Official Report 298KB pdf
Under item 2, the committee will take further oral evidence in its inquiry into female offenders in the criminal justice system.
I will answer first; Ruth Parker could then perhaps continue.
Do you see any initial barriers to achieving that intention? What, if anything, gets in the way of achieving the results that you would like to see?
One factor is the burden of the problem. Drug problems are almost universal and the vast majority of offenders have a mental health problem. We are geared up to appreciating the burden of care need, but the women's needs are complex and are not necessarily well articulated or easy to tease out, because they come along with other expressed needs, such as housing needs or despair. Problems are not just crisply expressed as mental health and addictions.
Are prisoners compelled to undertake programmes?
Fundamentally, no. The punishment is going to prison. Prisoners are entitled to care—we have an inescapable duty of care towards them—but they have the choice of whether to take up treatment options. We cannot coerce them, but an element of need must be addressed. Sometimes, prisoners cannot engage in mental health treatment because they lack insight or because they do not perceive mental health to be the major and immediate issue for them. If prisoners have severe and enduring mental illness—such people form the minority with mental health problems—their insight is impaired anyway. That is difficult to tease out straight away.
How far does that go? Does that constitute a lack of capacity?
Yes—it can.
We will ask specific questions about mental health later, so I will not go into that too much.
Dr Fraser said that a significant number of inmates have mental ill health. What degree of mental ill health would someone have to display to be placed in an environment for patients with mental health problems rather than in prison?
There are two broad types of mental health problem. One is severe and enduring mental illness, which is normally understood to be schizophrenia or psychosis—the two conditions belong together—or manic depression. That is characterised by a loss of contact with reality, a loss of insight and so on. That affects 6 to 9 per cent of women and 3 to 9 per cent of all prisoners—the figure is slightly higher among women.
The question was generic; we have questions on mental health that will cover the specific point later.
Perhaps I should keep my question until later; I realise that we will ask about mental health. My interest is in an issue that runs through the inquiry—forgive me for asking one question that relates to mental health, but it might not be asked later. Will you comment generally on the mental health profile of women in prison as distinct from men in prison? The committee has a running interest in the similarities and differences. If you give a brief answer on that, I will not mention mental health again until the appropriate time.
I preface my answer by saying that we have about 400 women in prison—the figure was 399 this morning. They are the most chaotic and deprived of prisoners and have the most multilayered experience of poverty and ill health. It is difficult to compare those women with 400 men in the prison service who are as chaotic. There might be 400 comparable men but, if we compare all women to all men in prison, we find that the women have much more profound issues and a common experience of mental health problems. Further, the reasons for those problems are more to do with being victims, experience of abuse and very poor past circumstances. It is difficult to give a clear answer on whether women have an even worse experience than men but, in general, they do.
That is helpful.
We are very interested in the mental health issues, which is why we will ask specific questions on that later.
Given the high number of women who arrive in custody with drug and alcohol problems, we want to encourage those individuals to work with us. We encourage them to access the services that are delivered through our national contract with Phoenix Futures. Through the induction process, all prisoners are encouraged to attend a harm reduction awareness session.
How are they encouraged?
As part of the national induction programme.
Are there specific incentives for people to attend the programme?
It is not a programme as such—it is an awareness session. Prisoners are encouraged to go to the induction to find out what services are available in prison. That involves introducing them to addiction services. We have a national contractor to provide services—Phoenix Futures—as well as various health services. The induction process is an opportunity for prisoners to find out what services are available in their prison, how to access them, what the criteria are—for example, the sentence range for prisoner programmes—and how to link in with services in the community, such as in-reach services and throughcare services when prisoners are on their way out. We encourage as many prisoners as possible to go along to the induction.
We will move on to that. You have answered the generic question about what the programmes are intended to do. Marlyn Glen will follow up on the extent to which they achieve success.
We are all aware that hard statistics are necessary to ensure that we secure resources. Is it possible to measure objectively whether your services have, over time, improved inmates' behaviour or attitudes upon release compared with their behaviour or attitudes on admission?
We conduct surveys of service use and uptake. In the case of substance misuse, we aim for free or stabilised status. We also survey the proportion of people who have substances in their system on leaving prison. There is a sharp drop in that figure compared with the proportion with substances in their system on admission: from about 70 per cent to around 38 per cent. I think that that is right.
That is the overall figure.
