Risk and Vulnerability in prison populations - PowerPoint Presentation

Slide1

Risk and Vulnerability in prison populations

Monica Lloyd,

Forensic Psychologist, University of BirminghamSlide2

An appreciative presentation!

Present some key current inspectorate findings

Look at the management challenge

Acknowledge some of the research challenges

Reprise the findings on solitary confinement

Look at how the negative outcomes can be mitigated

Examine the concept of post-traumatic growth

Look at some future directions for developing practiceSlide3

HM Inspectorate annual report 2015/16

100 self-inflicted deaths (up from 79 in previous year)

6 homicides (up from 4 in previous year)

27% rise in prisoner assault; 38% rise in staff assaults (2014 2015)

evidence

that self-harm was linked to bullying, violence, debt and the prevalence of new psychoactive substances Prisoners with mental health problems still placed in segregation by defaultThe three issues of violence, drugs and mental health are intertwined and compounded by overcrowding, poor physical environments in ageing prisons and inadequate staffing. Slide4

Segregation findings

A

third of reports

were

critical of inadequate governance and oversight of segregationIn almost half the prisons inspected reintegration planning to assist segregated prisoners back to normal locations remained inadequate Over a third of reports were critical about one or more elements of the living conditions, including cells, toilets, exercise yards and showersIn two-thirds of the prisons inspected r

egimes were inadequate,

with little access to constructive

activity

In

half of the prisons inspected prisoners on ACCTs were still located in segregation units without adequate justification

Most prisoners were locked up for more than 22 hours a day with nothing meaningful to occupy them

Relationships

between segregation unit staff and prisoners remained broadly

positive (overall outcomes for Respect were better than in previous years)Slide5

‘Just management’ of risk and vulnerability in prisoners

Prisons hold within them a proportion of

damaged and damaging

people who act

out their

pain and frustration through harming others, themselves and/or smashing up their cells and their possessions Their difficulties are increasingly aggravated by new psychoactive substances and culminating in serious violenceSome may attempt to usurp control by barricading, taking hostages, assaulting staff, dirty protests or other acts of indiscipline

Some

seek a

safe space

in segregation either

by virtue of their

offence, their gang

membership, bullying

or

because they have become indebted to other ruthless prisoners

A

small number

act out their pathological narcissistic

needs and

love of violence

through harming others, staff and/or prisoners

so what is ‘just management’? Slide6

The role of segregation

Prisoners are withdrawn from the mainstream for the following reasons

t

o preserve order and control

f

or individual protectionto prevent contamination of evidence pre-trial (Scandinavia)for adjudicationfor punishmentIn the last two scenarios segregation is time limited; in the first three it can become protractedThe managers dilemma:

Segregation manages

risk of

harm to self and

others in the short term but

c

an increase

the harm to the segregated individual as each day passesSlide7

Is prison segregation solitary confinement?

Solitary

confinement is defined as

the

physical isolation of individuals who are confined to their cells for twenty-two to twenty-four hours a day

Prison segregation fits these criteria and is therefore a form of solitary confinementAs a general principle solitary confinement should only be used in very exceptional cases, for as short a time as possible and only as a last resort. (The Istanbul statement on solitary confinement 2007)It is distinct from isolation or seclusion for medical

purposes,

in psychiatric

settings or in extreme environments such as polar

outstations

The key difference being that prison segregation is enforced and its beginning and end is controlled by others

(

Sourcebook of Solitary Confinement,

Shalev

,

2009)Slide8

Research challenges

Access to prisoners in the most inaccessible parts of prisons is difficult

Interviewing segregated prisoners over the course of a research project in itself reduces their symptoms of isolation

Faking good is a possibility if the prisoner wants the segregation to end

Self report psychometrics collected over

time are subject to statistical regression to the mean that can produce spurious findingsAsking staff to complete daily behaviour ratings rarely delivers complete informationPartiality is a compounding variable, in the context of lawsuits or when conducted by medical personnel employed by the authorities There is a danger that you find whatever you are looking for in that some individuals are genuinely less resilient than others

So what does research tell us?Slide9

Outcomes of prolonged segregation of prisoners

General consensus that

solitary confinement is damaging to health and

well-being for between 30-90% of prisoners and adversely

affects

their chances of successfully reintegrating into society Haney (2003) Scharff Smith (2006)Though there is evidence that symptoms can diminish rapidly when isolation ends

Grassian

(1983); Andersen

et al.

