Lydia Smith cached version 08/02/2019 16:13:15 en What happens when mental health professionals also get sick? <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p class="normal">It’s no wonder that almost half of all psychotherapists in the National Health Service say they feel depressed.</p> </div> </div> </div> <p class="normal"><img src="//" alt="" width="460" /></p><p class="image-caption">Credit: <a href="">Pixabay/Geralt</a>. <a href="">CC0 Public Domain</a>.</p> <p class="normal">Overwhelmed by soaring demand, mental health services are under growing pressure on both sides of the Atlantic. According to a <a href="">2017 Mental Health Foundation survey</a> two-thirds of British adults experience mental ill-health issues at some point in their lives. In England alone, <a href="">such issues in young people have risen sixfold since 1995</a>. US figures paint a similar picture: <a href="">a study published in Psychiatry Online in 2017</a> found that more than eight million Americans suffer from serious psychological distress.</p> <p class="normal">But this crisis isn’t just affecting the general public; an increasing number of mental health professionals are also struggling with their wellbeing. In a recent <a href="">survey</a> undertaken by the New Savoy Partnership—a coalition of organisations that came together in 2007 to persuade government to recognise the value of providing psychological therapies free of charge—almost half of 1,227 NHS psychotherapists said that they had felt depressed in the last week “some, most or all of the time,” up from 40 per cent in 2014.</p> <p class="normal">In already highly-pressured environments like the NHS, increasing demands on staff, tight time limits and the prominence of targets mean that many nurses and specialists are suffering from the same mental health problems they are treating in their patients. This isn’t just a problem for professionals who lack access to the appropriate support; keeping staff healthy is also crucial for patients, communities and our collective wellbeing.</p> <p class="normal">“High caseloads, lots of clients back to back—the work of a therapist is tough emotionally and takes a lot of energy out of you,” counsellor and psychotherapist Katerina Georgiou told me in a recent interview. “It’s also a very responsible role—you’ve got vulnerable people placing their trust in you, and that’s a responsibility you can’t take lightly. You need to care about people and fully attend to them. You’re switched on throughout a session. If you’ve then got five or six sessions back to back, that’s a lot of time switched on,” adding that burnout can be common.</p> <p class="normal">At a time when the demand for mental health services is rising, funding cuts and austerity measures have caused essential resources to dwindle, staff workloads to mount, pay stagnate and morale crumble. According to <a href="">The Centre for Mental Health</a>, mental illness accounts for 28 per cent of the overall disease burden of the NHS but receives just 13 per cent of total funding.&nbsp; Between 2009 and 2017, the King’s Fund think tank reported a <a href="">13 per cent drop in full-time NHS mental health nurses</a>.</p> <p class="normal">“Mental health professionals will feel the cuts in the sense of noticing increased caseloads, perhaps not having much time in between clients, not as much time to write up notes, and the demand for outcomes increased,” Georgiou says. “The breathing space decreases, which can increase stress, maybe even build resentment. And the thing is, you can’t let that stress and resentment get in the way of your work.”</p> <p class="normal">Health staff are being asked to see huge numbers of patients for shorter periods of time, and their managers are under pressure to prioritise targets—like treating minimum numbers of clients—over their wellbeing. As a result, sickness rates among staff have become a common concern, with stress and anxiety-issues <a href="">one of the most frequently stated causes of absence among mental health </a><a href="">nurses</a>.</p> <p class="normal">“Working in an under-resourced, under-pressure NHS leaves doctors struggling to provide the high-quality care patients deserve,” <a href="">British Medical Association</a> Consultants’ Committee mental health lead Dr Andrew Molodynski told me. “This leads to doctors burning out and becoming unwell, and patients suffer further.”</p> <p class="normal">Louise Watson, a UK-based clinical psychologist, adds that professionals working privately may also face “internal pressures,” perhaps seeing more clients in a day than may be healthy because of the intense nature of the job. Moreover, mental health professionals may struggle to come forward for help, or simply soldier on and mask their problems. “I think another internal pressure is that perhaps mental health professionals feel a level of demand that they shouldn’t be struggling with mental health issues themselves,” Watson told me.</p> <p class="normal">“Most people who are in the profession are there because there is something in their personality or background that means they are comfortable in that role of helping other people, so to be on the other side of the fence is difficult. They may put off going for help longer than they should because of that.”</p> <p class="normal">Making sure that everyone who needs help is able to access it is essential, not least because the number of people in need of specialist care is growing, and staffing levels are already in crisis. “It speaks for itself that if mental health professionals are off work with stress, or aren’t functioning to their full capacity because they are under too much pressure, then there won’t be anybody to look after anybody,” Watson says. “It’s a bit like on an airplane and the oxygen masks drop down, you need to fit your own oxygen mask first before you help others.”</p> <p class="normal">Mental health services in the US are also under threat. Earlier this year, President <a href=",-school-safety">&nbsp;Trump’s budget proposed slashing Medicaid, the major source of public funds for mental health treatment</a> which serves more than 70 million low-income and disabled people. America is also facing an acute shortage of mental health professionals in rural areas, with 65 per cent of non-metropolitan counties lacking a psychiatrist and nearly half without a psychologist according to a recent study in the <a href="">American Journal of Preventive Medicine</a>.</p> <p class="normal">It’s no surprise that a shortage of staff and other resources have had a direct impact on access to services, including longer waits for people in dire need of help, which can lead to an <a href="">increased risk of self-harm and suicide.</a> In 2018, the US <a href="">Centers for Disease Control</a> found that suicide rates have risen by 30 per cent in America since 1999. An increasing number of teenagers in England and Wales are also dying by suicide, <a href="">with 177 suicides among 15- to 19-year-olds in 2017</a> compared to 110 in 2010.</p> <p class="normal">“There would be an argument to say that we ought to be prioritising making sure people who are helping others are healthy,” Watson told me. “If we don’t, there won’t be any mental health care. And that will have knock on effects on society like having large numbers of people off work with stress.”</p> <p class="normal">It’s not just public health that suffers if we fail to support mental health staff but the whole of society and the economy. The UK government’s <a href="">Thriving at Work review</a> published in 2017 concluded that poor mental health costs the economy up to £99 billion a year. Of this amount, employers lose up to £42 billion through staff turnover, sick leave and ‘presenteeism’—working while sick, which causes losses in productivity.</p> <p class="normal">Importantly though, if a mental health professional is experiencing a problem and seeks help, this can be a positive thing for care all-round. “It increases your ability to empathise with your own clients if you have been through a similar situation, and gives you first-hand experience of seeing what you thought was helpful,” Watson explained. “If you work in mental health and you suffer with an issue yourself, maybe it ought to be seen as a helpful experience in terms of improving our own practice.”</p> <p class="normal">It also breaks down the ‘them and us’ feeling that is common in the health system, Watson adds. “The client may see the psychologist as a doctor who is there to fix them, but what I think can be helpful in a therapeutic relationship is to feel a rapport—that we are both human beings. It is about working together to find an answer.”</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/transformation/lydia-smith/why-mental-health-is-hidden-cost-of-housing-crisis">Why mental health is the hidden cost of the housing crisis</a> </div> <div class="field-item even"> <a href="/transformation/lydia-smith/why-we-should-all-be-concerned-about-musicians-mental-health">Why we should all be concerned about musicians’ mental health</a> </div> <div class="field-item odd"> <a href="/transformation/ray-filar/mental-health-why-were-all-sick-under-neoliberalism">Mental health: why we&#039;re all sick under neoliberalism </a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by 4.0 </div> </div> </div> Transformation ourNHS Transformation Lydia Smith The politics of mental health Care Tue, 18 Sep 2018 19:09:08 +0000 Lydia Smith 119690 at Why we should all be concerned about musicians’ mental health <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p class="normal">Music is crucial to everyone’s wellbeing, so when musicians suffer so does the rest of society.