Prison

Prison

Thursday, 11 September 2014

Acts of Despair… Suicide in Prison

The latest annual report issued by the Prisons and Probation Ombudsman (PPO) makes very grim reading. Even the title – A Rising Toll of Despair – fails to prepare the reader for the dismal and unremitting catalogue of tragedy, casual negligence, inhumanity and institutional failure that afflicts our failing prison system. You can find the whole document here.

Allow me to take you on a brief tour of the highlights of this particular catalogue of horrors. The headline figure, of course, is the substantial rise in the number suicides in custody during the period 2013 to 2014. A total of 90 prisoners took their own lives, up from 55 in the previous year. That represents an increase of 64 percent year on year. I’m not a statistician, but I’d say that rise was ‘statistically significant’ by any measure of the term.

Within these grim statistics, there was an increase in suicide among adult male prisoners, particularly among 25 to 30-year-olds (24 percent of the total), who accounted for 22 deaths, up from 14 in 2012-2013. The report also draws attention to an increase in suicide among prisoners newly sent to prison. 

In his introduction to the report, Nigel Newcomen, the Prisons and Probation Ombudsman observes that: “Self-inflicted deaths among prisoners are tragic indicators of the level of personal distress and mental ill health in prisons. Some may even evidence broader institutional stresses and failures.” He adds that the rise in the number of suicides was “a troubling reflection of the state of our prisons”.

A grim place to die alone
Mr Newcomen, a man I genuinely believe means well but who has little real power or authority, also highlights what he describes as “a rising toll of despair among some prisoners”. While he acknowledges that his office cannot offer a “definitive explanation for this increase [in suicides]”, it is also clear that he is highly critical of the institutional failures that underlie too many of these personal tragedies and acts of desperation. 

As he rightly points out: “… there have been too many instances of prisons failing to adequately identify the risk of suicide posed by prisoners, despite clear warning signs being present. Even where risk of suicide was identified, monitoring arrangements and case reviews were too often inadequate.”

One of the specific issues flagged up in the PPO report is concern as to whether the Prison Service can actually cope with the rising levels of mental illness among prisoners. Readers of my previous blog posts on this subject will be aware that my own view – based on my experience in prisons – is that current shortages of staff, serious overcrowding in many establishments and the mismanagement of very limited mental healthcare resources all have a part to play in the institutional failure to reduce levels of suicide and self-harm in our prisons.

Too few prison staff?
The contentious issue of inadequate staffing levels – always a highly political point – is raised by Mr Newcomen. As he points out: “It has been suggested that prison staff are now so stretched, and the degree of need among some prisoners so high, that they may no longer be able to provide adequate care and support for some vulnerable prisoners.” 

However, he goes on to observe: “The evidence for this remains anecdotal and every day prison staff do save many prisoners from themselves – an achievement which goes largely unreported and without which the tragic number of suicides would be even higher. Nevertheless, the prison system is undeniably facing enormous challenges.”

Personally, I’d agree that prison staff and support services are over stretched and are often unable to cope. I have also seen for myself the casual, even callous manner in which some prison officers deal with cons in crisis, dismissing them as weak or attention seeking cry babies. Moreover, the monitoring of inmates who are considered to be at risk of self-harm or suicide can be extremely lax or overly complacent. 

Prisons are supposed to use the Assessment, Care in Custody and Teamwork (ACCT) system to assess, monitor and share information about such people when they are placed on what is often called the “ACCT book”. However, when this is used more as a ‘tick box’ exercise, the outcomes can be tragic. As the PPO annual report acknowledges: “While we believe that the ACCT process can be an excellent tool to help keep prisoners safe, if it is not implemented correctly, it can provide false assurance for both staff and prisoners.”

The reality for many prisoners
From a personal perspective, however, I could point to other issues playing a part in the rising suicide rate, such as the toxic ‘legacy’ cases left over by the catastrophic (and now discontinued) Indeterminate Sentence for Public Protection (IPP) where thousands of prisoners have been left in a soul- and mind-destroying limbo, often with no realistic prospect of release even when they are years over the minimum tariff handed down in court. 

