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Coping in the chaos: Pentonville’s neurodiverse unit is changing prison life

A radical and caring prison experiment has changed both prisoners and wardens. Nick Jones visited London's oldest prison.

Nick is the senior editor of Seen & Unseen.

An arched gateway to a prison sits behind a low raised wall. No windows are visible
First opened in 1842, Pentonville Prison serves a large part of central and east London.
Ben Sutherland via Wikimedia Commons

A London prison has seen a reduction in violence among prisoners and improved staff morale thanks to a new neurodiverse unit.  Pentonville prison’s new unit identifies and treats prisoners with autism, brain-injury, learning difficulties and even dementia. 

Jo Davies, Pentonville’s managing chaplain, helped set up the programme after conducting many regular prisoner reviews with colleagues. She noted that there was an apparent higher incidence of autism among prisoners than the general population. 

Prison is a challenging environment for those with autism. Routines are imposed, vulnerabilities are exploited by others. Frustrations can boil over into violent and self-destructive behaviours. Non-verbal behaviour also makes each interaction with other prisoners and staff a potential flashpoint leading to protesting behaviours or withdrawal.  All against a backdrop of a harsh white noise. Metal doors slam, Conversations and challenges are shouted, all constantly echo through the four open floors of each wing of the prison.  

Other neurodiverse conditions are present in prisons. An ageing prison population even has prisoners suffering from early onset dementia. Some forget the circumstances of their imprisonment.  

Teaming up with prison officers and support staff like psychologists, doctors and teachers, chaplain Davies notes that “now staff make it their business to work out how to work with these prisoners”. The unit has capacity for 45 prisoners in single cells. They share a common area for eating and other activities. Staff spend 10 weeks assessing the prisoners who can then benefit from up to 12 weeks of additional support. 

Ruth Hipwell, who leads the new unit, says: “it’s good to have a place in prison for those people who can’t cope.” Support ranges from little things like teaching a prisoner how to make a cup of tea or providing earplugs to reduce noise, to helping prisoners make better plans for coping and learning – both in prison and outside. 

On the wall of the unit is a timetable of events, illustrated by pictograms. Sessions include how to handle familiar tasks in the unfamiliar environment of prison: how to buy things or use the telephone, getting clean clothes and even how to handle being unwell.  Other sessions include accessing learning and getting a job.  

Robbie*, a prisoner in the unit says:

“It relaxes you. It’s wicked. The difference is the support.” 

The unit started work in October 2022 and the difference it made was spotted fast. It transformed staff, recalls Hipwell. “They have found their purpose. We have a level of multi-agency integration others can’t match.” 

Ian Blakeman, Pentonville prison’s governor, identifies additional benefits. “It frees up staff time and staff export skills to other parts of the prison.” These positive effects also help him keep good staff. A major challenge in London’s competitive labour market.  Other programmes reinforce this change in culture across the prison range from addiction treatment to rebuilding family relationships affected by gang affiliations.  

Pentonville now has the lowest self-harm rates in the country and is the least violent prison of its type in the UK. 

With prisons a low political priority, it’s even more remarkable to learn that Pentonville’s neurodiverse unit required no additional budget. Its win-win results are a flicker of hope in a bleak landscape. Times columnist Matthew Parris recently wrote: 

“Every generation looks back and spots an outrage. Today, when we think of slavery, child labour and lunatic asylums, we wonder how our ancestors could have been so cruel. What will horrify our own successors is our disgraceful prison system.” 

In response to Parris’s column, Jonathan Aitken, a former prisoner and now a chaplain at Pentonville who works with the neurodiverse unit, wrote to the Times.   

“The real disgrace lies not inside our prisons but in the failure of both public and private rehabilitation efforts to help prisoners into jobs, housing and law-abiding lives after their release. The good work done by prison officers, managers and governors is underreported… We are on a roll of improvements… But such advances are like clapping with one hand if they are not met by comparable efforts to rebuild the lives of prisoners after they walk out of the gate. Correcting the failures in this area should be a high priority for our politicians and for our society.” 

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Who holds the vital ingredient as healthcare shifts from hospital to community?

The trusted anchor institutions that can provide pastoral care and more.

Esther works as a Senior Consultant for the Good Faith Partnership. She sits in the secretariat for the ChurchWorks Commission.

A social prescribing project in full swing.
A social prescribing project in full swing.
Theos.

On 11 November, the Good Faith Partnership, the National Academy of Social Prescribing (NASP) and the Bishop of London convened a roundtable discussion in the House of Lords to call for a collaborative relationship between faith groups and NHS social prescribing providers. 

Faith leaders from the major religions in the UK gathered alongside senior officials such as from the Department for Health and Social Care, NHS England and arm’s length bodies.  

‘There are lots of exciting opportunities with a new government in place,’ said Charlotte Osborn-Forde, CEO of NASP, adding that as part of her desire to see social prescribing available in NHS services beyond GP surgeries ‘there are huge and untapped assets in communities.’  

Marianne Rozario from Theos, the lead researcher on a groundbreaking new report on faith and social prescribing, elaborated, saying that faith groups are trusted anchor institutions in local communities that are well networked, offer resources in the form of buildings and volunteers, and have expertise in pastoral and spiritual care.  

Mark Joannides, Deputy Director for Community Health in the Department of Health and Social Care, added that: ‘Faith groups are going to have to be part of this,’ when referring to the government’s health mission and the three big shifts from hospital to community, analogue to digital, and sickness to prevention.  

The conversation focused on how this integration could take place, particularly through securing shared investment funds for faith groups, co-locating healthcare services into faith buildings, and integrating faith groups into the NHS 10-year healthcare plan. 

A range of ideas were shared by those present including the importance of investing in faith groups to provide palliative care, focusing on reducing health inequalities, and investing in local infrastructure.  

On 30 January, Good Faith Partnership and Theos will publish the first ever report into the role of faith communities in the social prescribing system. This timely report collates research into the role of faith groups in social prescribing and aims to facilitate further discussion on how collaboration between faith groups and the NHS can support the needs of the most vulnerable in our society. Alongside the report, two ‘How To’ guides will be published, providing faith leaders and social prescribing link workers with a step-by-step process for building relationships with one another.  

To hear more about the research recommendations, explore next steps and to access the practical ‘how-to’ guides register for a free hour-long webinar on 30 January using this link: 

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