Information Needs Of Women In Prison With Mental Health Issues
Information needs ofwomen in prison withmental health issues
AcknowledgementsNacro would like to thank the staff and prisoners at HMP New Hall and HMP Styal and all thosewho participated in the compilation of this report. Staff gave freely of their time and expertise, andwe would also particularly like to thank all the women prisoners for their frank and honestconversations.This report was written by Judith Ford.It was produced by Nacro Policy and Research Team and edited by Nacro Communications. Nacro 2009Nacro is the leading charity in England and Wales dedicated to making society safer by reducing offending.Our practical services give offenders and those at risk of offending the skills, support and motivation they needto change their lives for the better. We combine services with campaigning: lobbying for better ways to reduceoffending, while demonstrating how this can be done in practice.NacroPark Place10–12 Lawn LaneLondon SW8 1UDTel 020 7840 7200Fax 020 7840 7240www.nacro.org.ukNacro is registered as a charity, no. 226171.Nacro welcomes a wide circulation of its ideas and information. However, all reproduction, storage andtransmission must comply with that allowed under the Copyright, Designs and Patents Act 1988, namely for thepurposes of criticism or review, research or private study, or have the prior permission in writing of the publishers.
ContentsIntroduction4First night and induction7During sentence9Healthcare and medication12Approaching release14Equality and diversity15Summary173
IntroductionNacro was asked by Mind to carry out a short investigationwith women prisoners to find out what information couldusefully be provided for women in prison with mental healthissues. This report details the findings from our investigation,together with some suggestions for Mind on producinginformation for this group of prisoners. We felt it was alsoimportant for this report to convey a sense of what help iscurrently available, and what life is like for women in prisonas the environment in which they live can have a huge impacton their mental health and well-being.In our experience, the mental health needs of women inprison are very complex: they are often linked with historiesof abuse, manifest themselves in high levels of drug misuse,and are compounded by the effects of imprisonment. In manycases, prison regimes can exacerbate mental distress.Prison is known to have more serious psychologicalimplications for women. The small number of women’sprisons means that women are often held far away fromhome. Women prisoners are much more likely to be solelyresponsible for the care of children and the maintenance of ahome than male prisoners, many women will lose their homeas a result of going to prison and some may also lose custodyof their children. Self-injury is very common throughoutwomen’s prisons.1 Two thirds of women in prison are sufferingfrom a mental disorder with record numbers being driven tosuicide or self-harm by the lack of appropriate care.2 As theprison population continues to rise, so too does the numberof prisoners with mental health issues. Some of these issueswill be relatively mild, such as anxiety or depression, whilstin some cases they will be far more profound and requirespecialist interventions from psychiatrists and other membersof the prison’s mental health team.Prisoners with severe mental health problems are cared forby prison in-reach teams who liaise with services in the1. Social Exclusion Unit (2002), Reducing Reoffending byEx-prisoners, London, HMG Cabinet Office2. Rickford D and Edgar K (2003), Troubled Inside: Responding tothe mental health needs of women in prison, London, PrisonReform Trust4community. These in-reach teams, commissioned from localmental health NHS trusts, comprise multi-disciplinary teamssimilar to community mental health teams and aim to offerprisoners the same kind of specialist care and treatment theywould receive in the community. They should be able to makeappropriate community referrals for the women when they areready for release.In addition to the mental health team, each prison has adisability liaison officer whose responsibility is to assess andsupport prisoners with a disclosed disability. In many casesthese disability liaison officers provide support and guidancefor prisoners with both mental and physical disabilities, as wellas referring them to other specialist staff within the prison.Due to the very vulnerable nature of many women in prisonthere are huge demands placed on the mental health teams– a demand that we were told is not always fully met. Areport by the Prison Reform Trust3 also found that mentalhealth provision in prisons is of a much lower standard thanelsewhere in the NHS. During our discussions with womenprisoners as part of this research the disparity between thedemands that are placed on these services and the availabilityand quality of support in prison for women with mental healthissues was apparent.Furthermore we are aware that the number of womenrequiring