Risk and Vulnerability in prison populations MONICA LLOYD

Risk and Vulnerability in prison populations MONICA LLOYD, FORENSIC PSYCHOLOGIST, UNIVERSITY OF BIRMINGHAM

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 practice

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 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 default The three issues of violence, drugs and mental health are intertwined and compounded by overcrowding, poor physical environments in ageing prisons and inadequate staffing. 2015)

Segregation findings A third of reports were critical of inadequate governance and oversight of segregation In 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 showers In two-thirds of the prisons inspected regimes 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)

‘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 violence Some 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’?

The role of segregation Prisoners are withdrawn from the mainstream for the following reasons to preserve order and control for individual protection to prevent contamination of evidence pre-trial (Scandinavia) for adjudication for punishment In the last two scenarios segregation is time limited; in the first three it can become protracted The managers dilemma: Segregation manages risk of harm to self and others in the short term but can increase the harm to the segregated individual as each day passes

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 confinement As 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)

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 findings Asking staff to complete daily behaviour ratings rarely delivers complete information Partiality 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?

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 90 s has focussed on post-traumatic growth in which adversity can be a catalyst for positive change Joseph (2012)

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 state Psychological Anxiety, ranging from feelings of tension to full blown panic attacks Depression, 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 psychosis

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 activity loss of autonomy decline in brain lethargy and depression destructive rumination aggression, violence, self harm anger,

What protects? Individual: Cognitive strength Emotional strength Maturity of the individual Degree of introversion and desire for solitude Ability to find meaning in the experience Contextual: Understanding why it is happening and how and when it will end Its perceived legitimacy, the context in which it occurs A positive relationship with staff Access to purposeful activity Opportunities for exercise inside and outside Opportunities for social interaction Support from family and friends

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)

O’Donnell’s seven Rs of survival (2014) Rescheduling Removal Finding ways of communicating, fighting staff, litigating Raptness Focussing on the present moment Resistance Sleep, drug use Reorientation Immersing self in distracting activity Reduction Chunking time Absorbing self in a meaningful individuating activity Reinterpretation Recasting your predicament in a religious or political frame. Finding meaning

Managing segregation well Ensuring that protective influences are present staff provide meaningful social contact with prisoners purposeful activities and daily outside exercise are always provided, in association with other prisoners wherever possible Access to mainstream activities is allowed where it can be safely managed volunteer visitors are encouraged communication with and visits from family and friends are encouraged Ensuing that segregation policies are properly implemented individuals 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 segregation 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 the use of strip cells is regularly scrutinised and kept to a minimum

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)