IWD 2020 What about the women in prison?

In light of International Women’s Day (IWD), on 8 March, we are prompted to think about women everywhere, including in prison.

IWD started as a radical struggle by women to recognise their status as equal human beings, protected by and entitled to the same rights as men. Is this being achieved for women in prison? What other gender issues play out around activism and prison?

A few months ago, the Committee for the Prevention of Torture published its report (CPT, 2019), dominated by scathing commentary about the treatment of women in Scottish prisons. Horrific examples described women with severe mental health and physical health issues being held in isolation. In one case CPT investigators noted a woman who had gnawed her arm to the point that her bone was visible (see pages 7, 48). Additional observations of extreme suffering by women prisoners should shock and shame Scotland into action. One wonders whether this report, on the back of a similarly negative assessment by Audit Scotland in 2019 and other recent troubles, is behind the recently announced retirementof the Scottish Prison Service Chief Executive.

Exceptionally abhorrent examples should not, however, blind us to the routine ways that women in prison suffer and are let down by those in a position to help. Following the CPT’s visit to Scotland, women continue to die in prison, be locked in their own cells or segregation units for 22-23 hours a day as standard (see p. 28), and to be subject to infantilising, degrading treatment. Where are Scotland’s vaunted human rights mechanisms, its champions of women prisoners, and its politicians, and why has there been no outcry about the generally poor conditions of this group?

The Scottish Government accepted the findings of the nearly decade old Angiolini Commission on Women ‘Offenders’, including that most women should not be imprisoned, and to close HMP Cornton Vale. Neither of these has happened. While there are fewer younger women going to prison (though some still do including the fatal imprisonment of Katie Allan in 2018), the overall rate of women’s imprisonment in Scotland is stable, and still among the highest in Europe.

A neglected feature of the sympathetic, reforming tone in Scottish policy and academia towards women in conflict with law has been about the dangers of a victim discourse. This frames women passively as victims – more screwed up than men, having deeper or worse histories of trauma, denied existence as people themselves but identified and important mainly in relation to others (as unfit mothers or troubled daughters). As Una Barr points out, ‘when women are constructed solely as victims, they are pathologised, their agency disappears’ (page 151), incapable of organising their own lives, or finding their ways out of trouble. Women thus are positioned as in need of constant and coercive state rescue.

An irony of Scotland’s turn towards policies that support families and communities is that in prison, this has meant eroding the quality of the prison experience for women. How does this work? Co-locating groups – women, remand, men, protection (i.e. vulnerable) prisoners – in local prisons to bring them nearer to families has crowded these prisons and complicated their scheduling of activities (regimes). The easiest means of managing multiple groups is to keep them locked in their cells. Rationales are produced to explain this practice as reasonable. For women, this involves pathologizing them as both more bullying and bullied, more disruptive, deranged, disturbed.  Women also are subject to traumatising body searches (see p. 26) that have been challenged by the inspectorate of prisons.

Another irony of dispersing women around Scotland’s local prisons has been increasing the amount of time they spend in prisoner transport vans. This issue was of such concern to the Prison Inspectorate for Scotland they included an appendix charting a single day’s journey showing the amount of time women spent in vans (see pages 8 and 11; the issue remains a serious problem, see page 49); sometimes this was up to 12 hours – with no or few bathroom breaks, no menstrual products/accommodations, delayed or missed meals – all while handcuffed within these comfortless vehicles, isolated in claustrophobic cubicles on moulded plastic seats.

As one of the smallest groups, women have reduced access to the most worthwhile activities in prison including: education, jobs, family visits, exercise. All of these things are essential to surviving the prison experience. An additional effect is to reduce women’s visibility and ability to participate in activism around their confinement. Our existence as a collective was able to develop through the regular access our imprisoned men members had to contact with outsiders through education and other initiatives. Imprisoned women participated to some extent, but were much more constrained. In one case, our women colleagues were unable to attend education groups because of their having laundry jobs – not only typical women’s work, but also prioritised by the prison over their education.

We call for greater attention to be brought to this violence of women’s imprisonment and for it to be recognised as violence, and to resist ideology of prison as the care of victims. In the radical spirit of IWD’s origins, we urge well-intentioned reformers to abandon the paternalistic, infantilising language of victims, and to work towards ways of empowering the political awareness and participation of women everywhere.

And on a final note, we include unequivocally in the struggle for women’s rights in prison and in society, trans women, who face distinctive and profound forms of violence.