support and treatment whilst in prison is higherthan the number of women currently identified as being inneed of mental health support. Not all prisoners will chooseto disclose that they have mental health issues for fear ofbeing stigmatised or being perceived as ‘different’ by otherprisoners. Some worry that if they disclose any weakness,this could leave them open to bullying and intimidation.The consequence of this is that some women prisoners withmental health issues – particularly those who are sufferingfairly low levels of anxiety or distress but who would benefitfrom some form of intervention – go undetected anduntreated.3. Rickford D and Edgar K (2003), Troubled Inside: Responding tothe mental health needs of women in prison, London, PrisonReform Trust
Our researchOur research took the form of an enquiry to establish whatinformation was available for women in prison with mentalhealth problems and what more could be made available.4 Thefindings from this report will help Mind compile informationspecifically for women in prison.We used mainly focus groups on the basis that they are a loteasier for prison staff to facilitate and far less time-consuming:namely, the attendees could all be brought to the focus groupvenue together and then returned as a group to their location,requiring a member of staff to make just two journeys asopposed to the many journeys that would be required if eachwoman was being collected and returned individually. The onlyexception to this was when working with juvenile girls at HMPNew Hall where they were seen either individually or in pairs– experience has shown that young offenders in a group donot all participate fully due to peer pressure.We initially proposed (and had approval) to work with HMPDrake Hall, HMP Styal and HMP New Hall. We planned to holdtwo to three focus groups in each prison. In the event we heldthree focus groups at HMP Styal and three at HMP New Hallbut were not able to arrange any at HMP Drake Hall in spiteof National Research Committee approval and the authorityof the governor to proceed. The aim of holding three focusgroups in each prison was to allow us to capture the views ofa cross section of women, including younger and olderwomen, BME women and foreign nationals.Women experience high levels of both severe and enduringmental illness and psychological distress and seek help morereadily than men,5 and we were hopeful that this willingnessto seek help would mean that the women we saw would behappy to engage in a frank discussion with us about theirinformation needs.We sent information leaflets to the appropriate members ofwing staff and the disability liaison officers and these weredistributed to the women, along with an explanation of thepurpose of the focus groups and interviews. Prisoners wererecruited either by the disability liaison officer at HMP Styalor the wing staff at HMP New Hall, and the staff involved at4. For the purposes of carrying out this research, we receivedapproval from the Prison Service National Research Committeeand consulted with relevant national policy leads in NOMS,including healthcare, drugs and the Women and Young People’sGroup.5. HM Inspectorate of Prisons (2007), A Thematic Review of theCare and Support of Prisoners With Mental Health Needs,London, HM Inspectorate of Prisonsboth establishments were extremely helpful. The majority ofthe women prisoners were approached to take part in semistructured focus groups, while the juvenile women at HMPNew Hall were approached to take part in semi-structuredinterviews.The following two charts illustrate the profiles of theparticipants involved in our research in each establishment.Profile of participants by age – lBMEBMEWhiteWhiteSentenceof overSentence12ofmonthsover12 monthsProfile of participants by age – New eSentenceof over12 months50 5
The interviews and focus groups investigated the experiencesand needs of women prisoners in the following areas: the information they received on reception into prison access to listeners (ie, prisoners trained by the Samaritans 6to work with prisoners experiencing distress)how prison affected their emotional well-beingreferral to healthcaremental health support prior to imprisonmentaccess to the mental health in-reach team in prisonmethods of relieving stress and relaxationawareness and availability of alternative therapies inprisoncontact with outside agenciesreferral to a counsellor in prisonmembership of any groups in prisoncontact with the disability liaison officerinformation that would be usefulThe content of the interviews was recorded by researchersalong with any relevant quotes and the findings then analysedby the research team. From this it was possible to categoriseinformation requirements into five broad areas as follows: first night and inductionduring sentencehealthcare and medicationapproaching releaseequality and diversityThe rest of this report will detail the responses of thewomen in relation to each of these five areas and makerecommendations for Mind on the kind of information thewomen said they would like to receive.
