Outsiders inside

The prison system is creaking under the unmet needs of thousands of disabled prisoners. Katharine Quarmby investigates

Suicide, self-harm, victimisation and despair: this is the picture that many disabled people paint of their time inside Britain’s creaking prison system.

Despite the fact that the Prime Minister’s Strategy Unit reported in 2003 that there was “no convincing evidence that further increases in the use of custody would significantly reduce crime” and that almost two-thirds of all those incarcerated re-offend, the numbers of those imprisoned continue to increase.

England and Wales has the highest imprisonment rate in Western Europe and the numbers of women being imprisoned, two-thirds of whom are mothers, has nearly doubled over the last decade – as has the number of older people imprisoned. And many women and older people in jail have impairments.

Prisons are designed for young, fit, non-disabled men, the chief inspector of prisons, Anne Owers, told Disability Now in an interview in October. But it is now thought that perhaps more than half of those incarcerated have impairments, when older prisoners with impairments, those with physical impairments and those with both diagnosed and undiagnosed learning difficulties and mental health conditions, including many war veterans, are included.

And, as the system works at the moment, their needs are not being met.

Last year, in her annual report, Owers drew attention to the problems that many disabled prisoners face and described the diversity strategy on disability as “underdeveloped”.

She continued: “The response to the needs of prisoners with disabilities remains reactive, rather than proactive…there is little monitoring of regimes to ensure equal access for prisoners with disabilities; reasonable adjustments, or thoughtful adaptations, are rarely in place.”

Ower’s survey of disabled prisoners (in her annual report) who self-identified as such reported a much more negative experience of imprisonment than non-disabled prisoners.

They had more problems than any other group when arriving at prison and were more likely to have been victimised, both by staff and prisoners. They were less likely to have been involved in activities and reported less help on release. Older prisoners, too, many of whom have age-related impairments, also had very negative experiences. Owers reported poor links between health and social care, with local authorities and the prison service disputing who should pay for essential equipment for disabled inmates.

A study in 2003, by the University of Oxford, found that 80 per cent of sentenced older prisoners had an impairment or chronic illness. And the numbers of older prisoners are soaring – up 55 per cent between 1995 and 2000. More than half have depression or other mental health conditions.

In a report published earlier this year, Anne Owers documented the kinds of problems that many older prisoners face. She said that though the situation had improved, far too many had basic unmet support needs. Almost half said they had been bullied or intimidated by staff or inmates. And adaptations that were made were often clumsy – Owers said that at one prison, a cell had been adapted for a prisoner with a physical impairment, but the doorway was too narrow for a wheelchair.

Many older and disabled prisoners ended up on the healthcare wing because of a lack of accessible cells. She found that some staff would not push wheelchairs because they “had not been trained”.

A number of studies have identified that neither prison officers nor prison nurses saw it as their role to carry out daily personal assistance for disabled and older prisoners, meaning that they were not always able to visit the toilet or wash regularly.

Some prisons had made adjustments but the national picture was patchy and confused.

In 2007, Anne Owers published a review of mental health in prisons, five years after the arrival of prison-based mental health teams. Although much progress had been made, the report identified deficiencies in mental health screening on reception for all prisoners, particularly those with learning difficulties.

She concluded: “Prison has become the default setting for those with a wide range of mental and emotional disorders, and unless gaps in community provision are filled, prisoners will continue to fall through them and into our overcrowded, increasingly pressurised prisons.”

Women in prison were particularly likely to have mental health problems. A report by the University of Oxford in 2006 found that women in custody were five times more likely to have mental health “concerns” than women in the general population.

Baroness Corston was commissioned to look at the state of women’s provision in prison after the deaths of six women at Styal prison. The Corston report, published in 2007, recommended that women should be housed in smaller units that took account of their needs, in particular their mental health. She could see no point in locking up women who posed no danger to the public and called for the closure of women’s prisons over ten years.

Corston went on to recommend that all courts should have access to schemes that divert women with mental health problems away from prison, but these are not yet available everywhere. The University of Oxford report went further, stating that many women committed “offences directly linked to mental health problems”. Diversion from prison for women with mental health impairments would bring down numbers dramatically.

The government accepts that work should begin to promote community sentences instead of prison for women – but, for the moment, the problem remains.

Women in prison self-harm in record numbers – nearly one in three self-harm, compared to just six per cent of men in prison. A number also kill themselves. Last year, the numbers of women who killed themselves more than doubled, after falling for a number of years.

Anne Owers found that rates of self-harm were far lower in small units – and one open prison inspected had recorded no incidents of self-harm. Owers concluded: “The specific needs of women, some of them extremely vulnerable, cannot easily be met within the current configuration of the prison system.”

She also found that 93 per cent of all disabled women inmates reported having problems on arrival, far higher than non-disabled women, and many more felt unsafe and had been intimidated by staff and other prisoners, and were half as likely to feel that healthcare was good.

Women with physical impairments were particularly badly treated. (Nearly four-fifths of women interviewed in the University of Oxford study said that they had a disability or long-term illness.) Many found that their mobility difficulties meant that they were unable to participate in activites. Their basic physical needs were not treated with respect.

