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 Jones

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.”

Article

Change

Psychology

27 August 2024

5 min read

Recovery came softly

A vision of grace amid an eating disorder.

From Mockingbird

Mockingbird connects the Christian faith with the realities of everyday life.

Under a tree, backlit by a sun set, two people sit in chairs outside and talk.

Harli Marten on Unsplash.

This article, by Lindsay Holifield, first appeared in Mockingbird. Published by kind permission.

I turned sixteen years old in a lavender-walled bedroom on the eating disorder unit at Texas Children’s Hospital. Surrounded by eagle-eyed nurses watching my every move and whirring machines keeping me alive, I quietly transitioned to Sweet Sixteen. The unit’s charge nurse was a gruff woman named Lupe, and despite her job, she did not particularly like children. But it was my birthday, and in an uncharacteristic act of kindness, Lupe offered me a slice of cake. She must have briefly forgotten her surroundings, because I was not a normal teenager. I was a patient on a pediatric eating disorder unit, and I broke down sobbing at the mere thought of such a high-calorie food entering my body.

This was my first birthday in a clinical treatment facility for anorexia, but it would not be the last. After receiving the initial diagnosis of anorexia nervosa as a teenager, the doctor’s pronouncement sounding like a death-knell at the time, I would admit to twenty treatment facilities on separate occasions across a period of fourteen years.

The treatment staff began to greet me knowingly when I would re-admit after only a few months out, as though I was an old friend returning from vacation. “Welcome back, Lindsay,” they would say, as they took my luggage and inserted yet another nasogastric feeding tube. Over time, I began to be labeled “chronic,” and I internalized a belief that I was one of the sufferers who was fated to live the rest of my life under the oppressive weight of this struggle.

I would have to try harder. I would have to pull myself up by my bootstraps and willpower my way into recovery. After each attempt under this approach, I would fall flat on my face.

It seemed that no matter how much motivation I mustered up, this internal drive to self-destruct would not leave me alone. I desperately wanted to wake up each day without having to submit afresh to the hellish existence of self-starvation and running till my lungs felt on the verge of collapse. But I felt chained to this destructive cycle deep into my bones, despite my best intentions.

I was often berated by various treatment providers for not having enough motivation. I didn’t necessarily want to die, but I could not find the strength within me to fight off the voice in my brain that demanded self-destruction. Doctors and mental health clinicians made it clear that if I really wanted to get better, I would have to try harder. I would have to pull myself up by my bootstraps and willpower my way into recovery. After each attempt under this approach, I would fall flat on my face. The despair of my situation began to swallow me whole: there was no way out, because I could not yell at myself enough to make myself well.

Because of the lavish softness I was shown, I began to approach myself with greater softness.

I was twenty-six years old, and I was sitting in a green folding chair in the summer on a farm in Nashville, Tennessee. The woman in the folding chair across from me is decidedly in support of my recovery, but she isn’t yelling at me or giving me a stern lecture. Instead, she is explaining with great care and tenderness how much sense my struggles make in light of my previous life experiences. “Perhaps,” she says gently, “your brain was trying to survive great pain. Perhaps you were simply trying to make the ache go away the best way you knew how.” Her compassionate words break something open within me, and I start weep like a small child. No one has ever approached me with compassion like this; they are all afraid being too soft will simply enable me to further harm my body. But they are wrong. It is precisely this compassion and sense of being witnessed that softens my armored heart.

Recovery did not come overnight, but I can unhesitatingly say that the compassion of a woman on that farm in Nashville is what radically changed the trajectory of my life. Because of the lavish softness I was shown, I began to approach myself with greater softness. The voice of condemnation quieted, and I slowly turned from self-destruction to life.

Do you not hear the gospel ringing out here? My story of recovery is simply a zoomed in image of the grander story, the beautiful truth that makes up the fabric of our existence. Admitting powerlessness to destructive forces of sin and death is important, but the condemnation of the law will not save us. It is the extravagant, one-way grace of God that resurrects the dead.

I have heard similar fears in faith communities that I continually hear in my recovery communities: if we are too extravagant with compassion, we are enabling sin and destructive behaviors. But I am a living testament that compassion is what softens hearts of stone, armored up by self-protection and attempting to earn love through behavioral perfection. I would have died many times over save for the compassion that chased me down and embraced me, and being held in such tender kindness was the only thing that could have changed my fate. I believe this for mental health, yes, but more importantly, I believe this for the rescue of all of humanity. The grace of God is the sole agent of resurrection and change.

To the surprise of those who cling tightly to rigid, white-knuckling versions of recovery, my behavioral change occurred only after I was met with a grace without strings attached. This should not be surprising to Christians, however. Here again, the gospel glaring back at us, that repentance is a response to the kindness of God. This is the God who loved us while we were dead in our sins, while we were powerless to the forces of the world, the flesh, and the devil. Against our behavior-driven moral sensibilities, God offers us grace that is a free gift, compassion in its fullest expression, and it is the only thing that will bring renewal and healing to the inhabitants of this desperately aching world: minds, hearts, and bodies included.