Screenshot 2020-03-11 at 12.59.52
Images are from the Barnard Center for Research on Women, as part of a collection and exhibition on Women’s Prison Activism. (url: http://bcrw.barnard.edu/archive/prison.htm)


Armstrong, S. and McGhee, J. (2019) Mental Health and Wellbeing of Young People in Custody: Evidence Review, Glasgow: Scottish Centre for Crime and Justice Research. Available at: https://www.sccjr.ac.uk/wp-content/uploads/2019/05/SCCJR-Mental-Health-and-Wellbeing-of-Young-People-in-Custody_Evidence-Review.pdf(accessed 10.03.20)

Audit Scotland (2019) The 2018/19 Audit of the Scottish Prison Service, Edinburgh: Audit Scotland. Available at: https://www.audit-scotland.gov.uk/report/the-201819-audit-of-the-scottish-prison-service (accessed 10.03.20)

Barr, U. (2019) Desisting Sisters: gender, power and desistance in the criminal (in)justice system. Cham, Switzerland: Palgrave Macmillan.

Barry, EM. (2000) Women Prisoners on the Cutting Edge: Development of the Activist Women’s Prisoners’ Rights Movement, Social Justice, Vol. 27, No. 3 (81), pp. 168-175.

Cee Whitehead, J. (2007). Feminist prison activism: An assessment of empowerment. Feminist Theory, 8(3), 299–314.

Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) (2019) Report to the Government of the United Kingdom on the visit to the United Kingdom carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 17 to 25 October 2018, Council of Europe. Available at: https://rm.coe.int/1680982a3e (accessed 10.03.20)

HM Inspectorate for Prisons Scotland (HMIPS) (2017) 2016-17 Annual Report, HMIPS. https://www.prisonsinspectoratescotland.gov.uk/sites/default/files/publication_files/SCT06174847802.pdf (accessed 11.03.20)

HM Inspectorate for Prisons Scotland (HMIPS) (2019) 2018-19 Annual Report, HMIPS. https://www.prisonsinspectoratescotland.gov.uk/sites/default/files/publication_files/Annual%20report.pdf (accessed 11.03.20)

HM Inspectorate for Prisons Scotland (HMIPS) (2016) Follow-up inspection of HMP & YOI Cornton Vale. HMIPS. Available at: https://www.prisonsinspectoratescotland.gov.uk/sites/default/files/publication_files/HMP%20YOI%20Cornton%20Vale%20-%20Review%20Inspection-%2011-13%20October%202016.pdf (accessed 11.03.20)

Moore, L. and Scraton, P. (2013) The Incarceration of Women: Punishing Bodies, Breaking Spirits. Basingstoke, UK: Palgrave Macmillan.

Moore, L. &and Scraton, P. (2009) The Imprisonment of Women and Girls in the North of Ireland: A ‘Continuum of Violence’, in Scraton, P. and McCulloch, J. (eds.), The Violence of Incarceration. Basingstoke, UK: Palgrave Macmillan, pp. 124 -144.

Why penal reductionism must be at the centre of prison reform 

Once you are in it is difficult to get out.

It is well established that prisons do not reduce re-offending. For individuals released from custody in 2014-15 (the last year where detailed statistics were published by the Scottish Government) 60% of those serving a sentence of less than three months were reconvicted. While reconviction rates for longer sentences are lower, almost a quarter of those serving between 2 and 4 years were reconvicted (Scottish Government 2017). So what effect does the prison have?

The prison of course makes a massive impact on individuals, families, communities and society. Counter to current prison policy, we suggest that it is crucial to examine the effect of prison itself, rather than continuing to pathologise those within it as “bad” or “anti-social”, constantly positioning the prison as a site where these people can be repaired and from which good can flow. Indeed, there is strong evidence that criminal justice system contact can be criminogenic, with young people who are drawn into the justice system less likely to desist than those who engage in the same behaviours, but do not experience an intervention from the criminal justice system (McAra and McVie 2005).

Similarly, in 2008 the Prisons Commission highlighted that even short periods in custody disrupts positive and supportive relationships in the community and, notably, that the physical geography and institutional regimes of prisons discourage independence and personal responsibility, institutionalising (and we would add traumatising) many of the people who are sentenced to this form of punishment. Imprisonment can also create or exacerbate problems relating to housing, child care, employment and discriminatory public attitudes[1].  For instance, a 2016 YouGov survey commissioned by DWP found that that 50% of employers would not consider employing an offender or ex-offender (House of Commons Work and Pensions Committee 2016).  Thus, for many people, imprisonment reinforces barriers to paid work, secure housing and personal and family wellbeing; all of which are factors supportive of desistance.