First night and inductionFrom all the discussions that we had with the women inrelation to issues that affect them whilst in prison, the firstnight and induction period was reported to be the mostdistressing.One said:‘You don’t know what’s going on. You are guessing andwatching. You need more written information. I was inshock and it wasn’t what I expected. I hadn’t made anyplans, I have children and I was very worried. The phone onthe landing wasn’t working.’6Another said:‘It’s a scary place. It is intimidating when someone comesto your door. All the information is thrown at you and youcan’t take it all in. I didn’t even know if I could come out ofmy room.’7For many women this is their first experience of imprisonmentand they have no idea what to expect. They are allowed aphone call and told that during the next week or two they willundergo an induction process introducing them to the prison,its regime and the various departments operating within it.The information that was provided on the first night and atreception varied. Both HMP Styal and HMP New Hall hadinformation on the prison and its regime (though somewomen reported that this information was missing fromtheir first night cell) and also limited information from otheragencies. It was found that on a day when a large number ofwomen are received into the prison or where prisoners arrivelate at night, this can affect the amount of help andinformation they receive.she had to pay for her meals. The women widely reported thatthey received as much, if not more, information from the otherprisoners than from the prison.‘You have to wait a week for induction and there is nothingto do. No books or anything. The other girls give me moreinformation.’8‘Induction is done over a few days, everyone gets a booklet,there’s lots of form filling and you have to keep nagging ifyou want something. Induction is very much about prisonrules.’9For those women who had been in prison before it wasslightly less daunting as they had some understanding of theprison regime and what was expected of them. However, incertain cases this led to them being fast-tracked through theinduction process which meant they could miss vitalinformation if things had changed since their last sentence.The women also found the noise levels in the first night centrevery distressing. The more mature women were particularlyaffected by this and tended to shut themselves away in fear ofwhat was happening outside their cell.‘Old and young are together during the day but separate atnight. It is scary in the first night centre if you are new toprison – there is a lot of noise and bells. I was frightened bythe younger women and the wing was daunting.’10There was a general perception from the women we saw thatthere was not a lot of information to help with their emotionalwell-being on reception and induction, and some reportedthat they did not feel the staff were listening to them orgrasping the issues they raised.Many of the women claimed to have been told very little onFor those women with mental health issues the mental healththe first night and said they had to ask the other women toin-reach team does form part of induction but there may be afind out what they needed to know and what to do. This made wait to see them.them very anxious in case they broke the rules. Many foundprison language and terminology very confusing and thisadded to their anxiety. One woman reported that she thought8. Young prisoner, HMP Styal9. Adult prisoner, HMP Styal6. Adult prisoner, HMP Styal10. Mature prisoner, HMP Styal7. Young prisoner, HMP New Hall7
‘Induction is not always done in the first week, the mentalhealth team are part of induction so if you have a mentalhealth issue you may not get help immediately.’11‘The leaflets are general; and there is nothing relating tomental health.’12‘I was scared. I had mental health [issues] but I didn’t wantto declare it. It could be depression or anything.’13For those who are dependent on drugs there is the additionalissue of de-toxing and, for some women, a forced change totheir usual medication which they can find very distressing.Any medication they were taking prior to coming into prisonhas to be approved and authorised by the prison doctor. Insome cases this can lead to a delay in the medication beingavailable, and in others a change or removal of medicationwhich may lead to side effects (see ‘Healthcare andmedication’ on page 16 for more on this).If a woman has come from another prison and there is a delayin the paperwork being transferred, this can also mean a delayin her treatment at the receiving prison.