I worked within offender care Sep ’16 – Sep ‘17 and have since moved to another position within the NHS, as Clinical Research Assistant in a Community Mental Health Team. This article was prepared in my personal capacity and its opinions expressed are my own and do not reflect the view of any organisation.
‘Offender Care’ in UK Prisons
Providing mental health assistance in offender care was a defining experience, both professionally and personally. The impact of working in the challenging, yet rewarding reopening of HMP Downview was a journey I will never forget.
HMP Downview was closed in 2013 following a national review of the female Prison estate. Then, just three years later, it was hurriedly reopened in order to accommodate the demand caused by the sudden closure of HMP Holloway. During 2016/17, Downview went through a huge transition: a new regime was commenced, modified then re-established; ambitious projects were scheduled then inevitably delayed; new staff were hired; long-serving inmates were returned; comprehensive physical and mental healthcare services were launched; anyone and everyone helped renovate long-since vacated workplaces; systems, policies and procedures were all tweaked to meet requirements. Overall, a community of professionals and prisoners worked as a team, collaborating to turn an empty, non-functioning building into a modern-day prison fit for purpose.
As considerable debate exists around the precise purpose of imprisonment[i] , I began to wonder whether any prison in the women’s estate is truly ‘fit for purpose’. Whether the aim is to protect the public or to provide rehabilitation, reform or punishment, it seems something is amiss.
During HMP Downview’s transformation, I was continually surprised at the prison population’s patience; incarcerated women and caring staff showed considerable appreciation that change takes time and often does not go to plan. Despite some inmates experiencing serious mental health difficulties, and complex emotional and behavioural difficulties, there seemed to be an understanding: ‘things are far from perfect, but everyone is trying their best.’ Throughout my tenure I truly believe staff did try their best, and as is the case across many public sectors, they viewed the lack of staff, funding, resources and flexibility as additional challenges rather than total roadblocks. Despite all that incredible effort, I couldn’t help but wonder whether prisons are fit to manage the needs of modern-day society’s complex social dynamics and healthcare requirements.
Are best efforts enough in an archaic system which is both at capacity and failing to deliver the results it promised? Does depriving women of their liberty really help in their reform and therefore reduce crime rates? As far as I could see this system of justice appeared to be designed centuries ago by men, for men. The inability of the current system to provide optimal offender care was astounding. Many women in prison have high levels of mental health needs and histories of abuse, and there have been rises in self-inflicted deaths and self-harm[ii] . Any cursory review of the literature highlights the depth of these shortcomings.
I began to wonder if future generations will look back at this period of time in the same way we view asylums from the past: where society believed locking up its’ citizens would cure their disease of mind, when in fact, history shows us that individuals’ ailments often significantly worsened. Today, among the general public, rates of psychoses are around 1 in 25[iii], whereas in the prison population this soars to 1 in 4 women reporting symptoms indicative of psychosis[iv]. Women released from prison may return to their families and communities with even more complex mental health needs.[v]
In 2013 over 25% of women in the penal system said they had received treatment for a mental health problem during the previous year[vi]. Yet despite this, every year since, less than 1% of community sentences have included any mental health treatment requirement[vii]. Even if this was not a legal requirement and instead additional support and access to local mental health services were provided, this could help reduce the likelihood of sentencing altogether. Not only that, but fundamentally it would help keep families together, resolving the spiralling systemic problems caused by splitting up families and taking children into care. Children in care are more than twice as likely to be cautioned or convicted as their peers[viii]. Having worked in children’s care homes, young offenders’ institutes and latterly the women’s estate it has been staggering to witness the cycle of trauma caused through family separation.
It is perhaps unsurprising, therefore, that suicide rates in prison remain significantly higher than the general population. The devastation and tragedy of suicide is enormous. In 2015 there were over 11 times more self-inflicted deaths in custody than the general public[ix]. Of these self-inflicted deaths in prison, 70% had already been identified with mental health needs[x].
Feeling like a tiny cog in a machine that is widely accepted to not be working caused a personal philosophical debate. “48% of women are reconvicted within one year of leaving prison. This rises to 61% for sentences of less than 12 months and to 78% for women who have served more than 11 previous custodial sentences[xi]”. Hence the moral dilemma: whether to continue working, making any tiny difference I can, or leave, knowing the archaic system and its overarching structures are ultimately failing the very individuals it is supposed to help. Any business has to adapt to its requirements, failure to do so would result in its demise. For instance it is unthinkable that a car manufacturer would produce vehicles where within a year 48% would seriously malfunction, requiring them to be returned to the factory.
I have the upmost honour and respect for the hardworking dedicated professionals working with Her Majesty’s Prison Service. Wherever I went I found humour and compassion regardless of circumstances. I will be forever grateful for my experience working with some of the most invisible members of society[xii] in complex environments; enabling me to challenge the system on their behalf.
Despite frontline staff’s best efforts, the entire machine appears to be breaking. With snap-decisions on prison closures followed by their rushed re-openings, not only does the government’s current criminal justice reform strategy appear short-sighted, but the entire approach is simply outdated. The collective impact of this upon individual’s and communities’ mental health and wellbeing remains unknown. Instead of marginalising and penalising the most desperate and vulnerable in our society, perhaps we should shift to a more compassionate and effective approach, beginning with creative thinking and open-minded reform of a system currently incapable of delivering that very thing: “reform”.
[i] Gerry, F., & Lyndon, H., (2016) ‘Women in prison: is the justice system fit for purpose?’, Halsbury’s Law Exchange
[ii] Prison Reform Trust (2017), ‘Prison: the facts’, Bromley Briefings
[iii] Wiles, N., et al. (2006) ‘Self-reported psychotic symptoms in the general population’, The British Journal of Psychiatry, 188: 519-526
[iv] Ministry of Justice (2013) ‘Gender differences in substance misuse and mental health amongst prisoners’, Surveying Prisoner Crime and Reduction, London
[v] Harne, H., & Riley, S., (2012) ‘The Impact of Incarceration on Women’s Mental Health’, Responses From Women in a Maximum-Security Prison, SAGE Journals
[vi] WHO Consensus Statement on Mental Health (1999), WHO Regional Office for Europe, Mental Health Promotion in Prisons
[vii] House of Commons written question 67348, 29 March 2017
[viii] Blades, R., et al. (2011) ‘Care – A Stepping Stone to Custody?’, The Views of Children in Care on the Links Between Care, Offending and Custody, Prison Reform Trust
[ix] Office for National Statistics (2016) ‘Suicides in the United Kingdom, 2014 Registrations’, Newport, Office for National Statistics
[x] Prisons and Probation Ombudsman (2016), Prisoner mental health
[xi] Ministry of Justice (2016) ‘Women and the criminal Justice system’, London, Ministry of Justice
[xii] Covington, S., (2008) ‘Women in Prison, Approaches in the Treatment of Our Most Invisible Population’, LCSW, Women & Therapy Vol21, Issue 1