Written evidence from Dr Gillian Buck

1.      I am currently Co-Investigator for a UK Research and Innovation project examining Prison Regulation, for Safer Societies. I also co-direct the Prisons, Health and Societies research group. I have published a book about peer-to-peer work in criminal justice and multiple peer reviewed journal articles. My research has been funded by UK Research and Innovation, the Economic and Social Research Council, the University of Chester and the Cheshire and Merseyside Social Work Teaching Partnership.

2.      This submission is based upon my ongoing research with former prisoner peer support workers. Prisoner suicide rates consistently exceed those in the general population. Prisoners deliver suicide prevention initiatives in a range of organisational forms across England, e.g., Samaritans Listeners are serving prisoners who volunteer to offer confidential support 24 hours-a-day to fellow prisoners as part of the national prison suicide prevention strategy (NICE guidelines, 2018; HMPPS Chief Executive, 2011). Our innovative research approach, coproduced by academics and people with lived experience of imprisonment, involved reflective focus groups and highlighted limitations and potentials of peer-delivered suicide prevention.

3.      My evidence is relevant to the committee’s focus on the appropriateness of prison for those with mental health needs; support available to those with mental health needs; and the quality and availability of mental health support in prison compared to that in the community. Our research highlights high levels of mental health need and suicidality, inconsistencies in in-prison support for those working to meet these needs, gaps in mental health provision for prisoners, and the potential for secondary trauma given imprisoned volunteers do not have access to the respite and resources of community volunteers.

4.      Between 2020 and 2021, we held reflective focus groups with a small group of former prisoner peer supporters. Reflections highlighted the riskiness of peer support in prison; inconsistencies in support for volunteers and the value of peer support. These are summarised briefly below.

5.      The riskiness of peer support – Peer support is central to the suicide prevention strategy in prisons, yet there are unique risks of being a peer supporter within prison settings that are not present for community volunteers. These include sometimes fraught relationships between prisoners and prison officers. For example, officers may not support volunteers when they witness self-harm or suicide attempts. Peer supporters can also be targets of bullying from other prisoners or pressure to pass drugs, mobile phones or information. It was unclear how prisons and/or charitable providers are protecting volunteers from these risks.

6.      One former prison Listener highlighted clear potential for secondary trauma[1] given high levels of need and a lack of institutional support: “Someone wants to see me in her room… she has cut both her wrists. I shout the officers…no-one comes for a couple of minutes…When the officers arrive, they grab me and fling me against the wall while they attend to her…I am left covered in blood, hoping she is OK. An officer returns and I’m escorted to my dorm… I am locked in for 3 hours along with the rest of the wing for security purposes. That was it, no: ‘do you need to speak to anyone? do you want a quick shower?’ Not even the smallest aftercare. I’m left thinking ‘maybe it was my fault, I didn’t say the right thing? or ask the right questions? or maybe I shouldn’t have gone to her room when asked in the first place?’ These questions will remain unanswered in my head” (former prison Listener).

7.      Working conditions and support – Group members detailed extreme levels of mental ill health and distress that they were called to as volunteers, including people experiencing psychosis, who had seriously harmed themselves or attempted suicide. These are challenging situations for trained, experienced, and well supported professionals, but peer supporters can sometimes enter them with insufficient training and limited support from a prison officer whilst being escorted back to their own prison cell. Some spoke about being woken in the night to sit with people in distress for hours and still being expected to work the next day. The lack of in-prison management support for volunteers left some feeling undervalued and vulnerable in an already emotionally heightened environment.

8.      One former peer supporter recalled feeling ill-equipped for the level of need and shocked at the lack of a formalised mental health response: “Sometimes people were having severe psychotic episodes, I got called down to the Seg [Segregation block] and a woman was in a very, very, VERY bad way….taking her clothes off, becoming naked, screaming, shouting… I just always remember thinking, what THE HELL do I do? This was a really severe thing”.

Another outlined the lack of human resource management which left volunteers subject to excessive working hours, despite listening to suicidal thoughts throughout the night: “[Officers] would come and get you out of your cell at any time, 3, 4am, but after that, they expected you still to go to work at 7.30-8am…I had to go work or they wouldn’t pay me”.

9. The value of peer support – we do not wish to see an end to peer support in prison, indeed our former prisoner colleagues were anxious to avoid this outcome, seeing peer support as highly valuable to prisoners who need someone to talk to. There is a clear role for Listeners and befrienders, but these volunteers cannot be a frontline mental health service. We advocate for more specialised mental health support for very unwell prisoners and more robust forms of training, support, and quality assurance (coproduced with those who have lived experience of the realities of prison) to strengthen vital peer to peer services.

10.  One former Listener argued that peer support can be a useful addition to professional intervention, but is no substitute for specialist mental health provision and support is needed for the supporters: “[The prisoners] just needed someone to talk to, and to show a bit of empathy… It is really needed…We want to support; however, we are unaware and ill-equipped of how to unpick and reconcile someone’s mind. People study academically for years to ensure they are ready to do work such as this, with mandatory concentration on self-care, something that seems missing in the peer-support incarceration arena”.

11.  Prisoner peer supporters are ideally placed to identify the scale of the mental health crisis in prisons and the need for more suitable, comprehensive and specialist mental health services and facilities. We advocate that (former) prisoners are facilitated to get involved with prison mental health strategy at local and national levels. (Former) peer supporters can catalogue the aggregate nature of prisoner call outs (e.g., sadness/ anxiety/ self-harm/ severe mental health episode), offering anonymised insight into the needs of prisoners. Regular meetings between service providers and volunteers (e.g., quarterly safeguarding reviews) could add anonymised context and facilitate the coproduction of safeguarding action plans for individual prisons.

12.  Peer support volunteers are not trained to respond to people with severe mental illness, yet many prisoners had mental health needs and there is limited mental health treatment/ service provision in prisons:

“We used to have to hand over to another Listener and tell them he’s highly likely to hurt himself. I wrote it up like this, but no-one checked on him. By the time the Listener got there they had to press the bell and say he is dead…There is no due care and attention or follow-up that could have prevented that from happening…it has just become normal. Seeing someone with mental health problems in prison is normal now (male ex-Listener).

Many thanks for your consideration. I am happy to expand if useful.

May 2021

References

Bober, T., and Regehr, C. (2006). Strategies for reducing secondary or vicarious trauma: Do they work? Brief treatment and crisis intervention, 6(1), 1.

Buck, G. (2020). Peer Mentoring in Criminal Justice. London: Routledge.

Evces, M. R. (2015). What is Vicarious Trauma. In Quitangon G., Evces M. R. (Eds.), Vicarious trauma and disaster mental health: Understanding risks and promoting resilience. London: Routledge. pp.9-23.