‘None of my paperwork came from the other prison. Nopaperwork and no meds [medication]. I didn’t get my medsfirst night and had no sleeping pills.’14Case study: Jane’s story15Jane has been in and out of prison many times. She iscurrently serving a two-year sentence in HMP Styal for fraud.She suffers from anxiety and depression and takes antidepressants and sleeping pills when not in prison.On reception into prison her medication was stopped whilechecks were made with her GP and until she could see theprison doctor. The doctor changed her medication and shesuffered mild withdrawal symptoms which she found verydistressing as no one had explained to her the consequencesof the change in her medication.Jane spent her first night in prison in the first night centrewhere she found that the information available on the prisonand its regime was very limited. She also found the first nightcentre very noisy and, as a more mature woman, she chosenot to associate with the younger women as she found themintimidating and very loud.Jane was fast-tracked through the induction process as shehad previously been in HMP Styal two years beforehand. Shefelt that she didn’t see all the staff she needed to request helpwith her medication and get advice on her housing andbenefits.Jane was not told about the Diversity Unit and only cameacross it herself by chance. Having discovered it, she was fullof praise for the diversity officer who invited her to attend amature women’s forum. At the forum Jane was able to share acup of tea and chat with other women of a similar age whichshe found very therapeutic.Access to relevant information when a woman first entersprison is essential and this should cover many areas:information about the prison and its regime; medicationand healthcare; sources of further help and information;information about housing and relinquishing a tenancy –these are just some of the key areas of concern on firstcoming in to prison.11. Disability liaison officer, HMP Styal12. Young prisoner, HMP Styal13. Juvenile prisoner, HMP New Hall14. Mature prisoner, HMP Styal815. Mature prisoner, HMP Styal
During sentenceSome of the women who were very involved in activitiesspoke about how they found it more difficult to cope at theweekends when fewer activities were available, things weregenerally much quieter and they had to spend longer in theircells or rooms. For others though, their rooms were a refugewhere they would retreat to collect their thoughts and enjoythe peace and quiet. One young woman said that when shewas feeling down, she would go to her room (if possible) tosleep, as this helped her to calm down. Other women reportedA number of the women found moving from the first nightthat going to their room was all they could do to cope withcentre to a wing, house or unit very scary, as they weretheir anxiety. However, depending on the prison, the locationexpected to adapt fast to the systems and procedures. Manywithin the prison and the stage they were at in their sentence,relied on the other women to help them find their feet orsome women also said they had no choice but to be in theirturned to staff – some of whom they found extremely helpful,cell for long periods which actually caused them added stress.others less so.In addition, some women reported that they found earlyFacilities and resources available during sentence vary frommornings and night times hard to deal with if they were onone prison to another, but many of the women we interviewed their own in a cell or room.spoke about the importance for them of making the bestTherapies such as yoga and acupuncture were available inpossible use of whatever was available in their particularsome locations for those experiencing stress. These helpedprison, and keeping as busy as possible. Keeping busy was,alleviate problems for those who could access them.for many, their coping strategy, and included getting involvedThe kind of activities that some of the women did during theirin activities such as the following:own time to keep emotionally well included: attending education classes writing letters work (where jobs were available) keeping a journal of good and bad days going to the gym and attending any exercise classes thatmight be available blocking things out of their mind going to religious services and other faith-based events listening to music(eg, bible study) spending time in the peace and ies taking long baths (when possible)(eg, joining a book club if there is one) taking physical exercise (if by spending time with friends they had made in prison (whoa psychiatric nurse three times a week and activitieswere often quoted as the best source of support)include creative writing, pampering days, art therapyMental health support was cited as an issue by a number ofand craft)women. Some said they still felt scared to declare their need becoming a ‘buddy’ or a ‘listener’, and getting involvedin prison and would prefer to be able to pick up a phone andin other acti
information was available for women in prison with mental health problems and what more could be made available.4 The findings from this report will help Mind compile information specifically for women in prison. We used mainly focus groups on the basis that they are a lot easier for prison staff to facilitate and far less time-consuming:
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