Mental health is a bit more difficult to measure, but we ask women whether they feel better about themselves when they leave than they did when they arrived. Early surveys considered men and women and showed that about 80 per cent felt better about themselves on release. However, it is not only about the effect of prison on mental health; it is also about the effect that the stigma of coming into prison and the shock of imprisonment may have on mental health.
To find out whether there was a long-term effect, you would have to do follow-up work on the same women.
Yes. So far, we have not done that; we have only considered reoffending rates. There are many influences on why people reoffend, never mind why they feel the way they feel, have poor mental health or use illegal substances. Because women's needs are multilayered, complex and often profound, it is difficult to tease out the major influence on how they get on after they leave prison.
Yes, it is difficult.
There are always things that we would like to do that we do not do. Looking at our performance internationally—which we do—we do pretty well. We are proud of what we try to achieve in Cornton Vale. It is a remarkable institution for its effect on women's mental health and its ability to address substance misuse.
What about the addiction side?
Dr Fraser touched on throughcare. For me, it is much more about working between prison and the community. We need to share information and ensure that our interventions are delivered not only in the prison but in the community so that we can continue throughcare. Work to enable that is on the horizon through the development of alcohol and drug partnerships in community justice authorities.
The committee has been told that many inmates, such as short-term and untried prisoners or women on remand, have limited or no access to services at Cornton Vale. Given the length of their sentences and the obvious pressure on prison resources, is it realistic to expect that short-term prisoners' offending behaviour can be challenged while they are in Cornton Vale? Could you give us some clarity about how long some women are in prison? How long is a long-term sentence, and how short is a short-term sentence?
The technical term "long-term prison" means a sentence of four years and longer; very few women are doing that. Forty per cent of women in prison on any one day are serving sentences of fewer than six months or are on remand. That is a big wedge of the prison population. That is on one day, but the turnover of that short-stay population means that those people form the substantial majority of prisoners in any one year.
I find it quite confusing that you cannot do much with short-term prisoners. I totally understand what you are saying about people who are on remand or untried and how they might not get a prison sentence, but if short term means up to four years, that could mean someone being in prison for three and a half years. That is quite different; it would seem to be a good length of time in which some work could be done.
Yes; sorry. There is a gap between the six months and the four years. Short-term prisoners who are serving between six months and three and a half years are offered a lot more than those who stay with us for very short periods. Ruth Parker can help us here.
When someone comes into prison to serve more than a remand period, for example, that is an ideal opportunity to offer routes into treatment and to encourage them to work with our services, and we do that. As has been said, we need to ensure that the women are motivated so that we get a positive outcome. We encourage them and explain the benefits.
Thank you.
The submission that we received from Families Outside refers to a pilot for a women offenders programme, which I believe was modular and specifically targeted at very short sentences. When people are in prison every day for six months, which is roughly 180 days, but we do nothing with them to address their literacy and numeracy, that is such a waste. When the Justice 1 Committee did some research on that, the conventional wisdom that resources should be targeted at people who are serving very long sentences was turned on its head; it should be the other way round. Resources should start to be piled into those people who are in prison every day for six months, although of course resources then become an issue.
In general, prisoners who are serving sentences of more than 31 days can access education and addiction services. The prisoner programmes have to be offered to people who are serving longer sentences, because the programmes are more intense and concentrate on offending behaviour. A programme needs to be in place for a long period if it is to have a positive outcome.
If interventions during shorter sentences are not being made, because they are not deemed to be worth while or because there are not sufficient resources, are you able to say that such interventions would not have a dramatic effect and would not help—if only as a signpost to other services?
We make interventions. As I said, there is a national contract for addictions; there is a similar approach to education. If an individual accesses a service while they are in custody we make the effort to link them up with services in the community, through our throughcare services.
Does that happen even if someone is serving a very short sentence? For example, would a person who was serving a sentence of three months have access to such services?
They would not have access to in-depth prisoner programmes, but if they wanted to access education awareness group work we would do our utmost to link them into community services, so that that work could continue.
If you had unlimited resources, what would you do differently, given the current prison population?
We would put greater investment into ensuring throughcare, in partnership with the NHS and other agencies, so that if we started a particular intervention we could be sure that it would continue when the individual returned to the community.
I reiterate what Dr Fraser said. A thorough assessment is required before many programmes can be accessed. We need the information that tells us whether a programme will be appropriate, particularly if it relates to wider offending behaviour.
I apologise if this question is naive, but is mandatory drug testing compulsory for people on remand and, if so, does that give you helpful information about people's drug use? Would it be helpful for disposals if compliance with a programme was part of the sentence and was reflected in the length of the sentence? Would a positive report from you about remand prisoners buying into programmes be an incentive for them to become involved in the various programmes to which they have access?
