Perspectives from the inside

A new (May 2016) publication from the Howard League for Penal Reform and the Centre for Mental Health: Preventing prison suicide: perspectives from the inside focuses on the views and experiences of current and former prisoners about what contributes to vulnerability and what increases or reduces their risk of suicide.

The report

The Centre for Mental Health worked with the User Voice to facilitate four focus groups – two in prison and two with former prisoners who had
been released within the previous 12 months. 30 participants took part in the focus groups, including 15 men and 15 women.

The report is written in the context of a worrying rise in prison suicides. In 2014 there was a marked increase in suicides in English and Welsh prisons, when 89 prisoners took their own lives. This was the highest number of suicides since 2007. In 2015 another 89 prisoners took their own lives. The number of suicides in prisons has remained high for two years, and by the end of March 2016 there had already been 27 self-inflicted deaths in our prisons. Additionally rates of both self-harm and assaults have risen considerably.

The report looks at four categories of risk factors contributing to vulnerability to suicide.

Personal risk factors

In discussing the factors that increase vulnerability, prisoners described historic and current risks that were not being addressed. These included historic mental health problems, exposure to trauma and abuse, having lived in care, homelessness, drug use, receiving a sentence later in life, risk of deportation and child custody concerns.

Not only did prison exacerbate these challenges because they were not appropriately addressed within the prison system, but imprisonment made many prisoners feel powerless to deal with issues such as their children’s wellbeing.

Prison life

Arrivals, transfers and release were all seen as high stress factors which made prisoners feel particularly vulnerable. The loss of liberty and control contributed to vulnerability and feelings of powerlessness which were often aggravated by the isolation and boredom of prison life.

Prisoners also spoke about feeling unsafe in prison, about how sharing a cell with someone who was vulnerable often exacerbated a person’s own feelings of vulnerability and how prison culture and environment made it almost impossible to express feelings of vulnerability. Prisoners also spoke about the difficulties in talking to staff with many (but by no means all) not having the time or inclination to respond to requests for help or a supportive conversation.

All these issues were judged to have worsened since the recent reductions in staff numbers.

Mental health services

Prisoners’ experiences of mental health services in prison varied widely. Prisoners mentioned befriender and listening schemes, therapeutic communities, short term projects run by external organisations, safer cells and medication.

They described that generally their experience of mental health interventions had a “medication focus”. Several referred to being introduced to medications for the first time in prison, which had an impact on their wellbeing, resulting in them feeling “completely flat”. There was mistrust around the intentions behind medicating prisoners. Conversely, Some prisoners explained how they had been taken off medication that they had been receiving in the community before being sentenced. They talked about how it had left them feeling particularly vulnerable, with “nothing to numb the feelings”.

Is prison the right intervention?

A recurrent theme of the focus groups was whether vulnerable people should be in prison in the first place.

Some felt it was often difficult to distinguish those most at risk, since all prisoners were vulnerable. Nevertheless, most felt that people at high risk should not be in prison, given the potentially tragic effect it can have.

Prisoners felt that often mental health needs and risks to mental health go undetected, resulting in many people going to prison who should not be there. As one participant explained:

Spending a couple of years in prison was not the intervention [I] needed…I am the same person and you haven’t protected the public from me because I was nothing… I was naïve and that was the environment I was living in… made me think that crime was normal and just what happens… but when I was sentenced they left my door open because they thought I was going to kill myself because I was in hysterics, on the floor crying… I was so frightened… Was that the best place for me? Probably not…

Conclusions

From the perspectives of many prisoners and former prisoners, life in prison does not address vulnerability, and in many cases it exacerbates it.

The report finds that relationships between staff and prisoners are key. Prisoners need to feel supported, cared for and able to confide in and trust staff. Prisoners reported that staff shortages, inexperience and lack of training can all increase the risk of suicide.

Prisoners described a culture where distress was often not believed or responded to with compassion. They highlighted arrival, being released and being transferred as times when prisoners felt most vulnerable.