Progression – a game of snakes and ladders

An issue of particular concern to SPARC is that for those serving long or life sentences it can be incredibly difficult to progress through the system.  Progression is central to how lifers and long termers are managed. Prisoners are meant to incrementally graduate to lower levels of security, ultimately as a means to test and monitor their levels of responsibility and safety, ultimately achieving parole – a process that we have elsewhere likened to a game of snakes and ladders as many prisoners are downgraded and held back. While we know that the average tariff a person on a life sentence serves has almost doubled between 2000-2012 (Howard League Scotland, forthcoming), the number of “lifers” in Scotland who are serving time over their tariff is not routinely made publically available.

Our own advocacy/research work suggests that those who are most likely to experience delayed progression through the system are those who are already the most disadvantaged: those with addictions, poor mental health, difficulty building relationships with officers, those who are less able to advocate for themselves.  Yet, even when people in custody do face these barriers, the availability of places on courses which are required to reduce risk or move on to the next “stage” of their sentence can create considerable delays.

This raises fundamental questions about justice, fairness and what are people in prison being punished for?  We contend that it is unacceptable for people to be held in custody solely for reasons relating to poor mental health, addictions or a lack of resources.

This issue takes on a particular urgency and salience in Scotland because the number of life sentences imposed is disproportionality high here. Speaking at the Howard League Scotland in March 2018, Professor Dirk Van Zyl Smit noted that the number of people serving life sentences has steadily risen over the last 15 years, with “lifers” accounting for 19% of the prison population.  The comparable figure across European countries is 3%, with lifers accounting for 0.9% of the prison population in France and 6% in Turkey. Indeed, Scotland has more than double the number of lifers than France (1,083 vs 489).  Together, the UK and Turkey have more lifers than the rest of Europe combined, including Russia[2].

This is troubling for a country which, ten years ago, sought to position itself as in line with the apparently more progressive approach of the Nordic/Scandinavian jurisdictions. Professor Van Zyl Smit concluded that this raises questions about how Scotland responds to serious crimes and the utility of mandatory life sentences. These must be used only in circumstances where no other sentence will do, as the effects of being of life licence retain a person permanently within the criminal justice system, undermining their ability to return to “full” citizenship.

Within a custodial environment instruments of care become tools of punishment 

The Prisons Commission was also critical of what it termed Scotland’s “warehousing problem”, or the unnecessary use of prison to hold people suffering from trauma, abuse, victimisation, addictions and poor mental health.

We would agree that this is an unnecessary and unproductive use of custody which must be curtailed. However, we also want to build on this point to suggest that very often when a “care” or personal development need is identified in prison, the response is framed in terms of addressing offending behaviours e.g. expressing frustration, distress or anger may lead to a referral to anger management course; or a desire for more contact with children may lead to a parenting course.

This is problematic because it has the effect of re-framing what are often structural problems such as poverty, or genuine health needs such as mental illness, as personal choices and failings (Kendall 2002); which can in turn warrant an additional criminal justice response.  This is perhaps seen most clearly in the response to addictions.  While we would argue this should be seen as a health issue, not least because the prison environment can exacerbate or shape drug use in particularly harmful ways[3]failing to manage or overcome an addiction can delay progress towards release, effectively imposing additional punishment on those with addictions.

Prison harms 

Finally, and most importantly, our reliance on prison must be reduced because prison harms.

Reviews of research suggest that time in prison is itself damaging to cognitive function (Meijers et al 2015). Research on Scotland by Prof Lesley Graham has further established that those who are in prison have higher mortality rates, of two to more nearly six times higher, than those in the general population, even when controlling for social deprivation. Such work establishes, unsurprisingly, that confinement of human beings is deeply damaging, and this damage should be carefully considered.

This is reflected in the higher than average rates of drug and alcohol use and poor mental health identified by the Prisons Commission.  While detailed data on the prevalence of mental health problems in Scottish prisons has been argued to be lacking, research suggests that mental health is one of the most important health issues in prisons, with the majority of prisoners having at least one mental health problem[i](Gillies, Knifton and Dougall 2012). While areas of good practice have been identified, mental health services in prisons have been argued to be under-resourced, leading to significant unmet need[4](ibid).

Mental health problems can be fatal.  When we look back to deaths in custody in 2013, which is the first year in which at least some of the families in question are not still awaiting the outcome of a fatal accident inquiry, seven men committed suicide and a further two died in an “Event of Undetermined Intent/Overdose”.  The deaths of these men equate to over a third of fatalities in custody in that year.