I have often reflected that had I received an IPP, I’d have very probably joined the ever-lengthening list of suicides myself. A determinate sentence – even a very long one – at least has an eventual end point. You can dream and plan of what you’ll do with the rest of your life after release. 

With an IPP sentence, you have nothing to hang on to, even if hope dies last. I’ve known innumerable cons serving these sentences and the stress of it mentally destroys them. In my own opinion, some are probably far less mentally stable, and more angry and bitter now than when they were sentenced. That doesn’t bode well for future public protection if these men do ever get released. 

Of course, there is a wide range of other root causes of self-harm and suicide in UK prisons. These include relationship breakdowns (very common inside, as well as out in the community); overwhelming guilt over terrible crimes committed; the death of close family members and mental illness, particularly depression. Older prisoners may also conclude that spending what is left of their lives in a concrete cell really isn’t worth the effort, especially if they are in poor health or severe pain. While individual screws and other staff may be supportive and good listeners, the Prison Service as a whole is not well equipped to deal with these personal tragedies and crises. 

Good intentions: not always enough
Even when inmates can find a kindly member of staff ready to listen, such as wing officers or chaplains, their hands are often tied by the endless red tape and regulations that can even prevent them facilitating access to a telephone so a distressed prisoner can make a compassionate call to a loved one dying in hospital or a sick child. I’ve sat with sobbing inmates who are terrified that their relative will die while they are imprisoned miles away, utterly helpless and unable to be there to say goodbye. 

The recent tightening up of the rules for Release on Temporary Licence (ROTL) is likely to block some cons from being able to visit close family members on their death beds in hospitals or from attending funerals. This will doubtless be made worse by the current shortage of staff to serve as escorts for such compassionate leave outside the prison walls.  

And I think that there are other factors to consider. The changes to the rules for the Incentives and Earned Privileges (IEP) system introduced on 1 November 2013 in PSI 30/2013 may well be playing a role in making the experience of imprisonment much more difficult to endure. Placing more and more cons on the highly punitive Basic regime, particularly those who are steadfastly maintaining innocence, is never going to improve mental health. 

Almost anyone, no matter how strong, will eventually deteriorate mentally and physically if held in what amounts to solitary confinement for up to 23 hours a day with no rented TV and next to no personal property or opportunity to telephone family or even take a shower. It would be instructive to know just how many of the prisoners who have committed suicide, or attempted to do so, were on the Basic regime at the time of their deaths or a serious attempt to self-harm.

Wilde: first hand experience
Beyond those pressures, I would also add the general, all consuming weariness of prison life, particularly for those cons serving very long sentences. As Oscar Wilde so accurately observed in his Ballad of Reading Gaol

All that we know who lie in gaol
  Is that the wall is strong;
And that each day is like a year,
  A year whose days are long.

Sometimes the prospect of those long days and even longer years proves to be too much for some prisoners to bear and even death seems to offer a merciful release. While I never considered myself to be particularly suicidal, I have to make a confession: I never moved into a new cell in a B-cat or C-cat nick without checking on all the available ligature points. I always knew in my heart of hearts that if things ever got too much to bear, by making use of either the TV coaxial cable or my belt, I could exit on my own terms. 

Ligature points
As I’ve written in earlier blog posts, three of my friends in prison – one of them just 21 years of age – did opt for that course of action in their misery and sadness and I still think of them almost every day. Perhaps you could call it survivor’s guilt.

However there is one man who is probably incapable of feeling any compassion or guilt whatsoever. Our Secretary of State for Justice, Chris Grayling, is a man in total denial. His public statements bear all the hallmarks of a classic prison psychology report: “he refuses to acknowledge or accept responsibility for the consequences of his actions” and “he lacks empathy with his victims”. He had better hope he never ends up in the nick! Prison psychologists would have a field day.

No matter how strongly Mr Grayling maintains his innocence, we all know the truth. He and Mike Spurr of the National Offender Management Service (NOMS) have blood on their hands. All the forensic evidence in the reports by HM Inspectorate of Prisons and the Prison and Probation Ombudsman doesn’t lie. 

