Women Offenders–Managing Risk

The President: Good evening, ladies and gentlemen. This evening we have a talk about women and prisons and managing risk, and we have two very, very experienced women who have been working in the Prison Service for a good many years between them.

First, Barbara Treen, who is the Head of the Women's Team in the National Offender Management Service. She joined the Prison Service in 1983 and worked as a Prison Officer for a year or so at Holloway before moving to Lewes as an Assistant Governor (trainee), and then served successfully at Wormwood Scrubs, at Aylesbury Young Offenders Institution, then the prison at Woodhill and also in Prison Service Headquarters. She was seconded for a couple of years to the Thames Valley Partnership, a registered charity, whose aim is to support partnerships to reduce crime and the fear of crime. From May 2002 until December 2004 she was Governor of the Prison and Young Offenders Institution at Brockhill, which was then a women's local prison in Worcestershire. She is now Head of the National Offender Management Service (NOMS) Women's Team, and I understand the task of that team is to ensure the “gender-specific” needs of women offenders are met within the prisons and when under the supervision of the Probation Service. So I am looking forward to hearing what she has to say.

Then Caroline Stewart is Lead for Research and Specialist Interventions for Women within the NOMS Women's Team. Caroline is a principal psychologist and has worked for the last 38 years in the Prison Service and the National Offender Management Service. During that time she has been on secondment to the Immigration and Nationality Service (which must have been pretty interesting) and the Civil Service College (spending five years with each of those), and had a placement at the Missing Person's Helpline (now “Missing People”). She has worked with prisoners at prisons at Long Lartin, Wormwood Scrubs and Holloway, and trained civil servants in management skills and helped develop policy to reduce the risk to the public caused by prisoners re-offending. Since 1997 she has worked within the NOMS Women's Team championing and developing appropriate interventions to meet the particular needs of women offenders, so another very interesting speaker.

Barbara is going to kick off. Welcome. (Applause.)

Ms Treen: Hello. Can I just introduce as well Mike Poselay, down here, who is also one of our colleagues. We have brought him along partly because he is also a very experienced prison governor but also because he has also had training as a barrister, and he is a practising solicitor at the moment. So if you have got any difficult questions about the law, he is the guy we will ask. Caroline actually officially retired a week ago. She has come out of retirement just to do this talk, so we are very pleased to see her again.

These are some statistics about women's sentencing and women in prison [Slides 1 and 2]. I won't go through all of them, but some of them are quite interesting. For instance, 16% of women prisoners have no previous convictions, compared with 9% of men. One thing that occupies everybody who works in women's prisons is the amount of self-harm that you see, particularly in women's local prisons. We think around 37% of women in prison self-harm, compared with 7% of men and the even more stark statistic is that 50% of all the self-harm incidents that happen in prisons are committed by women, even though they are only 5% of the population. Few women in prison are assessed as being at very high risk of serious harm, compared with 11% of men. So women are less high risk in prison but more vulnerable. There are lots of other statistics around this that describe the vulnerability of the population in women's prisons compared with men.

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Slide 1

Some statistics

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Slide 2

Women in prison: main preoccupations over the last decade

I am going to say something about how working with women offenders has changed over the last few years [Slides 2 and 3]. Up to about two years ago we were seeing an escalation in the number of women in prison, which was quite scary. We had male prisons re-rolled into female prisons all over the place and there seemed to be an unprecedented rise and no real understanding of why this was, although some of us suspect it was largely a reaction, in the male estate as well as in the female estate, following the sentencing of the killers of Jamie Bulger.

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Slide 3

Women in prison: main preoccupations over the last decade (2)

So what we have at the moment is a geographical spread of establishments. There are only 13 women's prisons, none in Wales, and most of the prisons have a variety of specialisms. So you don't just have a prison serving the courts; you don't just have one prison serving the needs of life sentence prisoners, or anything like that; most of the women's prisons do a bit of everything, so at any one time they will be holding women for the courts, sending them to the courts, assessing them, sorting out their health-care issues, including detoxification and holding them for a while to do things to try and address their re-offending, preparing them for release. The way we are moving means that it will become more like that over time, where we have geographical spread of prisons hopefully meeting the needs of the local populations but all doing a variety of specialisms.

We have also seen an increase in numbers of foreign nationals, particularly long sentences for drug importations and “false instruments”, and the characteristic of that population is that generally speaking it is a very compliant population; women foreign nationals are nearly always first offenders and they are doing very long sentences. They have particular issues, of course, in particular, keeping in touch with their families. We also have many foreign nationals in our Mother and Baby Units.

The thing that has occupied the work of this team for three or four years, at least, is to try and nail down what exactly are the different needs of women compared with men in prison and to source evidence for what practitioners “think” are the differences. To do this, a couple of years ago we produced a very comprehensive set of what we call “Gender-Specific Standards” for how we manage women in prison and this became Prison Service Order 4800, which is a comprehensive reference guide about how women differently experience imprisonment, about how differently we should treat women prisoners. The standards range right through from how women experience reception – coming into the prison – to how their special needs should be addressed in terms of their re-offending.

We were able to do a lot of research talking to prisoners, talking to staff and talking to all the experts about what women's different gender-specific needs might be, and really spell them out for the first time. Before this, incidentally, there was only ever one instruction that specifically related to women, and that was about the running of Mother and Baby Units. Before that it was assumed that all Prison Service policy applied to both men and women equally. In some of those many other instructions there was maybe the odd reference to women, but quite often there wasn't, or women were completely overlooked, and the result was that there were just gaping holes where it was clear that the system was operating and had to operate differently with women.

When we produced the Prison Service Order we also put into that what we call two additional “pathways” for women. The NOMS had previously come up with the idea that there are pathways towards offending, and these related to: accommodation, health, employment/training/education, finance/benefit/debt, drugs and alcohol, attitudes/behaviour and children/families. Any of these might singly or collectively make someone more vulnerable to offending and needed to be tackled. Well, we basically invented two more pathways based on what we saw out there in women's prisons. One of them was the prevalence of women who had experienced domestic violence and abuse and rape, and the other one was the number of women who had been involved in sex work. Even though many women sex workers aren't in prison for working in the sex industry (although some might be in for brothel keeping etc), lots of women were in prison who had been involved in sex work and some were trapped in that existence.