</p> </div> </div> </div> <p><img src="//" alt="" width="460" /></p><p class="image-caption">Scott Hutchison of Frightened Rabbit live @ The Caves, Edinburgh. Credit: <a href="">Flickr/Marcus Thorsen</a>. <a href="">CC BY 2.0</a>.</p> <p class="normal">Last month, the tragic news of the death of Frightened Rabbit singer <a href="">Scott Hutchison</a> hit the music community hard. He had spoken openly about his struggles with anxiety and depression, and channelled raw emotion into his songs. He was found dead at the age of 36.</p> <p class="normal">Hutchison wasn’t alone in facing these problems. Around <a href="">one in four people</a> in the UK experience mental health issues each year, and this problem affects musicians disproportionately. A <a href="">2016 survey</a> by the University of Westminster for the charity <a href="">Help Musicians UK</a> found that those working in music can be up to three times more likely to suffer from depression than the general public. Addressing this problem isn’t just crucial for musicians; it’s crucial for the whole of society and the economy, and for our collective health and wellbeing, because we all benefit when the creative arts are thriving.</p> <p class="normal">Mental health is complex and there are many factors that can impact our wellbeing, from our surroundings to our relationships. But the Westminster research highlighted something that many people already know only too well—that musicians face unique pressures.</p> <p class="normal">Low and unpredictable pay and a lack of financial stability affect musicians’ mental health, and the uncertainties around employment go hand in hand with the pressure to be ‘creative on demand.’ Many are forced to juggle several jobs and often work away from home which can be exhausting and isolating. The absence of a regular routine along with poor sleep and bad eating habits all influence wellbeing.</p> <p class="normal">“Being a musician has the impact of any self-employed job, you never switch off, everything is connected to your success; your relationships, your friendships and your social life,” Joe Tilson told me in a recent interview, a singer-songwriter from West Yorkshire. “At the time I never thought of music as the cause of any of my low points, I saw it as the escape and cure, that I was lucky to have it.</p> <p class="normal">Now I’m looking back from a more balanced life of music, work and family, I can recognise that a lot of the things that caused me anxiety and dark times were as a result of my devotion to music. Maybe if being devoted to music was more widely accepted as a choice for a living, the less disconnect there would be from the majority of people.”</p> <p class="normal">But it’s not just the conditions that musicians face in the music industry that creates these problems—it’s also the condition of the industry itself. Over the last decade, austerity in the UK has <a href="">squeezed</a> local authority spending on arts and culture. Early in 2018, <a href="">research by the Musicians’ Union</a> found that 44 per cent of orchestral musicians in the UK say they don’t earn enough to live on because of funding cuts.</p> <p class="normal">Because of this increasing financial squeeze, professional musicians who have spent years honing their talents are being forced to take other jobs, and it’s not a stretch to say that someone’s self-worth may decline when they aren’t able to use their skills to make a living. Musicians in the UK aren’t alone in facing this problem. In the US, for example, President Trump has repeatedly <a href="">sought</a> to end federal funding for government arts programmes, although fortunately, he’s been unsuccessful so far.</p> <p class="normal">Despite the huge contribution of the music industry to the economy—with creative industries <a href="">estimated to generate £85 billion net annually to Britain’s GDP</a> according to 2016 figures—governments &nbsp;still fail to recognise its importance, including in education. Recent research by the <a href="">BBC</a> found that creative arts subjects are being cut back in many schools because of funding pressures and an emphasis on a narrow core curriculum. For universities meanwhile, courses in creative subjects are being undermined by a focus on graduate salaries as a measure of success, with many arts and humanities courses being labelled as a waste of time because they won’t lead to well-paid employment.</p> <p class="normal">Music venues, which are integral to local communities, are closing. Around a third of the UK's small gig spaces have closed in the past decade, according to <a href="">Music Venue Trust</a>. One venue in south London, <a href="">The Montague Arms</a>, shut just a few months ago only to be replaced with a music-less gastropub—of &nbsp;which there are plenty already.</p> <p class="normal">While these issues may not directly lead to mental health problems they send out the message that creativity isn’t valued, and when combined with the challenges musicians already face they have the potential to undermine their wellbeing even further. Witnessing the arts being sidelined runs the risk of depleting musicians’ self-worth and self-belief. Therefore, ensuring that everyone working in music has access to mental health support is essential, and there are a number of organisations which do offer help.</p> <p class="normal">Last year for example, <a href="">Help Musicians UK</a> launched <a href="">Music Minds Matter</a>, a 24/7 nationwide mental health service for anyone working in the music industry. Despite government cuts to arts funding, the charity is increasing its support for various initiatives including the <a href="">Musician’s Hearing Health Scheme</a> and the <a href="">Creative Programme</a>, which supports emerging artists.</p> <p class="normal">Musicians can also access free health assessments through <a href="">The British Association for Performing Arts Medicine (BAPAM)</a>, while the charity <a href="">Music Support</a> offers help to anyone working in the music industry struggling with their mental health. It also provides ‘safe tents’ at music festivals for artists and those working backstage to address issues that may come up while on tour. <a href="">Mind</a>, the national mental health charity, also provides advice and support.</p> <p class="normal">None of this is just an issue for individual musicians; protecting them and their ability to make music is also crucial for the health and creativity of society as a whole. We often express our innermost emotions and feelings through music and communicate to others what isn’t always possible in words. Listening to music has a major, positive impact on our mental health, in part because <a href="">it releases dopamine</a>, a neurochemical that’s linked to wellbeing.</p> <p class="normal">Music lessons in schools also have huge benefits for children, boosting their <a href="">happiness</a>, self-esteem, concentration, <a href="">numeracy and language skill</a>s. “The positive impact of art and culture on society can’t be overstated,” Ruth Kilpatrick told me, who works with the ‘<a href="">PRS for Music Fund</a>,’ a charity providing financial help and support to members of <a href="">PRS</a>, the UK’s music licensing organisation.</p> <p class="normal">“Human beings thrive on connection and shared experience, a feeling of belonging and a sense of purpose. Music, art and culture in general all connect us to a common thread and deserve to be valued as such.”</p> <p class="normal">Singer-songwriter Joe Tilson takes this argument one stage further: in an age where more work is being automated, he told me, it’s especially important to recognise the importance of creative arts and music.</p> <p class="normal">“There is so much value and transferable skills from the world of performing music that can make people a positive addition to the workplace. People will always be creative. The less support the government gives, the more the government will be the focus of poor, angry, frustrated musicians.”</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/transformation/lydia-smith/why-mental-health-is-hidden-cost-of-housing-crisis">Why mental health is the hidden cost of the housing crisis</a> </div> <div class="field-item even"> <a href="/transformation/ray-filar/mental-health-why-were-all-sick-under-neoliberalism">Mental health: why we&#039;re all sick under neoliberalism </a> </div> <div class="field-item odd"> <a href="/transformation/amber-massie-blomfield/austerity-inequality-and-arts">Austerity, inequality and the arts</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> Transformation Transformation Lydia Smith The politics of mental health Care Culture Tue, 12 Jun 2018 20:29:41 +0000 Lydia Smith 118284 at Why mental health is the hidden cost of the housing crisis <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Our homes are supposed to be safe and welcoming, yet one in five adults in the UK suffer from mental health problems due to housing pressures.