This morning (9 February 2022), HM Inspectorate of Prisons took the unusual step of publishing a briefing paper “Focus on women’s prisons” alongside a critical inspection report of HMP Foston Hall. The briefing paper reveals both the impact of COVID but also a number of key concerns not related to the pandemic. The inspectorate calls for “clear and committed leadership” to address persistent weaknesses.
The Foston Hall report details a number of major concerns:
- Very high levels of violence
- The use of force by staff had doubled since the last inspection and was the highest in the women’s estate
- Far more frequent use of the poor segregation unit
- The highest levels of self harm in the women’s estate; women were making more than 1,000 calls a month to the Samaritans
- No strategy to reduce self harm or improve the care for those in crisis
- The response to women in crisis was too reactive, uncaring and often punitive
- Staff morale was low with nearly one third of frontline officers non effective and non deployable
Briefing based on on 5 recent inspections
The short briefing paper is based on five inspections of women’s prisons (Foston Hall, Send, Low Newton, Downview & Styal) conducted over the last six months. It is important to be clear that inspectors found plenty of positive practice alongside their concerns.
The inspectors make it clear that self-harm is much more common for women in prison than men and has increased during the pandemic to record levels. In some months during the COVID-19 restrictions, the rate of self-harm for women has been seven times higher than for men. Some women use self-harm as a day-to-day coping mechanism or in response to triggers which often relate to current or previous trauma.
In one recent inspection about 10 women accounted for 66% of all self-harm incidents.
Despite clear evidence of acutely unwell women going to prison because of a lack of suitable provision in the community, inspectors emphasised their frustration that there is no systematic process for gathering data nationally, which means that neither the prison service, the courts nor the Department for Health and Social Care know the extent of the problem. Some warrants authorising imprisonment clearly state that a prison is being used as a ‘place of safety’. As the inspectors say:
“nobody would agree that prisons are the right place to keep women who are acutely unwell”.
Individualised and proactive care is key
The first few days or weeks in prison is a risky time for women. Inspectors found the best outcomes where women had easy access to good support, including help from peers and easy to understand, up-to-date information about the prison and its regime. They highlighted examples of best practice.
At Low Newton, an ‘early days in custody’ project worker received referrals from court to offer immediate individual and practical help to new arrivals, with the aim of addressing their main concerns and reducing the likelihood of self-harm.
Inspectors identified better models of care as those which were underpinned by targeted support for women who self-harmed regularly. This was based on meaningful day-to-day engagement, proactive care to help women avoid getting into crisis in the first place and providing support for their often-complex needs. Better practice was based on a ‘whole prison’ approach to supporting each woman.
At Styal the work was not just left to the safer custody team; all departments showed a commitment to working with the woman to respond to her risks and needs. In the most positive approaches the woman’s self-harming behaviour was not seen as a hindrance to her progression, nor was it allowed to define her. Instead, her strengths were recognised, including the importance of purposeful activities to encourage a sense of self-worth and develop alternative and more positive coping skills. Care was also enhanced by individual psychological work, day-to-day action plans for wing staff and importantly, involvement in meaningful employment, education, or training.
At Send, further support was provided to women who were likely to be more vulnerable and to self-harm at weekends when there were fewer activities and less time out of cell. A meeting, held each Friday, reviewed the risks and set out simple steps to take to help the woman reduce them.
Inspectors highlighted the installation of in-cell telephones and the introduction of video calling as an important development, but noted that the uptake of video calling was poor in most prisons. When face-to-face visits restarted, the take up was low, largely because of the restrictions on physical contact. Women told the inspectors about the confusion and distress of their children when they were unable to hug their mother. Again, inspectors identified some good practice:
HMP Low Newton had been able to keep a multidisciplinary team of family engagement workers and a full-time parental rights advisor. The team investigated why the uptake of visits was so low and worked with individual families to encourage take up, resulting in a 30% increase. The same establishment also used video calling innovatively. For example, one mother was able to video call regularly her five children in two different foster homes; another mother was able to call her son in a secure hospital with the social worker present; and another took part in a parents evening at her child’s school.
Inspectors found that release on temporary licence (ROTL) for family contact was too slow to restart in full. At one prison, inspectors were concerned to find that relatives of babies living on the mother and baby unit were not allowed to take the babies out of the prison to bond with them, even when they were soon to become their sole carers.
Positive and meaningful relationships
Inspectors found that women prisoners were more satisfied than men in the area of staff relationships. 76% of women (compared with 70% of men) said most staff treated them with respect, and 84% (vs 70% men) said they had somebody they could turn to for help. However, this overall figure concealed large variations by prison with perceived respect levels varying from 62% in one establishment to 85% in another.
The inspectors called for a more trauma-informed approach and gave a number of straightforward examples including:
- creating a more positive living environment that has open areas and more space,
- not using loudspeaker systems or shouting down the landing to attract someone’s attention and
- involving women in making decisions about their care and setting goals for their future.
Inspectors concluded that that most positive relationships were those which recognised women as individuals. In one prison, women who self-harmed were encouraged to write down simple ‘dos and
don’ts’ for staff to follow if they self-harmed again.
Resettlement under threat
Disappointingly (if unsurprisingly), inspectors highlighted that the reunification of the probation service had resulted in the removal of services helping women in prison (both sentenced and on remand) to access help with the key issues of housing and finance.
Reflecting on these findings, the inspectorate calls for clearer and more committed leadership.
Thanks to Andy Aitchison for kind permission to use the images in this post. You can see Andy’s work here