So, we put our two “pathways” into the Prison Service Order and, to cut a long story short, lots of work has been done, and is still being done, by our team and prison staff to support their women prisoners in these particular areas. Staff will make referrals for appropriate treatment and support. Indeed I understand that the requirement to provide support for these issues has now even been extended to male prisons where of course there are also men who have experienced abuse and men who have been involved in the sex industry. We also thought about the needs of particular groups of women; i.e. women from BME (Black, Minority Ethnic) backgrounds, foreign nationals, younger women and older women. All these women have lots of different needs which may need to be dealt with slightly differently.

I talked about self-harm briefly. This governs a lot of people's time within prisons. Of particular concern are the extremely high levels of self-harm by women, some of which is very risky behaviour. This is a concern on everybody's mind, particularly in the local women's prisons. We know there is a correlation between self-harm and experiences of abuse. We think about half the women in prison have experienced domestic violence of some sort. We think a third of those women have experienced sexual abuse, often in childhood, or rape. It is not surprising then that one of the ways that lots of women deal with this is to “self-medicate” with alcohol and illicit drugs, which in turn brings them into custody on charges for instance, of theft to fund drug habits. There are strong links between self-harm, drug misuse, sexual abuse and physical abuse, and what we do see, when women come into prison and get off drugs, hopefully, is that often self-harm problems then begin to manifest, because they are now less able to block out memories and experiences.

We think that about 60% of women have significant problems with drugs and alcohol. We think that about 60% of women are primary carers. The issues about managing as a mother in prison again are reasonably different from the experience of being a father in prison. More women are likely to be primary carers. Because there are only a few women's prisons they are more likely to be held further away from home, and one of the sad realities is that if you go to a visiting room in a male prison and into a women's prison you will find the male prison is full of visitors; there are women bringing up their children; there are women still looking after the children at home; but if you go to a women's prison there are hardly any visitors, because most women don't leave behind a supportive domestic home in which the children will be raised and then brought up to see the mother; it isn't like that.

What we have concentrated on a lot since the publication of the Corston Report, which you have probably heard about and which I will talk a bit about in a moment, is the need to divert women from custody. The Corston Report was written after a series of deaths at Styal Prison in a very short period of time. Corston pointed out that women were different from men in prison; they experienced different things; they generally didn't pose the same level of risk as male prisoners, but many women were very vulnerable. We think about 80% of women have got some kind of mental health problem. The main recommendation from the Corston Report was that women should not be sent to custody unless it was really, really necessary. So lots of work went on, under the previous Government and this Government, to try and divert as many women as possible from custody. Fundamental to that was the funding, with about £14–15 million, of women's projects in the community that would offer a holistic, one-stop shop type approach for women, to head women off from the criminal justice path or to be there as support for when they leave prison.

The other thing that was recommended in the Corston Report was that we should train people better in issues to do with women's offending and the gender differences, and for that end we leapt enthusiastically into the fray and came up with some training courses ourselves:

Women Awareness Staff Programmes (WASP) for staff and partner agencies working with women in prison;

Women Awareness Staff Programme In the Community (WASP ITC) for probation and community partners (including magistrates) working with women in the community;

Sex Workers in Custody and the Community (SWICC) for all staff and partners working with women involved in the sex industry.

WASP in the community is a training course and also a forum now for community organisations and including magistrates which helps practitioners to understand the different issues that affect women's offending and address them, but also to work together locally to try and provide credible options for sentencing other than custody. Often magistrates will say to us, “There is no other option. I don't really want to send these women to prison, but there is no other option”. There are a lot of options out there, but sometimes magistrates don't know about them, and we are not good enough at making sure everybody knows about them all either.

Caroline is now going to talk more about the needs of women in prison.

Ms Stewart: Thank you. Barbara has touched on some of the points that I am going to be discussing, but I want to really put a bit of flesh on the bones and give you an overview of the needs of women.

One thing that struck me in the time that I have been working in the Prison Service – and I shock myself to hear long it is; I started in Holloway in 1976 and was there for about eight years before going on to the various other jobs that I did and then, returning to the Women's Team in 1997 – was how much there still needed to be done on actually understanding the needs of women. What I want to talk about now are some of the ways in which over these 10 years (the period since our team has been in place) the understanding, the sort of profiles of the needs of women, have really increased and are increasingly well understood. Barbara has indicated some of those, but there are three specific areas I want to say something about. [Slide 4]

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Slide 4

Managing women in prison

One is what do we know about the background early experiences of women, of their life events, that might increase their risk of re-offending or make them more likely to reconvict? There have only actually been a very small number of reconviction studies on women. I would like to say in passing however that one of the problems about research, and in particular reconviction studies of women, is the relatively small numbers. The cohort of women offenders in any large study (and there have been some) will probably be in their hundreds, and we'll push hard to get 500 or 600 in a particular study, whereas the sample size for men may be 5000, and this reflects the fact that the women's population is only 6% of the prison population; a similar ratio applies to the community offenders as well, so we are always a very small group, and it is actually very difficult to get the sorts of numbers needed for robust studies. But there are some studies on reconviction. I will comment on the findings of a couple of these which have looked at previous life events which are significant.

I also want to say a little bit about what assessments actually take place for women when they are in prison and how we identify their resettlement needs against the pathways that Barbara has actually referred to.

We are here primarily to consider the issue of risk, so I think we are going to be saying that for NOMS one of the core functions is reducing the risk of re-offending. But what do we really mean by risk? Are there other things as well as re-offending? I would just like to share with you some thoughts about what we actually mean when we are thinking about risk.

Starting with studies that have looked at early life events and pathways into offending: a study by Hollin and Palmer (published in 2005) is one of the few studies that actually did a long-term follow-up study of women interviewed in prison and then followed up on release, and they did have the great difficulty of actually “losing” women included in the original sample as they went along; either they “filtered out” because they didn't re-offend or they “filtered out” because we couldn't find them, or for other numerous reasons. So it was a considerably difficult area to research, and their conclusions were based on relatively small numbers; but what their study found began to help us understand the key issues and confirmed our views from my early days at Holloway and my early days in the Team.

