When the UK went into lockdown in March last year, there were warnings that 2,000 prisoners could die from coronavirus. They were locked in their cells for up to 23 hours a day to prevent the virus spreading, taking almost all privacy away from those sharing a cell, and isolating those on their own.
So far, the number of prisoners who have died from coronavirus has been a fraction of 2,000. But the restrictions have left many prisoners feeling unsafe and had a “profound” effect on their mental health, according to a report by HM Inspectorate of Prisons.
“It’s rare to meet a prison governor who believes every woman in that establishment should be there.”
A Guardian investigation found that the number of prisoners put on suicide or self-harm watch in the first half of 2020 was almost as much as the whole of 2010. The pandemic has prevented staff from carrying out face-to-face wellbeing checks with prisoners, according to a report by Prison Reform Trust.
Only some prisons have kept inmates up to date with what’s happening, says Juliet Lyon, chair of the Independent Advisory Panel on Deaths in Custody.
“People have been left feeling like they don’t know what’s happening to them,” she says.
The restrictions have been particularly hard on the female prison population. In March last year, Justice Secretary Robert Buckland said pregnant women and mothers in prison would be urgently considered for temporary release. But the actual number released was much lower than expected.
The most up to date government data shows a 24 per cent increase in self-harm incidents in female prisons over three months, compared with a 5 per cent increase in the male prison population. This is an all-time high.
“Isolation and feeling powerless and hopeless can really trigger self-harm,” says Penny Bennett, community link manager at Wish, a charity that supports women in prison.
“For some women who’ve experienced domestic violence, or been sectioned in hospital, being locked up must’ve brought back a lot of memories and feelings.”
Lyon says self-harm rates have been exacerbated by a combination of dashed hopes after the prospect of early release last year, and the sudden drop-off of contact with staff and other women in prison.
“But the biggest thing of all is closing down of family visits,” she says. “The vast majority of women in prison are sole or primary carers with dependent children.
“Combine all of that with the state many women are in anyway when they arrive in prison and the self-harm statistics didn’t surprise us. It points to the fact we have to be very clear about the impact on women of being in prison.”
Charities are now calling for prisoners to be prioritised for vaccines so they can spend more time outside their cells, and for the release of some prisoners, including mothers and pregnant women, to continue after being paused in August last year.
Although isolation measures as a response to the pandemic have exacerbated rates of self-harm, experts argue there are longstanding and systemic problems with how England’s criminal justice system treats women inside and after prison.
Women are more likely to self-harm in prison than men because of lower self-esteem, according to Working Change, and are more likely to turn inwards to cope with anger and frustration. They’re much more likely than men to have been victims of abuse before prison, and research at Staffordshire’s Drake Hall prison by Disabilities Trust suggested around two-thirds of women have brain injuries.
Around 46 per cent of women in prison have attempted suicide at some point. In 2016 and 2017, 30 women died in prisons in England. Of these, more than half were self-inflicted deaths.
Anna (not her real name) came out of prison six years ago, around the time that self-inflicted deaths were the highest they’d been for over a decade. She self-harmed for most of her sentence, but didn’t feel supported.
“There was no provision for mental health. You get evaluated when you go in, but that’s just to make sure you’re not going to kill yourself there and then, and that’s it. I was on anti-depressants before I went in but it takes weeks for things like that to filter through,” she says.
“The healthcare team’s response is to give you stickers to distract you. I wanted someone to talk to, to help me.”
Anna eventually received counselling through a charity. She found it helpful, but says her words were misinterpreted and reported back to the prison, who put her on suicide watch.
Talking to other inmates was a huge part of coping for Anna. She says there was a culture of helping each other, but it would become tense when anyone did something that resulted in everyone being punished. Anna says she was traumatised from seeing other women self-harming.
“There were more incidents of self-harm than there were women in there – it was the same people cutting and cutting,” she says.
Prison staff removed objects from the cells of people who self-harmed – including their cellmates’ possessions. When Anna self-harmed, her cellmate’s knitting needles were confiscated.
If you injure yourself particularly badly, staff gave you plasters, she says. But if you asked for plasters yourself, you were at risk of annoying the guards and having privileges removed, such as TV or phone calls.
“The safer custody team were so busy that, if you had a history of self-harm and knew what you were doing, you were left alone. They could tell quickly who was intent on hurting themselves, rather than self-harming as a habitual stress relief.”
Like many women in prison, Anna suffered domestic abuse prior to being convicted.
“The judge who sentenced me didn’t take into account any circumstances around why I did what I did. I was told I should know better – never mind that I’d been beaten for 10 years, stabbed and had a gun held to my head,” she says.
Anna struggled when she was released from prison. She was given no support, and slept on her parents’ sofa for five months.
“Even people who didn’t have a mental health issue before going into prison do when they leave. But, as a woman, you’re pretty much written off when you have a criminal record,” she says.
“I didn’t engage with probation at all. I was angry I went to prison in the first place. I didn’t think I should’ve done.