</p> </div> </div> </div> <p><img src="//" alt="" width="460" /></p><p class="image-caption">Credit: <a href="">Pixabay/TheDigitalArtist</a>. <a href="">CC0 Public Domain</a></p> <p>For six years, Anastasia Miari has suffered from clinical insomnia triggered by anxiety.</p> <p>Like many other people, financial worries keep her awake at night. The 27-year-old freelance writer lives in a house-share in east London and pays £750 a month for her room, but is considering moving to cut down on her rent.</p> <p>“I get bouts of real anxiety but it doesn’t come in the form of panic attacks—it rears its ugly head in my sleep,” Miari told me in a recent interview, adding that she only slept one hour the previous night.</p> <p>“Basically, it is difficult to know how much money you’re going to earn every month and if your rent is super expensive, you can’t afford to save to buy a house. A place has just become available at a friend’s house and it is £100 cheaper a month than mine, but it’s a box room.”</p> <p>Our homes are supposed to be safe and welcoming places free from the pressures of everyday life, so it’s no wonder that housing problems have a major impact on our mental wellbeing.</p> <p>High rents, the threat of eviction, overcrowding, substandard housing and financial pressures brought on by the ‘<a href="">bedroom tax</a>’ (in which tenants in social housing have their benefits reduced if they have a so-called ‘spare’ room) are all issues which can lead to stress, anxiety and depression, and which have a knock-on effect on all aspects of our lives from work to relationships.</p> <p>London is Europe’s most expensive city in which to rent according to recent research by the analytics firm <a href="">ECA International</a>, but prices are rising across the UK, including in Manchester, Edinburgh and Glasgow. And with increasing rents and stagnating wages comes financial insecurity, which plays havoc with our mental health.</p> <p>In fact one in five adults in the UK suffer from mental health problems due to housing pressures, according to research carried out by the <a href="">charity Shelter</a>. In the worst cases, some people reported experiencing suicidal thoughts.</p> <p>According to the same source, around one in six adults also said that housing problems had affected their physical health too, in the form of hair loss, nausea, headaches and exhaustion.</p> <p>“Housing and mental health are closely related,” said Helen Rowbottom, policy officer at the National Housing Federation, when I talked to her. “The negative impact of poor housing on someone’s health and wellbeing is well evidenced. In many cases, it can prolong illness and escalate healthcare costs.”</p> <p>Housing problems not only cause mental health problems, they also have the potential to make existing conditions worse. People with mental health conditions are one and a half times more likely to live in rented housing, according to research by the <a href="">NHS Confederation mental health network and the National Housing Federation</a>, leaving them at higher risk of rent increases which perpetuate the cycle of stress and anxiety.</p> <p>In addition, since it was introduced nearly five years ago, the bedroom tax has hit some of the most vulnerable people in society the hardest, leaving tenants in social housing out of pocket just because they have a ‘spare’ room. Three-quarters of people paying the tax have had to cut back on food, according to a report published by the <a href="">Department for Work and Pensions</a> in 2015. Nearly half had also cut back on heating for their homes.</p> <p>It doesn’t take much imagination to link these problems to mental illness. Three months after the Department’s report was published, a <a href="">study</a> in the Journal of Public Health found that all of the residents in one community in northern England—in which 68.5 per cent of the population live in social housing—reported stress and symptoms of anxiety and depression as a result of the bedroom tax.</p> <p>In a recent interview, Gareth Bradbury, a 54-year-old single father from Bolton, told me that his girls were nine and five years old when they came to live with him. The family lived in a three-bedroom house and he worked as a gardener to support his daughters, who went on to attend university.</p> <p>Then, a string of problems changed Bradbury’s situation. He had a heart attack and had to have bypass surgery, but later went back to work. While cleaning the gutters of his house he fell and seriously injured one of his legs, leaving him unable to work. When the bedroom tax was brought in in 2013, the added pressure on his finances took its toll on his mental health.</p> <p>“The bedroom tax came in and I have to pay £30 a week out of my benefits,” he said, “but I also need a car to get about so my disability [allowance] pays for that. I have been on meds for depression and I’m still on them. I went for a swap of houses to a two-bedroom house, but got knocked back. I was offered a one-bedroom flat but my daughters still come and stay with me so I could not accept it. I’m stuck paying this forever.”</p> <p>Against the odds, Bradbury says he has managed to cope. “I got on with my life and now I run a small group of volunteers called <a href="">Bolton Community Kitchen</a>. We feed the homeless, vulnerable and elderly people of Bolton every Monday night. I’m a lucky one that will bounce back.”</p> <p><a href="">Anne Power</a>, a professor of social policy at the London School of Economics, told me that the bedroom tax has undermined people’s confidence in their entitlement to the “peaceful occupation of their home,” which is a legal entitlement—a right.</p> <p>“It has made them feel insecure when they simply cannot afford to pay the additional rent and many people have had to turn to family when they couldn’t meet the rent, increasing the feeling of being a burden,” she said. “Generally, welfare reform has greatly increased people’s sense of anxiety and uncertainty, which is the last thing you need in your home.”</p> <p>For Bradbury, his community has been a source of support during difficult times. But if you don’t have that kind of support and housing pressures are affecting your mental health, it’s worth getting in touch with Shelter which provides <a href="">advice</a> on a range of issues, from falling behind on your rent to living in a home which isn’t up to standards.</p> <p>The mental health charity <a href="">Mind</a> also covers the impact of housing problems on mental health extensively and can provide crucial support, as can another organisation called <a href="">Rethink</a>. Speaking to your GP about a mental health problem is always important.</p> <p>It may also be helpful to contact <a href="">Citizens Advice</a>, who give free, confidential advice to people struggling with housing issues. Your local council may also be able to help in the form of a <a href="">discretionary housing payment</a>—an extra payment to people who claim housing benefit—which could help you if your housing benefit doesn’t cover your rent.</p> <p>Whether it’s the pressure of paying an extortionate rent or financial anxiety caused by the bedroom tax, Britain’s housing crisis is having a serious effect on mental health. What’s worse, this is a problem that is being largely overlooked, and with very dangerous consequences.</p> <p>When Brenda, from Manchester, was evicted from her home she spiralled into a deep depression. “You blame yourself and you feel a sense of total helplessness. I remember not wanting to go on and wondering if I should end it,” she told <a href=",_depression_and_panic_attacks_due_to_housing_pressures">Shelter</a>.</p> <p>Things began to turn around after she spoke to one of the charity’s advisors. “She was the first person who had asked how they could help me. It was the beginning of me taking back some control. I think about that call practically every day. All you need is someone to listen.”</p> <p>&nbsp;</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/transformation/rhiannon-colvin/why-aren-t-we-thriving-at-work">Why aren’t we thriving at work?</a> </div> <div class="field-item even"> <a href="/transformation/penny-wangari-jones/how-to-decolonise-mental-health-services">How to decolonise mental health services</a> </div> <div class="field-item odd"> <a href="/transformation/ray-filar/mental-health-why-were-all-sick-under-neoliberalism">Mental health: why we&#039;re all sick under neoliberalism </a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> Transformation Transformation Housing Rights Lydia Smith The politics of mental health Care Mon, 19 Feb 2018 08:00:00 +0000 Lydia Smith 116128 at Lydia Smith <div class="field field-au-term"> <div class="field-label">Author:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> Lydia Smith </div> </div> </div> <p>Lydia Smith is a freelance journalist with a focus on health, mental health, wellbeing and human rights who writes for national newspapers and magazines. Follow her on twitter @Lyd_Carolina.</p> Lydia Smith Wed, 14 Feb 2018 16:35:43 +0000 Lydia Smith 116129 at In Britain’s top security prisons, the mentally ill experience official brutality and neglect <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Close Supervision Centres in three prisons hold Britain’s most troublesome prisoners. The partner of one inmate claims the system fails inmates and society</p> </div> </div> </div> <p><em>Close Supervision Centres in three prisons hold Britain’s most troublesome prisoners. The partner of one inmate claims the system fails inmates and society</em></p> <p>March 2011, Milton HMP Woodhill, the Close Supervision Centre. An inmate walks away from an officer and is pounced on from behind.