Women with poor mental health are being imprisoned unnecessarily. Some never make it out There are some memories former prisoner Lucy* will never forget. “You saw girls who were really, really hurting themselves,” she […]

There are some memories former prisoner Lucy* will never forget. “You saw girls who were really, really hurting themselves,” she says quietly.

Young and softly spoken, she looks down at her lap and twiddles her hands as she reels off some of the most disturbing things she saw. “There were girls in there shoving pins in their arms and their legs, cutting themselves. Blood everywhere.”

Twelve women died in prison in 2016 by suicide, the highest number on record for 11 years.

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84% of women have been sent to prison for non-violent crimes – Prison Reform Trust

I’m sitting in a room of a charity that helps ex-offenders because I want to find out why.

Most women find themselves being driven through prison gates after committing non-violent crimes, many already suffering from poor mental health or having been in abusive or exploitative relationships. Some emerge in a much worse state, their lives disrupted beyond repair by a short prison sentence.

Last year, a number of these women didn’t make it back out of those gates at all. A quarter who died by suicide were in prison for theft.

The 12 women who killed themselves in one year

“Dramatic and depressing” was how this rise in self-inflicted deaths was described by the prisons and probation watchdog.

The report noted: “Female prisoners report poorer mental health than males across a range of disorders, and that almost one in two reported having attempted suicide in the past. This was more than twice the male rate.”

The Ministry of Justice (MOJ) knows this is unacceptable. It’s working with health services to try and provide more community-based interventions and mental health treatments alongside sentences, and trying to offer women gender-specific care in some cases.

‘Even a few weeks in prison is enough time to lose your job, home and children’ Dr Kate Paradine, Women in Prison

Diversion services, which identify vulnerable people and those with mental health problems, are currently being trialled at two-thirds of police stations and courts across England so women can get help earlier.

It’s hoped that this could lead to fewer women ending up in prison – diverting them instead to more appropriate support. NHS England plans to expand this service to the whole of England by 2021.

So why are more women going to prison then?

But the number of women in prison exceeded 4,000 in July for the first time in more than four years. This figure represents an “alarming” rise in the number of women behind bars, according to the Prison Reform Trust.

The message from campaigners and charities is clear: short prison sentences benefit no one – women need help in the community through government-funded women’s centres.

The Conservative manifesto was clear on what prison is supposed to be: a place of reform and rehabilitation. It adds “but we should always remember that incarceration is punishment for people who commit serious crimes.” All well and good, but this important caveat is one that seems to have been ignored.

Female prison population 30 June: 4,007 7 July: 4,020.

What actually counts as a serious crime if theft, including shoplifting, is one of the most common reasons for incarcerating women? Twenty women went to prison in 2015 for not paying their TV licence fines. These convictions come with short sentences, but life-long consequences.

“Even a few weeks in prison is enough time to lose your job, home and children,” says Dr Kate Paradine, Chief Executive of Women in Prison.

Prison feels more like a psychiatric hospital

As the Director of the Prison Reform Trust’s campaign to reduce women’s imprisonment, Jenny Earle has visited institutions across the country. The prison staff she has spoken to often say many of the women they see should be receiving mental health care in the community. “A lot of people who visit women’s prisons say it feels more like a psychiatric hospital than a prison,” she says.

Thirty per cent of women have a previous psychiatric admission before being taken to prison: Prison Reform Trust

Lucy is one of three women I’m sitting with at the ex-offender-led charity UserVoice, all of whom know from experience how poor mental health care can be inside. The atmosphere should be sombre, but Helen, who suffered from psychotic episodes, is telling me about the time she called the Samaritans to try and convince the volunteer on the other end of the phone she was the prison governor and had accidentally locked herself in a cell – and would they be so kind as to send someone to let her out? The room (Helen included) is in fits of laughter.

‘Did it work Hels?, her case-worker asks between breaths. “Er, no.” It’s a welcome moment of levity -Helen’s story is far from funny.

