02
Were you not expecting to see a black person on [over speaking]?


CB - 0:27:04
No.  But I remember feeling like, gosh, well, fair play.  This guy, so much respect.  And there was a level of awe and respect that I had for him.  And that was me experiencing that. 

Actually, it’s very powerful to see someone who looks like you to be that role model.  We had a conversation before the interview because I was quite early, and he was from the same place, so he’s also from Ghana.  It’s very powerful.  I don’t think you can underestimate the impact of having a role model, someone who looks like you, or someone you can relate to culturally.  It does make a difference. 


- 0:27:47 - MUSIC PLAYS - 


H - 0:27:55
The American writer, Malcolm Gladwell, said that if you want to change the way your workforce looks, if you want to make it more diverse, change the leadership. As a priority, we need more diverse leadership in the NHS and the education sector.  

Christian’s recommendation is the Vox Media Explained series – short documentary-style infotainment on a variety of interesting topics.  I second that recommendation.  

A big thank you to Christian for his time and we look forward to talking to more people who work in criminal justice and psychiatric wards in upcoming episodes. 

I’d like to ask a big favour, please do rate the show on your preferred podcast app and if you think it’s of interest please do share with colleagues.  The more reach we have, the more we can advocate for the profession and ensure that communities across the UK can get access to life-changing services they need. 

Until next time, keep safe. 
 
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