One said: “I can’t bathe myself, I can’t go in the shower. I feel degraded.” Another disabled women, who had fallen out of bed, was left on the floor as the nurse said that
she couldn’t move her. Another prisoner said: “She was lying in her own urine. You wouldn’t treat an animal like that.”

Penny Bennett, from the user-led women’s mental health charity Wish, said that such experiences were common among the disabled women who the charity visited in prison and that even basic adjustments, such as a non-slip shower mat in an adapted shower, took months to arrange. Many also reported difficulties when they wanted to leave prison, as accessible transport was not routinely arranged.

Prisoners with learning difficulties are very disadvantaged in prison.

The Prison Reform Trust (PRT) has just concluded a comprehensive three-year research project about such prisoners, No One Knows. (The work was guided by people with learning difficulties, some of whom had been in prison.) The PRT estimates that between 20 and 30 per cent of all offenders have learning difficulties or “disabilities” (such as dyslexia, communication impairments and autism).

Jenny Talbot, the author of the report, has identified three major problems. Prisoners are at risk of reoffending because of their unidentified needs. They are unable to access most offender behaviour programmes, as they are not designed for prisoners with learning difficulties and they can therefore not complete their sentence plans and be released (the parliamentary joint committee on human rights believes that this may contravene the Disability Discrimination Act). And they are more likely to be victimised than other prisoners (see Breaking News, pages 8-9, for more details about the report).

Many reported not being able to read menu sheets, or use the phone, or fill in visiting forms. One interviewee said: “I don’t know how to use the phone; it’s that PIN thing, isn’t it?” Another said: “I was always getting slagged off by other inmates about my hearing and my speech.”

Anne Owers told Disability Now that disabled prisoners “get overlooked” and concluded that the prison service has a “patchy and inconsistent” record towards disabled offenders – a conclusion borne out by Disability Now research.

A Ministry of Justice spokeswoman said: “The National Offender Management Service (NOMS) is committed to addressing the issues raised in the Prison Reform Trust report and is developing a programme of work to address the issues. The work programme will form part of the NOMS Single Equality Scheme, due to be published in March 2009. NOMS will work closely with the PRT in developing the work programme. There are a wide range of identifiable issues in this area and to comprehensively tackle the issues associated with mental health, learning disabilities and appropriate accommodation, for example, requires a cooperative approach from a number of stakeholders, an approach that NOMS is firmly committed to.”

A spokeswoman from the Equality and Human Rights Commission (EHRC), commenting on the case on page 26 and on the general issues, said: “The Commission intervened in this case because we believe there is a need to tackle the systemic institutional problems that disabled prisoners experience in the prison system.” She added that the EHRC would “monitor the Ministry of Justice and prison system to help prevent similar issues arising in the future”.

Access needs ignored in prison

Lawyers acting for disabled prisoners believe that the prison service often fails to make reasonable adjustments for disabled prisoners – and is, therefore, in breach of the Disability Discrimination Act (DDA).

Sean Humber, a partner at Leigh Day and Co, told Disability Now: “All too often, the prison service seems not to want to properly assess a prisoner's needs for fear of then being required to address them. However, even when a prisoner's disability needs are properly identified, they are then often unmet."

Humber brought a ground-breaking case this year, challenging the Prison Service's treatment of an inmate, Mr X, under the DDA.

Mr X is a wheelchair-user with a visual impairment. When he entered prison in 2006, staff told him that he was not allowed to use his motorised wheelchair because the battery would pose a security risk. He has also been accommodated in the healthcare wing, or in cells that have not been adapted, and has had problems using the toilet and sink.

After three court hearings, the Prison Service has agreed to allocate Mr X an adapted cell and provide him with a motorised wheelchair.

Lawyers argued successfully in another case that the prison service had breached the DDA.

The Secretary of State and parole board agreed that a prisoner serving a life sentence should be transferred to an open prison to enable him to adapt to life after release. But the only open prison providing the course required by the parole board refused to accept him because staff were not prepared for him to administer his own drugs or dispense them when the healthcare centre was closed.

Sunil Peck

Jenny’s story

I started self-harming when I was in junior school, because I was bullied. I used to scrape my knee across the floor till it bled and I could go home. I got bullied even worse when I was in high school and carried on self-harming. I used to punch the wall and break my knuckles. I’ve lost three of them.

When I went to prison the first time, I was so ill I don’t remember much about it. I carried on self-harming, cutting myself with a comb. I was also in a wheelchair. The first time I came out, the prison did get me a taxi to the train but they wouldn’t get me a taxi home the other end. I had to wheel myself home and I had blisters on my hands because it was a long way and I had to carry my prison bag as well.

I went back inside again in 2005 and I got to see a psychiatrist two months later and got medication. I carried on self-harming and I tried to hang myself twice. The staff were quite sympathetic, but they didn’t seem to know about the mental health side of things. I felt forgotten about.

There were other disabled women in prison and some, who self-harmed, were bullied. A woman with learning difficulties was bullied because she didn’t stick up for herself. But quite a lot of the prisoners were good to me – they would push me if it was hard going in my wheelchair.

• Jenny was talking to Katharine Quarmby (with thanks to Wish)