A moratorium on prison-based research
This is a guest post by Chantal Edge, Professor Andrew Hayward & Professor Alastair Story (all from the UCL Collaborative Centre for Inclusion Health) and User Voice.
Research and the pandemic
COVID-19 has undoubtedly focussed a public eye on the importance of timely research. The world is waiting with bated breath for findings of clinical vaccine trials and serological studies, to understand when as a community we may be able to move fully past pandemic restrictions and return to ‘life as normal’. Policy makers and researchers are also keen to ensure that the research agenda seeks to understand the wider and long-term effects of COVID-19, for example those related to mental health. As a result a multitude of studies and resources have been directed towards understanding these issues within wider community settings.
Pandemic research in prisons
Yet at the time of speaking a current moratorium is held on all prison based research in England, restricting both current and new research studies in prisons. The justice system no doubt has very valid concerns about infection control and the burden on staff for facilitating research, but this must be balanced with the need and benefit that could be accrued from allowing selective research studies to be delivered in prisons.
Prisons are high risk environments for COVID-19 transmission, prison establishments need to understand how to safely lift restrictions and manage the backlog of new prisoners as the court systems return to normal. Prisoners may also be particularly vulnerable to the effects of control measures on mental health. (Hewson et al, 2020) Recently published research priorities for pandemic mental health include the individual and population psychosocial effects of COVID-19. (Holmes et al, 2020) Authors of this position paper defined eight vulnerable groups requiring particular focus in regards to the psychological effects of social distancing, isolation, loss of group activities and reduced health and social care. Prisoners were specifically named as a socially excluded group who should be a priority for this type of research.
Prison research is needed more than ever to guide pandemic response and recovery. The decision to suspend all research is in stark contrast to the rest of the country where there has been an unprecedented level of rapidly funded and implemented research to guide pandemic response.
We propose key research questions to inform ongoing pandemic response in prisons include:
- How effective have control measures been at preventing infection?
- Which elements of the control measures were most effective and which measures can be safely lifted?
- What has been the impact on mental health and how can this be minimised?
- How has the pandemic impacted on staffing and occupational health considerations?
- What are the challenges with planning for and releasing prisoners during a pandemic?
- How can the research community more effectively involve prisoners in designing and delivering public health measures? E.g. cohorting, coping measures for extended lock-down, maintaining relationships with families and communities
- What can be learned from local and international experience to inform future responses?
The COVID-19 pandemic is likely to affect us for at least the next year and probably beyond. The prison sector needs to actively develop a research strategy to learn from the response so far and prepare for coming waves of infection. Failure to allow prisoners to benefit from the insight or interventions that can be delivered through relevant research, risks widening inequalities in comparison to the community COVID-19 response. Evaluating care is also a part of providing care. We invest a huge amount of resource in robustly evaluating the effectiveness of community healthcare services and prison healthcare should be treated with equivalence in regards to this research resource.
Delivering this research agenda
Prison research can be hard to conduct even in non-pandemic situations, issues with access, security and multiple approvals can lengthen the time taken to design and conduct academic research. However there remains a wide pool of highly experienced prison researchers in England who would undoubtedly work in partnership with HMPPS to deliver timely and sensitive research in the pandemic context and associated prison regime.
User Voice’s peer-led engagement teams are back in many prisons already, their members are skilled at engaging with people in prison and having conversations which gather honest, unfiltered views of prison life.
In the early stage of ‘data collection’, they ‘walk the wings’ or ‘work the phones’ (pandemic!) asking open ended questions so that people in prison can start to identify and share issues about their circumstance. This information is collected, collated, and ultimately put through a process of thematic analysis before being delivered as proposals for change to prison governors.
There is huge barrier for research in prisons due to the lack of trust and ‘them & us’ mentality. User Voice teams have lived experience, which is a significant factor in breaking down these barriers. Their teams can bridge that in a way that has been invaluable to many research teams, most recently with our work on prisoners’ hospital visits in a partnership with the research team led by Chantal Edge..
Even during this pandemic User Voice has continued to hear from people in the criminal justice system and has shared weekly reports with our NHS partners about the mental wellbeing of those in prison.
The experience of prison lockdown
Many of the issues raised by the UCL inclusion health team in terms of missing information about the impact of social distancing and loss of social and support groups is information we have heard about. We know that people are feeling that loss deeply and seeking out ways to connect with each other, sometimes through calling our 0800 number. Key issues raised include:
- 87% of prisoner reported feeling more frustrated than prior to the lockdown83% felt more isolated during the lockdown
- 80% felt more stressed
- 23% prisoners who have called us have tried accessing mental health support during the lockdown.
Individual prisoners make clear how difficult living in prison lockdown is:
“Not being able to socialise with people leads me to overthink so I go into depression mode.” (Female prisoner)
“23hrs behind a door is not good for mental or physical health.” (Male prisoner)
“It’s a frustrating time for me as the 23 hours lock up has stressed my mental health. I suffer from PTSD and sometimes have vivid flashbacks of past incidents. Earlier this week, I was taken on an “ACT” as I was having suicidal thoughts. Since then my medication has been re-stabilised and I feel much better. I haven’t been able to implement my coping mechanisms as I have no access to education, employment or general time out of my cell which allows me to have some form of normality.” (Male prisoner)
The User Voice model is high impact and low-level disruption. Prison staff want us back in the prisons we work in because of these very reasons. In order for research teams to fully utilise our model there needs to be a greater appreciation for peer-research and an understanding that the model can withstand the rigour of academic research.
Evidence that the User Voice model works comes in many ways. The most powerful, as ever, comes from the community we serve and like all qualitative data can best be understood once quantified. We’ve heard from over 2418 people since the start of lockdown. That’s 2418 people in the criminal justice system who volunteered to share their feedback, their opinion and in research vernacular, their data with our team and our lived experience.
Hewson T, Shepherd A, Hard J, Shaw J. Effects of the COVID-19 pandemic on the mental health of prisoners. Lancet Psychiatry. 2020;7(7):568-570. doi:10.1016/S2215-0366(20)30241-8
Holmes, Emily A et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. 2020 7, (6): 547 – 560
Thanks to Kelli McClintock for permission to use the header image. You can see Kelli’s work on unsplash here.