&nbsp; Other officers join in the struggle to pin him to the floor and the first officer violently grabs and squeezes his genitals.&nbsp;The inmate bites the officer's shoulder to release his grip and is subsequently accused of assault.</p><p>In a letter to the inmate’s solicitor, the CSC's Operational Manager Claire Hodson defended the officer who attacked a man from behind by saying that he feared for his life. Inmates at Woodhill CSC are frequently attacked and sexually assaulted — officers commonly grab&nbsp;inmates by the genitals when restraining them. &nbsp;It has been caught on CCTV,&nbsp;inmates have filled in complaints forms. Nothing happens.</p> <p>An inmate who has been violent may be locked in a high control cell to give him a cooling down period.&nbsp; It is meant to be assessed daily —&nbsp;and is not meant to be a punishment.</p><p>One inmate with a serious mental illness has been kept here for months, locked 24 hours a day in a bare shell of a cell, fed through a hatch, no exercise, no association, no shower, no TV, radio, no newspapers, no phonecalls, toiletries — and no access, either, to complaints forms (or indeed a pen).&nbsp; <br /> &nbsp;<br /> On the occasions when the cell is unlocked he is confronted with six officers kitted up in riot gear holding shields in front of them and told that any sudden movement will result in him being beaten&nbsp;up and restrained in handcuffs. <br /> &nbsp;<br /> With his hands cuffed behind his back he has been accused of assault and more force has been used to restrain him, including grabbing by the genitals. This inmate is inevitably so disturbed that when the door is unlocked he is violent and aggressive again, and then locked back in with apparent justification, and so the cycle spins round.<br /> <br /> Inmates&nbsp;feel that CSC officers deliberately target and goad them into reacting so that they can be put back in the high control cell.<br /> <br /> If they are vocal&nbsp;it is regarded as aggression, if they are silent&nbsp;they are accused of not interacting. Inmates say officers may try to get a reaction by making silly or threatening remarks, laughing outside the cell of an inmate known to be paranoid, ensuring an inmate is last to lunch so the food is cold, hurrying him out of the showers, not letting him make a phone call —&nbsp;little things that are inescapable when you’re locked up on such a small, claustrophobic unit.&nbsp;If an inmate manages to resist the bait&nbsp;he has his own inner turmoil to deal with and this cannot be kept up indefinitely.<br /> <br /> CSC officers are trained only in how to control.&nbsp;They are not skilled in recognising the behavioural traits of mental illness, which leads to misunderstanding and heavy-handedness towards 'difficult' prisoners.<br /> <br /> The Close Supervision Centre is&nbsp;a prison within a prison. Based in HM prisons Woodhill (near Milton Keynes), Wakefield and Whitemoor, the CSC system was set up by a Labour government in 1998 "to remove the most significantly dangerous, challenging and disruptive prisoners and manage them within a small highly supervised unit". Director General Richard Tilt called the system "therapeutic, not punitive", and the aim was to return prisoners to normal wings after a year or so. But how would that be possible if the inmates chosen were to be those deemed incapable of progression and incapable of being reformed? </p> <p>After early failures with disruptive inmates, the CSC began to select those who they felt would cooperate. Disruptive behaviour&nbsp;abated and it started to look like a success, even though <a href=";c=the_controlled_environment">genuine persistent troublemakers rarely got selected anymore</a>.<br /> <a href="">Inmates began to be selected after just one disruptive incident, or for alleged gang activity, or for what is perceived as religious extremism</a>. <br /> <br /> Then <a href="">inmates with diagnosed mental illnesses began to be selected</a> — they are easier to manage because they are easier to medicate.<span><br /> </span><br /> My partner David was selected after repeated bouts of segregation. He has a personality disorder and cannot cope on busy wings. Segregation desocialises an inmate even further and each time he was returned to the wing more problems arose for which he was again segregated. </p><p>Like many other prisoners he was referred to the CSC and selected in breach of the procedural requirements detailed in the <a href=";rls=en&amp;q=&#039;Managing+Challenging+Behaviour+Strategy+(MCBS)&amp;ie=UTF-8&amp;oe=UTF-8&amp;redir_esc=&amp;ei=99VZT46qDYPA0QXh9sSNDw">referral manual</a> that the CDC should be a last resort after other options (primarily the Managing Challenging Behaviour Strategy) have failed. Such management tools are frequently bypassed.</p><p>Secure hospitals, seeking to save money, would not accept him, despite recommendations, because they said his needs could best be met in prison. Nobody looked at his documented history, addressed any issues with therapy or fully took his illness into account. His medication was increased and he was referred to the CSC, an even more extreme form of punishment and containment than segregation.</p><p>CSC is not a hospital, it is a prison control unit that is being used against the mentally ill as a substitute for appropriate mental health care. In effect, the mentally ill are being punished for being ill, a bit like leprosy in the Middle Ages.</p> <p><a href=";c=neurotics_psychotics_and_psychiatrists">Solicitor Shahida Begum, writing in Inside Time,</a> says: “It is common knowledge that Close Supervision Centres are widely used to manage ‘mentally ill’ prisoners, and that mentally ill prisoners are overrepresented in segregation units. Prisoners who are deemed as dangerous or chronically disruptive are placed in prolonged solitary confinement as a prison management tool.” <a href=";c=an_open_letter_to_the_national_offender_management_service">Self-harm and suicide attempts</a> on the Woodhill CSC are disproportionately high.</p><p> The high numbers of mentally ill held in the CSC&nbsp;means the psychiatrist&nbsp;doesn't have time to interview every inmate and is regularly absent with no cover - he doesn't see every inmate every week and if he does see an inmate then time is short because he has so many others to see.<br /> <br /> David found there was no consistency or continuity. An inmate could see a psychiatrist one week, stirring up really powerful issues, then be left alone to deal with the fall-out, often for weeks, because next week and the following week the psychiatrist may not be available.<br /> <br /> There is no mental health cover in the evening or at weekends so if an inmate mistimes his crisis he has to cope alone, even on suicide watch.&nbsp; If he rings the bell for help, nobody is there.</p><p>Frustration can lead to self-harm, a tiny respite from mental torment —&nbsp;in Woodhill one inmate cut off his own ear in the shower.&nbsp; Months later, in the shower again, he was allowed another razor and cut off the other ear.</p><p>Each and every day presents a trigger, and for those who are vulnerable and less well-equipped mentally and emotionally to cope with such a regime — pretty much everyone there — the perpetual tension is impossible to endure. Sleep is a luxury most lack.&nbsp;When the door is unlocked&nbsp;in the morning and the inmate is interpreted as hostile or threatening&nbsp;further restrictions are imposed. <br /> &nbsp;<br /> Prolonged solitude is not an effective management technique —&nbsp;it&nbsp;only allows the prison to claim that disruptive "incidents" have been stopped.&nbsp; Those at&nbsp;risk of self-harm and suicide should not be isolated; it can push them over the edge. It will create illness in those not already vulnerable to start with.</p> <p>David had consistently good reports in the CSC, overcoming daily provocations, and had been given Enhanced status but this is meaningless in the CSC as nothing is available on the unit.&nbsp; Because of the regime and the understaffing&nbsp;he was kept locked up for 23 hours a day with no association and restricted access to the gym and showers.</p><p> In August 2011 a few inmates were selected for their good behaviour to progress to the newly-opened B wing.&nbsp;They had been told that it would help them progress towards deselection and a return to normal wings. Instead, it was the same as the A wing they had just left behind except with a different letter on the door —&nbsp;no course work, no therapy, no stimulation, education, nothing.&nbsp; And now others are randomly being put on this wing dragging the whole unit down so that those who had behaved well because they wanted to progress are now locked up for 23 hours a day again.&nbsp; Six months later they are bored out of their skulls, demotivated, getting restless, feeling cheated, and in limbo.