Finally, prison also harms families and communities. Supporting a person in custody requires a considerable investment of time, money and emotional labour from families. Concerning, it can also create or exacerbate poor relationships between families and the criminal justice system, undermining both feelings of citizenship and penal legitimacy (Jardine, forthcoming).

When we recognise this harm, we are compelled to scrutinise even the best intentioned use of imprisonment. The best way to reduce these harms is to reduce our reliance on this damaging form of punishment.

This post is based on SPARC’s presentation at the 10thAnniversary of the Scottish Prisons Commission 


Gillies, M., Knifton, L. & Dougall, R. (2013) Prison Health in NHS Greater Glasgow & Clyde: A health needs assessment. Glasgow: NHS Greater Glasgow and Clyde. Accessible here: https://strathprints.strath.ac.uk/42745/1/FINAL_PRISON_HNA_REPORT_2012.pdf

Graham, L. (2012) Justice Committee, Transfer of prison healthcare to the NHS Written, submission from Dr Lesley Graham: http://www.parliament.scot/S4_JusticeCommittee/Inquiries/Dr_Lesley_Graham.pdf

House of Commons Work and Pensions Committee (2016) Support for ex-offenders: Fifth Report of Session 2016–17, London: House of Commons. https://publications.parliament.uk/pa/cm201617/cmselect/cmworpen/58/58.pdf

Jardine, C. (In press) “Eroding legitimacy? The impact of imprisonment on relationships between families, communities and the criminal justice system”, in Condry, R. and Scharff-Smith, P (eds.) Prisons, Punishment and the Family: Towards a New Sociology of Punishment, Oxford: Oxford University Press.

Kendall, K (2002) ‘Time to think again about cognitive behavioural programmes’ in Women and Punishment: The Struggle for Justice, Carlen, P (ed), Willan: Devon

McAra, L., & McVie, S. (2005). The Usual Suspects? Street-life, Young People and the Police. Criminal Justice5(1), 5-36. DOI: 10.1177/1466802505050977

Meijers J, Harte JM, Jonker FA and Meynen G (2015). Prison brain? Executive dysfunction in prisoners. Front. Psychol. 6:43. doi: 10.3389/fpsyg.2015.00043

Scottish Government (2017) Reconviction Rates in Scotland: 2014-15 Offender Cohort Edinburgh, Scottish Government.  Accessible here: http://www.gov.scot/Resource/0051/00517255.pdf

Van Zyl Smit, D. (2018) Life imprisonment: an appropriate ultimate penalty in Scotland?, Lecture hosted by Howard League Scotland, 12 March 2018.


[1]There is a large body or research evidencing the harm and damage caused by imprisonment.  See, for example, Kendall (2002);


[3]For instance, a desire to avoid detection in MDT’s can encourage the use of more addictive substances or legal highs

[i]The authors note “The most comprehensive and robust data on the prevalence of psychiatric disorder in the prison population in the UK are from a 1998 Office of National Statistics study of 1,250 men and 187 women aged 16 – 64 years imprisoned in England and Wales (Table 3) [29]. The prevalence of mental disorder in the prison population was high; over 90% of prisoners had one or more psychiatric disorder (psychosis, neurosis, personality disorder, drug or alcohol dependence). Dual diagnoses were extremely common; 80% of prisoners had two or more psychiatric disorders (most commonly a major psychiatric illness and substance misuse) and 12 – 15% of prisoners had 4 or 5 co-existing disorders.” (Gillies, Knifton and Dougall 2012: 59)

Ross Kemp Behind Bars: Hiding from the hard questions in Barlinnie

Last week we saw actor and documentary maker Ross Kemp spend time in Glasgow’s Barlinnie prison, in an attempt to address a question which has long troubled academics, policy makers, and those sentenced to custody: what are prisons for?

That Kemp and his documentary team selected Barlinnie to explore this question seems very much to have been a deliberate choice, taken to capture the viewer’s attention through multiple references to Barlinnie’s “dark history” and “stone walls”.   However, while Barlinnie’s age, scale, and history may make for a striking setting for a television documentary, they are somewhat atypical of modern prisons in Scotland.  As a recent inspection report of Barlinnie notes, while the vast majority of men in Barlinnie are accommodated traditional, “imposing” Victorian halls, this reflects Barlinnie’s place as one of Scotland’s oldest and largest prisons.