“They say you get initiated into the prison mentality within the first 60 minutes of being in custody, but no one teaches you to be normal again when you come out.
“I felt like no one understood or cared what I’d been through. It felt like they were waiting to trip you up to lock you back up again, which isn’t the case. Probation officers do care, but you get the impression in custody that they’re mean.”
Understaffed prisons and inexperienced workforces are another driver of poor mental health and self-harm among female prisoners, experts say – but the government cut prison staff by 30 per cent in 2013.
Pamela Taylor, professor of forensic psychiatry at Cardiff University, who had been doing research in prisons, found that the prison environment rapidly deteriorated after this.
“When we saw prisoners after the cuts to staff, they all said their days were routine and dreary,” she says.
Prisoners’ mental wellbeing can be hugely influenced by the prison staff around them, experts say.
“It’s the officer on the wing of that woman who can make all the difference. The way you’re spoken to and dealt with day-to-day makes a big difference,” says Penny.
“There aren’t enough prison officers at the moment, the prison workforce is less qualified now, and suffers the effects of high turnover. That must make a massive difference,” Bennett says.
Another contributor to high rates of self-harm in women’s prisons is a lack of evidence on how best to manage and treat mental health in this setting, argues Seena Fazel, psychologist and researcher on mental health in prison.
“Targeted, evidence-backed treatment is crucial to tackling self-harm among female prisoners, because they tend to have had more traumatic experiences growing up and more psychosocial difficulties,” Fazel says. “If we want to drive rates down, this has to come from evidence-based approaches.”
This can only be done if carrying out research in prisons is made easier for researchers, adds Fazel, who is currently trying to understand the reasons why people repeatedly self-harm, and how these people can be identified so that resources can be better allocated.
“There’s a lot of research on developing cognitive behavioural therapy in the community and transplanting it into prison, but most of those studies haven’t shown that improvements are sustained,” he says. “If you have cancer, you’re almost always invited to an ongoing trial because they want to improve the evidence base, but it’s not done like this in the prison system.”
This is because research is often deemed too risky, according to Fazel. Prisons need to be more receptive to research, he believes.
“Each prison can veto a project if they don’t like the sound of it. There are a lot of hoops you have to go through.”
Fazel was almost stopped from doing some research where he asked prisoners about suicide as he was told it would upset them, but the prisoners told him afterwards it was actually very therapeutic to talk.
Amanda Perry, forensic psychologist and senior lecturer at York University, runs a scheme that aims to help people in prison to develop problem-solving skills, with the aim of reducing self-harm, and is exploring how it would be introduced into female prisons.
Designing the project involved adapting pre-existing models of treatment to make it fit with the prison environment.
“We changed materials, like booklets and worksheets, to fit with their environment so people could relate to them. When you’re trying to get people to engage, you need to find acceptable interventions, because if they don’t think it’s relevant to them, they’re never going to engage with using the problem-solving skills,” she says.
Taylor agrees there’s a lack of good quality research in prisons and on those coming out of prison. Her research has been delayed before because of archaic prison IT systems.
“There’s a poverty of investment in prisons, but it’s not a vote-winner to invest in them properly,” she says.
She says future research can’t even get approved in principle right now because of the pandemic, and that this will delay research for 18 months at least – but it could be up to five years.
“Covid has set us back but it’s not an explanation for the relatively little work in this area. It’s a Cinderella area, and we could do a lot more if there was more research input and funding.”
But the strongest argument for preventing self-harm – coming from across academia and charities supporting women with convictions – is that women would be better supported in the community.
“There’s masses of research showing that prison has a harsher impact on women than men,” says Lyon.
There should be a focus on preventive work to stop vulnerable women entering the criminal justice system, she says, including drug and alcohol treatment, and support for women who’ve suffered violence or sexual abuse.
“It’s rare to meet a woman in prison who’s committed to a life of crime and it’s very rare to meet a governor of women in prison who believes every woman in that establishment should be there,”
Lyon says.
“So many things add up to the path to prison that could be dealt with by more support and early intervention. I’d like to see a shift in focus, with civil servants being employed to really focus on reducing prison numbers for women.”
The government, however, seemed to go in a different direction when it announced 500 new prison places earlier this year.
“This flies in the face of evidence and the government’s own female offender strategy,” says Lizzy Jewell, head of communication and engagement at the charity Working Chance, which supports women leaving the criminal justice system into work.
She says very few women should be in prison, because they don’t commit violent offences and are usually given short sentences.
“Three months is enough to really disrupt their children’s lives, disrupt rent payments and to lose their jobs.”
Before she went into prison, Anna had a steady job, a house and car, and lost it all because of her 13-month sentence. She met a man in probation who had just spent 16 years in prison and lost the same as she did.
Since leaving prison, Anna has been supported by a charity to study law and criminal psychology so she can better understand the psychology of offending. She now has a job supporting ex-offenders, and believes her lived experience makes her a more empathetic practitioner.
“There’s so little support for women leaving custody,” she says. “I want to make it better.”
Photo: Andrew Fox/Alamy
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