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.”

Column

Change

Identity

Psychology

Taylor Swift

2 January 2024

7 min read

Self-belief: what Ted and Taylor get wrong

Psychologist Roger Bretherton questions whether believing in ourselves is all it’s cracked up to be, despite what culture icons might say.

Roger Bretherton

Roger is Associate Professor of Psychology, at the University of Lincoln. He is a UK accredited Clinical Psychologist.

A man in a blue jumper holds a yellow sign reading 'believe'.

Ted and that sign.

Psychotherapists can be really irritating. You may not have noticed how irritating they are, but I have. And that’s saying something. Because I am one - an irritating psychotherapist that is. In nearly two decades of practicing and training people to counsel, coach and generally therapize (I know that’s not really a word, but I can’t help irritating you by using it), I have curated an ever-growing list of the therapeutic practices by which I am most likely to be irritated.

To my mind, the gold medal in the irritating therapist Olympics goes to a winsome and playful hypnotherapist called Stephen Gilligan. Some psychotherapists treat everything that comes out of their clients’ mouths as treasures to be prized, it clearly wasn’t the way Gilligan saw it. In fact, he developed a therapeutic strategy designed to confront any sense that it is possible to define ourselves simply. Every time a client made an ‘I am…’ statement, he would respond with a twinkling eye and a lilting voice, ‘Of course, you are [insert dramatic Pinteresque pause here], except when you’re not.’

Consequently, the pantomime of therapy goes like this. You think you’re a failure? Of course, you are... except when you’re not. You think you’re a coward? Of course, you are... except when you’re not. You think you’re a control freak? Of course, you are... except when you’re not. You think you’re always punctual? Of course, you are... except when you’re not. You think you’re disciplined? Of course, you are... except when you’re not. You think you’re accepting of everyone? Of course, you are... except when you’re not. You think this is all really irritating? Of course, it is... except… You’ve probably got the gist of it by now.

But why would Gilligan, with all his charm and playfulness, risk infuriating his clients like this? Perhaps because he knows something important about human identity that most of us tend to forget. None of us can be summed up in a single sentence, and whenever we try, something grates against us. Any attempt to cram the complex fabric of our lives into the all-too-tiny suitcase of our self-definitions causes us pain. After all that’s what irritation is. It is the gnawing sense that something doesn’t quite fit.

Psychologists note the difference between anger and irritation. When we are angry, we are usually angry at something. Someone or something has blocked our plans. We’re frustrated. It’s not right and we fight against it. There is a sense of indignation and injustice. But with irritation we’re not always sure what’s bothering us, and if we are sure what it is, we’re not sure it should bother us. It’s the young couple whispering behind us in the cinema, the door that only closes with just the right pressure, the person who subtly insults us. Not quite enough to make us leap into action, but just enough to steal our attention. To be irritated is to be slightly annoyed that we are annoyed; to be annoyed while wondering whether we have any reason to be annoyed.

We are whole and perfect just as we are, and no can tell us otherwise. It is the gospel of self-belief, that lingers on the lips of cultural icons from Taylor Swift to Ted Lasso: believe in yourself.

Stephen Gilligan was confronting his clients with the fact that we often wear our identities like this, like ill-fitting clothes that bulge or chafe in the places where the tailoring fails to match the way our lives really are. We can be described in many ways, but we cannot ultimately be contained in, reduced to, or summed up by any single concept. Some part of us always colours outside of the lines. The human equation always leaves a remainder.

The idea that we are ultimately a glorious mystery, even to ourselves, is not a comfortable thing to live with. We would much rather come up with a bold simple label and stick ourselves to it. At least then we’re safe from uncertainty. At least then we’d be something. Most of us to some extent play this game, and the good news is that our culture offers us numerous ways to play it. The bad news is that none of them really work.

Perhaps the most popular way to play the identity game is to believe that we already are everything we need to be. We are whole and perfect just as we are, and no can tell us otherwise. It is the gospel of self-belief, that lingers on the lips of cultural icons from Taylor Swift to Ted Lasso: believe in yourself. You’d think that would be a good thing to believe, but it does run into problems, particularly when the rest of the world fails to hold the same opinion of us.

If we believe ourselves to be wonderful in every respect it comes as a bit of a shock to discover that not all our colleagues, bosses, or friends regard us with the same breathless awe. At this point, many of us modify our view of ourselves to something more realistic. But if we are not prepared to do that, there are only a limited set of options by which to square the circle of knowing ourselves to be magnificent in a world that refuses to agree with us. We can attack the world in rage, we can flee from it in fear, we can hide from it in shame. A surprising number of people respond with paranoia. Which makes sense. If almost everyone you speak to seems intent on undermining your matchless brilliance, you could be forgiven for thinking the world was out to get you. None of these responses are good.

Thankfully, in recent years, therapeutic psychology has issued a corrective to the shortcomings of the self-esteem movement. More nuanced practices of self-acceptance and self-compassion, recognise that it is part of being human to not always be as we would like to be, and we will certainly not always be treated as we think we should be treated. A simple grandiose belief in ourselves is too flimsy to endure the buffeting of real life. Self-belief is not enough.

Accepting acceptance is a radical reorientation of the self because it doesn’t start with us

Some psychologists have argued that the twentieth century should be named ‘The Century of the Self’, the historical period in which Self replaced other larger concerns, such as Country or God, as the ultimate reference point for good human living. The fact that so many of us unthinkingly endorse the need for self-belief, suggests it is a popular option in our current cultural menu of ways to live with ourselves. But it is difficult not conclude that the cultural currents in which we swim are somehow misaligned, or that we suffer from a widespread lack of imagination if the lynchpin of our aspirations doesn’t really deliver. It makes me wonder if we have taken a wrong turn somewhere.

The Christian view of all this is that we as human beings, far from being selves to believe in, are the recipients of a radical kind of acceptance. We are not called upon to generate self-acceptance out of thin air. We have been divinely accepted at the deepest possible level, not because we are special or exceptional, but as a gift to us from a generous God. All we have to do is accept that acceptance. Which is harder than it sounds, because we’d rather believe we did it under our own steam.

Accepting acceptance is a radical reorientation of the self because it doesn’t start with us. It starts with a God who is willing to do whatever it takes to close the distance between us and Him. If God wasn’t like this, if he was vindictive or didn’t care, or if he refused to come anywhere near us until we’d reached the required height of spiritual perfection, there would be absolutely nothing we could do about it. But as it stands, all our attempts to impress God are pretty much useless. There is little point frantically reeling in a god who is already closer to us than we are to ourselves. What’s the point of trying to justify our existence if our existence has already been justified. This is where Christianity begins, but not where it ends.

Divine acceptance does something more. If self-belief asserts that we are what we are, and no-one can tell us any different; then divine acceptance takes us as we are but refuses to leave us there. Something happens to us when we know that we are known and loved right to our bones. We no longer fear being abandoned because of our flaws, and we start to harbour a growing hope that we may be able to overcome them. Our self-awareness improves, we see ourselves more clearly. We learn to live life dynamically, with nothing left prove, but a lot still to learn.