This focus on traditional, or even clichéd, symbols and stories of prison life persist throughout the hour that we spend with Kemp in Barlinnie.  The only workplace we see within the prison is the kitchen, where the emphasis is placed on the need to manage any risk of violence rather than the work being done.  Kemp suggests that “potential weapons” abound in the prison kitchen, noting the potential harm that can be caused by knives, boiling water, and even soup.  The residential hall where we spend the most time is E Hall, where men who require protection from the remainder of the prison population due to the nature of their offence, serve their sentence.

We also explore the prison exercise yard, where interviewees attest to the dangerous nature of the prison environment, before being shown an array of weapons and mobile phones which have been confiscated by officers.  This then seems to serve as justification for showing viewers a detailed cell-search, including a strip-search of the individual under suspicion.  While his identity is concealed, there is no reflection on the invasive nature of broadcasting this element of the prison regime for public consumption, nor any consideration of how this person might feel as a consequence.  The only glimpse we see of the individual as a person, rather than a faceless prisoner, is when the officer thoroughly searches a pile of immaculately kept letters, presumably from his family.

There are intriguing moments where some of the more complex issues facing those living and working in prisons are alluded to.  For instance, the difficulties of sentence progression for those serving indeterminate sentences are highlighted in the account of one man who remains in Barlinnie six years past the “punishment part” of his sentence, as a consequence of a heroin addiction he developed to cope with the prison environment.  When Kemp asks if he has been rehabilitated, he responds that he is not sure if it is growing older or rehabilitative programs that have led him to change, but in any case this doesn’t matter while it is his addiction, rather than his offending which is keeping him in custody.  This raises questions relating not only to the progression process for life sentences, but also whether addictions can or should be addressed within the criminal justice system.

The prison officers interviewed by Kemp also provide a more sophisticated account of life in Barlinnie.  From the officer working with protection prisoners who emphasises the need to see the whole person and not just their offence, to the officer running the gym who highlights the critical importance of relationships in creating a well-run prison, these officers provide insights which would have made a more challenging and engaging documentary than the continuing emphasis placed on violence and offending by Kemp and his team.  However, it is not only their accounts which are neglected.  We also do not see the library, the education centre, the prison radio station, the visiting room or any other space which might allow for a more rounded view of the lives of the men serving their sentences in Barlinnie.

These choices of the production team to limit what the audience see of Barlinnie are important.  Sociologists who study prisons frequently highlight that these are places where individuals are denied full adulthood, in that they are not trusted to choose when to go to bed, what to eat, what to wear, when to use the phone, where they would like to work or what possessions they may have.  The limited view of Barlinnie presented by Kemp reflects this process of infantalisation, but here it is not the prisoners who are not afforded full trust or maturity, rather it is the audience themselves.  This emphasis this documentary places on common tropes of imprisonment, such as drugs, violence, beasts, “banking”, fear, and cell-searches undermines attempts to meaningfully interrogate questions such as “what are prisons for” and “do they work”.

Kemp concludes the hour by posing what is perhaps the most interesting question documentary: are we as a society doing everything we can to support those who want to change their lives?  This inevitably requires acknowledging our shared humanity and recognising the whole person, not simply seeing them as a “prisoner” or an “offender”.  This documentary may have set out to ask hard questions about our prisons, but by not trusting the audience to understand the complex nature of both the prison and lives of those within it, it instead presents a simple narrative which is unlikely to open up a constructive debate around these questions.

What society needs to learn from people with convictions

Clinks, an organisation that supports voluntary organisations working with ‘offenders’ and their families issued a call for responses to this question: “What do offenders, prisoners and ex-offenders need to learn?”. It will publish responses sometime in 2017. SPARC has submitted a response as follows…

We are not children who “need to learn”.

The question that is put out for response – “What do offenders, prisoners and ex-offenders need to learn?” – insinuates that as a group there are things we ‘need’ to be taught. Not only is this framing of inquiry slightly offensive, it has authoritarian and paternalistic overtones that keep us in our place at the bottom of society where we need constant interventions into our lives. The invitation to hear from those with first-hand experience as ‘prisoners and ex-offenders’ is welcome, but risks itself becoming a means of re-drawing a line between an ‘us’ and ‘them’. Even well-intentioned efforts to help others can be a way of othering and demonising, rather than humanising people. There is a long-standing tradition in penal practice, research and reform of infantilising and denying the agency of those involved in criminal justice. We have re-framed the question to support our position that user voices should not be used just to gain information (to support development of services or better rates of rehabilitation) but should help shape the very debate over reform itself and what the problems of punishment are.

