Women in prison: a "tough place"

Olivia Rope. While studies have shown that people in prison have a disproportionately high rate of poor mental health (around one in seven have a serious mental health condition), for women the rates are even higher. Sadly, suicide and self-harm incidents are common in women’s prisons. A study looking at 24 countries found that women in prison were four times more likely to commit suicide than women in the community. There are many factors that can affect a person’s mental health. Many people have difficult life histories and prisons can be very tough places. Prisons are often overcrowded and can be violent environments for both prisoners and prison staff. Many people in prison do not have adequate food, safe water or access to fresh air and natural daylight.

Most prisons have been designed with the needs of male prisoners in mind and do not always provide the services needed by women, such as childcare or gender-sensitive healthcare facilities. In prisons where both men and women are detained, this may mean that women have less chance of taking part in education, training and work opportunities.

Limited privacy and isolation, including solitary confinement, and the use of restraints or force are also commonly used in some prisons. All of these factors can negatively affect a person’s physical and mental health. Other issues that impact people’s mental wellbeing in prison is their experience at the initial stages of entering the criminal justice system. Women are particularly vulnerable after their arrest and during admission to prison. Negative experiences during arrest can impact people’s mental health. In many countries, sexual harassment and abuse of women by police is common. Separation from family can affect a person’s mental health and well-being. For women who are often the main caregivers it can be very distressing to be separated from their family. Furthermore, there are many prisons around the world that cannot provide good physical and/or mental healthcare and this may affect women worse.

This is because women have specific, and sometimes more complex healthcare needs. Women often arrive at prison with desperate need for help, not only practical but also psychologically.

This is often associated with the high levels of abuse and sexual violence. And research shows that a large proportion of women in prison have experienced violence in their lives. Our new guide does not claim to solve these challenges. Instead, it gives ideas of practical steps that can help.

OR. In 2018 we were thinking about what we could do to address the major shortcomings in mental healthcare provision in prisons that we have documented almost every year in our annual report Global Prison Trends. In many countries, there are major shortages of specialised, trained healthcare staff to address the many mental health needs of people in prison. This is the case in both low and high-income countries. For example, in one south Asian country there are a mere 10 doctors for a total of 68 prisons across the country. In another country in West Africa, there are reported to be just two doctors providing medical services to over 15,000 people in 46 prisons. In Europe, there are shortages too, impacting prisoners’ rights as documented in the recently published report by the Fundamental Rights Agency. With this context, we see that prison staff are on the frontlines responding and working with people who have poor mental health on a daily basis. Looking to the international standards, namely the UN Nelson Mandela Rules and the UN Bangkok Rules, we recognised that prison staff play a critical role in the mental wellbeing of people they supervise.

In their everyday work they can either improve or respond humanely to mental health conditions, or their approaches and measures taken can exacerbate or even be the cause of mental health issues of people in prison.

We therefore decided to publish Mental health in prison: A short guide for prison staff. This new guide, Women in prison: mental health and well-being - a guide for prison staff, supplements the first one in that it has a particular focus on women. Given the high level and complex mental health needs they have as I mentioned before, this guide goes into particular issues commonly seen in women prisons, but can be used in any setting.

OR. This guide describes how to recognise the signs of poor mental health and how best to respond. The guide aims to break down the stigma and discrimination attached to poor mental health. Some of the signs of poor mental health we have detailed include being quiet, sad or withdrawn, or experiencing extreme moods or behaviour, finding it hard to recognise your own problems and needs, or finding it difficult to communicate problems and needs. These are some examples from a whole list we give which can help prison staff identify if someone they are working with may be experiencing poor mental health.

There is also a summary of the common types of mental health conditions, and explanations to help understand the symptoms of poor mental health. The guide also gives key pointers for “What prison staff can do to support the mental well-being of women in prison” in a “Quick guide”. One example is knowing, and then looking out for a person, around important dates that may trigger poor mental health, such as a child’s birthday or anniversary of the death of a family member or close friend. We also know that prison visits are important times and the guide explains how these can affect people in different ways.

There are a whole host of suggestions in the guide for staff to promote and respond to mental health needs of women in prison. To give a few examples, these include: acknowledge the feelings of women prisoners; treat any signs or expressions of poor mental health seriously – don’t ignore individual prisoners or dismiss them as ‘attention seeking’; encourage women in prison to discuss their needs and what works best for them (involve them through regular meaningful conversations on an individual and group basis). It is also important to use everyone in the prison as a positive resource, for instance trusted peers can be encouraged to speak to fellow prisoners who may be particularly isolated, including through more formalised ‘buddy’ schemes which have been successful in some countries. Other ways suggested are around the programmes in prison. Setting realistic goals for involvement in these, and encouraging progress and providing positive feedback are all examples of regular ways staff can promote mental well-being among women.

The guide also gives tips on providing a safe and secure prison environment and how to ensure women have maximum contact with the outside world. Importantly the guide gives some tips on responding to urgent situations of mental health like self-harm or suicide.

There are two good practice examples on programmes within a community sanction/probation project, and in a woman’s prison, that we showcase in the Guide to inspire change – and finally, an appendix provides a “Human rights and mental health policy checklist” for prison and healthcare leaders. We hope the Guide can assist prison staff (and anyone working with women in criminal justice systems) to put into practice the UN Bangkok Rules on women prisoners, which will be 10 years old this December.

The guide was funded by Better Community Business Network (BCBN) and the Eleanor Rathbone Charitable Trust.