Monday, May 28, 2012

England: In Britain's Top Security Prisons The Mentally Ill Experience Official Brutality And Neglect.

Close Supervision Centres in three prisons hold Britain’s most troublesome prisoners. The partner of one inmate claims the system fails inmates and society

March 2011, Milton HMP Woodhill, the Close Supervision Centre. An inmate walks away from an officer and is pounced on from behind.  Other officers join in the struggle to pin him to the floor and the first officer violently grabs and squeezes his genitals. The inmate bites the officer's shoulder to release his grip and is subsequently accused of assault.

In a letter to the inmate’s solicitor, the CSC's Operational Manager Claire Hodson defended the officer who attacked a man from behind by saying that he feared for his life. Inmates at Woodhill CSC are frequently attacked and sexually assaulted — officers commonly grab inmates by the genitals when restraining them.  It has been caught on CCTV, inmates have filled in complaints forms. Nothing happens.

An inmate who has been violent may be locked in a high control cell to give him a cooling down period.  It is meant to be assessed daily — and is not meant to be a punishment.

One inmate with a serious mental illness has been kept here for months, locked 24 hours a day in a bare shell of a cell, fed through a hatch, no exercise, no association, no shower, no TV, radio, no newspapers, no phonecalls, toiletries — and no access, either, to complaints forms (or indeed a pen). 

On the occasions when the cell is unlocked he is confronted with six officers kitted up in riot gear holding shields in front of them and told that any sudden movement will result in him being beaten up and restrained in handcuffs.

With his hands cuffed behind his back he has been accused of assault and more force has been used to restrain him, including grabbing by the genitals. This inmate is inevitably so disturbed that when the door is unlocked he is violent and aggressive again, and then locked back in with apparent justification, and so the cycle spins round.

Inmates feel that CSC officers deliberately target and goad them into reacting so that they can be put back in the high control cell.

If they are vocal it is regarded as aggression, if they are silent they are accused of not interacting. Inmates say officers may try to get a reaction by making silly or threatening remarks, laughing outside the cell of an inmate known to be paranoid, ensuring an inmate is last to lunch so the food is cold, hurrying him out of the showers, not letting him make a phone call — little things that are inescapable when you’re locked up on such a small, claustrophobic unit. If an inmate manages to resist the bait he has his own inner turmoil to deal with and this cannot be kept up indefinitely.

CSC officers are trained only in how to control. They are not skilled in recognising the behavioural traits of mental illness, which leads to misunderstanding and heavy-handedness towards 'difficult' prisoners.

The Close Supervision Centre is a prison within a prison. Based in HM prisons Woodhill (near Milton Keynes), Wakefield and Whitemoor, the CSC system was set up by a Labour government in 1998 "to remove the most significantly dangerous, challenging and disruptive prisoners and manage them within a small highly supervised unit". Director General Richard Tilt called the system "therapeutic, not punitive", and the aim was to return prisoners to normal wings after a year or so. But how would that be possible if the inmates chosen were to be those deemed incapable of progression and incapable of being reformed?
After early failures with disruptive inmates, the CSC began to select those who they felt would cooperate. Disruptive behaviour abated and it started to look like a success, even though genuine persistent troublemakers rarely got selected anymore .Inmates began to be selected after just one disruptive incident, or for alleged gang activity, or for what is perceived as religious extremism .
inmates with diagnosed mental illnesses began to be selected — they are easier to manage because they are easier to medicate.

My partner David was selected after repeated bouts of segregation. He has a personality disorder and cannot cope on busy wings. Segregation desocialises an inmate even further and each time he was returned to the wing more problems arose for which he was again segregated.

Like many other prisoners he was referred to the CSC and selected in breach of the procedural requirements detailed in the referral manual that the CDC should be a last resort after other options (primarily the Managing Challenging Behaviour Strategy) have failed. Such management tools are frequently bypassed.

Secure hospitals, seeking to save money, would not accept him, despite recommendations, because they said his needs could best be met in prison. Nobody looked at his documented history, addressed any issues with therapy or fully took his illness into account. His medication was increased and he was referred to the CSC, an even more extreme form of punishment and containment than segregation.

CSC is not a hospital, it is a prison control unit that is being used against the mentally ill as a substitute for appropriate mental health care. In effect, the mentally ill are being punished for being ill, a bit like leprosy in the Middle Ages.

Solicitor Shahida Begum, writing in Inside Time, says: “It is common knowledge that Close Supervision Centres are widely used to manage ‘mentally ill’ prisoners, and that mentally ill prisoners are overrepresented in segregation units. Prisoners who are deemed as dangerous or chronically disruptive are placed in prolonged solitary confinement as a prison management tool.” Self-harm and suicide attempts on the Woodhill CSC are disproportionately high.

The high numbers of mentally ill held in the CSC means the psychiatrist doesn't have time to interview every inmate and is regularly absent with no cover - he doesn't see every inmate every week and if he does see an inmate then time is short because he has so many others to see.