What society would benefit from considering is what people in the system themselves want to move their lives forward. The majority of us feel that support, understanding and guidance would serve both people with convictions and the tax paying public better, in the place of constant interventions delivered from above. Too many services are organised around one size fits all diagnosis of what people need. By ignoring the individual realities of a person’s situation, and their own ideas about the kind of support they need, means that any help becomes prescriptive and reinforces the idea that people are not capable of taking control of their own lives in positive ways.

What we have found has helped us the most both in prison and on our journey out, is the help and understanding on a personal level from those who treated us as people, and as adults, no different from themselves – with strengths, flaws, goals and vulnerabilities. Meaningful, genuine encounters – 15 minutes with a member of staff listening and hearing you – has had a more real, positive and powerful impact than ‘offender change’ programmes, which officially document our rehabilitation.

Prisons and contact with the criminal justice system is inherently damaging.

Prisons are inherently damaging places to be, both for the people locked in them as well as the family they leave behind. Ideas of prisons as holiday camps has taken hold in the media and in public imagination whilst the idea of a loss of freedom remains too abstract. It’s not what we’re given in prison that should be the focus of concern, but the fact that these things – whether tellys or Xboxes or DVDs – do not compensate for what is taken away. Taken away from family and friends, from our lives on the outside, but also taken away from a sense of normality and autonomy and placed in an institution where just about every dynamic is about control and disempowerment. These losses de-skill and dehumanise us, yet these skills and this sense of self-efficacy are the main sources we need for support on release. That is, ‘reintegration’ support is needed because of the effects of prison itself, and criminal justice, on people. Too often, reintegration is treated as a reflection of an individual’s deficits, as if committing an offence demonstrates complete incapacity in all areas – to maintain family relationships, housing, a job.

The public read about a prison that we have never experienced – where life is like a holiday camp and you get to do whatever you want. Not only do the tabloid media get it wrong, for their own reasons, but prison services often mislead about how ‘normal’ life on the inside is.

Prisons are not filled with the country’s most dangerous criminals.

Whilst imprisonment is admittedly necessary in any civilised society in order to lock up those who have committed the most damaging, serious forms of harm – it has turned out to be a dumping ground for those of us society has failed. It has become a waste management solution where the lowest of the low in society can be dumped, rather than dealing with wider social problems of poor quality jobs, inadequate housing, and lack of mental health support. Crime is at an all-time low, yet our prisons are still overcrowded – with one in three males accruing a criminal conviction in Scotland and one in four in England and Wales. How can this be? Society needs to consider its culpability in the failure of so many of its citizens, and appreciate that prison could, and does, happen to anyone – we are more alike than we are different.

We have a civic future if prisons and society allows us the time, space and capacity to do work towards it.

Research on education and democracy shows that by helping someone build their educational attainment they are more inclined to take part in valued aspects of community activities. Participating in society this way is clearly a factor in reducing offending, but reduced reoffending, we believe, should not be the main aim of education, or of education in prison. Education is a prerequisite of robust democratic societies; reduced reoffending is the happy by-product of this. Civic participation increases as levels of education increases – especially liberal arts forms of learning, which encourage freethinking, creativity, empathy and curiosity. Societies and prisons need to learn that we are not all in need of basic literacy and numeracy courses, or employability skills courses (which lead neither to qualifications or actual jobs). And society needs to learn that prisons often use opportunities like education (as well as family visits) as a carrot and stick to ensure disciplinary compliance in prison. Personally we have heard people complain about prisoners getting an education amongst other things, even people close to us that qualify their comments with – but you’re different because you’re doing so well.

The attitude of politicians towards people with convictions gaining any kind of civic identity can be illustrated by former Prime Minister David Cameron’s comments regarding prisoner voting, the very thought of which apparently made him ‘physically sick’. Never mind that the UK has been in violation of European rulings since 2005 for its blanket ban on prisoner voting. This sends a clear message that people with convictions are not welcome as full citizens – despite the rhetoric about rehabilitation. We also reject the idea that we are not citizens when we enter prison, and that prison can act as a ‘citizen recovery’ service, as it has been touted by the current head of Scottish prisons. We do not lose our status as human beings, adults and citizens by having convictions.

How academia, the media and the public interact with people with convictions matter.

Questions like the one posed for this paper show how even third sector and academic attitudes towards people with convictions are entrenched with negative assumptions. These assumptions are based on the belief that people with convictions are all stupid individuals who are one intervention away from being taught that our way of living is wrong and we can be saved from a life of crime. We reject such infantilising and patronising thinking, which sadly is embedded in much of what we have read about desistance models. The media continue to run stories about the ned – the chav, the neet – who is forever causing trouble wherever he goes due to his low level of intelligence and lack of respect for society. This is eaten up by the public who according to the media are outraged at the luxury we live in when in prison and the opportunities we are given. Society needs to learn that some of us have caused the worst possible harm to others and to society, and having been through this, we are now seeking meaningful ways to re-join and contribute to our communities. We cannot do this when we are disempowered, pitied, de-skilled, de-humanised and told by others what it is we need to learn.

