Prison welfare: making it impossible to kill yourself
by Cate Hennessy
“A prison that focuses on needs and strengths would mean we would have a whole new prison system.” – Kim Workman, Director Rethinking Crime and Punishment.
A major goal in New Zealand’s suicide prevention action plan is reducing access to the means of suicide, particularly in prisons, where hanging is a commonly used method.
But there’s one organisation that believes some prisons are being too myopic in focusing on this goal alone, at the expense of promoting the mental health and wellbeing of prisoners – the ultimate suicide prevention tool.
Rethinking Crime and Punishment is a strategic initiative to increase public debate and discussion about the use of prison and alternative forms of punishment in New Zealand. Its director, Kim Workman, believes New Zealanders need a better understanding of how our criminal justice system works and how well it’s working by promoting transparency and accountability, and encouraging active community involvement and engagement.
Prison population increasing
New Zealand’s current prison population is approximately 9,000 people, and the imprisonment rate has increased by 53% in the last decade. In the western world, New Zealand is second only to the United States in the rate at which it locks people up.
Kim, director of Rethinking Crime and Punishment, says because numbers have increased so rapidly, basic conditions have decreased.
“This is recognised in the National Health Committee’s 2010 Health in Justice report,” he says. “It paints a pretty miserable picture of health in general, and mental health in particular.”
Some of the issues picked up were prisoners double-bunking, being locked in their cells 20 hours a day and not being allowed to exercise or participate in other activities. Kim believes these infringements to people’s human rights are a mental health issue as well, and tend to aggravate and cause mental health issues, such as depression.
Suicide in prisons
Although even one death is a loss, given the size of the current prison population the rate of suicide among New Zealand prisoners has remained relatively low since it peaked in mid 1980s. The highest in more recent years was in 1994, when there were 10 suicides.
However, according to Kim, the issue is not the number of suicides, it is how self-harm and suicidal behaviour is addressed in prison.
“What is happening is that prisoners are being monitored and medicated, but their issues are not being treated.
“There is a difference between treating a prisoner and ‘managing’ their behaviour. Our research has found that in most prisons self-harm is ‘managed’ by physical isolation, having a cellmate that can ‘sound the alarm’, or by chemical means.
“In the most extreme cases of mental distress, prisoners are moved to special units such as Auckland’s Mason Clinic and the Henry Rongomau Bennett Centre in the Waikato.”
Kim says there is a lot of effort put into physical prevention but not so much effort is put into mental wellbeing – “which is what we would want to see”.
Kim’s colleague, research advisor Catherine McCullough, agrees. She says while custodial prison staff receive some mental health education, the overall approach taken is ‘I am going to make it impossible for you to kill yourself’.
“They will remove the physical dangers, such as shoelaces and belts, but are not able to build up mental wellbeing. This is as far as they are able to go unless we have a massive shift in how we think and manage our prisons.”
Challenges and benefits of promoting wellbeing in a prison
Rethinking Crime and Punishment works within prisons with prisoners to support and educate them about keeping mentally and physically healthy. Kim says what he sees happen sometimes is quite extraordinary.
“One man had a head injury, which made him violent and difficult to manage. He joined the choir in our group and was difficult to begin with. He sang with a tea towel over his head and with his back to the crowd.
“Then he began to relax. After a few months, he decided that he wanted to come off the medication he was on as it was making him very sleepy.”
There were some concerns this would exacerbate his behaviour, but Kim says he was no bother.
“He managed his impulses and two months later he was leading the choir. He went on to lead an exemplary existence within prison and when we checked on him a couple of years later, he was still doing really well.”
Catherine says there are many barriers in place in prison preventing good mental health.
“Access to basic needs such as exercise, sunshine and contact with loved ones is difficult in the custodial prison environment that exists in New Zealand. And if you are in a stressful, degrading and non-therapeutic environment, your mental health deteriorates.”
Kim believes that wellbeing in prison needs a public health provision rather than individual treatment based on self-diagnosis or self-identification – “but that is reliant on the availability of funding”.
Kim believes health provision in prisons should occur within a pro-active public health framework, rather than relying on prisoners to report illness, in the expectation that the system will respond. However, that would be reliant on the availability of funding”.
He says given the opportunity to address their mental and physical health issues, lots of prisoners are interested in making a permanent change in their lives.
“Seven years ago, when we offered the QUIT programme to prisoners, one third took up the offer. When prisoners are concerned about their health, they will take whatever opportunities are on offer to maintain a healthy lifestyle.”
“Those that come from very poor communities often expect their health to be poor – they don’t know what good health feels like because they’ve never experienced it. Once they start feeling well and realise how good it feels to be healthy it can be a trigger to address other issues.”
The benefits of promoting wellbeing are huge.
“If you can deal with mental health issues in prison then you can reduce incidences of mental distress within prison,” Kim says.
“A prisoner’s mental health is often one of the factors that leads to further offending. Good mental health also makes for successful reintegration, and can reduce considerably the tensions that often exist within the family and whanau, and the wider community.”
What next?
Kim suggests we should be taking our lead on how to improve wellbeing in prisons from existing international models.
“The World Health Organization’s Health in Prisons or Professor Andrew Coyle’s A Human Rights Approach to Prison Management developed at the International Centre for Prison Studies could provide a guide."
“The basic question we need to ask is whether it is necessary to send people to prison? The evidence would suggest that community based treatment is better.”
Catherine adds, “We need to think about who we are angry at and who we are afraid of, for example, sociopaths, psychopaths. Prison is not the place to ‘teach people a lesson’ and even for the people who are the worst of the worst, there are ways of running a prison humanely.”
Did you know that:
- New Zealand prisoners are charged $1 per minute to make phone calls – a deterrent to keeping in contact with their families.
- New Zealand prisoners tend to lose their rights as citizens - most recently, the right to vote.
- In Scandinavian countries, the focus is on keeping people in their communities where possible and to provide treatment for any alcohol and drug or mental health issues instead of sending them to prison. Those who are sent to prison can be sent to either a 'closed' or 'open' prison. While 'closed' prisons are similar to what we have here, open prisons allow people to leave the grounds for work and other appointments (eg, doctor's visits) - returning to prison at night.
- There are programmes, such as at the Samaritan’s Prison Listener’s scheme in the UK, which promote wellbeing by teaching prisoners to listen to each other.