David found there was no consistency or continuity. An inmate could see a psychiatrist one week, stirring up really powerful issues, then be left alone to deal with the fall-out, often for weeks, because next week and the following week the psychiatrist may not be available.

There is no mental health cover in the evening or at weekends so if an inmate mistimes his crisis he has to cope alone, even on suicide watch.  If he rings the bell for help, nobody is there.

Frustration can lead to self-harm, a tiny respite from mental torment — in Woodhill one inmate cut off his own ear in the shower.  Months later, in the shower again, he was allowed another razor and cut off the other ear.

Each and every day presents a trigger, and for those who are vulnerable and less well-equipped mentally and emotionally to cope with such a regime — pretty much everyone there — the perpetual tension is impossible to endure. Sleep is a luxury most lack. When the door is unlocked in the morning and the inmate is interpreted as hostile or threatening further restrictions are imposed.

Prolonged solitude is not an effective management technique — it only allows the prison to claim that disruptive "incidents" have been stopped.  Those at risk of self-harm and suicide should not be isolated; it can push them over the edge. It will create illness in those not already vulnerable to start with.

David had consistently good reports in the CSC, overcoming daily provocations, and had been given Enhanced status but this is meaningless in the CSC as nothing is available on the unit.  Because of the regime and the understaffing he was kept locked up for 23 hours a day with no association and restricted access to the gym and showers.

In August 2011 a few inmates were selected for their good behaviour to progress to the newly-opened B wing. They had been told that it would help them progress towards deselection and a return to normal wings. Instead, it was the same as the A wing they had just left behind except with a different letter on the door — no course work, no therapy, no stimulation, education, nothing.  And now others are randomly being put on this wing dragging the whole unit down so that those who had behaved well because they wanted to progress are now locked up for 23 hours a day again.  Six months later they are bored out of their skulls, demotivated, getting restless, feeling cheated, and in limbo.

They are told to "engage" but Care and Management meetings are frequently cancelled, and there is no structure. Inmates are constantly led to believe that they are on the verge of being deselected (transferred out of the unit) but four to five years is an average stay, despite fully cooperating, not the one to two years originally proposed, and ten years is not unheard of.  They face the impossible task of proving they can cope on normal wings while not being allowed to go there.

One inmate who has been stuck in the system for thirteen years does yoga and tai chi — not, to me, indicative of a dangerous man incapable of progression and beyond help. In 2007 one young offender stuck in the CSC for five years hanged himself.

Former head of High Security Prisons Lord David Ramsbotham has been critical of the CSC from the start, acknowledging that lengthy isolation should cease as it jeopardises mental health. In the Guardian last year, he argued:
"If you are holding people suffering mental health problems, then they should be held in conditions similar to those in secure mental health hospitals. This is clearly not the case at Woodhill.”

Claire Hodson, Woodhill's CSC Operational Manager, states in a letter quoted by the Guardian : "CSC inmates often present with highly complex needs", but she ignores the fact that the CSC cannot help with those needs. She describes self-harm as a "maladaptive coping strategy" but, when asked what procedures are in place to remove those psychologically unable to cope and displaying serious signs of illness and self-harm, she makes no reply. 

Responding in June 2010 to an Inside Time article, “Great Well of Psychiatric Morbidity”, written by a relative of an inmate of Wakefield CSC, Danny McAllister, Director of High Security Prisons , dismisses with breathtaking arrogance everything she has observed.  He still maintains that the CSC is a force for good when experience of inmates demonstrates that it isn't, and still insists it provides opportunities for inmates to address their psychological and mental needs when clearly it doesn't.  He claims he is satisfied that it is achieving its aims and says prisoners can use the complaints forms if they encounter problems. They do. Nothing happens.

An HM Inspectorate of Prisons report on Woodhill in 2010  found:
“There was a need for a more structured evidence-based violence reduction programme within the CSC estate, addressing smonitoring of the regime and independent psychiatric assessment of inmates instead of the prison-funded psychiatrists who aid the prison in its control ethos. Abusive officers should be charged for abusing the mentally ill, as anybody else would be. Prisoners have rights too and the state is obliged to safeguard human dignity. 

If people are offending because they are ill then surely treating their illness will reduce their offending? Secure hospitals need to be brought to account for refusing inmates who clearly need this intervention.
Twelve years of the CSC has proved not only that it doesn't work but that in most cases it makes inmates worse. How much longer before government finds the courage to act on the evidence and fund something that actually works?

There is special funding for the CSC. Can it not be diverted to more places in secure hospital units? There needs to be an independent home of the underlying behaviours and attitudes presented. A programme had been piloted at Woodhill in 2004/05 and a recent business case submitted for funding, which had been turned down on the basis of cost.”

"Lydia Smith" and "David" are pseudonyms