</p><p> They are told to "engage" but Care and Management meetings are frequently cancelled, and there is no structure. Inmates are constantly led to believe that they are on the verge of being deselected (transferred out of the unit) but four to five years is an&nbsp;average stay, despite fully cooperating,&nbsp;not the one to two years originally proposed, and ten years is not unheard of.&nbsp; They face the impossible task of proving they can cope on normal wings while not being allowed to go there.</p> <p>One inmate who has been stuck in the system for thirteen years&nbsp;does yoga and tai chi&nbsp;—&nbsp;not, to me, indicative of a dangerous man incapable of progression and beyond help.&nbsp;In 2007 one young offender stuck in the CSC for five years hanged himself.<br /> <br /> Former head of High Security Prisons Lord David Ramsbotham has been critical of the CSC from the start, acknowledging that lengthy isolation should cease as it jeopardises mental health. In the Guardian last year, he argued: <a href="">"If you are holding people suffering mental health problems, then they should be held in conditions similar to those in secure mental health hospitals. This is clearly not the case at Woodhill.”</a><br /> <br /> Claire Hodson, Woodhill's CSC Operational Manager, states in a letter <a href="">quoted by the Guardian</a>: "CSC inmates often present with highly complex needs", but she ignores the fact that the CSC cannot help with those needs. She describes self-harm as a "maladaptive coping strategy"&nbsp;but, when asked what procedures are in place to remove those psychologically unable to cope and displaying serious signs of illness and self-harm,&nbsp;she makes no reply.&nbsp; </p> <p>Responding in June 2010 to an Inside Time article,&nbsp;“Great Well of Psychiatric Morbidity”,&nbsp;written by a relative of an inmate of Wakefield CSC, <a href=";c=great_well_of_psychiatric_morbidity">Danny McAllister, Director of High Security Prisons</a>, dismisses with breathtaking arrogance everything she has observed.&nbsp; He still maintains that the CSC is a force for good when experience of inmates demonstrates that it isn't, and still insists it provides opportunities for inmates to address their psychological and mental needs when clearly it doesn't.&nbsp; He claims he is satisfied that it is achieving its aims and says prisoners can use the complaints forms if they encounter problems.&nbsp;They do. Nothing happens.</p> <p>An <a href="">HM Inspectorate of Prisons report on Woodhill in 2010</a>&nbsp;found:</p><blockquote><p>“There was a need for a more structured evidence-based violence reduction programme within the CSC estate, addressing some of the underlying behaviours and attitudes presented. A programme had been piloted at Woodhill in 2004/05 and a recent business case submitted for funding, which had been turned down on the basis of cost.”</p></blockquote> <p>There is special funding for the CSC. Can it not be diverted to more places in secure hospital units? There needs to be an independent monitoring of the regime and&nbsp;independent psychiatric assessment of inmates instead of the prison-funded psychiatrists who aid the prison in its control ethos.&nbsp;Abusive officers should be charged for abusing the mentally ill, as anybody else would be. Prisoners have rights too and the state is obliged to safeguard human dignity.&nbsp; </p> <p>If people are offending because they are ill then surely treating their illness will reduce their offending? Secure hospitals&nbsp;need to be brought to account for refusing inmates who clearly need this intervention.</p> <p>Twelve years of the CSC has proved not only that it doesn't work but that in most cases it makes inmates worse.&nbsp;How much longer before government finds the courage to act on the evidence and fund something that actually works? </p><p> <br /><em>"Lydia Smith" and "David" are pseudonyms</em></p><div class="field field-topics"> <div class="field-label">Topics:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> Civil society </div> </div> </div> Shinealight uk ShineALight Civil society Prisons & child prisoners Shine A Light Lydia Smith Sat, 10 Mar 2012 10:00:29 +0000 Lydia Smith 64637 at Consider the impact of rape on a child: paedophiles must spend longer in jail <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>The partner of an abuse survivor convicted of killing a suspected paedophile calls for longer sentences for sexual offences against children</p> </div> </div> </div> <p>A child who has been raped or otherwise sexually assaulted can grow up to feel unsafe in the world, to feel that everyone is going to hurt it, to have little self-confidence, be fearful, isolated and angry.&nbsp;This child can feel powerless, fear losing control, and lack respect for and trust in authority.</p><p> All this is compounded and intensified if the child has no support, is met with disbelief or simply cannot tell anyone.&nbsp;A child is isolated by abuse.</p><p> The abuse breaks the normal bonds that hold society together, it transgresses boundaries.&nbsp;If there is family breakdown, no home stability and a lack of solid nurturing roots, such children are known to do less well at school because they are either not there or when they are there they can't concentrate.</p><p> Missing out on a consistent education and qualifications, their job prospects may be poor —&nbsp;they're more likely to be unemployed or on a low income, with no conventional means of earning a decent living.<br /> <br /> The abused and isolated child may feel no link to the rest of humanity and there is a danger that the child will learn by imitation, surviving by aggression to bolster confidence, feeling unloved will not give love, feeling disrespected respects nobody, feeling powerless seeks control, lacking respect for elders and authority will not respect the law.</p><p> When the worst has already happened, what is there left to lose?</p> <p>Of course, not all&nbsp;abused children&nbsp;have problems with the law.&nbsp;The effects of child abuse on adult male offending is under-researched but Janet Currie in ‘<a href="">Does Child Abuse Cause Crime?</a>’ finds that it is a significant factor in offending behaviour: it approximately doubles the probability of engaging in crime —more so for boys — and the probability increases with incidence and severity.</p><p> <strong>Abuse survivors in prison</strong><br /> It is difficult to find UK statistics relating to abuse survivors in prison but research by the Ministry of Justice and the National Offender Management Service (NOMS) records a 28 to 37 per cent&nbsp; <em>Yes</em> response to the question "Were you a victim of childhood abuse?" (It is not clear how the respondents defined abuse). The survivors’ group AMSOSA (Adult Male Survivors of Sexual Abuse) which counsels survivors in prison, puts&nbsp;the figure at 80 per cent.&nbsp; Surveys in the United States suggest 66 per cent of the prison population are survivors of abuse, with an even higher rate for women.<br /> <br /> In traumatic situations it is common for victims to dissociate.&nbsp; A child being ‘abused’ (which is a very woolly term that does not fully express the horror of rape and sexual abuse) often learns to ‘zone out’ as a coping strategy — if he or she can't physically escape from what is happening, the child&nbsp;will detach from the situation; the mind splits into two.</p><p> This response may persist into adulthood to the extent that the survivor can slip from one facet of themselves to another so easily and frequently that they feel they are not functioning as a single person.</p><p> Survivors commonly report intrusive memories, vivid flashbacks so real it's like it's happening again, terrifying nightmares. Anything might trigger these off, including&nbsp;smells or sounds.&nbsp; These ‘tuned out’ states to try to blank-out the flashbacks can be achieved through drugs and alcohol, depression, and&nbsp;self-harm.&nbsp; In extreme cases this dissociation can develop into a dissociative personality disorder.<br /> <br /> My partner David has been in prison for 16 years for killing a suspected paedophile, and he has attacked convicted abusers in jail.&nbsp;He was horrifically abused himself as a child. Neither his first abuser, nor any of the subsequent paedophiles in the children's homes he was sent to, were convicted. How can anyone grow up with a sense of self-worth and respect for a society that allows such people to walk free? David had no support, and developed a personality disorder in his twenties, prior to his offence. David does not think any of this is&nbsp;an excuse or justification.</p><p>We all have responsibility for our actions, we all have personal choice.&nbsp;Easy words. David is ill.</p><p> In the detached state of a personality disorder episode, when someone has 'switched', then reason, logic, reality, and consequences do not mean anything.</p> <p>All that child's rage had to go somewhere.&nbsp;It is simple cause and effect.&nbsp;You cannot treat a child in this way and expect nothing to happen.</p><p> David 'switches' to the child he was and feels it is the child itself who is demonic, not what was done to that child.&nbsp; He is not himself and has no control over what is triggered off, and&nbsp;he has no&nbsp;proper memory of it afterwards.&nbsp; To try to overcome these violent feelings he engages in&nbsp;furious 'automatic writing' he equally has no control over.&nbsp;He will starve himself in an attempt to weaken the rage.