Negotiating barriers: prisoner and staff perspectives on mental wellbeing in the open prison setting
Date | 05 February 2018 |
DOI | https://doi.org/10.1108/JCP-03-2017-0016 |
Pages | 3-19 |
Published date | 05 February 2018 |
Author | Kara Danks,Alexandria Bradley |
Subject Matter | Health & social care,Criminology & forensic psychology,Criminal psychology,Sociology,Sociology of crime & law,Deviant behaviour,Public policy & environmental management,Policing,Criminal justice |
Negotiating barriers: prisoner and staff
perspectives on mental wellbeing in the
open prison setting
Kara Danks and Alexandria Bradley
Abstract
Purpose –The purpose of this paper is to explore the perspectives of prisoners and prison staff in relation to
mental wellbeing and the negotiation of barriers to accessing and providing support. This small-scale study
includes the experiences of 11 prison staff and 9 prisoners within a Category D male prison.
Design/methodology/approach –A focus group was conducted with the prisoners and interviews with
prison staff. Thematic analysis identified three core themes: “context enabling factors”,“barriers to accessing
support for mental wellbeing”and “peer support roles”.
Findings –Prisoners conveyed a reluctance in reporting mental health issues due to the fear of being
transferred to closed conditions. All staff indicated the benefits of peer support roles.
Research limitations/implications –Further research is required on a wider scale, as it is acknowledged
that the findings of this study are from one prison and may not apply to other settings. Although there are
barriers that may impact the reporting of mental wellbeing issues, there may be small relational steps that can
be taken to address these.
Originality/value –Few studies exist that explore the nuances and barriers within open prisons, perhaps
due to the overwhelming need within closed conditions. A context-specific approach considering early
prevention strategies to support a safer prison system and successful rehabilitation is explored.
The combination of prisoner and staff experiences is of value to both academia and policymakers.
Keywords Mental health, Rehabilitation, Wellbeing, Peer support, Prison staff, Prisoners, Suicide
Paper type Research paper
Introduction
It is widely recognisedthat prisoners have higher incidence of mentalhealth conditions than those
in the community (Prison Reform Trust, 2016; HM Inspectorate of Prisons (HMIP), 2007;
Singletonet al., 1998). Further, the prisonenvironment and experiencecan have a negative impact
on health and wellbeing(Liebling and Maruna, 2005; South et al.,2014),aswellascompounding
existing mental health issues (Birmingham, 2003; HMIP, 2007). Singleton et al. (1998) found that
90 per cent of prisoners have common mental health problems, yet often their needs fall below
the threshold to access community-based treatment, prior to custody. The Revolving Doors
Agency (2007) suggested “it is clear that the holes in the safety net of service are too large
for this group, so that they fall through into the criminal justice system easily and repeatedly”.
The existingliterature supported by findingsfrom the current researchindicates that individualsare
entering the prison estate with undiagnosed and unmanaged mental health needs.
Part 1 of the Prisons and Courts Bill (2017) sets out in law, for the first time, that prisons are a
place where prisoners should be reformed as well as punished. Following the White Paper
“Prison Safety and Reform”, the Ministry of Justice (2016) have been under pressure to provide
strategies for improvement within the prison service, to ensure the safety of both staff and
prisoners. The official statistic for self-inflicted deaths in custody for 2016 was 119 deaths;
a 32 per cent increase on the previous year and the highest on record (Ministry of Justice and
Received 13 March 2017
Revised 11 May 2017
Accepted 26 May 2017
Funders: one of the studies
included in this research was
conducted during a PhD
studentship funded by the
University where the author is
based. The other, also a PhD
studentship, is collaboratively
funded by the same University and
NHS England Health & Justice.
Research ethics: the two studies
required ethical approval from
three organisations. First, the
university where the authors are
based. Second, the Health
Research Authority and finally the
NOMS. Local-level approvals were
also gained from the prison site
where the data were collected.
Kara Danks and Alexandria
Bradley are PhD Researchers,
both at the Department
of Social Sciences,
Northumbria University,
Newcastle upon Tyne, UK.