Health Inequalities in Scottish Prisons

SPARC recently responded to the Health and Sport Committee’s call for responses to contribute to their current inquiry into healthcare provision in Scotland.

  1. What do you consider are the current pressures on health and social care provision in prisons?
  2. How well do you consider that these pressures have been responded to?

In general, the move from SPS healthcare provision to the NHS has been a positive development as it moves Scotland towards a vision of the person imprisoned as a full and equal member of Scottish society, with the same rights to care as anyone else. However, evidence to date suggests that in practice this commitment has not been realised. Here we refer to the Royal College of Nursing Scotland’s comprehensive review of this transfer Five Years On (2016). We are sure the Committee is fully aware of this report but we wish to be added to the voices of those seeking for its powerful findings to be taken into account. We find its method and approach robust in flagging up key issues in provision of health and social care for those in prison.

The key pressures this report identifies, and which is consistent with our own experiences and awareness of the research relate to:

  • An inability to adopt a prevention focus due to extensive staff time devoted to medication management of those in prison;
  • Lack of continuity in care before, during, and following a prison sentence impacting on the cost effectiveness and efficiency of health care delivery in prison;
  • Relatedly, this finding suggests more than coordination issues between SPS and NHS staff but a more fundamental need to understand and address possible organisational culture differences between health and punishment sectors – from experience we have seen ‘prison security’ and prison personnel staffing issues affect medical delivery (for example, the timings of medication rounds is a direct function of prison and NHS staff shift times and prisoners may receive an evening dose at 4 in the afternoon on weekends, when prison staff levels means after this many are locked in cells). In addition, NHS staff should never, under any circumstances, be required to provide medical interventions to primarily support SPS security and control, this violates the principles of equitable medical care and erodes trust between prisoners and medical staff. Nor should medical staff prescriptions or treatment plans be amended post hoc by SPS. Instances of both have been seen or experienced by members of this group;
  • Finally, staffing levels and pressure generally on staff emerged as a consistent finding and one which requires consideration to maximise optimising health care, outcomes, prevention focus and effectiveness and efficiency issues; however, a core concern of our collective is to ensure that problems within the prison system do not become arguments for expanding the prison system or expanding the prison’s budget compared to other settings where health and other outcomes (i.e. the community) are better supported. Hence, we express concern about the repeated use in the RCNS report of the idea that ‘prison offers the best chance of catching people’ and addressing their health needs. Prison is never the best place to work with people, all other factors remaining equal.
  • Lack of data and understanding of health issues and provision gaps: The RCN wrote that: ‘It is not possible to evidence the impact that the transfer has made on tackling health inequalities and addressing the health care needs of people in prison. This is because there are still some gaps in our understanding of people’s health needs in the criminal justice system and a lack of national reporting and quality outcomes data for prison health care’. An annual prison health report on the existing health inequalities, systemic improvements and kinds of provisions that make up the NHS work, e.g. budgets, would be useful to ensure continual prioritisation and awareness of the issues. The Government needs also to demonstrate more explicitly how prison healthcare is integrated in their national vision of stronger, safer, fairer and healthier Scotland. Therefore, prison healthcare must be recognised as a distinct area of service provision within the long-term strategic plans for Scottish health. Finally, the lack of data reflects wider gaps and progressive loss in knowledge: for example, the most recent published statistics on the prison population date from 2013-14 (with significant disinvestment of resource in producing official statistics on prison populations in Scotland in the past 10-15 years). Effective policy making and transparent democracies require clear and open understandings of who is imprisoned, where, why and for how long. We are concerned that prison healthcare will fall under the same opaque reportage and loss of public oversight.

The fact that 66 deaths in prison custody since 2013 remain undetermined (SPS website) receives far too little Government and policy scrutiny despite extensive recent media coverage:

Staffing and other resource issues likely play into this, but we challenge those concerned with the health and social care of those in prison to prioritise explaining, resolving and providing closure to families of people who die in state custody.