Anyone working with women in prison knows, as Barbara has said, that domestic violence and abuse is a critical issue. You can't really think about women offenders/women prisoners and their needs without addressing the issue of the abuse they have experienced, either in domestic relationships or through sex working or through violent sexual assault. When we actually consulted our statistical colleagues, they would say, “Well, if you put abuse into the mill and run the statistical analysis it doesn't come out as a significant factor”, and this is one concern for us as gender-specific issues may be lost in the aggregate of the much larger male numbers. Hollin and Palmer's study was really helpful because it enabled us to understand that abuse and early adverse life experiences did play a significant part for women offenders.

They didn't conclude they were causally related or that there was a direct correlation to offending, but they saw them as factors that set a sort of predisposition or increased a woman's vulnerability, which then could lead to her need to seek psychological support; or to have emotional difficulties, psychological difficulties, which often may lead the women to take drugs (which in some cases will be an offence in its own right) or to misuse alcohol, perhaps as a way of self-medication to ameliorate their difficulties. In other cases it resulted in offending because it led to the action of theft, shoplifting, in order to get money for drugs or what have you. So the evidence they gave us put firmly at the centre of our considerations the significance of the experience of abuse as being something that is important to consider, to look at and to address its impact on the woman and how she actually copes with the stresses of her life at the moment and how it has played its part in her offending, and that was actually very important in that it enabled us to have the additional “resettlement” pathway that has meant we now have members of staff in each prison looking at how we best support women who have been affected by abuse as a key part of their role.

What was interesting though was that it wasn't necessarily that the woman herself as a child was abused. The critical thing was to have experienced abuse in the sense of having it happen in the house around her between her parents in another room, to hear domestic violence was in some cases sufficient to have the adverse impact on the woman. So it is a very significant and important aspect of the work we have been doing, and her misuse of drugs, her misuse of alcohol would then be seen as self-treatment really, self-medication to cope with the impact that experience of abuse had had on her earlier in her life.

I would like to mention a second example: the Cabinet Office's (then) Social Exclusion Unit, who looked at a number of women in prison, women on community sentences and women at risk of offending. Their view again reinforced the “integrated” approach we were increasingly beginning to take, and their phrase was “the connecting threads” across the life histories of the offenders [Slide 5a]. They saw that there was a relationship between individual factors and things about the woman herself, her family and the extent to which her family was supportive, or dysfunctional and potentially damaging to her, and the community factors. So those were things like poverty of expectation, deprivation; “entrenched deprivation” they talked about as well. The importance of this work is really in feeding what has been a bit of a mantra in working with women, which is that we are looking at the integration of these problems and the integration of the approaches that are needed to address them in a more holistic way. The word “holistic” has got a bit out of favour, but it is still, I think, a very useful way and it was this, again as Barbara mentioned, that underpinned the approach and recommendation of Corston, that we would have community-based projects that were actually one-stop shops, because all these factors with women are interrelated, so abuse and trauma have to be dealt with in the context of drug taking because they are related in that sort of palliative relationship that I talked about before.

Just to say a little bit more about some of those vulnerabilities of women that Barbara touched on again, that are really examples of the interconnecting threads we talked about. I am going to let you read the slides. You will receive copies of these as well after this evening. I just wanted to make some general points about each of the four boxes on Slide 5(A), and then there are a few more in Slide 5(B).

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Slides 5(A), 5(B)

‘Connecting threads of life history…’

Home background

Thinking about home background, it is interesting that about a quarter of these women had actually been in care. The funny thing I have never understood is when we have tried to do some research and speak to these women, they “disappear into the woodwork”; we have never been able to find any who would come forward to speak about their experiences in care. Now, some think that the women maybe don't want to disclose they have been in care because they think that will work against them in some way. I don't know, but we have tried several times to do research on this population but it hasn't worked. We haven't been able to find the women to actually speak to about it. But I think what these home background features are telling us is that many, many women had a lack of family support in their lives; they did not come from loving families where there were strong attachments, where there was consistency, where there was regularity, where there were all the sorts of things that we would see as being conducive to good, strong emotional and personal development. These women also are experiencing the loss of their own children when in prison. If the home breaks up (and I will come to that again in a moment) some of the children will go into care and subsequently be adopted. Most of them are actually cared for by other relatives, but there is a separation from the mother in prison and the break up of the family home, and the concerns there, of course, are the cycles of disadvantage: the intergenerational impact, longer term impact of history repeating itself and the next generation experiencing the same lack of family support as the previous generation.

We do have a little cohort – and this is another research study that might be done some time – of women in prison who are the children of women in prison, or possibly the grandchildren of women in prison. I think the first Mother and Baby Unit opened in – I was in Holloway at the time – about 1975/1976. There were women with babies in prison years before that as well, but the first current generation of Mother and Baby Units started in the mid-1970s, so we may even have grandchildren of women born in prison. I am not sure what it is saying, but it is worth mentioning in passing.

Education and employment

Education and employment, low expectations, under-achievement, under-attainment, among women offenders is a huge issue. Inevitably, if you are not learning to read and write, you are not getting qualifications, and all the rest, so you are going to have limited life options; you are probably going to have limited expectations about your abilities and society's willingness to take you on because you have never shown you are any good at anything, all those sorts of things. What I am about to say about this will be on a sort of positive note actually: this is something that prison can fix to some extent – “given enough time”, I was going to say. I said that once before and I was slightly misunderstood that I was recommending that women got sent to prison for a certain number of minimum years. I am not. But if women are in prison, then in fact they can benefit from the sort of educational opportunities that are there, and I will come back to that in a minute.

Accommodation

Again, Barbara said they are less likely to have anyone bring the children up. They are also more likely to lose their homes, because they are less likely to have a stable partner who is going to maintain the rent and keep the family together in the family home. Children get farmed out to a sister, who has already got three children; she is phoned up and asked, would she take the children, another three, as the sister has just been sent to prison and the flat is empty and she will lose it. The implications of that are:

The loss of her children once again. This creates though, the loss of accommodation, difficulties of acquiring new accommodation on release.

