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Change
Freedom
Mental Health
3 min read

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.” 

Article
Change
Mental Health
1 min read

Removing pain’s barriers to healing

How do we open the window to let the air in?
A window sheds light through locked bars into a dusty and dark room,
Denny Müller on Unsplash.

One of the trickiest situations you can encounter if you’re a counsellor is having a client you can’t reach. They sit there in front of you, pain in their eyes, but somehow every approach you make meets with resistance. It’s like trying to touch someone through a closed window – you can see them, but you keep bumping into the glass. 

I have two at the moment. One is Cypriot; I’ll call her Androulla, and she scares me rather as she is a doctor and never smiles and knows everything. ‘Yes, I have tried that,’ she says. ‘Yes, I am familiar with that book/ line of thinking/ philosophical method – it hasn’t worked for me.’ 

And I know that we’ve found the poisonous plant in the heart of her heart and pulled it up by the roots. I am as sure as I can be that she will get better now.

Yet she is dreadfully sad. Her mother died out in Cyprus, and she couldn’t get there in time. Her grief is eating her. She glares at me, desperate to be helped but bristling with gun turrets. Hmm. 

Eventually I remember something Jane Goodall said. Jane Goodall is one of the world’s wonderful people… her work with chimpanzees back in the 60s dramatically changed our relationship with animals, and she still travels the world at the age of nearly 90 encouraging young people to take action on climate change. In her lovely Book of Hope she describes how when she’s completely knackered or stuck with something, she sort of hands herself over to an outside power. ‘I just relax and decide to appeal to the source of hidden strength,’ she writes. ‘There’s a wisdom that’s far, far, far greater than my own.’ When she surrenders in this way, she often gives her best lectures she says.  

I think I might give it a try with Androulla. As a gradually-learning-to-be-more-trusting Christian, it seems most appropriate to follow in the footsteps of St Francis. So just before our next session I shut my eyes and say, ‘Help Lord, I don’t know what to say to her. Please take over and use me as a channel – she could really do with your peace and grace, and I seem to be in the way’. I’m quite a controlling person normally so I feel a bit reluctant… but if it works for Jane Goodall and for St Francis, I’m not going to argue! 

To my surprise, I find myself asking Androulla what her understanding of the word ‘mercy’ might be – not a very usual counselling question. Even more surprising, her eyes fill with tears and suddenly she says that the last time she saw her mother, she told her she hated her, and had a physical fight with her and hurt the skin on her old arms. Crying properly now, the poor woman says she doesn’t deserve forgiveness after that, and I find myself telling her how mercy sees everything with utter clarity and loves and accepts it whatever is deserved or not deserved. And I know that we’ve found the poisonous plant in the heart of her heart and pulled it up by the roots. I am as sure as I can be that she will get better now. 

Something compassionate has breathed on these locks, and the stuck windows have suddenly yielded and opened to let the air in. 

Then today the same thing happens again – with Bella, my other client who cannot forgive herself, in this case for the fact that her violent alcoholic husband drank even more after she finally left him and died of organ failure in a homeless shelter. We’ve gone over and over her guilt for weeks, and she has remained shiny and brittle and artificially bright and fine. We’ve got nowhere. Until now. ‘Dear Lord,’ I say before I ring her, ‘help me find a way through to her. Let me remove myself and all my assumptions, so that your healing can flow through to her and give her some rest.’ I do my best to relax into our conversation, just to let what wants to come, come. And out of nowhere, I am suddenly inspired to ask her whether she’d feel guilty if her husband had died of some terrible illness like cancer. 

‘No,’ she says. 

‘Well… you’re a medical secretary. You’ll know better than me that alcoholism is an illness,’ I say. 

There’s a very long silence. 

‘Doesn’t that mean you’ve both been suffering from this terrible illness?’ I ask eventually. ‘Dave because it drove him crazy and then killed him; you because it blighted your life, and is blighting it still? Isn’t it time you said, “No, enough!” to this pestilence?’ 

I can see it in my mind’s eye, the alcoholism, like a swarm of red locusts or a scarlet dragon, devouring both Bella and Dave. I don’t feel that’s an image I came up with, it’s just there in my mind. I can feel this lodging in Bella’s mind too… a whole new way of thinking, a great big shift in emphasis, a transfer of responsibility from her to the monster. 

I don’t know whether the idea is fully rooted yet, whether we can rely on it to grow and flourish and bear good fruit. But I sense that it is at least planted and watered. A bit more sunshine, some careful tending… and probably a lot more trusting would seem to be the way forward. 

It’s not in the training manual, this technique. You won’t hear the British Association of Counselling and Psychotherapy recommending that therapists hand themselves over to Jane Goodall’s ‘outside power’. But something compassionate has breathed on these locks, and the stuck windows have suddenly yielded and opened to let the air in.