It would be helpful for prisons to have further background information from the courts on people's issues when they enter our custody and during the initial screening and assessment process. We carry out drug testing for three specific reasons: first, for clinical prescribing on admission—if somebody has a drug or alcohol problem, we carry out the appropriate tests in order to support them; secondly, to assess the risk posed in transferring individuals and to allow us to use negative tests to motivate individuals to continue to participate in prisoner programmes; and, thirdly, to identify the prevalence of drug use across the prison estate.
From what has been said so far, it is obvious that a number of our questions will be cross cutting. As has been said, many female offenders have multiple problems, such as drug and alcohol addiction and experience of sexual abuse. Naturally, therefore, working with other agencies is greatly to be desired. Are there barriers to sharing information with those agencies? For example, I do not know about data on prisoners who are patients. Is it difficult to deal with other agencies because you are institutionally not set up to do so?
Yes, there are barriers. To be candid, one of our frustrations is at the lack of information sharing. There are reasons for that, though, and I would never blame the Data Protection Act 1998 for anything. The Scottish Prison Service is a different provider from the NHS, so there is no automatic flow of health care information, for example. However, many women want a service, so they will disclose. If we have the patient's consent, there are no problems and off we go.
I will follow up on the throughcare element. Some of us visited the 218 centre in Glasgow. I was impressed by the set-up there, in particular for people coming in on a daily basis for support, treatment and care. Do you work closely with that organisation for people once they have been released from prison? I do not know whether this is possible under the remedies from the courts, but is it possible for those people to use the day care facility at 218?
I am not in a position to answer that. Lesley McDowall, who is giving evidence after us, will know what happens in that regard. My understanding is that, up until now, 218 has served as a disposal from the court, as an alternative to a prison sentence, so it is not a question of one and then the other. However, there is no barrier in principle to handing somebody on from one agency to the other.
To maintain the throughcare element, I was thinking.
That would be effective.
This is not quite on the same subject, but if there were more community prisons, what impact would the dispersal of prisoners have on the services that you could provide at Cornton Vale? Do you require to have a certain number of prisoners in the system to be able to afford the care that you provide at the moment?
The issue has come up on a number of occasions in previous evidence sessions, and I would subscribe to the view that there must be a balance between the scale of the operation that is being run and the menu of possible interventions on offer. The smaller the number of people in a particular women's unit, for instance, the greater the risk that the quality of the regime suffers and the breadth of what is on offer narrows, which would mean that it would not be possible to access the same opportunities that are available at Cornton Vale—the interventions are available in two places, but largely at Cornton Vale.
You will know the reason for the question. Some female prisoners have been transferred from Cornton Vale to Greenock. Inverness prison has also been used as a facility and, although it is not being used at the moment, it is maintained in case it is required to address any potential overexpansion in the number of prisoners at Cornton Vale. That might bring some of the people who are serving sentences closer to the areas where they come from, and it could bring them greater family support. Is that a good route to go down, or is it not viable, because it would make it impossible to deliver all the services that are provided at the moment in a centralised manner at Cornton Vale?
The answer to that is twofold. My understanding is that the decision to house some prisoners at Greenock to assist with overcrowding at Cornton Vale is based on postcodes. Throughcare services are therefore much more available to prisoners from that area. The throughcare links are beneficial. There is also a need for sufficient numbers to allow services and interventions to be delivered effectively and cost effectively in the unit. In the past, because individuals were not motivated enough to get involved in the programme and because, as a result, the numbers in the unit were very small, it was not always cost effective to deliver it. The number of people will have to be large enough to allow it to be delivered.
I do not think that the balance is as critical with health and addictions interventions as it is with other interventions. I am going a little outside my range but, in prisons, some of which such as Inverness and Aberdeen are really quite small, work-related and employability activities require women to work in groups separate from men. The security implications of such separation mean that the regime is limited. As far as health and addictions interventions are concerned, group treatments might well be missed out but, given that many of the interventions are on a one-to-one basis, there would be no detriment to women from living close to where they come from, no matter how small the unit might be.
I realise that the prison estate is limited by economic and other factors. I take it, therefore, that you do not believe that more staff resources would be available at Cornton Vale, which is the central prison unit, if there were more community prisons outside the central belt.