An increased risk of her not settling and of maybe re-offending on release because of the known association between having a stable home and accommodation and not re-offending. Also, particularly with the younger group of women, the lack of accommodation makes them much more vulnerable to (let's call them) “predators”, people who see their vulnerability, groom them, ply them with tempting offers of drink or drugs on the gate as they leave the prison, and a lift for supper to his home. There are examples of that. In fact, there was a TV documentary that showed a very painful example. That is the lack of accommodation. It is a very critical and key issue that we would want to attempt to address. More work always needs to be done.

Mothers as primary carers

Again, the statistics here are pretty much as Barbara mentioned. The 17,700 children a year separated from their mother is amazing, a huge figure. I think the issue for us there, in terms of working with women in prison is, for women as a primary carer as a mother, that is an extra layer of the pain of imprisonment and the distress she feels when she is there. But women do attempt to manage and run their families from prison, so the women actually will become quite desperate if they can't get the phone call through and hear how the little boy or the daughter has done at school, or if there has been a teacher's visit, or whatever. They are actively attempting to manage their families from prison, very different, I think, to men, who just know “the wife's” out there doing it and sort of “do their bird” and close the door. But for women there is this semi-permeable membrane, as it were, which also means actually they do suffer a bit more because they realise the impact of the things that are going wrong for the children, and because of the point Barbara made, that it is very difficult because of the 13 prisons widely distributed across the country, so the longer term women get fewer visits as time goes by. The difficulties maintaining not only relationships with children but relationships with family for any women doing long sentences, and also for our foreign national women, those difficulties are quite acute really.

Mental health

I think the thing to say about the very high rates of mental health problems among women in prison and women offenders generally is that for many of them – I hardly dare say this in front of a medical audience – they are sort of relatively low level (anxiety/depression) mental health needs. The issue for us would be, are they sufficiently needy to meet the criterion of “severe and enduring”, and there is an issue that maybe many women fall under the net because of that. That might be something we could discuss afterwards. I would like to have your views, those of you who are experienced with working with women in prison or prisoners generally. But the undercurrent of chronic mental health needs, whether or not caused by abuse – I am not going to over-argue that case – the chronic mental health needs lead to a sense of psychological not well-being, and it affects ability to cope with stress, it affects ability to cope with the pressures and it affects ability just to get on with things, and so it is sort of endemic in the lives of the women.

The point about abuse has been well made. It is now recognised as a significant issue, and I think that is really important. One of the interesting things that has happened is the development, as we would see it, in dealing with women these days, of abuse not being seen as a gender issue, because everyone says, “Well, hang on second, an awful lot of men have been abused as well, particularly the younger men”, and we'll say “Yes, that's absolutely fine. Do something about it”. But it doesn't take away from the fact that it is an issue for women. So abuse is an example of that.

Substance misuse

Again, I think we have made all the points. Again, if we have substance misuse experts in the room I'd be interested to hear their views in the debate. Our view is that the women's pattern of drug use is rather different. They tend to use more drugs, they tend to mix the drugs more, they tend to use alcohol more with the drugs; their drug taking tends to be palliative once again to just block it all out, less to do with social life, being with your mates, as it is with many male offenders (not all obviously), and the links I made before with abuse, sex working, exploitative relationships and grooming are very relevant for women, particularly women being enticed into the sex industry and groomed through their use of drugs.

Let me move on. When women come into prison, those doing sentences of more than 12 months will be assessed formally using OASys, which many of you will have heard about. Theoretically, or in principle, a prison will match its regimen, the activities it offers to address them, to the sort of profile of its prison. Now, there is always a bit of a time lag, so the reality is that most prisons will offer provision across the range of resettlement needs I just want to say something about the ones that are the front runners for women and just a couple of the ones that are the front runners for men, because there is a bit of a difference there.

Emotional well-being

That is the point I made about the high level of mental health needs, poor stress management, poor emotional control and query (if I dare use the words) borderline personality disorder. I am not sure how helpful that is or isn't, but you can tell me what you think about it.

Relationships

Very high, as well as the abusive/exploitative points I made before.

ETE

ETE is Education, training and employment. The issue there is that, while women need education and vocational skills, many of our women, because of the emotional well-being factors, are not in a state to be able to access learning. So in women's prisons you will actually find the education staff doing a lot of work trying to enable the women to get into the state of mind and the state of being able to work with other people in team work and working groups so that they can actually benefit from the opportunities they are being offered.

Thinking and behaviour

Well, that is sort of the core of all the cognitive offending behaviour programmes that as are being developed, and looks at the possibilities of decision-making and the sorts of things which again are very relevant to our women.

The two that probably are front runners for men are:

Lifestyle and associates and attitudes

Now, I don't want to stereotype men any more than I am actually stereotyping women a little bit, but those don't figure so much for the women, again reinforcing this notion that these same factors are at play with men and women, but for our women offenders the relationship patterns are a little bit different.

Risk

I did want to just spend a couple of minutes on risk [Slide 6]. As I said, our sort of whole modus operandi or reason for living, whatever it is, is the risk of re-offending. Now, Barbara has some up-to-date, complicated stats on this, but, very broadly, there is a slightly lower risk of re-offending for women. But, if women do re-offend, there is a tendency for them to re-offend with more offences, multiple offences, but they may be of less seriousness. It is rather complex, the whole business of re-offending, using that as a measure. It is clearly a priority for us, but I think that the other things on the list [Slide 6] are equally of concern when we are talking about managing risk and assessing risk and reducing risk.

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Slide 6

Understanding risk

Harm to self

One is harm to self, and we have already said how that is a major priority practical issue for women. The statistics that will come through in a moment are horrendous. They show a very high rate of self-harm among women.

Harm to others, including children

I think “Harm to others, including children” speaks for itself. So the issue of safeguarding and identifying children who might be at risk is very important.

