A Different Key

keys illustrating prison healthcare issuesThe call for action on prison failure is clear, as DDN reports.

There is an identifiable cohort of people responsible for prolific offending among those showing up in police stations and courts, Mike Trace, CEO of Forward Trust told the latest meeting of the All-Party Parliamentary Group on Drugs, Alcohol and Justice. ‘If we can identify, motivate and treat them, we can have a big effect.’

The Morgan Report (2014) had looked at effective approaches to crime prevention. We needed to apply that logic to prisons, he said, and look at motivating people not to reoffend.

Mike Trace, CEO of Forward Trust
Mike Trace, CEO of Forward Trust

A look back at recent history revealed a scattergun approach. Cranstoun’s release scheme and RAPt’s intensive abstinence-programmes had popped up in the 1990s and finally, at the beginning of the 21st century, there had been a good treatment budget. A specialist service was set up in every prison, with an expansion of both OST and abstinence-based treatment.

‘It all looked pretty rosy in 2010,’ he said, ‘but it all went wrong in 2012’ when drug treatment went from the Ministry of Justice to the Department of Health. ‘It wasn’t a bad decision to take it to health – but we lost all our learning,’ he said. There were new statistics, new priorities and new learning systems, with counselling, assessment, referral, advice and throughcare (known as CARATs) leading to a ‘quantity not quality’ system.

A vast amount of the target group got rushed interventions, said Trace – and the vast majority of the structured programmes in prisons were closed down. ‘Some were poor quality, but many were research-based and flying,’ he said. We had entered an era of decline and missed opportunities. Furthermore, ‘the wing drug dealers won massively in the 2010s’ with the expansion of markets, introduction of spice, and the pressure to use instead of engage. With drug markets now out of control, we had not created the environment where prisoners could go for treatment instead of using drugs in prison.

Dame Carol Black’s report represented a phase of refreshment, he said – a chance to come back from ten years of neglect. There was no underestimating the ‘awful challenge’ for prison staff, with ‘the nature of being a prison governor [being] to get through the day’. The bit of money would have to go a long way, as we were still faced with the same problems, with ‘services massively stretched’. But at least there was political attention and acknowledgement that things must change.

As criminal justice service manager at Humankind, Jessica Scott brought experience from a cluster of seven prisons in the North East, where the organisation had worked with its healthcare partner Spectrum and delivered psychosocial interventions.

Humankind Service Manager, Jessica Scott
Humankind Service Manager, Jessica Scott

‘It’s about reconnecting our men and women to health and their personal goals,’ she said. ‘Our services are about finding that glimmer of hope, and about clinical and non-clinical services working together, making sure there’s no break in support.’ Detox and therapies were available when people came into prison, to make sure they were well enough to have interventions, and there was planning around release that included carrying a naloxone kit.

‘We want to replicate in prison the options that people could have in the community,’ she said, including prescribing slow-release buprenorphine injections (which lasted a month and saved staff time as well as pharmacy visits) and providing a family service to create a strong network on release. Recruiting peer mentors had given an extra, and very valuable, level of support to recovery services, while resettlement workers looked at housing needs.

The demographic of different prisons had informed different initiatives – from a particular emphasis on harm reduction in a high-security environment, to care around hormones in a women’s prison, to an ‘Old Wise Lads’ mutual aid group in a prison with a population of over-50s. But throughout each estate, continuity of care was a real challenge, she said. ‘We need to look at our practice – and the gaps.’

Pete explained how, after leaving prison in 2000, he became trapped in a ‘cycle of failure’. He had treatment with methadone in prison, but once outside and faced with the same housing problems, he would be back on heroin, back to the police station, back to prison, back on a script. And so it continued. 

‘There was no support between prison and community, nothing ever materialised at the gate,’ he said. ‘The first thing I wanted to do was celebrate with a drink… then crack and heroin.’ It was similar each time, beginning with sofa surfing at the dealer’s. ‘I’d think, what’s the point? It’s all I know. And it happened to many others I know.

‘There’s such a culture of picking on the vulnerable. I saw the spice culture escalate and it was pitiful. I knew someone who committed suicide with no hope of getting out. You get used to blocking out feelings – you can’t show vulnerability.’

In looking for solutions and hearing the varied experiences of the group, it was clear that no one thing worked for everyone. For some, it was 12-step communities, but you had to ‘want them to work’. For others it was a methadone detox, and the opportunity to feel better. Training and employment programmes had offered ‘massive therapeutic value’.

But the reality for so many prisons was that life inside and outside was a struggle. Men leaving the prison on a Friday with £80 in their pockets had to navigate the line of dealers’ shiny cars and the newsagent doing a brisk trade in Kestrel Super. The key factors that would offer the chance of a different outcome were housing, recovery and employment – but if any of them were missing there was little hope. 

A change of direction for Pete came at the age of 42, when he ‘changed his mentality’ by focusing on restorative justice. Mike Trace believed that restorative justice was key – particularly when people were past their mid-20s, as it could be difficult to get through to them in the ‘gang stages’ when they were enjoying themselves and hadn’t yet hit the ‘misery stage’. Yet even though he’d listened to the ‘realities and difficulties of going against the flow’, we should never get to the position of saying someone can’t recover, he said. ‘Downview was once known as Brownview, because of all the heroin, but we created an oasis of calm, where 15 to 20 people lived differently.’ Similarly, living on a recovery wing in Wandsworth in the 1990s offered a very different experience. ‘Don’t be naïve,’ he advised – ‘but never say we can’t do it.’  DDN

prison scene

Some Challenging Questions

‘Can we address the drivers of drug use in prison?’ 

Pete: ‘We’re never going to stop drug use. People are making money and will just come up with something else.’ 

‘Did you get any help with trauma?’ 

Pete: ‘Is it the right environment to address trauma? Going back to hostile wings? You want to open people up to explore their emotions? I had to be left alone – it was the only way to deal with it. I felt powerless. I was angry and frustrated, but I couldn’t show emotion as blokes would walk all over that.’ 

‘Is there a difference to how women respond to treatment – and are there any factors that affect recovery?’ 

Jessica Scott: ‘Women can be a support to the whole family. Give them power. They keep everything together but no one is looking after them. Women don’t get a lot of visitors – men get women to visit them. And they are often exploited.’


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