Helen is in her fifties and has been homeless and in and out of prison since she was 16. She has struggled with addiction to a number of drugs including heroin and crack-cocaine. Her most recent spell in prison was on remand. After six months, she says she was sectioned and held in a secure hospital for more than three years. Helen has bipolar disorder and anti-social personality disorder, both of which she says remained undiagnosed until her most recent stay in prison.

Helen was “chaotic”, prone to mood swings and “quite violent” on the streets. She says officers would ask if she had “something wrong” with her during stays in prison. But when she raised concerns with healthcare workers, she says she always got a familiar answer: “it’s just the drugs”.

“Women are a minority in a criminal justice system that is designed with men in mind. “There is a better way. “Ministers should take steps to secure the future of women’s centres, which have proven to be hugely successful.” – The Howard League for Penal Reform

Prisoners do have one vital connection to the outside world for support: they can contact Samaritans’ emotional support services by phone. When Helen was trying to convince the woman from Samaritans that she was the Governor, the woman let her “ramble on” for a couple of hours. “God love her,” says Helen. “That helped me quite a lot, just to have that outside connection.”

They can also speak to a Samaritans ‘Listener,’ a prisoner who has been trained by the Samaritans to offer support to their peers.

But there are concerns that prison officers are relying too heavily on Listeners. One former prisoner who was a trained Listener remembers being called from her cell to help because a young woman with mental health problems had seriously self-harmed. Her account is too graphic to repeat here. This was someone she had become close to in the prison, and seeing her in such a terrible state was deeply distressing. “I passed out at the door when I saw her,” she says. “We weren’t trained [to deal with that].”

Women with poor mental health held in solitary confinement

Prisoners can be removed from the rest of the prison population and held in solitary confinement, known as segregation or more colloquially as ‘seg’, for a number of reasons. These include breaking a prison rule or becoming a danger to other prisoners or staff, or for their own protection.

Here, prisoners will go to the toilet, sleep and eat inside their cell. The only furniture in the room is a bed and desk, both of which are screwed into the floor.

Twenty-three hours of every 24 take place within the confines of these four walls. Each day is broken up by a bit of exercise, usually 30 minutes – half the minimum standard of exercise set out in the European Prison Rules and the UN Standard Minimum Rules for the Treatment of Prisoners (the Mandela Rules) – a five-minute shower and sometimes a phone call.

Helen explains how during her recent stay in prison, her behaviour became more erratic and unstable, and officers couldn’t cope.

25 % of women and 15 % of men in prison have symptoms indicative of psychosis, compared to 4% of the general population. Prison Reform Trust

“They didn’t have a clue how to deal with someone with really extreme mental health illness. I was really unwell. I was seeing things”.

She says she spent months being moved backwards and forwards between a healthcare unit and segregation and staff just thought her behaviour “was me just being awkward”.

“I had been suffering from psychosis, serious depression and had tried to kill myself before,” she says. “When I arrived in prison they put me in the main block at first but then they realised that I wasn’t very well so they moved me to health care. I was getting worse and worse and because my behaviour was so off the wall they would put me on report for different things. So if I called a screw a ‘prick’ or something like that I would be put on report and end up back in the segregation unit.

“They were doing the opposite of what I needed them to do. Being in prison when I wasn’t well was a really traumatic experience.”

Dr Kimmett Edgar, Head of Research at the Prison Reform Trust, co-wrote a detailed report on segregation. Some of the prison officers he interviewed for this report showed him a number of prisoners they believed should be receiving mental health care instead of being held in solitary confinement.

“The perpetual miss-use of prison to detain women who clearly have mental health problems and shouldn’t be held in a prison in the first place, let alone in segregation, has always been a problem,” he tells me.

He says staff in segregation units are generally non-judgemental and trying to take good care of prisoners. They want and are asking for training so they can properly manage women with mental health needs. “Staff are trying so hard to make it humane, decent, but the ‘regime’ in segregation and the decisions made about people, which very rarely include any input from that person – these are things the staff on the segregation unit do not have much control over.”

