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Prisoners on the realities of peer support in prison
Former prisoners and academics coproduce an innovative, retrospective examination of peer-delivered prison suicide prevention.

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Prisoners on prisons

 A recently published (25 May 2023) study on the Experiences of peer-delivered suicide prevention work in prison offers fresh perspectives, revealing overlooked limitations of listener and other peer delivered mental health services inside, particularly the risk of traumatisation.

The study was coproduced by a team of former prisoners and academics, many of whom are well known to regular readers: Gillian Buck (@gillybuck), Philippa Tomczak (@PhilippaTomczak), Paula Harriott (@paula_harriott), Rebecca Page (@BexPage1), Kate Bradley, Mark Nash and Lucy Wainwright(@Lucy1Wainwright).

Findings

There is research evidence to say that peer support can complement statutory services but the reflections of former prisoners who had been involved in peer support in prison were dominated by the mental health crisis in prisons and the high levels of distress and self-harm that volunteers faced as a norm, with little structural or personal support.

The research findings prompted the discussion of three key issues:

  1. the riskiness of peer support; 
  2. inconsistencies in training and working conditions; and
  3. the value of peer support

The riskiness of peer support

The researchers point out that evaluations of prison peer support  rarely acknowledge differences between volunteering whilst imprisoned and community volunteering. There are distinctive risks of prison volunteering including intimidating environments, high expectations and fraught relationships. Prisoner peer supporters can be bullied or pressured to pass drugs, phones or information and it is not clear how prisons or the charities operating peer support schemes are managing these risks and supporting the peer volunteers.

For example, Listeners are offered weekly or monthly offload sessions by the Samaritans charity, but the regularity of these meetings varies and the study noted that prison officers were too frequently present in such meetings when they did take place. Volunteers can also be left to undertake acute suicide prevention work in the middle of the night, in the absence of support. They could also be required to go to work the next day with very limited rest. As a result, volunteers often felt used and unsupported.

The research team make the point that working with acutely distressed people is challenging for trained, experienced, and supported healthcare professionals, but peer supporters enter these situations whilst dealing with their own incarceration and with very little preparation. They highlight the (to me, very real) risk of secondary traumatisation.

The value of peer support and listening

The research team acknowledges that there is an evidence of positive effects of peer support on prisoner wellbeing but argues that the approach used in this study where people can look back on their experiences as prison peer supporters and are free to express their opinions may enable more critical reflections. 

Conclusion

The research team is clear that Listeners and other mental health peer supporters in prison are an important source of support and should not be withdrawn. At the same time, they highlight the unsatisfactory current model which potentially exploits many people in prison:

We do not advocate peer support services being withdrawn. Yet, the risky contexts many peer supporters work in, often with insufficient training, support and services for the most unwell, pose a dilemma. We reflected on whether peer supporters should be doing this work at all, given that it risks offsetting prisons’ responsibilities for distressed prisoners onto prisoners themselves, compounding distress and deflecting attention from the need for structural reforms by applying a sticking plaster. At the same time, peer supporters offer vital places of safety within environments which can feel unsafe, uncaring, and devoid of trust.”

Recommendations

The research team make three principal recommendations:

  1. At minimum, prisoner volunteers require respect and understanding from staff, safe working conditions and supervisory support.
  2. Policymakers and providers should acknowledge and work to reduce the potential for secondary and vicarious trauma within peer support. Comprehensive volunteer training could introduce these concepts so that prisoners can make informed decisions about taking part.
  3. Voluntary organisations should regularly review volunteer experiences and mobilise this knowledge to stimulate changes in and beyond prisons.

Thanks to Andy Aitchison for kind permission to use the header image in this post. You can see Andy’s work here

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