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

Comment

Mental Health

1 February 2024

4 min read

We need to weep over the wreckage of mental illness

While its now OK to talk about mental illnesses, we need to weep over the harm caused and how we’ve tried to treat them, writes Rachael Newham.

Rachael Newham

Rachael is an author and theology of mental health specialist.

A grey and white wall graffited with a tag a image of a person crumpled and crying.

Today, February 1st, is Time to Talk Day. It's part of a long-running campaign encouraging people to have open and honest conversations about mental health. It's aim is to break down the barriers of stigma and misunderstanding. It has been a staggering success - what was a fringe issue talked by those only affected by mental illness a decade ago is now part of common parlance. Mental health training is widely available, and the charity’s work has been seen to have a significant positive impact on the mental health conversation

However, as our familiarity with the language of mental health has grown so too has the way we use it. People might talk about having PTSD after a bad date, or their friend being ‘so OCD’ about the way they organise. Unwittingly, as psychotherapist and author Julia Samuels points out, “[we have] awareness without real understanding.”

However, awareness without understanding means we actually don’t reach those most impacted by mental illness. We know about mental health in the way we know about our physical health - but we are no more aware about the serious, sometimes lifelong mental illnesses which rob people of hope, joy and vitality - sometimes leaving them with lifelong disability.

If you ask most people about mental illness they may tell you about depression and anxiety; the two most common mental illnesses which have become the acceptable face of mental illness. It’s reflected in the way funding is channeled to interventions that get people with mental illnesses back to work, or to NHS ‘Talking Therapies’ which offers short term psychological therapies (both of which are important initiatives) but have cut the number of inpatient beds from over 50,000 in 2001 to under 25,000 in 2022[3] which means those at the more severe end of the spectrum of mental health to mental illness are left to travel 300 miles for the care they need.

We have to survey the wreckage that severe and enduring mental illness causes, before we can begin to rebuild a society that is kinder - without prejudice or stigma.

Whilst it’s right that we have raised awareness about the most common conditions, we can’t ignore the illnesses which are termed ‘severe and enduring mental illnesses’ which include those such as bipolar disorder, major depression, schizophrenia and complex post-traumatic stress disorder.

For people living with these conditions, the general mental health advice that we give; for example getting enough sleep and time outdoors may not be enough to keep the symptoms at bay. Just as general physical health advice like getting your five a day will not cure or prevent all severe physical illnesses. Medication, hospitalisation, and at times even restrictions of freedom like being detained under the mental health act might be necessary to save lives.

These are stories that we need to hear. The debilitating side effects of life saving medications that can raise blood pressure, cause speech impediments. The injustices to confront (such as the fact that black people are five times more likely to be detained under the mental health act than their white counterparts) and the adjustments to life that those with disabilities are required to make to their lives.

We have to survey the wreckage that severe and enduring mental illness causes, before we can begin to rebuild a society that is kinder - without prejudice or stigma. We have to listen to the perhaps devastating, perhaps uncomfortable stories of those who live with severe and enduring mental illness. The mental health npatient units miles from home, the lack of freedom, the searing - unending grief.

Weep for the lives lost, the crumbling systems, the harm caused both by mental illness and the way we’ve tried to treat them.

By hearing these stories, we are accepting them as a part of reality. For those of us in churches it might be that the healing didn’t come in the way we expected, it might be also be all of us accepting that the systems designed to care for those with mental illness have in fact, caused more harm. It’s seeing the injustices and understanding that we, our systems and professionals need to change our attitudes.

Understanding and acceptance of the injustice are the way forward- that’s the only way change can come.

It might look like standing in the rubble, it might feel too huge and all but hopeless.

And yet in scripture and in life that is so often the only way we can begin to rebuild.

In the book of Nehemiah, one of the Old Testament prophets who had lived in exile far away from home for his whole life, we see that upon hearing about the state of the walls of Jerusalem, before he did any of the things we expect heroes and innovators to do- he wept. In fact, it’s estimated that for four months he wept over the state of the place that had once been the envy of the ancient world.

Perhaps we too need hear the stories and then weep.

Weep for the lives lost, the crumbling systems, the harm caused both by mental illness and the way we’ve tried to treat them and then slowly, we can begin the work of rebuilding.

It isn’t a work that can be done alone by a single agency much less a single person - it requires society to hear stories of the more than just ‘palatable’ mental illnesses with neat and tidy endings to the messy and sometimes traumatic stories that are there if we just care to listen to them. It might be reflected in the petitions we sign, the way we vote, the stories we choose to read.

So ,this Time to Talk Day - I’m saying let’s continue the amazing work of talking about mental health - we need to keep talking about anxiety and depression. But let us also make conversations wider, so that they encompass the whole continuum of mental health and illness.

We’ve seen the difference Time to Talk can make - now it’s time to talk about severe and enduring mental illnesses, too.