Prison and Suicide

One of the consequences with a blog that's in its ninth year and tries to focus on one fairly narrow subject area is that pretty much everything's already been said. With increasing frequency I find that when considering the next topic to fill the daily post, a brief search throws up extensive evidence of us having been there before, and often several times. Take suicide for instance and particularly those that increasingly are occuring in prison.

This line of thought was triggered by Andy Green and his recent Guest Blog piece describing the Safer Lives project, working with men awaiting sentence mostly for internet pornography offences and as a group, their noticeable propensity for depression and suicide. It got me pondering on my own practice experiences, historical involvement with the Samaritans and the struggle during the 1980's to get the prison authorities to accept their involvement. 

I've always had a lot of time for this organisation and was an active volunteer for many years early on in my probation career. Indeed the setting-up of the hugely successful Listener scheme in 1991 was largely due to the sustained efforts of another Probation Officer, Kathy Biggar who was National Vice Chair at the time. Here is Erwin Jones of the Guardian writing in 2006:-

A Samaritans scheme for prisoners has helped save numerous lives over the last 14 years, writes Erwin James

The other week I attended the annual Perrie Lectures at Prison Service Headquarters, Newbold Revel, near Rugby. I'd been invited to present a talk about my experiences with prison staff. This theme of this year's lectures, named after humanitarian prison governor Bill Perrie, was Prison Staff: Turnkeys or Role Models. Very timely I thought.

Each year an annual Perrie Award is presented to an individual who has performed "work of note" in our prison system. This year the award went to Kathy Biggar, former vice chair of the Samaritans and now Suicide Prevention Officer at the Department of High Security Prisons, in recognition of her heroic efforts and success in establishing the Listener scheme into prisons of all security categories throughout the country.

To my great honour, at the end of my talk I was asked to present the award to Ms Biggar, and I have to say that the moment was one of the most special in my post-prison life. The Listener scheme, whereby Samaritan trained prisoners provide a patient and compassionate ear for fellow prisoners in distress, is one of the most innovative inventions ever introduced to the UK prison system. It began in Swansea prison in 1992, following the death of a 15-year-old boy called Philip Knight who hanged himself in his cell.

The governor of Swansea at the time was Jim Heyes. Mr Heyes, a man of foresight who had been deeply affected by the death of the youngster, welcomed the Samaritans into his prison and worked closely with Ms Biggar to establish the Listeners as an integral part of his prison regime. Between them they created "a living organism", as one governor described the scheme that has spread through the prison estate like a healing liniment on a festering wound. Mr Heyes' support for the scheme was perhaps the first step in official acknowledgement that prison life is difficult, and that for some, it is insufferable.

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I started off by saying we've often been here before and in September 2016 I wrote:-  

Prison Suicides
The Samaritans is a highly-respected charity and in my experience hardly ever puts its head above the parapet and gets involved in politics of any kind. The fact that they have gone public regarding the suicide rate in prisons shows just how bad things have become. This from their press release:- 

Action is needed to tackle rise in prison suicides, says Samaritans
Samaritans is calling on the Government to recruit and retain more prison staff in the face of sharp rises in the rates of self-harm and suicide in jails. In the past year to June 2016, the self-inflicted death rate in prisons has risen by 20 per cent, self-harm is up by 27 per cent and numbers of prison staff have fallen by 25 per cent over the last six years.

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Here's Frances Crook of the Howard League on the general topic of prison reform writing for the WriteYou website:-

We need penal reform before it's too late
When the newly appointed Secretary of State for Justice and Lord (note, not Lady) Chancellor appeared before the Justice Select Committee last week she indicated that legislation on penal reform would come, but just not yet.

Michael Gove spent a year consulting on his plans for reform. David Cameron made a seminal speech setting out new principles focused on redemption and compassion. This was all very wonderful and it did help to change the public, and media, discourse. But, over that year, prisons deteriorated and community supervision that had been privatised by Chris Grayling slowly decomposed.

Things are so bad in prisons that someone takes their own life every four days. There is a record number of unexplained deaths, probably caused by a toxic cocktail of drugs. People are locked up in cells the size of a public toilet, and have to defecate in front of their cell mate, with little or no ventilation in the cell. They spend most of the day in this cell, lying on a filthy bunk in dirty clothes.

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By February 2017 in a blog post entitled 'Death of PSR Linked to Prison Suicides'  I highlighted the concerns of the medical profession:-

Rise in seriously mentally ill prisoners linked to record suicide rate, fears GP
Increased numbers of seriously ill people being jailed rather than sent to hospital could be contributing to soaring suicide rates, a senior GP working in the prison medical service has warned. GPC lead on prison medical services Dr Mark Sanford-Wood said he believed the numbers of people who are already significantly mentally ill being sent to prison was on the rise and was putting additional pressure on the system.

The HMP Exeter GP told GPonline that prison doctors were having to care for more patients with serious mental health problems because it had become more difficult to access specialist psychiatric support services. Dr Sanford-Wood’s comments came as the Ministry of Justice last week revealed there had been a 32% increase in suicides in prisons in England and Wales, with a record 119 people taking their own lives last year. Rates of self harm and violence against prisoners and staff also increased.