</p><p> David was not born this way.&nbsp; His abusers may not have stabbed the man he killed but they certainly sharpened the blade.</p><p> At his trial he was diagnosed with Borderline Personality Disorder (emotionally unstable) and Conduct Disorder, which is found only in children, but this was not taken into account — it was decided he was 'bad not mad'.&nbsp; Instead of being referred to hospital and given treatment&nbsp;he was sent directly to jail, whose purpose is containment not help: having to be on guard 24 hours a day on busy wings full of bullies, at risk of violence and rape, frequent strip searches by male officers — and confronted daily by jailed paedophiles and other sex offenders.<br /> <br /> David will not get out of prison until he can prove that he is not a danger to the very people who were so dangerous to him when he was a child.</p> <p>It’s a cruel irony of David’s situation that he would be of less risk to paedophiles if he were free. It’s on the inside, in prison, that he comes into regular contact with known identifiable paedophiles. </p> <p>To prove that he is no longer a risk to paedophiles he has to sit peaceably in group therapy with them and&nbsp; listen to their point of view. There is surely no other therapeutic situation in existence where a vulnerable person would be put in such close contact with those responsible, and have to listen politely to their self-justifications.</p><p> <strong>Paedophiles in prison</strong><br /> Having been transferred to&nbsp;many prisons over the past fifteen years, always on wings where paedophiles are held, David has become familiar with their patterns of behaviour.</p><p> Photographs of their victims are given to them when they get the paperwork for their cases. They can be observed gathering round, sharing these crime-scene pictures, swapping stories, as enthusiasts do, bragging, enjoying glorying in their crimes.&nbsp;&nbsp; </p> <p>They&nbsp;use pornography and get ideas from books by survivors, discuss strategies of how to continue offending without getting caught.&nbsp;</p><p>These men aren’t sorry. They don’t take responsibility for their actions.&nbsp; All is self-pity, excuse and justification. Released sex offender <a href="">Andy Deaves</a> has complained to the European Court of Human Rights that being on the Sex Offenders’ Register “is in serious breach of not just mine but my family’s human rights, fundamental freedoms, freedom of movement and Right to respect for private and family life. It also prevents us from returning to any kind of normal life after doing my sentence and paying my penance.” No mention in Deaves’s letter —&nbsp;<a href=";c=sex_offenders_register">published in prisoners' newspaper InsideTime</a> —&nbsp;of his victim’s chances of returning to a normal life.</p><p> <strong>Paedophiles and the law</strong><br /> Fifty-four year old <a href="">Barry McCloud</a> drug-raped a poverty-stricken ten year old girl in India after befriending her family. He was initially given a life-sentence with a tariff of eighteen years —reduced to&nbsp;fourteen years on a guilty plea (he shouldn't get credit for this; he couldn't very well deny it since he'd filmed himself doing it).</p><p>McCloud appealed this lenient sentence and at the High Court Justice Treacy, reducing it to a less draconian ‘IPP’ (Imprisonment for Public Protection) agreed that “life sentences should be reserved for even more serious criminals”,&nbsp;claiming that&nbsp; <a href="">"the offences were not so egregious as to require a term of life imprisonment"</a>.<a href="">&nbsp;</a></p> <p>Jo Sidhu, for McCloud, said in mitigation that "he&nbsp;restricted the abuse to one child". That's all right then. He had in fact downloaded child pornography images which is not a victimless crime and surely shows intent.</p><p> Perhaps the prevalence of child sex abuse has reduced its power to shock the courts.</p> <p>The familiar bleat that most child abusers were themselves abused as children should be met with scepticism as another cynical attempt to get leniency in courts.&nbsp; <a href="">The overwhelming majority of survivors would never pass the abuse on in this way</a>. In any case it would be no excuse.</p> <p>David Finkelhor, director of the New Hampshire-based <a href="">Crimes Against Children Research Centre</a>, identified a pattern of abuse:&nbsp; the abuser wants to abuse; overcomes his inhibitions to abuse; creates opportunities to abuse; and chooses to act.&nbsp; It is not a random,&nbsp;spontaneous lack of control;&nbsp;it is&nbsp;about control.&nbsp;They abuse children because they can.&nbsp;They are not ill.&nbsp; They know it is wrong and they choose to do it anyway.<br /> <br /> In prison, when the balance of power is against them, they call on the law to help them out.</p> <p>Attacks against paedophiles in prison are not uncommon.&nbsp; Prison hierarchy ranks sex offenders right at the bottom and delivers its own justice.&nbsp; Surprisingly, <a href="">those known to have a burning hatred of paedophiles frequently find themselves opportunely placed on the same wings</a>, like some interesting Roman sport.</p><p> Then the law steps in.</p><p> Ian Huntley, who killed two ten-year-old girls in 2002, wanted to sue the prison service for £100,000 damages for not protecting him against his attacker Damien Fowkes.</p><p>Fowkes went on to&nbsp;kill child sex killer Colin Hatch who had killed seven year old Sean Williams eleven weeks after getting out on parole, having served just two years of a three year sentence for a similar assault on another&nbsp;boy.&nbsp;</p> <p><a href="">Fowkes got twenty years minimum.</a>&nbsp;Huntley got <a href="">twenty years for each girl</a>.&nbsp;</p> <p>Lee Foye, who is in prison for killing his young girlfriend, for which he got a sixteen-year tariff, went on to kill paedophile Robert Coello.&nbsp; Foye had said on numerous occasions in prison&nbsp;group therapy that he wanted to kill paedophiles but was told to "keep talking about it".&nbsp; So was Coello encouraged to keep talking about his offences — <a href="">he loved bragging and&nbsp; was very vocal in the group</a> about the four rapes and twelve other offences against a schoolgirl for which he'd received a tariff of seven years. </p> <p>Foye has such a severe personality disorder that last year he cut off both of his own ears in the CSC in Woodhill prison.&nbsp; Four doctors recommend hospital; even the prosecution said he needs help.</p><p> But instead of receiving manslaughter&nbsp;due to diminished responsibility and a hospital order, he got another life sentence — this time with a tariff of thirty-five years.</p><p> Some might argue that the life of a man who rapes a schoolchild has as much value as the life of a 19 year old mother — but twice as valuable?&nbsp;</p><p>A quarter of child sex offenders are let off with a caution, according to records for 2008. Hundreds more get community penalties or suspended sentences, despite the seriousness of their crimes.&nbsp; In 2008, of 5123 offences against children, including rape, just 2559 were sent to jail.&nbsp; Almost a quarter (23 per cent) were given cautions, including thirty-six child rapists (918 community penalties, 302 suspended sentences). <a href="">Half of all paedophiles escape prison terms</a>.</p><p> The Sentencing Guidelines Council, whose guidelines are binding in crown courts in England &amp; Wales, told judges in May 2007 in relation to child victims under thirteen that <a href="">"it may be material in relation to sentence if the child agreed to sex"</a> — which totally disregards the principle of the age of consent, to protect children because they're too young to make such decisions and are vulnerable to coercion. </p><p>The Chairman of the Parole Board, Sir David Latham, speaking on the&nbsp;Today programme in January 2011,&nbsp;admitted fears that <a href="">more offences are committed by released dangerous offenders than official figures suggest.</a></p><p> The figures for recidivism for child abusers vary from 15 to 43 per cent, but these figures are meaningless anyway —reconviction is not the same as&nbsp;reoffending.&nbsp; A person who has been in prison, in&nbsp;any subgroup, may learn how not to get caught. Paedophiles learn better how to ensure their victims stay silent, often for decades.</p><p> Home Office estimates in 1993 state there were 110,000 men over 20 years with convictions for offences against children.&nbsp;15 per cent of that figure is 16,500 men. That’s a lot of men and a lot of victims. Every single crime can have devastating effect.<br /> <br /> More than half of those child offenders supervised by the probation service and two thirds of those discharged from prison have not been through a sex offender treatment programme designed to counter distorted beliefs, help control deviant behaviour, take responsibility for their actions, and increase awareness of the impact on the victim. Many do not sign on the Sex Offenders Register for fear of reprisals and simply disappear. The Home Secretary Theresa May&nbsp;has recently bowed to a Supreme Court ruling that up to 1200 convicted sex offenders a year will be allowed to seek removal from the register.<br /> <br /> Paedophiles’ victims don't get a second chance.