Article
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
Creed
Mental Health
4 min read

Have our worries changed over time?

A pep talk to teachers reveals whether our fears are age-old or not.
In an egg box sit two eggs with faces drawn on them with marker pen. One looks worried, the other looks on.

‘You’re not going to mention the psalms!’ my colleague said. ‘Are you?’ 

She was doing alarmed eyes at me, the sort which show white all round. I could see why really. We were on our way to give a talk at a big secondary school in Birmingham – multi-cultural, multi-ethnic, multi-faith. The sort where praying had been banned as divisive, and the wearing of crosses discouraged. Hijabs too, for that matter. Not the kind of place where you chat lightly about a part of the Christian bible, on the whole, unless you’re trying to be provocative. 

I did mean to mention them though. ‘I can’t think of another example,’ I said. ‘And anyway, it’s too late now – I sent the slides through last night.’ Deep breaths. 

Just to explain a little, as counsellors, my colleague and I had set up a programme of talks and workshops for schools in the area, aimed at improving mental health in the aftermath of the pandemic. We’d seen all the warnings about the ‘tsunami of mental health issues’ threatening to deluge the country and decided to take action. Recognising that we couldn’t get to every individual child who might need help, we’d focused our efforts on the adults in the schools. Steady the grown-ups and you steady the children, was our thinking. The young take their wellbeing largely from the pattern set by their elders, even in this age of smart phones and social media, and the levels of despondency were very high among teachers and school staff in our experience. Lots of people burning out and leaving the profession. Not a steadying influence then. Hence our topic for today: ‘How to feel better in difficult times’. 

I was nervous as I stood in front of the large hall full of people. Several hundred of them, all ages and stages. Some looking attentive, many expressionless, a few sleepy. I could see my colleague at the end of a row near the front. She had one hand up to the side of her face and was making herself small. Great, I thought. Very reassuring. But too late now, so on we go… 

I introduced myself. I introduced my colleague. I introduced our work. And then I mentioned the thing that needed no introduction. It was already familiar, a regular inhabitant – present here in the room, but also everywhere else we went: our homes, our classrooms, our friends’ houses, the streets, the supermarkets. Fear. Horrid fear, drifting through the air like smoke. I gave them some awful statistics I’d found, about the rates of anxiety and depression. About the levels of self-harm, about the fact that suicide is now the second biggest killer of children between 10 and 15. I let these sink in a bit. 

Then I asked, ‘So what are we afraid of, exactly?’  

It is accepted practice in all mental health disciplines to try to identify the causes of fear and face squarely up to them as that’s the only real way to defuse their power, I said. I was going to read them a list of potential causes – and while I was doing so, I’d like them to try and guess where the list had come from. Call out your guesses please. 

‘Getting old,’ I started. ‘Drinking too much. Tyrants swooping on other people’s countries. Teaching our children to be better than we are…’ 

‘Twitter!’ someone called out. 

‘Cutting down the forests. Loss of friends. Waking up sweating in the night. Other people saying awful stuff about us…’ 

This Morning!’ came another voice. 

‘Feeling very alone. No sign of things getting better. Envying the rich. Death. Food being short…’ 

‘The news this lunch time!’ 

‘Plagues and pestilences. Being in despair. Cruel words. The evils of the class system. Not having work. Feeling low. Feeling weak…’ 

‘It’s got to be The Daily Mail,’ someone else shouted. Laughter. 

I looked up. ‘Good guesses,’ I said. ‘All of them, thank you. Only they’re a bit out of date. By about four millennia, give or take!’ 

Surprise fizzed through the room. 

I had wanted to find out what people used to worry about, I explained. To see how that differed from our current worries. I hadn’t known where to look though, until I suddenly remembered the psalms. ‘Some of you might be familiar with the psalms,’ I said, ‘but for those of you who aren’t, they are 150 ancient songs full of moaning.’ They varied in age, but the oldest were thought to have been written the best part of 4,000 years ago – making them older than the pyramids. I’d taken twenty of these songs out of the middle of the book – Psalms 60-80 – and listed the things they were moaning about… as just demonstrated. 

A lot of the sleepy faces were looking more alert now.  

Since this ancient list is more or less identical to our own, we can draw two conclusions, I said. Both very good news. The first is that, clearly, these are the things we worry about – if we’re human. People from a totally different culture/ period in history/ part of the world/ ethnicity/ stage of economic development/ political system/ level of education and so on and on, worrying about the same things as us? Doesn’t it show that… er, it’s normal? For living, breathing, average, sentient human beings like us? 

And secondly it proves, surely, that we’re designed to survive this kind of worrying. We’re wired to cope. Our brains are built for it. Because – ta da! – here we all are, FORTY CENTURIES later, still moaning about exactly the same stuff! 

I looked at my colleague again. Not only were both her hands now down in her lap, but like a lot of the rest of the room, she was smiling. 

‘If we can clear fear out of the way, it’s much easier to get on with sorting out problems,’ I finished. ‘So now, shall we talk about where we can get started?’