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.”

Review

Books

Culture

29 April 2024

6 min read

Are we being anxious about anxiety?

Haidt's diagnosis of a 'doomed' youth is off. Instead, we should learn from them.

Henna Cundill

Henna is a researcher with the Centre for Autism and Theology at the University of Aberdeen.

A child sits atop a bunk bed holding a phone in front.

It’s common these days to hear about social anxiety, health anxiety, or climate anxiety – but I think I can see that a new pathology is beginning to emerge: anxiety anxiety. This is where parents, politicians, academics, or just members of society in general, start to get anxious about the fact that everybody is anxious. Diagnosis rates of clinical anxiety have shown a steep increase in the past decade, and numbers, we assume, don’t lie.

Of the many outcomes of ‘anxiety anxiety’, one is going to be people who (with the absolute best intentions) want to suggest solutions. One such person is Jonathan Haidt, with his book The Anxious Generation: How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness.

From the spaceman on the cover to the opening vignette about sending our children to Mars, Haidt’s premise is clear: smartphones are the alien invaders of our society. These electronic parasites are feasting on the brain matter of our young people, directly causing what is now an epidemic of clinical anxiety and depression.

I’m quite ready to read a sensible analysis of the impact of smartphone culture on mental health, so I was disappointed to find that Haidt’s book falls so far short of that. From a scientific perspective, the argument is a barrage of statistics, arranged to the tune of ‘correlation equals causation’. Given Haidt’s seniority in his field, this approach is surprisingly unsubtle, something which has already been heavily criticised by peer review. Numbers, it seems, do lie – or at least they can be easily curated to prove your point.

But even if we accept Haidt’s point – which is that rates of smart-phone use (particularly social media) and rates of young people being diagnosed with anxiety disorders have increased over the same time period – what can be done? Haidt’s solution is to ban young people from owning smartphones at all until the age of 14, and from using social media until the age of 16, or even better 18. In this way, owning and managing one’s own device and its access becomes a rite of passage into adulthood. But note: whilst parents are urged to implement these unyielding boundaries for their children’s device-habits, Haidt does not ask grown-ups to make any changes to their own. Adults can continue with their current norms of smartphone use, ostensibly because their brains are fully developed, and they therefore have the maturity to handle their own risk to mental health.

Smartphones are not aliens – they were designed by humans, and are willingly bought by humans, in response to the human need to communicate.

Of course, it does not suit Haidt’s argument to analyse why adult mental health is also seeing an increase in diagnosis of anxiety disorders. It may be true to say that rates are rising more quickly amongst young people, but there is still no consensus as to how much of that can be attributed to young people simply being better informed about mental health and more empowered to seek help than the generations before them. Noticeably, young people today have a language to talk about anxiety that simply didn’t exist when I was a teenager in the 1990s, and ironically enough, it is social media that has made that possible. Although suicide rates are on the rise, they are still quite significantly lower among young people than they are for those aged over 35, and it should be noted that a proven pathway to suicide prevention amongst young people is access to self-help via smartphone apps.

So whilst I am quite ready to believe that smartphone culture is one of many factors impacting the health and wellbeing of young people today, I think characterising smartphones as alien invaders, or as invasive parasites that have been selectively bred by Silicon Valley billionaires to infest the minds of our young people, seems to be a disingenuous response – and one that only serves to increase parental anxiety by implying that smartphones are sly, sentient beings, and out of our control.

Smartphones are not aliens – they were designed by humans, and are willingly bought by humans, in response to the human need to communicate and a perfectly natural human desire to seek out entertainment and culture. True, technology and software are developed by billionaires, and marketing and algorithms can influence our choices – but at the end of the day, any developer will tell you that products only ever evolve in response to what the market demands. Adults: we have the money in our pockets; we are the market.

As a more empathetic and intelligent generation, it seems they could probably teach us a few things about how to harness smartphone culture.

In other words, we (the adults) selectively bred these ‘aliens’ ourselves – and rather than try (and no doubt fail) to lock up our experiment in a lab (or, as Haidt suggests, a lockable phone-pouch) we, the adults, have more than enough agency to continue that process of developing smartphones into devices that meet needs and provide entertainment in the way that they were always meant to do. In his defence, Haidt does refer to this approach briefly, but still only with a view to making the phones be for ‘us’ (the adults) and not ‘them’ (the young people) by removing content that appeals to a younger audience. To me feels like we are victim shaming the youth of today for the fact that they have inherited a problem created by their parents.

One day when Jesus was teaching a crowd of followers, he advised them “Why do you look at the speck of sawdust in your brother’s eye and pay no attention to the plank in your own eye? How can you say to your brother, ‘Let me take the speck out of your eye,’ when all the time there is a plank in your own?” His point was about hypocrisy – it is far easier to judge someone else’s behaviour than it is to take responsibility for our own. Where did any of us last read or hear terrifying information about the decline in young people’s mental health? Was it on our smartphones?

Here are a few things that Haidt’s selection of statistics doesn’t say about the youth of today. They are the most compassionate and empathetic generation that we have seen for decades (Konrath et. al., 2023). They are able to wait longer for rewards than their parent’s generation (Protzko, 2020), they are also less lazy, less narcissistic, more cooperative and more intelligent (Kriegel, 2016). In addition, whilst obvious damage is done by ‘filters’ on Instagram photos, making some young people strive for unattainable standards of beauty, it was the previous generation of smartphone users who began this trend, and it is the current generation of young people who can be credited with the #nofilter #nomakeup countertrends. This same generation is now fuelling the rise of insurgent social media sites such as Bereal, which emphasise the importance of authentic photos and meaningful connection with friends online.

Overall, perhaps instead of restricting and controlling our young people’s online lives, as Haidt would have us do, we ought to be talking to them? As a more empathetic and intelligent generation, it seems they could probably teach us a few things about how to harness smartphone culture and develop it towards solutions to the problems that we ourselves created.