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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.” 

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Mental Health
Podcasts
4 min read

What all those BetterHelp ads say about ourselves

Podcasting and therapy alike scratch our itch to be inquisitive about things, even our own inner worlds.

Jamie is Associate Minister at Holy Trinity Clapham, London.

A podcaster speaks into a mic before a screen.
Soundtrap on Unsplash.

There's one dominion Amazon hasn't conquered. Jeff Bezos famously chose his company's name, in part, because it's the largest river in the world and he wanted to create the world's largest bookstore. And Amazon has flooded the market. But as the world of podcasting is taking over our commutes and leisure time, Amazon isn't taking it over. That top spot belongs to BetterHelp. 

Now that I've mentioned it, you probably know what I'm referring to: the ubiquitous ads offering online therapy, often reassuringly read by the podcast hosts themselves. Although Amazon is the second largest ad buyer on podcasts, BetterHelp spends more. A lot more. In the US, BetterHelp spent $22million in the second quarter of this year, followed by Amazon with $13million. . BetterHelp has pretty much been the top spender on podcasts Clearly, BetterHelp thinks the demand for therapy is right up there with the convenience of getting stuff delivered to your door. 

The message of online therapy, and the medium of podcasts makes for a neat match. It seems our wants and needs are more and more solo endeavours. Our desire for entertainment and help are becoming something we access alone, behind headphones and closed doors.  

Overhearing people talking about their therapist in a metropolitan café is now as as common as the extra-hot flat whites themselves.

I was stunned when I heard recently that Saturday Night Live celebrated fifty years on TV. It was a reminder of an age when families and friends would diarise prime-time weekend entertainment together in front of the glow of the screen. But common experiences are diminishing. Harvard fellow Flynn Coleman highlights that the third spaces  where we have customarily congregated, found community, and ourselves, are vanishing.   

She is, of course, right. We are just beginning to scratch the surface of the damage our atomised online worlds have created. But where the CDC health report last year tragically detailed the harm social media causes teenage girls, the online space is not without hope. Krish Kandiah writes, 'Instead of demonising new technology as the problem, perhaps we need to find ways to turn it into the solution.'The online world isn't going away, so it must be at least part of the solution. Teletherapy is now available on the NHS, and while there are questions over the affordability and availability of online mental health care, and I cannot vouch for BetterHelp, making therapy more accessible by taking it online plays an important part in winning the battle of declining mental health. 

Far from an echo chamber, an online therapist can challenge presumptions at right angles and enable clients to access worlds they previously only dreamed of. And, any good therapist wouldn't encourage you to isolate yourself. We still need community. 

Therapy isn't as much a solo endeavour as we might first think. Of course, the therapeutic relationship itself is between two people, however objective one party might be. And just as the old adage goes, 'a problem shared is a problem halved', overhearing people talking about their therapist in a metropolitan café is now as as common as the extra-hot flat whites themselves.  Therapy is losing its stigma, and the benefits of it are shared just as we want to share a podcast that's stimulated or amused us.

That elusive arrival at contentment, of happiness, of satisfaction is quite the claim for an online service provider to make. 

Some things are sacred, though. James Marriott recently argued in The Times that the burden on those in the public spotlight to overshare isn't always helpful. How, where and with whom we share our inner thoughts matters. The Christian tradition sees that growth happens through relationship, rather than through broadcasting. Spanish mystic St Teresa of Avila wrote almost half a millennia ago about a journey inward, inside of ourselves to a space where only God dwells, if we choose to let him enter. On that journey, she wrote ‘It is a great advantage for us to be able to consult someone who knows us, so that we may learn to know ourselves.’  

On that journey of self-knowledge, the online world can enhance our lives, but not replace it. Just as The Rest is History podcast can give you details about ‘greatest monkeys' that your friend can't, specialist help from an online therapist will help you in ways friends won't. But BetterHelp wants to be your friend. The main heading on their website mimics what we've probably all heard from someone we know: 'You deserve to be happy'. They've learnt from the Steve Jobs school of marketing: don't sell the product or service; sell how it will make them feel. That elusive arrival at contentment, of happiness, of satisfaction is quite the claim for an online service provider to make. 

Podcasting and therapy alike scratch our itch to be inquisitive about things, even our own inner worlds. Where podcasting has challenged the old powers that sought to control the flow of information, we also do well to listen to external expert help. In this age, the online stream can flow information to us which, like the Amazon, might overwhelm us. It’s worth us asking: is there an external source of even better help available? One that will overwhelm us too – but instead overwhelm with the love we crave in our deepest selves?