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I was particularly struck by two of the comments that resulted:-

Difficult not to think of 'alternative facts'. Here we have doctors worried about the mentally-ill being denied pre-court assessments and yet the sentencing council asserts that 'ideally' reports should be done on the day of sentencing.

The old ideal was to sentence on the merits of the individual case, which included the characteristics and motivation of the defendant. This ideal was not time specific and so time was allowed to investigate the circumstances of the defendant, especially where there were initial assessments of, or histories of mental health issues. Not anymore. The drive to reduce court budgets means those without resources, will be processed without regard to individual need. People are decanted into the prisons and placed at increased risk of poor healthcare, self-harm and suicide. And these practices are endorsed by the sentencing council, just as they were endorsed by the probation service – pre-TR as well – when management championed expedited reports that were forever getting shorter and faster, while quality never got a look in.

*****
Absolutely right  Increasingly when I think of all the things that are going wrong and when I see no managers putting up a fight or any objection, when I see them doing the opposite, going along with the nonsense, promoting it, selling it , entering into the narrative , making it the new norm, then I know that me, myself, I am the last Tuzla thin protective layer between the crushing inhumanity of an increasingly evil system and the service user. I find ways of not going along with what is being demanded, I speak against the narrative in word and in deed, pushing it as far as I can, being open about it to try and encourage my colleagues. We have to or we are no better than the system we work in. Nazi Germany would never have gotten as far as it did without the willing compliance of its bureaucrats and the minions of its bureaucracy, us. We have a responsibility. Do not be afraid. Say it as it is at work now.

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We all know what the issues are and the cost both personal and to society. There's a mountain of evidence and reports from extremely well-respected professional groups, organisations and academics, but nothing seems to happen and the prison suicide rate is still increasing. This Guardian article is from May last year, but could have been written last week:-

Government response to UK's soaring prison suicide rate has been pitiful
Record levels of self-harm and suicide in our jails reveal a collapse in mental health support for vulnerable prisoners. Last year there were 40,161 recorded instances of prisoners harming themselves, almost 8,000 more than 2015. That is almost 800 a week. Suicides reached 119, the highest since records began in 1978. That means a prisoner kills themselves every three days. Labour’s Luciana Berger has described it as “the death penalty by the back door”.

As well as coroners’ inquests and the findings of prison inspectors there have been at least 10 major reports investigating deaths in custody since 1991, including six in the last six years. Since 2010, according to Full Fact, the number of frontline prison officers has been cut from 19,900 to 14,700 full-time equivalents, as the prison population continues to climb.

This week, parliament’s joint committee on human rights – with members drawn from both the Lords and Commons – rushed out a report on mental health and death in prisons before parliament was dissolved. They have been trying to understand why the deaths have continued despite the endless investigations and government promises to do something. It identifies a series of mutually reinforcing failures behind the mounting toll.

Unforgivably, training for prison officers has been scaled back, leaving many ill equipped to identify and address mental health problems. There are huge variations in mental health support between prisons, with some unable to provide vital services. People who are acutely mentally unwell are given short prison sentences instead of community alternatives where they can be cared for more effectively. Fear among mentally ill prisoners of their prospects on release, such as the chances of getting a job, somewhere to live and continued support, actually increases the risk of self-harm and suicide towards the end of a sentence. Meanwhile, psychoactive substances such as spice blight prisoner mental health.

The government response is pitiful. It has promised to recruit 2,500 prison officers, far too few for the task and no substitute for the thousands of experienced officers who have been lost. A review of suicides in custody by Lord Harris found that relationships between prisoners and staff were key to managing suicide risk, with experienced officers using “jailcraft” to identify and manage vulnerable prisoners. The action promised on drones flying in drugs and phones is a glorified publicity stunt that will have a negligible impact.

Research by the Howard League for Penal Reform reveals that suicides are not an unfortunate deviation, but the inevitable outcome of a system that is responding to ever-growing prisoner numbers and too few staff by pursuing a punitive regime that creates precisely the conditions in which poor mental health, self-harm and suicide flourish.

The government has allowed prisons to become dirty, frightening and dangerous. Since 1990 the number of prisoners has almost doubled to around 85,000. Prisoners are routinely locked up virtually the entire day. There is excessive use of solitary confinement and other punishments. Prisons even fail to look after prisoners on the day they arrive, with shortcomings ranging from not telling staff about arrivals to locking someone up for their first night in the segregation block because there happened to be a spare bed.

The revised Incentives and Earned Privileges (pdf) scheme introduced by the Ministry of Justice in 2013 tends to put prisoners with a history of mental health problems on the lowest level of privileges, making it even more difficult for them to cope. The Howard League says this regime undermines precisely the factors that can reduce the risk of suicide, such as involvement in activities, contact with family and spending time with other people.

Prison mental health services are not just having to meet the needs of vulnerable and ill people; they are having to cope with mental illness created and exacerbated by appalling conditions which amount to an abuse of prisoners’ human rights.