When Dr Edgar gave a talk to parliamentarians on the difficulty of maintaining mental health in a segregation unit environment, the picture he painted was harrowing: “I’ve been able to describe to you images of what we saw. But in order to complete the environment, you need to hear the women who wail at night or shout out at the voices that they are hearing or bang their heads against the wall. You need to have the smell of the dirty protests.”

23 hours in social isolation

Dr Edgar also looked at constant supervision, the system for monitoring people considered at high risk of suicide.

For some, Dr Edgar says constant watch can be someone “constantly having a chat with her and laughing about things”. But others can have a much more distressing experience, especially if they have been suffering from paranoia. “The door to her cell remains open, and an officer sits in the doorway, staring at her. They are sitting there with a notebook and glancing up, just as if they are observing an animal in a zoo, every couple of minutes, and then writing another note and absolutely not speaking to the woman whatsoever.”

Some staff view self-harm as manipulative – as a way of getting a demand met, or attention seeking, says Dr Edgar. In one case, a segregation unit manager said he would not intervene on a prisoner using ligatures on herself while she was still talking.

Many women arriving in prison have been abused and being restrained can be traumatic. The women Dr Edgar spoke to were slightly more likely to have arrived in segregation while being restrained than men. One officer described a “long night” in segregation where he and a colleague restrained two women 27 times.

Prison officers are struggling cope

Under staffing is an inescapable problem facing the prison system. The number of frontline prison staff has dropped by 26 per cent over the last seven years. The Government has pledged to increase the number of prison officers by 2,500 by the end of 2018.

Two-thirds of women in prison have dependent children under the age of 18 IAP deaths in custody report

Lucy takes medication for depression and anxiety. But she wasn’t expecting a custodial sentence and arrived in prison without her tablets. Unable to access the right medication from the prison doctor, she says she spent the next six weeks without her prescribed tablets, giving her “really bad withdrawal” that left her shaking and feeling sick.

But there were plenty of other factors to make her anxiety worse. Sometimes women could spend most of the day locked in cells if prison was short staffed. “That made my anxiety really bad because you just don’t know what’s going to happen next, do you?”, she says.

Lucy spent six weeks in a closed prison before being transferred to an open prison. She was shocked by what she witnessed. “They put one girl into the cell next to mine. She would stand there and wet herself. They just told us to sort it out and help her, so we got shampoo and shower gel and offered to give her a hand. They kept her in the cell until she was taken away the next day.”

Women need housing, not tents

Claire, a volunteer at the homeless charity St Mungo’s, tells me about her spells in various prisons in a busy cafe in London. Claire was married and has children but does not have custody of them. Her husband has passed away. She left her family in Scotland as a teenager and lived on the streets for most of her life. It has taken her 30 years and help from St Mungo’s to finally get a place she could call home.

Claire was diagnosed with borderline personality disorder in 2005 and her mood swings can be severe, “up one time and down totally another”. She has tried to kill herself a number of times in prison. Her first custodial sentence was passed down when she was 21 for making hoax phone calls. She would spend the next 26 years in and out of the system. Each time Claire was released from prison she was homeless, leaving her trapped once again in a cycle of prison, temporary accommodation and eventually the streets.

On one of her releases, Claire did not have accommodation ready. Instead of a bed in a hostel, Claire says staff offered her a tent. “Where am I supposed to put that?” she remembers asking incredulously. She says one officer suggested she pitch it right outside the prison.

“No sleeping bag, nothing else,” says Claire. “Just a tent.”

Her experience is not an isolated one. A report published in 2016 by a prison watchdog found two women were offered tents when they were discharged from Bronzefield with nowhere to go. Others were given sleeping bags by the prison chaplaincy. 103 had left with no fixed address in the six months before the inspection was carried out. Many of these women had been down-graded to ‘low priority’ when it came to finding them accommodation.

