Women and young people worst affected
Dr Lucy Wainwright, Donna Gipson and the wider team from EP: IC Consultants explored issues around the mental health of people in prison during the COVID-19 pandemic, entirely from the point of view of patients. EP: IC used a variety of sources including direct responses from people in 19 different prisons which amounted to over 2,000 contributions. This allowed them to establish a broad and rich view of the challenges facing people in prison during the pandemic.
The research found variations across prisons on the extent to which lockdown has impacted on mental health. The lowest impact was seen in an open prison, where 40% people reported a decline in mental health. The highest impact was seen in a closed prison, where 84% said their mental health had deteriorated. The highest risk group for worsening mental health is that of women and young people (under 21 years old). However, overall the number experiencing a decline is around half of all people involved overall.
The impact of confinement
As readers know, prison cells are small, typically around eight by six feet. There is a research base on how experiences of confinement in such small spaces can impact significantly on the mental and physical health of those experiencing such conditions, in both the here and now and in the future. Cell size was cited as being particularly problematic during the pandemic for many reasons. Those without in-cell sanitation, who relied on a sanitation system to access toilets outside of their cells, faced additional challenges. There were increasing concerns over how the restrictions were impacting not only on the health of these individuals but also on their dignity and privacy.
“The problem for someone like me with IBS is if you’re 4th or 5th in the queue, you just can’t wait an hour, hour and a half to go. I’ve had to use the bucket; it’s degrading and depressing and you feel dirty.”
Despite cell confinement protection against transmission of the virus, being ‘cooped up’, ‘caged’ and ‘isolated’ was said to be ‘suffocating’ at times. All the usual outlets for typical ‘pains of imprisonment’ had been removed (such as seeing family, engaging in peer relationships, attending work or psycho-social courses). When coupled with social isolation and inactivity for long periods, this led to deteriorating mental health in many.
One person reported that officers allowed cell doors to remain open from time to time, despite not permitting individuals to leave their cells, and this was considered ‘a blessing’. Being shut behind a door for extended periods led to unusual behaviour in some instances, including those who usually cope well with prison life. Additionally, individuals who usually get on well with their ‘pad mates’ reported finding it difficult to manage the relationship in 24/7 confinement.
There were numerous reports of self-harm being used as a mechanism to cope with the enduring isolation caused from being in a cell for extended periods of time, and of normally compliant people becoming aggressive and disruptive. One person described how his neighbour had smashed the observation panel of his door in desperation:
“The bang up was too much for him; he felt cocooned. Without the glass panel he didn’t feel trapped in his cell.”
A number of themes recurred in people’s prolonged experience of lockdown in prison.
Boredom & Rumination
Being confined within a cell for many hours a day with little interaction made it difficult to remain upbeat and motivated. Some lost their sense of purpose and experienced increased thoughts of powerlessness. Boredom exacerbated the problems of loneliness, with little to divert individuals from their thoughts. Long days with little to do resulted in overthinking about other problems in life. People talked about how overthinking could lead to increased anxiety levels, paranoia or catastrophic thinking for some. This remained a prominent theme for worsening mental health.
Disruption to prison life
Interestingly, the disruption to the normal prison regime and separation from the community was an improvement for a minority of people in prison. Some felt safer and happier as increased in-cell time meant:
- less bullying and victimisation, and less overall violence
- less exposure to abuse from others (verbal, physical and sexual abuse were mentioned)
- celebrating abstinence from substances for the first or longest time since arriving in prison
- less community tensions and ‘prison drama’
- a sense of peace.
However, with the disruption came the suspension of social visits. Within survey responses, lack of contact with family was highlighted as the biggest cause for declining mental health. Not only were people sad at the separation from family and friends, they shared their fears and worries about their loved ones in the community.
“I have 5 children. It breaks my heart daily having to choose who to call for 5 minutes. We need more time to talk to families. This can’t be right.”
Anxiety about COVID
There was considerable anxiety about COVID-19 from people who often watched the news for hours, heightening their concerns and embedding them in a world totally dominated by the pandemic and ‘bad news’ stories. Many people said they were afraid to leave their cells and mix with others (whilst simultaneously desiring social contact). As painful as they found their time behind their cell doors, some considered it to be the only safe place.
Some people explained they refused to exercise because they felt unsafe and became anxious whenever an officer came to their cell door. One man became fretful in the hours prior to the medication queue.
Sentence progression and feeling stuck was a common theme raised, which was causing heightened anxiety. Many were concerned about not completing courses and how this impacted on their ability to progress through the system and be released. Not having clear communication about this exacerbated the problem. This resulted in further fear, anxiety and worry.
Access to services
Across all prisons, nurses were praised for their availability, consistency and compassion. However, individuals found it difficult to communicate as freely as they would have liked to, given the COVID-safe restrictions in place and the limited time allowance with them. Access to GPs was said to be very difficult for many, and anxiety over their physical health was having a knock on effect on mental health.
Those who previously relied on support from health services are keenly feeling the gap created by the suspension of the service, especially those who accessed mental health teams to help them stay well. Most people said it was difficult to see mental health workers, although it varied from location to location and over time; and change happened quickly and without warning.
Whilst some felt they had quite extreme or worsening needs, others simply needed an outlet to share how they were feeling. Consequently, some people experiencing new or worsening mental ill-health, had heightened anxiety, distress and confusion. In extreme cases, people spoke about self-harm.
Across all prisons there were instances of good practice and positive experiences, showing what helped people in prison manage their mental health during lockdown.
Connection to family and friends via telephone, letters and email was, of course, widely valued, whilst the suspension of visits was a major factor in declining mental health. Individuals emphasised the positive impact of some sympathetic and compassionate officers, and welcomed the array of responses such as additional phone credit from HMPPS.
Additional extra food packs and bottled water were regarded as positive interventions, and symbolised HMPPS’s recognition of the strain people were under. Others valued extra TV channels, newsletters, library books, extra post and outside fitness classes.
There is no doubt that, as time has gone on and little change has been felt by individuals in prison, emotional wellbeing and mental health has deteriorated. At the start of lockdown, there was a definite sense of solidarity with the outside world and a strong appreciation of prison and healthcare staff. People in prison felt they were part of a national movement to ‘stay home and protect lives’ and understood staff shortages to be a part of that.
However, as time has moved on and restrictions have remained, tolerance levels have reduced and there is a clear desire to return to some sort of normality. Individuals see no end to the restrictions, the confinement and the segregation from others in the prison community and loved ones, further impacting on how people were feeling, and subsequently managing. This became particularly apparent in the late summer months when people saw outside community restrictions relax, but few changes made to prison life.
Feelings of abandonment and neglect have been an emerging issue. People feel stuck and unsupported, with hope for change diminishing. It became apparent the cumulative effect of the ongoing lack of contact with loved ones, limited meaningful contact with mental health services and restraints on seeking peer support from friends in prison was taking a toll.
If you would like to read the full report click here and navigate to the bottom of the page.
Thanks to Andy Aitchison for kind permission to use the images in this post. You can see Andy’s work here.