Intergenerational risk

“Intergenerational risk” we have mentioned before. We may not be able to do a huge amount about it in prisons but we can perhaps through parenting courses and also just generally trying to reduce the risk of re-offending. We have other colleagues in NOMS who are working on family policies to attempt to support families that are particularly needy.

Hidden offending

“Hidden offending” is an interesting one. I do put that here because there are certain types of offences which we think are likely to be hidden – we have no evidence because actually this is an unknown question. These are offences that relate to women's traditional role – they also relate to men's behaviour, that is true – in the home and in the care of children, and I particularly have been involved over the last few years in working with women sex offenders, and they're a very good example, where the rates are, thankfully, very, very low. But it's been the question people hadn't wanted to ask, because they thought it couldn't happen. So, on the one level, we need to work to encourage people to recognise it can happen and therefore ask the question where was the woman when the man was assaulting the child in the home, for example, but, on the other hand, we have to do it in a way that is measured and doesn't have everyone throwing their hands up in horror and falsely accusing people. I remember some celebrated cases where there were terrible false accusations and a sort of hysteria developed. We were placed in a position where people said, “You can't accept sweets from your grandmother”, because any woman might be dangerous, but there are times when in fact there may be things going on but they are hidden because people don't want to ask about them.

We made the point before that risk of harm is the issue for us. We have very small numbers who are a real risk of harm to other people, but that is by no means to minimise the need to actually manage those women and work with them to try to reduce their risk.

Let's just spend the last few minutes thinking about our position in NOMS, but we're sort of focusing on custody. My focus has been always really on custody and Barbara will say something about community in a moment.

I mean, what is the range of options available to us? [Slide 7]

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Slide 7

What options are available to us?

Hold security

That is our business and we actually do that rather well. Prison can be restorative. Particularly women coming in having used drugs; if they get detox and they're eating properly, they're warm, they're dry, they have their regular lifestyle while they are in the prison, it can be very restorative. We do have a very, very small number of women who are very high risk, and our job there is really to hold them securely for a very long time. I may have time to say a little bit about those women. Those are the women who might have severe personality disorder; those are the women who might just be extraordinarily difficult and dangerous to manage in the prison. The numbers are very, very tiny, but that is one of the things we need to do, to hold those sorts of people very securely.

Time and maturation

Particularly for young offenders there is increasing interest in understanding the factors that actually lead to giving up offending. What are the positive things that lead people into the “new me”? Desistance is the technical term for this. Increasingly there is an interest in exploring that, so we can start trying to think about putting in place those positive things, rather than just trying to stop the negative things, and that is an interesting area of exploration and consideration at the moment.

Really, sort of the “meat” of the prison regimen is the development of interventions and programmes and the development of enrichment activities within the prison, of which work and education and linking work to education is very important. Two general points about that, and if there is time I will come back to just saying a little bit about some specific programmes that have been developed. The issue for us has always been can we develop programmes specifically for women? Do we have to develop them specifically for women? Can we take a programme developed for the vast majority of men and adapt it, “genderise” it (awful word), put she instead of he, or whatever, and use that with women? There has been a considerable debate and actually the reality is that some programmes work equally well with men and women. I think there is a driving-while-drunk one that works equally well; it is not gender biased one way or the other. There are thinking skills programmes where we have worked with the people, developing them to put in additional sessions for the women, because it is felt that women need more time one-to-one to reflect, but the core programme is pretty much the same for men and women; you change pronouns and you change the examples, but it is effectively using the same theoretical model of change. Then there are other programmes that we have commissioned specifically for women because they really take a more holistic approach, looking at where trauma meets drug use, meets violent behaviour, and the package there is very different and significantly different from what you would want to offer to men, and so invariably we have programmes that are specifically designed for women.

I think that is enough. Barbara, do you want to say something about community?

Ms Treen: This is the last bit really. Caroline is completely right that we can do good stuff for women in prison and men and women do achieve a lot in prison and come out feeling that their life has changed. However, it also is clearly destructive, so we don't want people being sent to custody to get help, and we know this happens. People say it to us, and in fact at a presentation we did to the Parole Board, a judge said he was horrified to hear about the self-harm in prison because, on principle, he would remand a woman for two weeks so they could get off the drugs, get stable, come back to court and then he could deal with them. But actually we don't want women remanded unless it really has to be that case. Wherever possible we should be accessing things in the community to try and stabilise women, because if we send them to prison they lose their kids, they lose their accommodation, lots of other things just fall apart and they're going to go out in a worse position, and of course lots of women do that because they get sent down on remand, they then get given a very short sentence and they go out with nothing, certainly not on licence, though some prisoners do go out on licence, young offenders, prisoners doing more than 12 months at the moment. One of the reasons we have found that there has been a rise in the women in prison is because of breach of licences. At one point a couple of years ago, half the receptions at Holloway were a breach, and we think one of the issues here is that, because women are often so complex, people think they are helping them by giving them lots of conditions, so you're kind of keeping a good eye on them. But actually people with chaotic lives find it very hard to keep any appointment, let alone hundreds of them. So the simpler the conditions are, the more likely that they are not going to breach. As soon as they breach they're back inside, it's all gone horribly wrong, and they are going to jeopardise the chance for further consideration for community sentences. So we and the Probation Service look after people on licence. There are all sorts of community sentences, but also there is community supervision and of course women and men (a small number of women) would be on the multi-agency protocols to try and reduce their risk.

We think there is a need probably for lifelong support for many women who really will never feel that they are part of mainstream society, and these might be in the Women's Community Centres, but there might be other things like mentoring, advocacy and Circles of Support, which some people might have heard of, which I think came from Canada originally, where you would have a circle of support around sex offenders, in particular, to provide them with human contact while also monitoring their risk in the community. That has been done occasionally with women. So that is what we would say.

Now, for those women on remand, bail is really important. There are different issues to do with granting women bail. We also have something called the BASS scheme (which is alarming in that nobody seems to know about it), which is funding for accommodation and other kinds of support for people who might be kept on bail to try and remove the damage that occurs when they are put on remand. Mike is the expert on that, if anybody wants to know about bail.