The truth is that women are very high users of services, which means that any dispersal will have an impact. However, given that at the moment we are talking about six, 12 or 18 prisoners—there might be more than that when Grampian prison is built—there will probably be no impact on the number of whole-time equivalent nurses, addiction workers and so on. There is a marginal effect on the resources that will be required, but it is not really measurable in terms of large numbers of people and support services.
You believe in principle that it is better for women to be dispersed to areas that are nearer to their communities and families and, indeed, that such a move would have the most impact on motivation and so on.
Speaking from a health, wellbeing and addictions perspective, I absolutely and definitely believe that. However, a balance needs to be struck when other elements of the regime come into play and there is a need to maintain women's safety and separation from the men.
Does the fact that some women simply do not take up the programmes create something of a chicken-and-egg situation? I wonder whether those women would have more motivation in a community setting, which in turn would address the problem of economies of scale.
I certainly agree, if they are supported and encouraged by their families to address their offending behaviour. As Dr Fraser has pointed out and as has been borne out by evidence from Cornton Vale, the majority of women need to be managed through one-to-one support.
That is helpful.
With regard to your comments on improving information flow, is this simply an information technology problem that could be sorted out by putting in a new system, which would obviously cost money, or is the issue more fundamental? I am interested, for example, in the pilot in Tayside, in which the police are bringing NHS medical teams into custody suites so that they can pick up records from general practitioners, find out information about medication that people might be on and so on. After all, we are not talking only about mental health problems; people might have other long-term health problems and require particular medication at particular times.
That is the direction in which we want to go and, ideally, such an approach should not stop at police custody suites but continue into prison. Of course, linking up the systems presents all sorts of technical challenges, but we have nothing against that if the interests of care are served. There are many reasons why that should be the case and why, given the patient's consent to share information, there should be no barriers. It is true that women have reservations about people getting to know that they have been in prison if we ask their GP, but many of them—particularly those who suffer from addictions and need to have immediate access to continuing addiction treatments—have an overriding need for intervention that means that they will see the sense in our sharing information. The practical effect of the barriers is not as great as you might imagine it to be.
A layperson would be surprised to learn that someone who was on continuing medication did not get access to that medication when they were in a police cell and, even if that were sorted out, did not get access to it in prison until they had been assessed and diagnosed again. Most laypeople would understand the importance of medical throughcare.
It defies logic but, as soon as someone is taken into custody, they disappear as far as the duty of care of the NHS is concerned, and the police's forensic medical examiners have to delve into the patient's health records, at the discretion of the NHS, to find out what has been going on. That has to be done, as they cannot necessarily take the patient's word for it with regard to what treatment they are receiving—you will know that people do not always remember the exact dose that they are supposed to be taking.
That is a massive problem. The committee has not touched on it to a great extent, but perhaps we should consider it in a bit more depth. When we visited Cornton Vale, we had a look at one of the cells that was adapted for prisoners with disabilities, and I was concerned about whether someone who was a wheelchair user or needed medication would be able to live as independently as others in the prison and be able to care for themselves and so on.
We are keen to do as much as we can for people who are disabled. It is also true that many of the people whom we have in prison have been with us before, which means that, in many cases, we pick up where we left off as we have their care needs in our own memory bank. However, it is sometimes quite a challenge to find out what has been going on with people who have not been in prison before as we have to start from scratch.
Do we know what the rates of reoffending are for the sentence groupings of offenders—those who receive sentences of less than six months, those who receive sentences of up to four years and so on?
Yes. Broadly, the longer people stay in prison, the less likely they are to come back. Why is that? Partly, it is an age effect. People who stay a long time in prison get older, and the older people are, the less likely they are to reoffend. Age is probably more important than the type of offence, in many cases.
As the convener said earlier, it seems that the repeat offenders are those who receive short sentences. It is therefore quite hard for us to see why those people would not be subject to more intensive work. I heard what you said about it being difficult to work with people whom you see for only a short time, but it strikes me as obvious that more work should be done with that group of people to try to overcome that.
You have heard in other evidence that people come to prison for various reasons. One of those reasons is that some people think that they will get a better deal in prison. In many ways, some people have an incentive to go to prison. I will not go into the reasons for that, but it is true for a certain section.
Would someone who received prison sentences of less than six months on multiple occasions—perhaps three or four times—receive little or no intervention work? I am interested in finding out whether the frequency with which people receive short sentences, with the result that no intervention work is carried out with them, might be a reason for their continued reoffending.