What needs to change

In June, the new Justice Secretary David Lidington admitted prisons are going through a “turbulent time”, somewhat of an understatement.

A highly critical report published recently by the public spending watchdog was clear: the rocketing rates of suicide and self-harm in prisons must be dealt with urgently.

‘We’re putting more funding into prison safety and have launched a suicide and self-harm reduction project to address the increase in self-inflicted deaths and self-harm in our prisons’ – MOJ

While the National Audit Office said prison authorities have “ambitious” aims for improving the mental health of inmates, it remains unclear how these improvements will actually be delivered.

Last year, the Government promised to publish a strategy to improve the treatment of female offenders in custody and after their release by early 2017, but this has yet to materialise.

This strategy was promised as part of wide-ranging reform across the prison estate, a pledge announced in a White Paper by the former Justice Secretary Liz Truss in November. The issue now is urgency – the Government needs to act quickly to bring about this reform and prevent further harm.

In Eastwood Park prison, in Gloucestershire, a fifth of the women are more than 150 miles away from home IAP Deaths in Custody report

While some who have been imprisoned speak highly of officers’ attempts to help them, the use of facilities such as segregation to manage women with mental health illness suggests prisons are failing to provide adequate care. There are staffing issues, training issues, difficulty with accessing treatment inside prison and continuing that care when women leave. Then there is the lack of secure accommodation and the distance from children which need to be addressed to stop women falling back into prison and the next generation being traumatised and ignored like their mothers were.

Mounting evidence suggests the system needs overhauling to focus on diversion instead of incarcerating women who are mentally ill, vulnerable or have committed minor crimes. Women need stable housing upon their release so they don’t have to walk back through their abuser’s door, or sleep on the streets. Staff need specialist training and women have to be let out of their cells. They need useful and engaging activities to occupy their minds and prepare them for life back outside.

Plans announced in November for five new community prisons for women are still in place. The Government says this will allow women to be held closer to their homes and receive more support for complex needs.

But the focus should be on building women’s centres, not new prisons, says Dr Paradine.

“As a group, women in prison are particularly disadvantaged – with lives characterised by abuse and sexual exploitation – including as children. There’s also mental ill health, substance misuse and poverty, including debt and homelessness.

“The increase in our prison population has been a choice, not an accident. It’s time we chose a different way which is just and reflects what really works.”

Selen Cavcav of INQUEST, a charity which supports bereaved people following a state-related death, said it is exasperated by the “scandalous” lack of action despite the evidence presented to successive governments. “At inquest after inquest, the circumstances of these women’s deaths and the tragic life stories behind them are laid bare for all to see and each time we question ‘why was she sent to prison in the first place?’”

Scotland’s evolving penal system is a model Mr Lidington should take inspiration from: a focus on recovery, building strong links with family on the outside and moving to a model of prison only when absolutely necessary. Scotland’s justice minister, Michael Matheson, is replacing the only women’s prison with a much smaller one and community units designed for rehabilitation to support those who have been abused and/or have mental health problems.

If the soaring self-harm and suicides are not compelling evidence as to why prison, as it exists now, is anything but a place of rehabilitation for women, look to the cycle the most vulnerable women like Claire are trapped in. Their lives are so disrupted by being repeatedly imprisoned for short spells and released, they actually start committing crimes to try and get back in. There were “loads” of desperate women who did this, Claire tells me. The prison system has completely failed when it becomes the only place some women can go to sleep on a bed, eat three meals a day and access the most basic support.

The Ministry of Justice told i: “We take the mental health of prisoners extremely seriously, which is why we have increased the support available to vulnerable offenders – especially during the first 24 hours in custody – and invested more in specialist mental health training for prison officers.

“We’re putting more funding into prison safety and have launched a suicide and self-harm reduction project to address the increase in self-inflicted deaths and self-harm in our prisons.

“But we recognise that more can be done and continue to work in partnership with HMPPS, NHS England and Public Health England to improve mental health services for offenders at all points of the criminal justice system.”