As Caroline said, most women's prisons offer a range of activities and interventions aimed at addressing the women's needs. We produced a poster for staff showing the range of needs and giving examples of how they can be addressed. It shows how the majority of women have a whole range of needs but some have greater needs requiring more specific, or more intensive interventions, but there are only a tiny number of women who are incredibly dangerous, and are a very challenging group of women to work with to reduce their level of risk. They do exist in the women's estate. There are not many of them, thankfully.

I just want to say a word about trafficking, as an example of a new issue for us and one we are dealing with at the moment. There is research going on right as I speak about the number of women in prison who are actually victims of trafficking, and quite often they're involved in sex work, cannabis production, which is a big one, or servitude/slavery, and they often get into prison through a variety of means, often through vulnerability. What often you do find, though, is that sometimes the people in charge of these criminal activities are also women who probably went through the same things themselves and had kind of come to accept that that is how it is. So, if you find women that you suspect of being trafficked, it is worth doing some investigation and getting some advice, and we know that they may well be in very poor homes and may be very frightened and very reluctant to seek help and have a total lack of control. Language is obviously an issue, and this is a big learning exercise for us really. I mean, with managing foreign nationals often what you do is put women together with other women from the area they have come from, so if you have a whole group of Chinese women, for instance, in a prison, or Serbs, you might want them in the same prison, you know, to help each other out, and often if you're not careful you use individuals for translation purposes and we've been in situations where we have actually found out that some of the women there have themselves been perpetrators of abuse.

It seems a strange place to leave it, but I think that is where we will leave it. So thank you very much for listening. (Applause.)

Discussion

The President: Barbara and Caroline have said they are willing to take questions. If you want to ask a question, would you kindly give your name and whether you are medical or legal, or neither? Thank you very much.

Mr Slee: Richard Slee; I am a surgeon and I have been a member of this Society for quite a long time and I have been to a lot of meetings. Can I make a slightly outrageous suggestion to you? If you isolate men and women in these separate prisons that in itself is a terrible punishment; to cut-off communication with the opposite sex is punishment in itself. I believe in Holland, for example, they build men and women's prisons adjacent to one another and they allow association during the day. So men and women have a good effect on one another. I've not done any research on this, nor am I a psychiatrist, but it does seem to me that the whole Prison Service is very cruel in the way it operates; it hasn't changed since Victorian times. Okay, they have offended, but to remove someone from 50% of society and lock them up I think is outrageously cruel. I don't know if you have any comments on that.

Ms Treen: Well, one thing I would say is that we have lots and lots of male staff in women's prisons and women staff in male prisons now, and that is actually quite comparatively recent, and we try and keep a basic ratio of 30–70% of male staff to women staff in women's prisons, and that is actually contrary, I think, to other European countries that don't approve of it at all. In fact, I think we were asked to sign up to something that would say we would never have male staff in women's prisons, because obviously there is potential for abuse by male staff on women prisoners, and that's happened certainly in some cases. But one of the reasons for doing that is normalisation and actually the really good, powerful opportunity of the positive male role model for women who may not have had any before in their lives. That is one thing that we do. But, yes, it is an issue. I mean, the whole issue of conjugal visits comes up regularly every few years and then there's a kind of little flurry of activity and people try and look at the case again. That hasn't arisen recently at all. So it is an issue. I mean, there is a place that has got a women's prison next to a male prison. In Peterborough it's a split site, but they don't have contact, and there have been all sorts of issues about a vulnerable women population and a less vulnerable male population in proximity. You know, there is nothing wrong with it in principle, but there would have to be lots of careful supervision to make sure that wasn't the case. I know this does exist in the high security psychiatric estate, doesn't it, in some places, where there must be safeguards put in place. I mean, in some prisons we do have male prisoners interacting with women prisoners. In the open estate, for instance, we have men employed sometimes in gardens and on ancillary duties in women's prisons. The interesting new thing, of course, is that we do have quite a lot of transgender prisoners, who may be various degrees down that process, in the women's prisons and male prisons who wouldn't have been there in years past.

Ms Stewart: Again, because of the relatively small numbers of women, we would need to manage that situation very carefully, because I think there would be nothing worse than having a very small group of women in a large prison with hundreds of men. We have six women for every 100 men. I think there would be issues there about vulnerability and about the potential for exploitation as well.

Mr Slee: I wonder who would exploit whom, with six women to 100 men.

Ms Stewart: Who exploits who, yes.

Ms Treen: There have in the past been prisons which have had small women bits. It is the same in Scotland. There are a couple of women's units, other than Cornton Vale, which are in male prisons. It has not worked well at all for us in the past and there have been very, very critical inspections, and what often seems to happen is, if you have a very small unit, it becomes very claustrophobic for women and it gets completely overlooked because of the security needs of the greater male population. They actually become more vulnerable, and again there were a series of deaths in Durham where that was the case. So it is not something that tends to work well, men and women held together, though it's working okay in Peterborough now, I think, but it took a while. Of course what we do is to provide visits and videolinks and quite often we have men and women prisoners visiting each other on accumulated visits, and that kind of thing. But, yes, it is a significant punishment.

Ms Lynch: I am Selina Lynch; I am a Coroner. I wanted to ask you about one of your slides where you deal with your concern about risk of harm to others, including children, and I was struck by that massive figure of 17,700 children, and I calculated, although my maths isn't very good, that that means something just over 16,000 are not kept at home or looked after by a partner. I know you gave us lots of statistics, but I wondered what the statistics are about those 16,000 who presumably will go to extended family, into care or for adoption perhaps, with women with long sentences, because one sees immediately that's 16,000 people who are going to be stuck in that cycle, with more risk of offending themselves in the future.

