Conference visit – “Best Practice in Mental Health”

Unlocked Graduate Scarlett blogs about a recent academic conference she attended:

Last week I had the pleasure of attending a conference on ‘Best Practice in Mental Health in the Criminal Justice System,’ hosted by the Centre for Mental Health. This piece cannot do all of the many brilliant speakers justice, but here are some insights from the day – ones which really stood out to me as a Prison Officer.

This focus is particularly important because I was immediately struck by the fact that I was the only Prison Officer at the conference. I was fortunate enough to have been able to book annual leave to be there (which is often tricky for prison staff!), and to have my ticket paid for by the amazing Unlocked Participant Development Fund. The many thought-provoking points made during this day-long conference re-affirmed my belief in how vital it is that we make frontline staff a part of academic debate that can affect change.

A key theme of the day was that communication between different agencies with related responsibilities is just not good enough. Local mental health (MH) teams’ information is not getting to prisons, and prison MH InReach teams’ information isn’t getting to probation and beyond. Agencies are not sharing information enough, which is why treatment stops-and-starts, at the expense of the patient.

The solution with regards to prison that I see here is that officers need a briefing on residents when they come in to custody. What mental health issues do they have? What are their triggers? What treatment have they undertaken? Then, instead of prison officers being oblivious to someone’s problems until they eventually face a breakdown, prevention and care could be possible. Confidentiality is an issue here but this is something that policy makers need to be thinking about.

One remedy that Lord Bradley discussed was mental health training, not just for frontline workers like prison officers, but for magistrates, probation workers and lawyers dealing with people in the Criminal Justice System (CJS). Community alternatives can be far more effective for rehabilitation, and, as Andrew Bell from the Centre for Mental Health pointed out, “The artificial environment of prison is the opposite of all things conducive to good mental health… and we wonder why people struggle!” With a broader understanding of mental health, better decisions could be made for those affected.

Residents being held on remand (when they are awaiting trial or sentencing but are kept in prison) was flagged as a huge issue for mental health. With a greater awareness of this, and of community alternatives, problems could be avoided. But where they can’t, Andrew Bell poignantly noted that “there is no stage within the CJS where you can’t offer mental health help…individuals are problematic because of the way services deal with them, not because they themselves are problematic.”

Another challenge is short sentences. Based on research by the Prison Reform Trust, in 2016 almost half of residents were sentenced to serve six months or less. The conference introduction noted that only 13 per cent of the budget for health is allocated to mental health. With such limited resources available, people who are struggling in prison on short sentences can often be viewed as a low priority – lost causes – as they are not there long enough to be helped. This must change in order to prevent issues escalating.

The conference did provide hopeful solutions from its speakers. Lady Edwina Grosvenor has set up trauma-informed workshops across the UK female estate, run by female residents for female residents, with her charity One Small Thing. The solidarity women showed each other was found to be live-changing. Lady Grosvenor noted that “Kindness is what they said changed their lives; which is not surprising, but incredibly profound.” One woman showing kindness to another helped to bring out their better nature and restore faith in humanity. Similarly, Andrew Bell’s initiative ‘The Engager’ links residents up with services they need, physically helping them build connections with agencies instead of just leaving them with a business card. It is often difficult to find the confidence to set up these connections so being more proactive with these services makes perfect sense!

Chief Inspector Michael Brown, who has served 20 years in the police (and whose blog on mental health and policing got made into actual guidelines for the police) argued that we also should not have to wait until people were in prison before we assessed their mental health status. He described how his interest in this subject was sparked because he was “overwhelmed…at how many arrests were connected to mental health.” He also, shockingly, added that the majority of people coming to the attention of the police were known to the local MH provider – and often discharged after missing one appointment. This highlights how people can be diverted from entering the CJS with better prevention upstream.

The day ended with a fantastic talk from the Head of Clinical Services at HMP Grendon, Richard Shuker. Grendon is a therapeutic community, meaning that it takes certain violent and long-term offenders who are ready to start making change, and comprehensively engages them with therapy (all kinds – group, art, drama). The residents live in a democracy where they have roles they are elected to, a job, and a voluntary position – in other words, they live in a community.

Richard was first intrigued by Grendon 20 years ago where he wondered how they were able to house violent offenders while maintaining an environment that was considerably less violent than other prisons. He pointed out that residents want to feel safe, so allowing a culture of respect and co-operation allows them to support that safe environment. With regard to group interventions, Richard noted, “It’s not the nature of the psychiatric intervention that matters, but the nature of the relationship with the group intervention members.”

Many of these people say they have never experienced an accepting place in their entire lives, so creating that at Grendon really is life-changing. A resident at Grendon said of the officers, “Their desire to help people sort of oozes out… They believe in change.” With a positive environment led by staff, allowing residents to be empowered, Richard explained the result is that prisons can be moral communities. And the effect on the men’s mental health? Well that’s a no-brainer.

What I learned at this conference was fascinating and inspiring, but the greatest lesson for me was from what I saw upon returning to my prison. When I told the men on my wing about the event, they were (sadly) astounded at the positive efforts going on in the world, outside the prison walls. Effort that is meant for their benefit. While we all hurry to our conferences and have our passionate discussions, there are real people sitting in their cells and they are struggling. They are struggling with their mental health. They are struggling with more issues than this blog allows me to discuss. Despite first-hand experience, residents are not hugely involved in such discussions. The result? Many believe that no one cares, when in fact the opposite is true. More change needs to happen, imminently, to ensure these men and women feel the benefits of our work.