That could be part of the reason for it. We mentioned the need for people to be motivated and how we try to motivate people to get involved but cannot make them get involved. Some offenders opt out and just remain in custody without taking part in any intervention programmes, but that is not to say that we do not encourage them to do so. As part of our integrated case management, we encourage all prisoners to participate in interventions that will benefit them and meet their needs; all prisoners are offered such interventions. Each prisoner's record will say when they were offered an intervention, why they rejected it and what was done to encourage them to take it up. Regardless of their sentences, prisoners are offered interventions continually, because the same issues are identified through the needs assessment process.
That touches on Mr O'Donnell's question about whether that might become part of the sentence in future.
Through the throughcare addiction service, more work has been done on addictions than on almost any other work stream. Prisoners feel more confident about continuing with an addiction programme when they leave prison than they do about almost any other agency link-up, whether with housing, employment or health care. We could always do better, but our work on addictions is one of the better spots of light.
I have a question for Ruth Parker about throughcare. According to one school of thought, if we take people with a drug addiction away from where they developed that addiction, they have a better chance of keeping off drugs, being crime free and contributing. According to another school of thought, that is not really the case. Where do you stand on the issue?
There are issues associated both with keeping people in the place where they developed their drug problem, but where they have the support mechanism of family contact, and with moving them to another area. The individuals concerned must make a choice; some choose to move. When they do, we do what we can to support them, through various addiction networks across Scotland. There are hurdles that must be overcome in relation to housing, tenancy and accommodation. We must ensure that they have the stability to be able to move.
Do you have an opinion either way, or do you think that it depends on the individual?
It depends on the individual, who must make a choice. We can only advise them on how we can support their choice, help them to make the right moves and put in place the services that they need. We have done that in the past.
I asked the question because I have visited the 218 centre, which is firmly of the view that to move people away is not to address the problem. The centre thinks that, if people cannot return to the community and be drug free, they have not addressed their addiction. It makes the point that people's companions in taking drugs are not friends and that they would not spend time together if they were not linked by drugs. That diminishes to some extent the force of the argument that people must move away.
I agree with the point that you make, but sometimes individuals move not because they cannot address their offending behaviour and drug problem but because their domestic situation in the area may be the reason why they are taking drugs or alcohol. We must deal with the whole package and give people appropriate support and services to enable them to do that.
We must identify the underlying causes so that we can get to the root of the problem.
Certainly.
That is helpful.
Dr Fraser mentioned short-term sentencing, which we often term the revolving door. Is there any information on the revolving escalator and the extent to which disposals increase with the number of visits?
Are you asking whether the length of sentence increases the more often people go to prison?
I have some sympathy with your view on the value of short sentences. If someone goes to prison for six months and suffers the consequences of that short sentence, do you find that they later come back for nine or 12 months on an escalating basis?
Yes.
How common is that?
We get all sorts of patterns—you have described one of them. In the jargon, we sometimes say that people are serving life sentences in instalments for repeated petty crime. In many cases, an increased tariff is imposed for roughly the same or slightly more severe offending. Attached to that pattern are personality disorders and impulsive behaviour. My clinical colleagues try hard to motivate such people, but it is difficult to get behind their behaviour and to help them see that it is in their interests to clean up and to adopt a law-abiding lifestyle. Many take the view—they are being realistic, rather than fatalistic—that we should wait until people have got through their 20s, when they are old enough and mature enough to be told that there are other ways of living their lives. I hope that I do not sound fatalistic, but in many ways that is a classic pattern of repeated offending and increasing tariff that we see a lot of.
I observe that you have quite an age range of prisoners in Cornton Vale. To what extent do prisoners have input into the age appropriateness of any programmes and services that are offered to them?
I conducted a small study in which I asked older prisoners about their experience of prison, including a group in Cornton Vale who were in outstandingly poor health. Whereas the men marched or sauntered in, the women came armed with wheelchairs, Zimmers and so on—their health status was dreadful. There were very few of them because it is a small population, but the overall impression I got was that they did not want to be regarded as old; they wanted equal opportunities, regardless of their age. Although they displayed seniorship to the younger women—there is a mother-daughter relationship—they wanted to be part of an integrated community, rather than apart. Although they wanted to do age-appropriate things at quieter times, they wanted to be part of the mainstream of the community in the main part of their lives.
How did the younger prisoners respond to the same question?
There are more of them. In fact, prison is mainly streamed for the younger prisoner. The modal age is 23 to 25 and the ages of the rest of the prisoners fall on either side of that range. Prison is largely structured around the needs of that group, but that approach allows for a wide age range to be dealt with. That is a challenge, but most prisons manage it. We already have an age bar for younger offenders, but I would be reluctant to have a separate, higher age bar after which offenders graduate to yet another institution. The evidence is also against that.
