Recognising shame and vulnerability are fundamental to improving approaches to prisoner mental health. Devolving some say in the running of accommodation over to prisoners has produced more harmonious environments also.
The Chief Inspector of Prisons has just described the past year as a "dramatic period in which we documented some of the most disturbing prison conditions we have ever seen – conditions which have no place in an advanced nation in the 21st century". Can there ever be such a thing as a mentally healthy prison? It seems difficult to answer in the affirmative.
"The dynamic of shame is introduced at sentencing where a judge’s summing up is very shame-based. There’s no thought for the person’s trajectory."
The reality is that, increasingly, prisons are places that are making people worse, with the wellbeing and mental health needs of the majority of those incarcerated being left unaddressed and lives put at risk.
In his annual report for 2017-18, Chief Inspector Peter Clarke said: “Mental health difficulties, anxiety about being in prison, drug use, violence, debt, isolation and poor regimes were some of the factors causing men to hurt themselves or even take their own lives.”
Clearly, environment matters. Placing people with mental health issues and those susceptible to poor mental health – the majority of people currently in prison – into a situation which is even more emotionally, psychologically, spiritually and physically damaging has consequences.
But, without a change in the philosophy underlying our prisons, what can be done?
“The notion of being locked up in a building, spending a lot of time on your own in a cell, not being in control of your life – these are all things that are clearly triggers for poor mental health anyway,” Andy Bell, deputy chief executive at the Centre for Mental Health told me.
“That’s compounded by the fact that the average prisoner will have had poor mental health since childhood and very often trauma in their lives, for which being in prison might be incredibly triggering.
“It’s an environment in and of itself that’s not mentally healthy and it’s probably never going to be and, yet, the vast majority of people going into prison will go in with at least a vulnerability to poor mental health.”
Mr Bell believes that a trauma-informed approach that prioritises wellbeing and sees every prisoner as vulnerable would be a step forward, as well as diverting people away from prison whose mental health problems are the main cause of their offending.
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“About three-quarters of the country now have a liaison and diversion service working in police stations and courts,” he added. “This is a very unsung but positive development.”
One former prisoner told me that prisons, by their very nature, cannot be mentally healthy because inmates feel they must hide their emotions.
“Prison hardens the soul and hardens the emotions,” he said. “One trains oneself not to show emotion as this can be a sign of weakness. Therefore, emotions are kept bottled up until they boil over.
“Prison breeds paranoia, one learns to expect the worst. The paranoia of hearing keys jangle outside one’s cell door presuming that you are about to be opened up and told some terrible news or the security department is about to raid your cell. I dreaded the noise of the keys.
“In this environment, mental health problems are left to flourish untended. Depression will hit everyone in prison at one time or another and will often go untreated. If you lock someone up in a cage for 23 hours a day what would you expect to happen? The medical staff are so overrun that it is impossible to treat everyone and that is why we see the dreadful statistics on self-harm and suicide.”
Dr Naomi Murphy, a prison psychologist of 20 years, said the institution of prison should be taken to represent a “parental figure" and that difficult backgrounds and a lack of wellbeing lay behind the behaviour of all the offenders she has worked with.
“Society wants people to come to prison and be punished and frightened into not offending again,” she told me. “But, all the research on strict parents is that they are the least effective. Permissive parents aren’t effective either, but it’s something about having a balance – being fair and kind but also firm. So, for prison to be effective in terms of rehabilitation and keeping people emotionally well while they are in prison, that needs to be central.
“I think the philosophy of prisons needs to be about a lack of wellbeing. I see crime as a wellbeing issue. It says something about their own internal world, how people feel they connect or belong to society, and if you don’t feel invested in society or that it’s not invested in you, it’s much easier to behave badly towards others because you’re not part of it. I know not everybody would behave like that when they feel on the margins, but if people don’t feel part it, they’re much more likely to behave in deviant ways.”
Dr Murphy said that prisons should not simply focus on a person’s offending but explore root causes.
“All the attention is given to the immediate circumstances, such as a person’s problems with drink or drugs, but the system won’t go into that deeper layer and ask why that person has got a problem with drink or drugs.
