Why prisons should be run
on therapeutic lines
1. Rates of childhood trauma
and personality pathology in
prisoners are equivalent to
those of psychiatric in-patient
populations
Psychosis – 4-10%
Major depression – 10-12%
Neurotic disorders – 6-60%
Substance use disorders – 21-
73%
US studies – serious mental
illness in 10-25% of prisoners
Childhood trauma
 HMP Cornton Vale (Hooks, Perrin, Treliving,
2011)
 Emotional abuse/neglect – 80% (33%
severe/extreme)
 Physical neglect – 92%
 Severe/extreme CSA – 33%
 All types of severe/extreme abuse – 25-33%
 Female prisoners
 US – physical or sexual abuse in 38%
 Canada – CSA in 50%
 Personality disorder
 Community – 4-16%
 Psychiatric out-patients – 25-31%
 Psychiatric in-patients – 65-90%
 Prisoners
 Antisocial PD – 13-37%
 Female US prisoners – BPD – 35%, ASPD – 44%
 HMP Cornton Vale – PD – 90%, BPD – 53%, ASPD –
52%, both – 37%
2. Therapy works
-
 1793 – Philippe Pinel unchained his patients at
Bicetre
 1801 – “le traitement moral”
 1874 – “the rest cure” – Weir Mitchell
 Relationship between therapist and patient as a
therapeutic tool
 1896 – “psychoanalysis” – Sigmund Freud
 1942 – “therapeutic communities” – Tom Main
 1967 – cognitive therapy – Aaron Beck
 1969 – attachment theory –John Bowlby
 1993 – dialectical behaviour therapy – Marsha
Linehan
 2003 – schema therapy – Jeffrey Young
 2004 – mentalisation based treatment – Bateman
and Fonagy
this is no longer
something we can do
nothing about!
 Therapeutic communities
 4 principles (Rapoport, 1960):
 Democratisation
 Permissiveness
 Communalism
 Reality confrontation
 Effectiveness
 Lees, Manning Rawlings (1999)
 Meta-analysis, 29 studies (10 RCTs)
 OR 0.57 (upper 95% CI 0.61)
 “very strong support to the
effectiveness of TCs”
 HMP Grendon
 1962 – experimental project
 235 cat. B male prisoners
 5TCs, 1 assessment unit
 Prisoners tend to be ‘high risk’
 Minimum 24 month stay, go voluntarily
 Large and small group work
 Inmates organise and run groups
 2 studies:
 Marshall (1997) Taylor (2000)
 700 prisoners
 2 control groups
 Waiting list
 General prison group
 Reconviction rates lower for those who had >18
months Rx
 Reduction in violent and sexual reconviction rates
 Low rates of violence and self-harm in the prison
3. Workable therapeutic models are
possible in secure settings
 In prisons, some modification of the
traditional TC model is required
 HMP Grendon (Cullen, 1997)
 Inmates have the power to make or influence
certain decisions, but not those that would
compromise security
 Deviant behaviour is addressed by the small
group and fed into the therapeutic process
(instead of being tolerated or punished)
 Communalism remained largely intact
 Confrontation is often done in a more direct
way
Now several prison based TCs
in England
HMP Dovegate (200 men,
4TCs, 1 assessment unit)
HMP Gartree (23 men, 1 TC)
HMP Aylesbury (22 young
offenders, 1TC)
HMP Blundeston (40 men, 1TC)
HMP Send (40 females, 1TC)
 Modified approaches (“TC light”?)
 Milieu approaches
Psychologically informed
environments (PIEs)
 No set definition
 The approach of the staff is informed by
a psychological theory which feeds into
the social environment
 More flexible than a traditional TC
 Based around reflective practice
 Staff training and supervision required
• Psychologically Informed
Planned Environments (PIPEs)
Specifically planned environments (e.g.
prisons) where staff have additional
training to develop an increased
psychological understanding of their work
• Recognise the importance of relationships
and interactions between staff and
prisoner
• Allows opportunity for all interactions to be
considered in a psychological way
• Currently 6 pilot PIPEs across English prisons
•