Ms Stewart: We did some years ago look at this in the context of another piece of research and it was quite interesting how few – I can't remember the exact numbers – but how few of the children were formally in care and how even fewer of them were adopted, though there are significant numbers. The most common arrangement was to be taken either, where there was a partner, by the partner, but often by a mother or a sibling or another extended family member, or even by friends who just found themselves with the children and they just stayed there, and the issue there is about whether they make any formal arrangement out of it; many of these families don't, and you wonder why not, because if you are formally fostering, then obviously there is a financial benefit to that and you will actually be remunerated for that, but of course to be accepted as a formal fosterer you have to be accepted and screened and the Social Services will be looking at every detail of your family life, and the mothers, daughters, other sisters, you know, really don't want to undergo that sort of scrutiny. So probably the largest single group are the children who are looked after by other family members or friends in a completely informal way. Several of the charities we work for, Action for Prisoners’ Families and PACT, are very concerned about this whole issue about who should care, because nobody knows that it's happening or where it's happening.

Ms Lynch: That is really what my question was. What are you doing to deal with that risk, or can you ask any other agency to manage that risk, if you think it is a risk that is a matter of concern, which you clearly do?

Ms Stewart: It is difficult to understand why we don't have a simple answer. The prisons don't actually know exactly how many children or who has children, it is dependent on the person disclosing that they have children. So for the prison system to actually discover that information with any degree of accuracy at the moment is well-nigh impossible. The group who have responsibility for family policy are looking at that and have been addressing that issue, because it does seem like the most obvious starting place, because we have the parent in prison, to get those routine regularly answered questions. PACT, the group I mentioned before, is actually working quite hard at the moment to promote the idea of doing a family impact assessment at court any time a woman is likely to be sentenced and this, if that were enshrined, might be a mechanism for actually identifying where these vulnerable children are.

Ms Treen: There is no legal requirement at the moment for an agency to tell any other agency that there are children with parents in prison, unless they think there is a child at risk; that is how I understand it; but we do ask women when they come in if they have got children. Some say yes, some may say no. Some people will say they are primary carers even though actually the kids have been with the grandparents for the last 20 years because of their drug problem, and others won't say at all because they're convinced Social Services, as soon as they hear, will whip the kids off. So these are all approximate figures and up until recently we never even collated those, so I think under the new computer system we at least will have a figure, but the figures we produce are kind of ones that have, I think, come out of needs assessment in the individual prisons over the years. It is a huge issue and I will tell you, we have a small number of Mother and Baby Units and only 77 places in the country for them. What is very sad is you often get mothers asking to have their babies with them in custody and they've already got three or four kids taken into care, but because they're in prison and they have come off drugs they now want the opportunity to prove they can be a good mother, and of course that isn't what the Mother and Baby Units are for; they're just for holding women who are already capable of being good mothers. We can't train them how to be good mothers, and that is very sad really for a woman who now sees an opportunity to become a good mother.

Ms Wakeling: I am Anne Wakeling and I am a prison visitor. I would like to know a bit about categories. If women's prisons and women prisoners are not categorised in the same way as men are …

Ms Treen: Yes.

Ms Wakeling: … how is it decided who goes where, because in my experience it doesn't work out there is enough access to their family?

Ms Treen: Because there are so many more men's prisons (150 or 140, something like that), you do have specialised functions. So, though you may have prisoners of a different category in each prison, mostly they will be the same category in there. They are B, C and D. D is open. Then you get category A prisons on top of that who are in what is called the “dispersal estate”. Women's prisons just have open and closed now.

Ms Wakeling: Yes.

Ms Treen: But there are some women that achieve Restricted Status and they're the high security equivalent to A, women that can be held in the women's estate. So there are particular prisons where those are held. In practice, because of the geographical spread, most of them do hold most types of women. If you had more specialised functions, if you had like a category C prison, you wouldn't have another prison in that whole area, so you would have to hold people out of area. So that is part of the reason for doing it. In fact, we did briefly have what they called semi-open prisons, which we did away because it was very confusing: if some of these people are for semi-open aren't those people for open, or is that the same as closed, so we changed those to closed prisons to enable more women to be held there that needed to be held there. So you can hold women and men in prisons that officially are higher security than they need. So in a prison, for instance, like Drake Hall, up in Staffordshire, which was a semi-open but is now a closed prison, you also may have prisoners who have broken licence conditions; it just suits them to be in that area. So what drives where people end up is purely the population demand and the capacity in that particular area. So, for instance, the prison at the moment with the highest turnover – it's like a couple of weeks – is Eastwood Park, near Bristol; there is no other prison at all in the South West and no prisons in Wales, so consequently they have got a massive turnover. That prison needs to be bigger or there needs to be more capacity in that area, and we have got prisons at the other end of the country where they haven't got a natural population feeding them, so we have to ship in prisoners from other places to take the capacity out.

Ms Wakeling: I visited one woman whose husband had just been diagnosed as being terminally ill and she has been moved a hundred miles away from home.

Ms Treen: Oh, right. I could talk to you afterwards about why that might be the case. I mean, obviously, if that was known to the prison, they would not normally do that, unless there were other reasons, I suspect.

Judge Michael Brooke: Michael Brooke, lawyer. I heard earlier this week, at an NHRC training session, a forensic psychiatrist saying he was puzzled at the discrepancy between the number of women with personality disorders self-harming and the high rate of transfer to hospital on a Section compared with the very low rate of similar personality disordered men self-harming who are just retained in the prison system. I wonder whether you have been struck by that and whether you have any observations on that.

Ms Treen: What we see in the prisons is women who are very, very sick indeed not shifting for weeks. I mean, it is better than it was, but we certainly don't see women just with a personality disorder and a self-harming problem being taken to hospital so often, I would say.

Ms Stewart: No. If anything, we are anxious for more women to have a hospital placement. So our experience isn't that women are particularly well served at the moment, I am afraid, and we also then have women who have been to a hospital and then have been returned to us as untreatable, or the hospital has done as much as it could do for them, and when she comes back to us she clearly still has a lot of problem behaviour and a lot of problems.

Ms Treen: It might be to do with not screening for personality disorder. We know that enormous numbers of women, in particular, have personality disorder and it will only come up as a problem depending on their severe self-harming behaviour; or there are, you know, other issues or other mental health problems, all these other things that can come to the fore. So it might be that they're not noticing some of the men with personality disorder and it is not seen as such an issue. I mean, the management of self-harm in a male prison is completely different than in women's prisons, and out of 300 men you could have maybe five on what we call “an ACCT”, which is a self-harm supervision system, whereas in a women's prison of 100 you could have 20 or 30 on “an ACCT”. Certainly most women that self-harm (full stop) with a minor personality disorder do not get transferred to hospital.