“Until we start focusing on people’s emotional needs within prison, it’s quite limited what can happen.”
“We don’t buy into the idea that people are born evil which I think is still pretty prevalent even amongst mental health professionals,” she added. “We would be looking to make sense of ‘why is this person behaving in this way?’
“But, society’s views about vulnerability and not allowing offenders to be seen as vulnerable really colour and restrict our capacity to think about what people really need.”
She describes prison as a “very masculine, harsh and brutal” system with “no softness about it”.
“There’s not much sign of growth within the environment. The exercise yard might just be four concrete walls. We know that nature has a therapeutic value for people and yet we don’t make use of that knowledge,” she added.
The psychologist said prison should only be for those who are dangerous to the public and believes short prison terms serve no purpose.
“Within prisons where you have people for the long-term, there’s probably quite a lot of changes that could be made to make them more therapeutic,” she said. “I don’t see the point in short-term sentences at all. They take people off the streets for a few weeks but they’re not going to do anything towards rehabilitation. It would be much better to save the money spent and reinvest it in community services and look at initiatives that enable connection and belonging within society in order to keep people as part of society. We push towards marginalisation and then they have nothing to lose. People need relationships that are functional, healthy, can enable you to feel cared for, can be guiding and safe. Prisoners in particular need that kind of experience. That’s not really thought or talked about enough.”
Des McVey, a mental health nurse who has worked in prisons and secure units for 35 years, also believes a more “compassion-focused” approach needs to be adopted that takes into account a person’s circumstances as well their crimes.
“The primary emotion in prison is shame,” he told me. “It’s the least spoken about but the most debilitating. The dynamic of shame is introduced at sentencing where a judge’s summing up is very shame-based. There’s no thought for the person’s trajectory.”
He believes that the ideology underlying a prison is key to the kind of environment it provides and that more needs to be done to draw on the work of Philip Zimbardo, professor of psychology at Stanford University, whose famous prison experiment highlighted the importance of situational, rather than dispositional factors, in influencing how a person behaves.
“It is evident that one does not appreciate the power of situations to transform one’s thinking, feeling and action when caught in its grip,” Zimbardo has written. “A person in the claws of the system just goes along, doing what emerges as the natural way to respond at that time in that place”.
Mr McVey said that “where prisons have a healthy ideology, you can have a healthy environment where prisoners can express their vulnerability” and that the toxic masculinity prisons foster – the ‘man up’ and ‘grow a pair’ culture – is one of the dynamics that holds prisoners back.
“Prison has to move from an institution that protects the public by incarcerating to one that reduces offending by addressing the individual formulations of prisoners and not thinking that one logic fits all,” he added.
Relationships and responsibilities are key
Pockets of good practice do exist. HMP Grendon in Buckinghamshire, for example, is one of the most researched forensic establishments in the world. Run as a community in which prisoners undergo therapy and share responsibility for their day-to-day decision-making and problem-solving, its whole ethos is about being therapeutic.
Prisoners at Grendon, many of whom are high risk and have personality disorders, are provided with a range of psychotherapeutic interventions within a 'social climate', which emphasises the importance of relationships as the basis for change.
Through therapy and living collaboratively with peers and staff, inmates learn to understand and address their behaviour and are given a real say in the day-to-day running of the establishment, which aims to give them greater insight into their own behaviour and a sense of responsibility towards others.
Studies have shown that men who are at Grendon for longer than 18 months have lower levels of reoffending. It is only one of two prisons in England and Wales dedicated specifically to this type of work.
In his last report on the prison, the Chief Inspector of Prisons said that, while not every prison can or needs to be like Grendon, its “values, principles and practice could provide positive lessons and inspiration for others”.
If not every prison environment can be a Grendon, then, at the very least, greater levels of support for mental health problems in prisons must be provided.
But, this would still only be a reaction rather than a remedy.
Until we have a wider debate as a society about what prison is for and who we should be sending there, led by politicians brave enough to do so, it is difficult to see how lives will not be further damaged rather than saved – of both prisoners and future victims alike.
Hardeep Matharu is a journalist, writer and researcher who specialises in prisons, criminal justice and social affairs. Follow her on Twitter @Hardeep_Matharu