‘Our system appears to have been designed centuries ago by men, for men’

13:30 – unlock time in HMP Downview. Prisoners leave their cells, walk through the wings and across the exercise yard to their places of work and activity. As the new cohort of attendees arrive for the Trauma Stabilisation Group I feel nervously excited about co-facilitating the group. It is my job to help provide an understanding about the psychological impact of trauma, outline common symptoms, and teach safe grounding techniques. As one group member shares her abusive upbringing, violent partner, drug usage to numb herself to this and the cycle of crime to fund it, I am struck by two things. One, a sense of privilege in being able to help provide support which will hopefully prevent repeated cycles of exclusion, suffering and crime. Two, an overwhelming sense of familiarity… I've heard variations of this story from so many previous inmates.

We had designed this six-week cognitive behavioural therapy group as a rolling programme to accommodate high demand and step-up care accordingly. The familiar narrative of prisoners' abuse, neglect, pain, suffering and separation sadly suggested that the majority might benefit from attending. Reflecting on this, I consider the important role psychologists have in an archaic system which is both at capacity and failing to deliver the results it promised. As the exact purpose of imprisonment is debated – is it to protect the public, provide rehabilitation, reform or punishment? – it seems something is amiss. Does depriving women of their liberty really help in their reform, thereby reducing crime rates? Our prison system appears to have been designed centuries ago by men, for men. My experiences working in female offender care and research proved this to be the case.

Firstly, women in prison have often been victims of much more serious offences than the ones they are accused of committing – according to Ministry of Justice figures from 2012, more than 53 per cent report having experienced emotional, physical or sexual abuse as a child, compared to 27 per cent of men. There are also significant differences in the offences committed, with the latest statistics showing only 21 per cent of women awaiting sentencing for violent offences compared to 31 per cent of men. Finally, according to 2013 figures published by Miriam Light and MoJ colleagues, women (49 per cent) are more likely than men (29 per cent) to report needing help with a drug problem on entry to prison. Perhaps the true offender care, for these women and society, would be more provision of community psychological support; protection from domestic violence, trafficking and coercion into offending; and treatment for addiction and mental health problems.

It is paramount to provide physical and psychological safety whilst recognising the distinctive needs of female offenders. The United Nations Rules for the Treatment of Women Prisoners and Non-Custodial Measures for Women Offenders ('the Bangkok Rules') call for consideration of histories of victimisation, and sentencing alternatives for women. In such alternatives, the field of psychology could play a pivotal role in counselling, psychological intervention, coping skills development, self-awareness, debt management, education and employment. And this approach has to begin in the community: in 2013 over 25 per cent of women in prison said they had received treatment for a mental health problem during the previous year, yet less than 1 per cent of community sentences have included any mental health treatment requirement.

There's also a spiralling systemic problem caused by splitting up families and taking children into care. Women in prison are far more likely than men to be primary carers of children and an estimated 17,240 children are separated from families annually, with just 5 per cent remaining in their own homes. Sadly, as psychologists are only too familiar, children in care are more than twice as likely to be cautioned or convicted as their peers. Having worked in children's care homes, young offenders' institutes and the women's estate it has been staggering to witness the cycle of trauma caused through family separation. How has this impacted our job as psychologists?

Whilst working in offender care I wondered if future generations will look back at this period of time in the same way we view asylums from the past: where society believed locking up its citizens would cure their disease of mind, when in fact, history shows us that the individuals' ailments often significantly worsened (see Henry Rollin on 'Psychiatry in Britain One Hundred Years Ago'). Today, among the general public, rates of psychoses are around 1 in 25, whereas MoJ figures show that in the prison population this soars to 1 in 4 women reporting symptoms indicative of psychosis. Women released from prison may return to their families and communities with even more complex mental health needs.

It is perhaps unsurprising, therefore, that Seena Fazel's data shows that women prisoners have a much higher rate of self-harm and suicide than male prisoners or women in the community. 2016 saw the highest number of suicides in prison since records began and during my tenure I experienced the all too familiar devastation this can bring. Thankfully Inreach psychologists worked with chaplaincy and prison staff to provide excellent care, preventing clustering of self-harm and mitigating the risk of subsequent suicide. This is something that is common on prison wings which are highly social, close proximity environments. Experiencing this tragedy further bolstered my belief in the need for increased alternative, community sentences and psychological intervention as opposed to more locks and keys.

Current figures show we still have a long way to go. Any business has to adapt to its requirements; failure to do so would result in its demise. For instance, it is unthinkable that a car manufacturer would produce vehicles of which around half would malfunction and have to be returned to the factory. Yet shockingly, 2016 MoJ figures on 'Women and the criminal Justice system' show that within one year of leaving prison, 48 per cent of women are reconvicted.