&nbsp; Why shouldn't paedophiles be kept in prison longer, punished for the damage they have caused, not released until they are demonstrably no longer a threat to children? </p> <p>A child who cannot speak of its experience, is disbelieved&nbsp;or is otherwise&nbsp;not supported may express itself in other, antisocial ways.&nbsp; It is not uncommon for an abused child to end up in 'care', to be further abused, runs away, and as a homeless child/teenager again falls prey to predators.&nbsp; Is it any surprise that eventually something changes within that child?</p> <p>David's mental health meetings in the Close Supervision Centre were often cancelled at short notice and there is such a high concentration of inmates with mental health problems that the psychiatrist simply does not have time to give them all the necessary attention.&nbsp; David was rejected by Broadmoor Hospital last year; they said his needs could best be met in prison but the fact is that nobody's needs are met in prison: that is not what prison is for.<br /> <br /> An abuse survivor, like anybody else with mental health difficulties, needs consistent reliable one-to-one care with a psychologist or therapist&nbsp;in a sympathetic environment, not having to sit in with a group of paedophiles describing their crimes in graphic detail.</p> <p>The National Association for People Abused in Childhood sends counsellors into prisons and has been getting support from the Ministry of Justice. They have found that if survivors get help in addressing the roots of their difficulties it helps break the cycle of offending. They will soon be delivering&nbsp;a pilot twelve-week course of group therapy at HMP Manchester. The survivors’ group AMSOSA also counsels survivors in prison.</p><p> If a survivor can go through this painful process&nbsp;and&nbsp;stop offending, then so can paedophiles humbly accept punishment for their offending behaviour and the devastation they cause.</p><p><strong><em>"Lydia Smith" and "David" are pseudonyms</em></strong></p><p>&nbsp;</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-sidebox"> <div class="field-label"> Sidebox:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <p><span>&nbsp;</span></p> </div> </div> </div> </fieldset> <div class="field field-country"> <div class="field-label"> Country or region:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> UK </div> </div> </div> <div class="field field-topics"> <div class="field-label">Topics:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> Civil society </div> </div> </div> Shinealight uk ShineALight UK Civil society Prisons & child prisoners Shine A Light Lydia Smith Tue, 31 Jan 2012 11:07:02 +0000 Lydia Smith 63896 at He’d take his medicine if only they’d bring it: mental health care in a British prison <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Prison is failing those incarcerated who suffer from mental health problems. This personal story is one harrowing example.</p> </div> </div> </div> <p><em>'Lydia Smith' and 'David' are pseudonyms.</em></p><p>"My blood was boiling and the adrenaline sky-high. I had to wait over an hour before my teatime meds were brought. &nbsp;At 4pm I know the meds are due. I know this both mentally and physically. &nbsp;4.15 I made enquiries asking where they were. I was told that the nurses were not in the office so must be on their way. &nbsp;4.30 still no sign of them so I begin pacing in my cell, cursing them, getting all worked up and anxious. &nbsp;5pm I get unlocked for my tea and I begin my rant, this carries on all the way down to the serving hatch where I state yet again how important the medication is. I tell whoever is there that I don't enjoy feeling like this, knowing that one wrong word or gesture would tip me over the edge. I am sweating and shaking with the adrenaline and barely keeping control. &nbsp;Go back to my cell, throw my food away and wait. &nbsp;5.15 my door is unlocked and the nurses are there all happy and totally oblivious to how I am feeling. It was a little scary knowing what was hiding just below the surface."&nbsp;</p><p>That is from a letter my partner David sent to me last month.</p><p>David is in prison and his medication is the antipsychotic drug Quetiapine. It is due every day at 8am, 11am, 4pm, and 7pm. &nbsp;But 8am often becomes 10.30; the 11am can be so late that it is lost because of the lunchtime lock-up from 12 to 2; &nbsp;4pm is frequently so late that it becomes the 7pm dose; &nbsp;and the 7pm &nbsp;may either be the late 4pm dose or it may not arrive till 8.30. &nbsp;Sometimes he gets only half the dose (one pill instead of two) and sometimes they forget the pill he needs to mitigate the side-effects.&nbsp;</p> <p>When the nurses don't come, David asks the officers where his medication is and the officers ring the health unit. The nurses say no, nothing for you, no&nbsp;drug&nbsp;charts, nothing. David asks again, the officers ring back. On and on it goes, for hours.&nbsp;&nbsp; Then they arrive. &nbsp;"I didn't realise!" &nbsp;"The other nurse didn't leave the charts out!" &nbsp;This happens several times a week. <br /> <br /> These are not aspirins for a mild headache but antipsychotic medication for a category A prisoner with serious mental problems.<br /> <br /> On average the Close Supervision Centre at HMP Woodhill &nbsp;houses 25 inmates — not a huge crowd of prisoners to remember and not all of them are on medication. It should not be too difficult for nurses to familiarise themselves with their client base. &nbsp;Do these nurses really believe his medication is suddenly just going to stop? &nbsp;Suddenly he's cured?<br /> <br /> The mental health care in the Close Supervison Centre has been managed by Oxford Health NHS since 2004. &nbsp;It was at this prison in August 2005 that a man was found hanged in his cell in the Healthcare unit (just two weeks into a sentence for relatively minor offences). &nbsp;He was known to be suicidal, had in fact told staff that he wanted to hang himself. His step-father had written a letter to the prison asking for him to be put on a watch and complaining that he wasn't getting the medication he'd been prescribed.<br /> &nbsp;<br /> Staff communication skills are part of the problem. Strict EU laws forbid testing Eastern European nurses on their communication skills in case it restricts "free movement of labour". The number of European nurses registering to work in Britain has doubled since strict checks on their competence and language skills was scrapped in October 2010 —&nbsp;in the first five months alone 1500 nurses arrived from the continent.<br /> <br /> Carelessness in the provision of vital drugs has a devastating effect on David. The stress, distress and agitation it causes are overwhelming, as is the agony of the superhuman effort required to control this.&nbsp; I have urged David to keep a record of these failures in his care, but he allows it to pass without complaint because he is determined not to let it undermine all the hard work he is doing with his psychiatrist.<br /> <br /> It has taken months of careful monitoring by prison psychiatrists to find the pill, the dosage, and a way of spreading the doses throughout the day that best suits David, and to find further medication that counteracts one of the physical side-effects.<br /> <br /> These pills leave him with an unpleasant sense of emptiness which he has struggled to adapt to, there is memory loss and his normal thought processes are suffering too because, as well as stopping intrusive thoughts taking hold, the drugs make it harder to maintain any other train of thought from start to finish.<br /> <br /> But still he willingly takes the pills as an indication of both his commitment to progress through the prison system and his sense of responsibility to others: David poses less risk to himself and to others when he’s calm.<br /> <em></em></p> <p>There is, understandably, little public sympathy for prisoners considered dangerous — these are the people we all fear and we tend not to care what happens to them.&nbsp; Public sympathy is rightly with innocent victims of violent crime. But many of these offenders have serious mental disorders and if we want these people to stop offending, the system must properly treat them. It is, after all, in all of our interests: most of them will eventually be up for parole and released.<br /> <br /> Prisoners have a much higher rate of mental health problems than the general population. &nbsp;Estimates suggest 72% of male and 70% of female sentenced prisoners have two or more mental health disorders. Some prison reformers put these figures even higher. &nbsp;Self-harm is more common in prison and the suicide rate is an alarming 91 per 100,000 compared with 8.5 per 100,000 in the general population. &nbsp;A <a href="">Sainsbury Centre report</a> says that at every stage the system fails prisoners in mental distress, and poor mental health, if not addressed, can be a factor in reoffending. <br /> <br /> David alerted his mental health key worker to the problems he was having&nbsp;with&nbsp;getting his&nbsp;medication on time and&nbsp;this nurse then&nbsp;reminded the medical nurses how important his medication is (they seem unable to work it out for themselves). I wrote to the director of High Security Prisons, Danny McAllister on 5th September (still no reply) and copied the letter to two&nbsp;governors at the prison itself, who have given assurances that the matter would be looked into. David brought it up at his Care and Management&nbsp;meeting where he was told the Healthcare manager would be reminded of the importance of punctuality. &nbsp;</p> <p>But still the problems continue. Two days ago he was given his night-time dose at 4pm —&nbsp;and 150m instead of&nbsp;the 100m he was due.