DOI 10.1108/JCP-03-2017-0016 VOL. 8 NO. 1 2018, pp. 3-19, © Emerald Publishing Limited, ISSN 2009-3829
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National Offender Management Service, 2017). The Prisons and Probation Ombudsman (2016)
analysed the self-inflicted deaths in custody between 2012 and 2014 and highlighted that
70 per cent of those individuals were known to have mental health diagnoses. Moreover,
they recognise that due to data recording issues and a lack of inclusion of dual diagnoses (mental
health issues and substance misuse), there is likely to be a gap in the reporting and diagnosis of
mental health issues. The Prison Reform Trust (2008) has estimated that 72 per cent of male
sentenced prisoners suffer from two or more mental health disorders, whilst 75 per cent of all
prisoners have a dual diagnosis. The Prison Reform Trust (2016) Autumn Bromley Briefing
indicated that there is currently “insufficient”data detailing the current prevalence of mental health
issues in custody. In terms of UK recorded suicide rates in those individuals that have been
released from prison, Pratt et al. (2006) indicated that the risk of suicide is eight times the national
UK average. Previous research such as this emphasises that mental wellbeing is a fundamental
rehabilitation need and the support individuals receive prior to their release is critical in the
preparation for life outside of prison (Bradley, 2009; Edgar and Rickford, 2009).
In this context, early preventative strategies are vital to support prisoner mental wellbeing and a
broad multi-disciplinary approach is required. These statistics highlight the multiple and complex
needs experienced by the prison population. The term multiple and complex needs is used to
describe an individual has two or more of the following needs: homelessness, substance misuse,
mental health issues and a history of offending behaviour (Boobis, 2016). The World Health
Organisation definition of health from the 1948 constitution states that health is “a state of
complete physical, mental and social well-being and not merely the absence of disease or
infirmity”. The term “mental wellbeing”has been used to describe the dynamism of an individual’s
mental state as it changes from moment to moment (Mind, 2017).
Haglund et al. (2014) investigated suicide rates in a Swedish cohort-based study, examining
27,000 released prisoners over a five-year period and found suicide rates to be 18 times higher in
this cohort than in the general population control group. The authors found a different pattern of
need and risk factors in the released prisoners compared to the general population including
substance misuse and a previous suicide attempt. They argue for the necessity of adequate
resources to aid the transition back to the community, with particular attention to those
individuals with those risk factors. In the UK context, Byng et al. (2015) explored suicide pathways
and the role of agency which found a risk both in those individuals that had a history of self-harm
and/or previous suicide attempt, as well as those with no previous history. They found those with
no previous history gravitated towards more violent means. The authors therefore suggest that
there is a cohort of high-risk individuals with no previous suicide attempt that require identification
and subsequent engagement.
Dyer and Biddle (2013, p. 531) explored resettlement pathways in relation to health and identified
potential ways to overcome the problem of newly released prisoners returning to the community
with mental health issues “equal to, or greater than, those that they faced when they first entered
the criminal justice system”, as this could also influence their likelihood of reoffending.
They suggest adopting a “whole prison approach”(HM Prison Service, 2003) or “care
management strategy”may improve the institutional health promotion which they argued could
support the active engagement of prisoners in understanding their own health issues. The early
identification and early prevention of mental wellbeing issues (and factors that may feed into
mental wellbeing) may help to avoid the escalation towards crisis. This also connects with
reducing the risk of reoffending by considering all of the factors that may link to offending
behaviour and preparing prisoners fully for release with the aim of tackling the issue of the
“revolving door”. Due to the gaps in recognised needs, a significant improvement would require a
“profound culture shift”to move towards an approach that is centred on prisoner recovery,
wellbeing and rehabilitation (The Howard League for Penal Reform, 2017). This is not a new
recommendation, as the HMIP (2007, p. 6) Thematic Review: “The mental health of prisoners”
indicated the need for a “holistic approach”in which all of those involved with the care and
management of prisoners take responsibility for their mental wellbeing. The report refers back to
earlier recommendations that are repeated, particularly the seminal “Patient or Prisoner?”report
(Ramsbotham, 1996) which recognised the higher levels of mental health issues in the prison
population, the negative effect the prison environment can have on mental health issues and the
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