All this is not to say that the entire system around female offenders is archaic and ineffective. There are encouraging developments as a growing number of prisons move to adopt trauma-informed practices, substantially reducing institutional violence (see One Small Thing, A Centre for Crime and Justice Studies Project; and Sheryl Kubiak and colleagues on 'Trauma-informed corrections'. In my role, I could use my background in psychology to provide perspectives with Officers to create a trauma-informed culture. One of the most enjoyable aspects was working alongside 'Mental Health Champions': prisoners who can help fellow prisoners make healthcare referrals and assist registered practitioners to deliver trauma psychoeducation. I found this an invaluable addition to the multidisciplinary team, with first-hand experience to the difficulties faced by criminalised women and skills to assist them access psychological support.

I have the upmost honour and respect for the hardworking dedicated professionals working with Her Majesty's Prison Service. Wherever I went I found humour and compassion regardless of circumstances. I am grateful for the opportunity of working with what Stephanie Covington calls 'our most invisible population'. So much so, that I feel it is my obligation to hold decision makers to account. An example which was extremely challenging for the inmates, and myself to an extent as Assistant Psychologist, was the turmoil created by the introduction of Imprisonment for Public Protection (IPP) sentences.

IPP sentences, originally reserved for serious offences of a violent or sexual nature, required individuals to be considered for release by the Parole Board after serving their tariff. In reality these sentences were latterly handed out for relatively minor offences, such as theft, where punishment normally warrants only months. By the time it was abolished more than 6,000 people were imprisoned on IPP sentences in England and Wales. Unfortunately, changes were not made retrospectively, therefore over 85 per cent of people serving an IPP sentence are still in prison having passed their tariff expiry date. This is reminiscent of the futuristic blockbuster 'Minority Report', where people are penalised in case they commit future crimes. This can have disastrous effects on individuals.

One of these individuals, whom I worked with, was imprisoned for theft on an IPP sentence which was many years over tariff. She spoke of her hopelessness of not knowing when – or if – she would ever be released. The traumatic impact in the separation from her children and grandchildren was immense. Moreover, her frustration at the lack of access to courses required by the Parole Board to prove her rehabilitation appeared to contribute to her depression and being institutionalised.  

Due to the sheer volume of prisoners across the UK, and courses only being available in certain establishments, there are inevitably long waiting lists full of desperate individuals in similar Catch 22 situations. The psychological effects of IPP make it particularly challenging for any clinician, myself included, to contain the desperation caused by these extreme systemic factors, and set therapeutic goals that are both meaningful and attainable.

Let me come back to that brave woman in the Trauma Stabilisation Group, who shared experiences of suffering, marginalisation and crime that were so similar to other group members. Instead of marginalising and penalising the most desperate and vulnerable in our society, perhaps we should shift to a more compassionate and effective approach: community custodial sentences, where psychological and social support benefits individual and community mental health and wellbeing in a myriad of ways. With psychology at its core it is time for creative thinking and open-minded reform of a system currently incapable of delivering that very thing: 'reform'.

- Chris Millar worked in offender care from September 2016–September 2017, and has since moved to another position within the NHS, as Clinical Research Assistant. This article was prepared in a personal capacity, the opinions expressed are his own and do not reflect the view of any organisation.

Key sources

Blades, R., et al (2011). Care - A Stepping Stone to Custody?. The Views of Children in Care on the Links Between Care, Offending and Custody, Prison Reform Trust.

Covington, S. (2008). Women in Prison: Approaches in the Treatment of Our Most Invisible Population. LCSW, Women & Therapy Vol21, Issue 1.

Fazel, S. & Benning, R. (2009). Suicides in female prisoners in England and Wales. British Journal of Psychiatry, 194, 183-4.

Gerry, F. & Lyndon, H. (2016). Women in prison: is the justice system fit for purpose? Halsbury's Law Exchange.

Harne, H. & Riley, S., (2012) 'The Impact of Incarceration on Women's Mental Health', Responses from Women in a Maximum-Security Prison. SAGE Journals.

Hawton, K., et al. (2014). Self-harm in Prisons in England and Wales: An Epidemiological Study of Prevalence, Risk Factors, Clustering, and Subsequent Suicide. The Lancet, Vol 383, Issue 9923, 1147–1154.

Light, M. et al. (2013). Gender Differences in Substance Misuse and Mental Health amongst Prisoners. London: MoJ.

Ministry of Justice (2012) Prisoners' childhood and family backgrounds, London: MoJ

Ministry of Justice (2013). Gender differences in substance misuse and mental health amongst prisoners. Surveying Prisoner Crime and Reduction, London.

Ministry of Justice (2016). Women and the criminal Justice system. London, Ministry of Justice.

Rollin, H. (2003). Psychiatry in Britain One Hundred Years Ago. The British Journal of Psychiatry, 183 (4) 292-298.