18 comments:

  1. It appears to me that a lot of issues you've written posts about (although not all) would be solved (or at least greatly alleviated) simply by ensuring more staff are employed in the Prison Service.

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    1. Thanks for your comment. I think that more frontline staff would definitely make a difference, but the best outcomes would be to reduce the number of people sent to prison for non-violent offences; to place people with severe mental health conditions in appropriate therapeutic environments; to provide appropriate mental health services for inmates suffering from less severe conditions and to recruit wing staff who are genuinely committed to supporting and encouraging rehabilitation. If the Scandinavian model works so well and cuts reoffending, why not import the best of what really works?

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    2. Yes, Halden is the most humane Prison in the World and Balstoy Island Prison rehabilitates sex offenders.

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  2. Thank you - that post makes sense to me.

    In a near 30 year career as a probation officer I visited over 60 prisons and worked or had attachments in 4 or 5 prisons or young offender custody centres from 5 days up to 5 years. I did suicide watch assessor work between 1997 and 2002.

    Please keep writing.

    You are right to direct responsibility to the Secretary of State for Justice and some who work in senior managerial positions in his ministry but that responsibility spreads far beyond them.

    It particularly involves David Cameron, who appointed Grayling and his whole government who uphold his dangerous criminal justice policies as well as those who support them in both houses of Parliament and possibly even us who elected them and take little interest in how they are doing our work as members of the UK State?

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    1. Thanks for your comments, Andrew. I think that we are experiencing the negative consequences of a paradigm shift in what the MOJ expects the prison system to do. The focus under Chris Grayling has been an ideologically motivated move back to the punitive theory of imprisonment when all of us who have direct experience of the prison system (from whichever side of the cell door) know doesn't deliver positive outcomes.

      As presently constituted the prison system fails on pretty much every test, except as a form of costly human warehousing that is no longer even safe or decent. Overcrowding, staff shortages and reduced budgets are making our prisons less safe across the board, but even more so for inmates who are vulnerable, elderly or who live with mental heath conditions.

      I would estimate that about 60 percent of the prisoners I encountered inside prison should not have been in custody at all. Some demonstrated disturbed behaviours such as indicated that they were in need of psychiatric treatment. Incarceration in a penal environment exacerbated their conditions to the point that some were a danger to themselves and others.

      Moreover, I still fail to see the justification for the imprisonment of people convicted of non-violent offences, or where there has been no evidence of offending behaviour for many years (as with some historic sexual offences). In my view, most of these prisoners could be supervised and/or treated much more effectively in the community and at a much reduced cost to the public purse.

      What we currently have is a criminal justice system that is increasingly informed by the editorials of the Daily Mail and the Telegraph (which I noticed of late is becoming uncharacteristically critical of our failing prison estate), often based on a dangerous combination of misinformation, supposition and downright deception.

      Chris Grayling is a shocker because I'm sure he knows that his policies are dangerous, inhumane and will not deliver positive results. However, he is also a very cynical ex-journalist and PR man who is playing to a very specific audience for purely party political advantage. Mike Spurr - whom I've known for 30 years - has spent his entire career in the Prison Service and NOMS and should know far better. In many ways, his betrayal of his colleagues is all the greater.

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  3. Sadly, too, attempted suicides being 'saved from themselves' (what a bizarre way to put it) is only a snapshot - what's to stop them trying again (and succeeding) at a later stage? Any attempted suicide is an indictment of the penal system in this country. I am Norwegian, and UK prisons seem to me to be draconian, degrading and, worst of all, pointless institutions.

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    1. And I hate Chris Grayling - he should be made to spend a month, or a week, or even 24 hours in one of his horrible inhuman prisons. Just as a publicity stunt.

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    2. Thanks for your comments. In theory at least that is supposed to be one of the reasons for the Assessment, Care in Custody and Teamwork (ACCT) system - to monitor prisoners who are deemed to be at risk of suicide or self-harm and to share this information effectively between the relevant departments within a prison, including healthcare and psychology. Unfortunately, this often just becomes a tick box exercise with staff glancing through the observation window into the cell.