Mr White: My name is Anthony White and I am a Consultant Rheumatologist. Before I went private from the NHS I was a Consultant to the Royal Free Hospital and Whittington Hospital in North London and I had a number of experiences of visiting prisons, because there was at the time an obligation on prisons who wanted a specialist opinion on one of its inmates to apply to the nearest hospital geographically, and it so happens that the Whittington Hospital is ideally placed to both Pentonville and Holloway. In those days it was a semi-autonomous service; it wasn't part of the Health Service, as it is now; and I was struck by the omission almost completely in any of the slides (at least, those I was able to read) about physical illness, apart from migrants, and of course prisoners are just as likely to have any of the diseases that anybody else in the population might have, but what happens to them in a prison situation is often very different. I am reminded of a particular lady who, embarrassingly for me, had the surname White, although she was a black lady, and she was a very successful dealer in drugs and she used to get very short sentences. I got called in to treat her really quite bad rheumatoid arthritis and by the time we'd managed to get something set-up to treat her in prison she was out, and before you could do anything about sorting her out in the community she'd re-offended and had moved back in again, which was, you know, very frustrating for everybody concerned. I don't think it ever got solved, at least not in my time. The other thing is you were talking about risks. I suspect there may be risks to people who visit prisons, too, from time to time. I know that it was possible for people to come to our outpatient department to be seen, but the problem with that was that the male offenders from Pentonville usually came shackled, with jangling chains, and the managers insisted that we saw them before the other patients because their presence in the waiting room terrified the other patients. That was unsatisfactory, so it was better for us to go to them, and sometimes that was quite alarming. There was a lady who I was sent to a room to examine, there being no couch and most of the furniture was screwed to the floor, which was a bit worrying to start with, and it wasn't until I had finished making my assessment and I came out that one of the Prison Officers said to me with great glee, “Oh, I suppose you didn't know that she'd murdered her boyfriend”, which was really a little curious. You know, one wasn't given any sort of warning as to what the person was in for. So there are several facets to all of this which didn't figure in your presentation, although it was an excellent presentation and I thoroughly enjoyed it.

Ms Treen: You are quite right. I suppose partly it might be because, as managers, we have to deal with the behaviour and it's the NHS that has to deal with the illnesses, but women, particularly women coming into local prisons, they really are a mess; they've got abscess history, drug use; they're emaciated, they look like famine victims; they haven't been through any health checks ever probably and, you know, their teeth are falling out, it's really very bad, and of course a lot of them are pregnant for good measure, so they've got really significant health needs. I mean, in women's prisons that have got any kind of inpatient – they don't call it inpatient, but health-care beds in prisons – they're nearly always full of women with mental health problems. You know, it's very unusual to see somebody with a broken leg, or something. So that is the case; women are pretty physically unfit.

Ms Stewart: On the point about you didn't know that she'd murdered her boyfriend, or whatever, I think that probably what needs to be done is a sort of risk assessment in terms of your safety and that the proper precautions should be taken, but I think you don't necessarily need to know what the offence is, because probably at no greater risk than anybody else, given there may have been other factors in that offence.

The President: Shall we take one last question. Are there any other questions?

Mrs Brahams: Yes.

Diana Brahams, lawyer. Thank you for your talk. With the high proportion of women with mental illness, it does seem to me that people are in prison when they should probably be somewhere else. Is that your view, that we are really containing these people and they are not actually getting proper treatment, and probably there could be admitted patients? Are you able to predict who is going to finish up there at a much earlier stage, given all the predictors you put up on the screen?

Ms Treen: Yes.

Mrs Brahams: Should you be taking steps at an earlier stage to try and avoid these people finishing up where they are, which sounds to me to be quite inappropriate anyway?

Ms Treen: It was certainly recommended in the Corston Report. That is exactly the case; we're holding women who shouldn't be in prison, and certainly anyone who works in prisons sees women with complex problems and histories of mental health problems and learning disability; you name it, they've got it; and we know it's a big risk factor. If you've got a parent in prison you're more likely to have a mental illness, eventually you are more likely to go to prison yourself; those risk indicators are there; that's what you get into – it's not our job as NOMS, but someone needs to deal with trying to support problem families and children at risk. The earlier you get to people the more preventive action you can put in. It is likely to keep people out of prison later on. There is pretty much a direct correlation, I think.

Ms Stewart: I think there is work going on at the moment to identify the opportunities for diversion of women, and any offenders really, at various stages along the process of the criminal justice system.

Ms Treen: Yes, including a commitment to bring in diversion from court from 2014, I believe, for everybody. Our concern there is that it might be for people with diagnosed mental illness, just straightforward mental illness, rather than the whole myriad of personality disorder, behaviour problems, and everything else like that. So we would like to divert women at that stage to support in the community, such as the women's centres, that can actually offer them a kind of holistic type of support.

Ms Stewart: That is the point I was making; the bar might be too high for access into that scheme, so you do, yes, divert a certain number of women, but we're still left with a significant proportion who have clearly got a myriad of needs but the level is not quite severe enough.

The President: Well, on that note, thank you very much, and I would like to call on His Honour Judge Michael Brooke to give a vote of thanks.

Judge Michael Brooke: Well, thank you very much. I think we were all struck by the 17,500 children a year separated from their mothers and the implications of that for what was described as the ongoing cycle from generation to generation. On the other hand, you said prison can be restorative, and I am sure it can be, and that there is enrichment in prison and I am sure that a lot of good work is done there. It was a fascinating talk. Thank you very much indeed. (Applause.)

The President: As is our tradition, I would like to present you with a small token of thanks from the Society. We don't offer great remuneration, but your contribution was very gratefully appreciated and thank you very much.

Ms Stewart: Thank you very much.

Ms Treen: Thank you.

Note: The views expressed here are those of the speakers [authors] and do not represent official NOMS policy.