Making space for mental health care within the penal estate

Abstract

In this paper we explore the enfolding spatialities of control and care within the penal estate through analysis of the creation of a unit for prisoners with serious mental illnesses (SMIs). Prisons have increasingly become the key institutions for mental health care provision, yet serious mental illness disrupts the self-government upon which contemporary prison regimes are based. Our analysis highlights the 'trouble' institutions face in making space for mental health care; in trying to fit different control-care regimes into existing carceral environments. We argue that the different actors that have made space for this control-care have been open to potentiality. Developments have been experimental, emergent and incomplete; often not officially challenging wider institutional processes, but eluding them. What emerges is an institution within an institution with a certain level of spatial autonomy but constrained in its transformative potential.

The Development of a Prison Mental Health Unit in England: Understanding Realist Context(s)

“…There is a clear need for sufficient dedicated officers to be identified to work on the unit so that the regime can continue uninterrupted and without the need to use officers who would normally work elsewhere in the prison such as the Segregation Unit. Changes in prison personnel can cause substantial disruption to the therapeutic regime that has been implemented on the unit (Cassidy et al, 2020). This regime should be configured as a therapeutic environment, including positive relationships and interaction with patients, time out of cell, and meaningful communal and social activities.…”

“…This article analyses the findings of this first phase review of process and provides an understanding of the context(s) within which the ISU, as an intervention, generates particular outcomes for particular prisoners. The ISU as a micro-level initiative exists and operates within the UK's multi-scalar systems of confinement and care (Cassidy et al, 2020). This means that impact is both complex and emergent (Byrne, 2005(Byrne, , 2013Williams & Dyer, 2017).…”

“…Mentally ill prisoners pose challenges to the organization and delivery of appropriate healthcare within the prison setting, and more widely in the health economy (Cassidy et al, 2020;Crichton & Nathan, 2015;Walsh & Freshwater, 2009). At the same time, a number of contextual issues have compounded the problems in meeting such high levels of complex need.…”

Highlighting “Risky Remands” Through Prisoner Death Investigations: People With Very Severe Mental Illness Transitioning From Police and Court Custody Into Prison on Remand

“…Prison is not, and cannot be a substitute for or safe pathway into secure healthcare. Questioning the appropriateness and highlighting the implications of people with severe mental illness at the time of their offense and remand entering prison in the first place serves to problematise recent scholarship on prison mental health, including e.g., spaces of potentiality for prison mental health care (63); the potential of trauma-informed practice in prisons (64); transfer times from prison to high and medium security psychiatric care (65); and the "success" of liaison and diversion services (30,31). Although prisoners may develop (more severe) mental illness whilst in prison, and should of course be provided with appropriate care and promptly transferred to hospital where required, this scenario should not be equated with people with very severe mental illness at the time of their alleged offense and remand entering prison in the first place.…”

Practices of Care in a Multipavilion Prison: An Exploratory Study on the Role of the Built Environment

“…Environments with varying institutional backgrounds, punitive or not, “indicate the intricate nature and complex lived reality at a nexus of care and control” (Disney & Schliehe, 2019). In various contexts from residential care (Repo, 2019) to imprisonment (Cassidy et al, 2020), this nexus transcends therapeutic practices and is enacted through the built environment (Emmerson, 2019).…”