      Another key weakness of the ACCT system is that it tends to rely far too much on self-reporting by an individual prisoner. When they are called in to routine reviews, the safer custody manager asks how they are feeling. If they state that they are no longer feeling suicidal, they may well be taken off the ACCT. If an inmate is truly serious about suicide then he or she is hardly likely to admit this.

      Another well-documented phenomenon is that when a person is so troubled that they come to see suicide as the only option, they often show external signs of having cheered up. Observers can often misinterpret this as indicating that the crisis is over. In fact, having made the decision to act, the person planning to kill themselves often relaxes because they believe that their misery is now coming to an end.

      I had this experience myself as a university student. One of my very close friends - almost like a brother - had been very depressed. Suddenly he seemed much improved and was even cheerful for a couple of days. Then he killed himself using a massive overdose of prescription medication. It took time for his friends, myself included, to come to terms with what had happened, but then I understood why he had suddenly cheered up. It was all about his relief once he had made the decision to die.

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    3. I think Chris Grayling hasn't made many prison visits recently. I think he realises that the hostile reception he would receive from both staff and inmates would result in a tsunami of negative media coverage and being a cunning and devious ex-journalist and PR man, he's far too canny to put himself in the firing line.

      As far as spending 24 hours in prison, I well remember the story - told to me by an officer - about a young screw who was on duty for the first time and was very nervous. His older, more experienced colleagues played a mean trick on him by saying that they'd had a tip off about some contraband items hidden in a particular cell. They told him to go and search for these when all the prisoners were out of their cells for work or education.

      This young guy made the mistake of not springing the lock on the cell door from the outside (the correct procedure to prevent staff getting locked in a cell by mistake or from being taken hostage by a prisoner slamming the door when the screw is inside the cell). As soon as he was searching, a fellow officer slammed the door shut and trapped him in the cell.

      They left him there for an hour and just ignored his frantic pressing of the cell call bell. When they returned to release him, he was crying and had wet himself in his panic. He was totally shattered by just having been locked up in a cell for one hour. Imagine how politicians would react!

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    4. Oh my goodness, how I would love to see Mr Grayling crying and peeing his pants!! Can you imagine the headlines?! I do wish something like that could be arranged. It'd do him good.

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    5. Who knows? Stranger things have happened. A number of former ministers have ended up in the slammer after Inspector Knacker has 'felt their collars'.

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  4. Just buy Chris Grayling a flight ticket to Norway for a Prison trip to Halden and Bastoy.

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    1. Only if the ticket is strictly one-way.

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  5. http://www.dropoutprevention.org/engage/incarceration-within-american-and-nordic-prisons/

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    1. Cheers for that link. Very interesting comparisons.

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  6. There should be a greater focus on prison literacy, it doesn't take much to teach a con to read and write. Dyslexia can be managed very easily with simple techniques

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    1. Thanks for your comments. Having been a voluntary adult literacy mentor (Toe by Toe) in four prisons, I would definitely agree that improving literacy has a major role to play in rehabilitation and future employability. The problem however, is that this programme is totally voluntary and even when you have a captive audience of cons, persuading some people to give up 20 minutes of their association period five times each week isn't always easy.

      In my experience, trying to impose compulsory education on adults in prison often becomes a disaster. I well remember being at a C-cat prison when this policy was introduced. I was then working as a paid peer mentor in the Education Department and we had endless problems. Refuseniks regularly disrupted classes, there was occasional violence, the alarm bell started ringing every day, civilian teaching staff were reduced to tears or took sick leave and - worst of all - those men who had volunteered for education in order to improve their reading and writing skills became distracted and disillusioned. My view is that forcing adults into classrooms is utterly counter-productive as I've previously written back in July in my blog post entitled A Prison Education.

      My solution would be to incentivise learning. Award phone or canteen credits to prisoner who hit targets or who pass exams. Distribute paperback books and magazines to those who regularly attend classes and work. Hand out pens and writing pads to cons so they can practice writing home. I believe that encouragement is far more effective than coercion. This really isn't rocket science.

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