(2003)

Those

with

PTSD

syndrome in which they are physiologically over-reactive to stress will likely fare worse

than those who are better able to engage their higher brains

Hughes (2012)

Research since the mid 90s has focussed on

post-traumatic growth

in which adversity can be a catalyst for positive

change

Joseph (2012)Slide10

The harmful effects of solitary confinement

Physiological

resulting from

physical inactivity

disrupted diurnal rhythm

lack of fresh air lack of exposure to distance negative mental statePsychologicalAnxiety, ranging from feelings of tension to full blown panic attacksDepression, varying from low mood to clinical depression

Anger, ranging from irritability to full blown rage

Cognitive

disturbances, ranging from lack of concentration to

confusional

states

Perceptual distortions, ranging from hypersensitivity to

hallucinations

Paranoia and Psychosis, ranging from obsessional thoughts to full blown psychosisSlide11

What makes it harmful?

social

isolation

loss of sense of

individual and social self

withdrawal, regression and ‘seclusiveness’loss of diurnal rhythm impairments in cognitive and emotional

functioning ,

compromised immune system

reduced

environmental

stimulation

decline in brain

activity

lethargy and depression

loss

of

autonomy

destructive rumination

anger,

aggression, violence, self harmSlide12

What protects?

Individual:

Cognitive strength

Emotional strength

Maturity of the individual

Degree of introversion and desire for solitudeAbility to find meaning in the experienceContextual: Understanding why it is happening and how and when it will endIts perceived legitimacy, the context in which it occursA positive relationship

with staff

Access to purposeful

activity

Opportunities for exercise inside and outside

Opportunities for social

interaction

Support from family

and friendsSlide13

Post traumatic growth

“…prison

does not destroy all of the people all of the time. Prisoners are resilient, and even in the bleakest environments they find opportunities to mature and, occasionally, to

flourish…..we

should not underestimate the capacity of even the most apparently recalcitrant offenders to build better

lives.”“A small number of prisoners in solitary confinement manage to reinterpret their situations; they come to realise that the ‘art of living’ can be practised anywhere, however unpropitious the circumstances… life can be meaningful as well as desperately unhappy” “They learn more about their psychological boundaries and how they can be redrawn; they identify capacities to cope that had not previously been recognised; they strike new terms of engagement with their

lifeworlds

; they become accomplished reappraisers

.”

Ian

O’Donnell (2016)Slide14

O’Donnell’s seven Rs of survival (2014)

Rescheduling

Chunking time

Removal

Immersing self in distracting activity

ReductionSleep, drug use

Reorientation

Focussing on the present moment

Resistance

Finding ways of communicating, fighting staff, litigating

Raptness

Absorbing self in a meaningful individuating activity

Reinterpretation

Recasting your predicament in a religious or political frame. Finding meaningSlide15

Managing segregation well

Ensuring that protective influences are present

s

taff provide meaningful social contact with prisoners

p

urposeful activities and daily outside exercise are always provided, in association with other prisoners wherever possibleAccess to mainstream activities is allowed where it can be safely managedvolunteer visitors are encouragedcommunication with and visits from family and friends are encouraged

Ensuing that segregation policies are properly implemented

i

ndividuals are always given reasons for their segregation and understand how they can

affect how long it lasts

mental health contraindications are always sought and observed

s

egregation is not used for those at risk of self harm or for those awaiting

tx

under the Mental Health Act

ongoing segregation is regularly

reviewed with a focus on progression

IMB oversight is robust

t

he use of strip cells is regularly scrutinised and kept to a minimumSlide16

Future directions

Explore the relevance of post-traumatic growth research to those providing the greatest management challenges such as those in long term segregation or Close Supervision Centres (CSCs)

Use review approaches that focus on positive outcomes as well as negative

Encourage psychologists to balance their

traditional

concern with psychological suffering against the positive psychology of growth following adversity. This is consistent with a general shift in prison interventions from retrospective risk based approaches to forward facing

Good Life approaches

Develop

training for segregation and CSC staff based on focussing on positive outcomes so that positive change is

flagged up and

nurtured and doesn’t pass unnoticed

(problem story v preferred story)