We are not aware of national reporting on prison healthcare and would welcome some mechanism for this. However, we also worry about the emphasis in the RCN report on inadequate assessment of health needs. While we welcome better understanding of these needs, it is important to set this in the context of extensive, almost relentless and often dehumanising assessment processes in prison where people are regularly required to recount multiple times issues of deep personal concern such as personal traumas, drug and alcohol issues, literacy issues, abuse issues and more. We urge a focus on care, prevention and positive, supportive relationships with professionals over endless inquiries (often in front of multiple strangers) in order to achieve perfect recordkeeping.

  1. To what extent do you believe that health inequalities are/could be addressed in the prison healthcare system?
  2. What are the current barriers to using the prison healthcare system/ improve the health outcomes of the prison population?

Health inequalities cannot be addressed effectively when health is viewed as a factor in reduced offending: The new NHS model of prison healthcare has sometimes been presented and justified as an improved form of medical provision primarily because it will help with reducing reoffending[1]. This directly undermines an agenda of reducing health inequalities because it implicitly values NHS provision in prison mainly in terms of its contribution to crime reduction. Healthcare, whether in prison or anywhere else, should be discussed only in terms of treating people who are in need, supporting citizens and improving health and wellbeing in Scotland in general. Prison healthcare should be motivated by the same ethos and vision as the recent National Clinical Strategy for Scotland which stated that: ‘Quality must be the primary concern – all developments should seek to ensure that there is enhancement of patient safety, clinical effectiveness and a person-centred approach to care’[2]. A key challenge to rectifying health inequalities, therefore, is the dominant ethos of the prison system in which all services delivered in this setting are assessed instrumentally in terms of reoffending outcome measures.

Health inequalities cannot be effectively addressed without recognising the harms of prison itself: Prisons, no matter how well they are run or designed, are innately damaging. Reviews of research suggest that time in prison is itself damaging to cognitive function[3]. Research on Scotland by Prof Lesley Graham has further established that those who are in prison have higher mortality rates, of two to more nearly six times higher, than those in the general population, even when controlling for social deprivation[4]. Such work establishes, unsurprisingly, that confinement of human beings is deeply damaging, and this damage should be carefully considered. A discourse has emerged of talking about people in prison as having lower cognitive function, greater health needs, more chaotic lives and so on; and while this may have some evidential support, it diminishes those in prison as a damaged ‘them’ and obscures the extent to which being in prison itself is a health risk and a mortality risk.

Importantly, this risk to health and wellbeing extend beyond the person in custody.  Drawing on large-scale US survey data, Wakefield and Wildeman found that the prison has become an institution which creates and reinforces deep social inequalities, increasing the risks of poor mental health, homelessness and infant mortality for children of an incarcerated parent[5].  While imprisonment rates in Scotland are not comparable with America’s “prison boom”, it is nonetheless clear that supporting a person in custody requires large investments of time, emotional support and financial resources from some of Scotland’s poorest families and communities.  Positioning families as a source of support to render prisons more “survivable” is therefore at odds with adopting a prevention focus or reducing wider health inequalities.

Health inequalities, therefore, cannot be addressed effectively until the harms of prison are addressed, and this includes taking into account Scotland’s high imprisonment rates in policy making and reform. This point also emphasises why we should never talk about prison as ‘being the best chance’ to deliver any public service. If the prison system operated adopted a Hippocratic oath, we would have strong doubts that it is achieving this.

[1] E.g. Michael Matheson: ‘However, factors outside of the control of the criminal justice system affect reoffending. The work of this group has found that reoffending is a complex social issue and there are well established links between persistent offending, poverty, homelessness, addiction and mental illness. When transitioning from custody to the community, gaps in access to vital support services and basic needs can hamper attempts to desist from offending’ http://www.nphn.scot.nhs.uk/wp-content/uploads/sites/9/2015/11/Ministerial-Group-on-OffenderReintegrationReport-2015.pdf

[2] National Clinical Strategy for Scotland, February 2016:2 http://www.nphn.scot.nhs.uk/wp-content/uploads/sites/9/2016/03/A-National-Clinical-Strategy-for-Scotland.pdf

[3] Meijers J, Harte JM, Jonker FA and Meynen G (2015). Prison brain? Executive dysfunction in prisoners. Front. Psychol. 6:43. doi: 10.3389/fpsyg.2015.00043

[4]Justice Committee, Transfer of prison healthcare to the NHS Written, submission from Dr Lesley Graham: http://www.parliament.scot/S4_JusticeCommittee/Inquiries/Dr_Lesley_Graham.pdf

[5] Wakefield, S. and Wildeman, C. 2014 Children of the prison boom: Mass incarceration and the future of American inequality. New York, NY: Oxford University Press