&nbsp; Now David's distress is changing to flatness, depression and paranoia: &nbsp;he feels it can't possibly be a coincidence and they are just trying to test him, to provoke him into doing something that will wreck all the progress he has made on the unit and give them another excuse to hold him back. &nbsp;Because if he does lose control, who will be punished? Not the negligent medical staff - <em>he </em>will.&nbsp;</p><p> Danny McAllister acknowledged my letter and passed&nbsp;it on to Nick Hardwick, the Chief Inspector of Prisons (in the same building).&nbsp;&nbsp;Mr Hardwick writes: "I am afraid I have no powers to intervene in individual cases . . . I will make sure your letter is made available to inspectors when we next inspect HMP Woodhill.” He gives no indication when this might be. </p><div class="field field-country"> <div class="field-label"> Country or region:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> UK </div> </div> </div> <div class="field field-topics"> <div class="field-label">Topics:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> Democracy and government </div> <div class="field-item even"> Equality </div> <div class="field-item odd"> Science </div> </div> </div> Shinealight uk ShineALight UK Democracy and government Equality Science Prisons & child prisoners Shine A Light Lydia Smith Thu, 03 Nov 2011 11:30:01 +0000 Lydia Smith 62422 at Stuck in “Dangerous and Severe Personality Disorder” limbo <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>'David' suffered child abuse, and developed a disorder that led him to kill a man who for him symbolised his abusers. He was labelled DSPD and must prove he is a 'reduced risk' before his release. But how can he, when DSPD is not a medical diagnosis, but a political construct?</p> </div> </div> </div> <p><em>Note: “Lydia Smith” and “David” are pseudonyms. </em></p><p>DSPD stands for Dangerous and Severe Personality Disorder, a term which, according to the Department of Forensic Psychiatry at Kings College, London, is not a medical diagnosis at all but a political construct —&nbsp;and one which has potential to be used for social control. The Labour government proposed&nbsp;the grave step of preventative detention for people labelled DSPD, regardless of whether they had committed a proportionate criminal offence. Mike Shooter of the Royal College of Psychiatrists contends that most people who are dangerous do not have a personality disorder and most people with personality disorders are not dangerous. <br /> <br /> My partner David does have a personality disorder and in certain situations with certain types of people (primarily sex offenders) he has sometimes been dangerous. After being horrifically abused as a child he developed an undiagnosed personality disorder in his 20s which eventually led to him killing a man who symbolised for him those men who had abused him.<br />He has now served nearly 16 years of a life sentence that had a tariff of 13 years, but it was only after he attacked a sex offender in prison 3 years ago that it was finally decided to look seriously at the roots of his offending behaviour. &nbsp; <br /> &nbsp;<br /> A DSPD unit —&nbsp;treating men with severe personality disorder —&nbsp;was suggested. According to a leaflet from HMP Whitemoor Fens Unit, these units work therapeutically “on the developmental experiences that generated these areas of dysfunction and so addresses maladaptive coping strategies themselves”. David's hopes were raised that this might be a route to mental wellness and eventual freedom.</p> <p>This treatment is available only in a couple of specialised hospitals and prison units. After one brief, hurried meeting with Broadmoor Hospital staff David was rejected — they said he lacked sufficient motivation. Then, he was accepted onto Whitemoor's Fens Unit DSPD, but the very next week they withdrew the offer saying he was "too high risk", even though they had all his details from the beginning and “high risk” is exactly what DSPD units are for.</p><p>All therapy in these units includes group therapy and all group therapy would include sex offenders — this is part of the programme. But before being accepted onto a unit where he would have to sit amicably in group therapy with sex offenders David is told he must first "reduce his risk" to them. He is striving hard to do this in one-to-one psychotherapy at his prison's Close Supervision Centre, but he won't ever be considered a sufficiently reduced risk until he has been tested in group therapy with sex offenders — and he won't be tested until he is considered a reduced risk.</p><p>Many psychiatrists have noted how impossible it is accurately to predict risk and how, because of high profile failures, psychiatrists tend to&nbsp;overpredict as a safeguard.&nbsp;(Such opinions, and the comments noted at the beginning of this piece are gathered in Max Rutherford’s report ‘<a href="">Blurring the Boundaries</a>: The convergence of mental health and criminal justice policy, legislation, systems and practice,’ Sainsbury Centre for Mental Health 2010).&nbsp;</p> <p>Risk assessment for sex offenders does not and cannot test them in situations where they will be dangerous (they&nbsp;are frequently&nbsp;freed to offend again). David won't be freed because his admittance to group therapy and progression will be blocked by the sex offenders who are allowed to progress to group therapy. So, as well as wrecking his childhood, they are wrecking his adulthood too.<br /> <br /> Even after David completes years of successful one-to-one psychotherapy, if nobody will take responsibility for testing him, how will he ever prove he is a reduced risk and move towards release? He has already had nearly 16 years on the prison shelf and the DSPD programme itself, at the end of its 10 year pilot, has cost half a billion pounds and still has no concrete evidence of success.</p><p>David's predicament is not unique. The prison population has a high percentage of inmates with serious mental problems who are not getting the help they need and deserve. Prison cannot do the work of specialised hospitals so, on the whole, these people are simply contained; their problems are never addressed and generally worsen over time putting themselves and others at risk.<br /> <br /> An offender’s past surely needs to be&nbsp;taken into account and addressed&nbsp;so that vulnerable people don't unnecessarily lose years of their lives neglected in prison. At the trial stage — and certainly once someone is convicted — in-depth, intensive psychological profiling and evaluation needs to be carried out swiftly, followed by prompt referrals for the necessary treatment. The present system lets problems fester indefinitely, so that 20 years later someone&nbsp;may still be offending and still be punished for it. <br /> <br /> Perhaps some inmates <em>will </em>prove to be untreatably dangerous and need to be kept locked up but many, like David, have difficulties that have a root cause and <em>can</em> be treated.<br /> &nbsp;<br /> Ultimately his risk is limited, and time ticks on. Why can he not now attend treatment daily as an outpatient? A loving supportive home environment would help him progress far better than prison and at much less cost. A single year for David in the Close Supervision Centre costs taxpayers £300,000. He could be tagged, sign on daily at a police station, spend the whole day in a day centre or hospital, and keep taking the pills that are now proving to keep him stable.</p> <p>Professor Peter Tyrer, of Imperial College, London led research into the DSPD programme and concluded last year: <a href="">"It has been incredibly expensive. We cannot say it has made any difference to the public and it seems patients have not been helped."</a> He said that prisoners in the scheme spent only 10% of their time doing anything resembling therapy.</p> <p>Jill Peay, professor of law at the London School of Economics (cited by <a href="">Rutherford</a>) says DSPD “is not an evidence-based programme. How could it be? If there is no agreed definition, no clear diagnosis, no agreed treatment, no means of assessing when the predicted risk may have been reduced, and no obvious link between the alleged underlying condition and the behaviour, how could outcome measures be agreed and then evaluated?”<br /> <br /> How many more years of David's life are going to be wasted in prison limbo before the Ministry of Justice starts properly to address these problems?</p><div class="field field-country"> <div class="field-label"> Country or region:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> UK </div> </div> </div> <div class="field field-topics"> <div class="field-label">Topics:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> Democracy and government </div> <div class="field-item even"> Equality </div> <div class="field-item odd"> Science </div> </div> </div> Shinealight uk ShineALight UK Democracy and government Equality Science Prisons & child prisoners Shine A Light Lydia Smith Tue, 04 Oct 2011 08:06:28 +0000 Lydia Smith 61793 at