Prison perspectives

A first-person account of nearly a decade at the frontline of prison substance misuse services.

‘I feel compelled to share what I feel is a poor level of care offered to clients in prisons.’

Last year I resigned from my position as a service manager due to burnout, having spent the last two years fighting to offer the best level of treatment and support to the clients we had in our care. I am a resilient individual but the experiences I encountered made it impossible for me to continue in my role as I felt my personal and professional integrity were being compromised.

Now, having had time to reflect, I am finally in a place to share my experiences. Furthermore, I feel compelled to share what I feel is a poor level of care offered to clients in prisons. This substandard level of care changed very little over my time working within the service.

I started working in addiction services because I felt I could make a difference. A great deal of the frontline staff that I worked alongside, and then managed, had the same belief. These staff maintained their dedication and commitment to the clients even though they were directed to work with programmes and models of treatment they knew were not best practice. We knew that we could offer more and do more but were prevented from doing so.

I have seen some of the best and worst practice in my time with the service, including the dismissive and unethical ethos of some managerial staff regarding clients in their care. I worked in a unit where every year it was common practice that clients would be rushed through a very intense treatment programme in less that the minimum time, so the yearly targets could be met. This demonstrated a real lack of care for clients and a compromise of good treatment practice.

I took on the role as service manager so that I could make sure such bad and unethical practices could no longer take place, and with the support of my line manager – who was amazing – I introduced a new programme that was open to all clients engaged in the service. This included holistic interventions such as Tai Chi, mindfulness, yoga and animal therapy. I established a recovery wing and integrated clinical and psychosocial services, and as a result more clients engaged with the service, referrals to rehabs increased, and the number of clients on methadone scripts declined by over 50 per cent.

Despite the improvements, I felt there was more we could do but it required the support of the organisation that I worked for, and its ability to adapt and grow. However the resistance was constant, even though the positive changes that we had already made demonstrated good results and a better level of care and treatment for the clients. The pressure from the organisation was immense, with increased audits, visits, meetings and constant questioning, and without acknowledgement or recognition that positive change was occurring.

Slowly the organisation fragmented the integrated service that I was successfully running and improving. I was no longer allowed to manage the whole service, and clinical services were re-allocated to another manager. As a result, this served only to withdraw the single point-of-service contact for the client, and, ultimately, the number of clients receiving prescribed medication began to increase once more. Any data collected led to little or no change in practices, and there is now no single point of contact for the client due to ineffective management and a separation of clinical and psychosocial treatment, leaving the client unsure who is taking the lead in their care.

I would like to add that prisons are very difficult places to work and over the past seven years they have suffered dramatically due to well-publicised funding cuts. It would also be easy to say ‘why should we care about these clients?’ Yet those of us who have worked with them know how valuable the work and the clients are, and that most have suffered mental and physical abuse, are from deprived upbringings – often growing up in the care system – and have fallen through the cracks in society.

Nevertheless, they can and do change, addiction can be effectively treated, and these clients can go on to live happy and productive lives. But we cannot do that without change. We need organisations that are prepared to evolve, accept change, become innovative and creative, and listen to the caseworkers and the clients. Without this, the level of care will continue to decline and clients will continue to suffer.

I believe that for a short period of time I scratched the surface of what could be achieved, and saw the real tangible effects for clients. I sincerely hope that change will come soon and, as we approach the next round of tendering, the ‘same-old, same-old’ does not prevail.