On the same subject, what is your response to the recent inspectorate report on young offenders in adult establishments? It was my understanding of that report that things are worse for the young women in Cornton Vale, which does not have the special services for young people that male prisons have. The report seemed to say that things are worse for the young. Does that ring true in relation to Cornton Vale and the equivalent male prisons, or would you challenge it?
That takes us back to an earlier point that was made when we talked about community-facing prisons, for example in Aberdeen and Inverness. There are very small numbers of young adults at those prisons—eight non-convicted people under 21 and 26 sentenced young offenders. Again, with low numbers there is a risk of there being a poor-quality regime for those prisoners because of the general need to cater for large numbers within a tightly resourced envelope. We will have to address such risks as a result of the inspectorate's report, which was certainly a wake-up call.
Some addiction services that are specifically for young people—the enhanced addiction casework services—are delivered in those establishments. Regardless of which interventions are delivered, they are provided to meet the specific needs of a specific age group. For example, we make the EACS available to young men regardless of whether they are in Polmont or Friarton, which was one establishment that was highlighted. However, we do not have in place reporting mechanisms that tell us who are young people and who are adults, so we have a bit of work to do in that regard.
I want to move on to another area. Dr Fraser has clearly illustrated the difficulty involved in teasing out complex issues. It is our understanding that no speech, language and communication therapy services are available in Cornton Vale. Does that impact negatively on your ability to tease out whether people have difficulties in that regard? How easy is it for people to access the services that you offer, or even to express their needs? What is Cornton Vale doing about that lack of service?
I noted the written evidence from the speech and language therapists. It is fair to say that in an ideal world we could do more; we could have people from more disciplines coming into the prison and so on. However, other therapists who did not submit written evidence, such as occupational therapists and physiotherapists, go into prisons on an as-and-when basis. We have arrangements in place for therapists, mainly from the NHS but also from local authorities, to come in occasionally to help us meet individuals' needs.
I would have thought that someone's ability to engage in basic levels of communication would be critical in identifying their other needs. It strikes me that that would be a critical element in assessing incoming prisoners, so there should be a focus on it. You seem to be saying that speech and language therapy is part of a suite of services and that it is not in any way prioritised.
We have a lot of competing priorities, especially among the women. There are very high levels of need. I accept entirely that the issue that you identify is critical for some women, but we endeavour to address it through good engagement and good relationships. There is no doubt that therapies of various types could help us do better. We will try to improve in various ways, partly through the transfer of responsibility for health care to the NHS, and developments in speech therapy could well be a part of that.
I want to follow up what Hugh O'Donnell said. The fundamental point is that a person needs good oral communication skills if they are to take part in all the rest of the therapies. If someone is trying to express their needs, but they have difficulties with literacy, numeracy and communication, they will not want to engage, because they cannot hear or understand what is being said and they cannot explain their needs. The message that we are getting from specialists is that speech, language and communication therapy is fundamental and that, without it, some people will reoffend because they cannot engage with any of the services that are on offer.
That is a fair point, but we pick up people's speech, language and communication problems through a variety of routes, such as assessment, education, psychology services and so on—and we try to address them through various means, including therapy.
We will move on. Do you consider that there are some women in prison with mental health problems who should not be there?
Do you mean specifically from the point of view of mental health and mental illness?
I mean from the point of view that they have mental health problems that should be treated elsewhere, not in the prison setting.
Yes, there are a few. We have quite a good relationship with forensic mental health services. When we detect that someone has a severe and acute mental health need, they will be assessed and will go to hospital. My colleague Lesley Graham audited that area a couple of years ago. The delays are minimal, and the results are certainly better than those from studies in other countries.
Is there sufficient capacity outside Cornton Vale to deal with those prisoners? For example, in the case of violent prisoners, I understand that Carstairs no longer takes women prisoners.
Yes. Scotland has an appropriate level of provision. We have discussed long and hard whether we should have high-secure provision for women in Scotland, and the assessment is that we should not, but that we should rely on single-case referral to an English facility in the rare instances when someone requires high-secure care. The capacity for caring for women in the medium-secure and low-secure estate in the NHS in Scotland is adequate.
What proportion of the women that we are talking about could be treated in the community, and what proportion would need some supported help, whether in high-secure provision or in hospital?
We must bear in mind the fact that quite a small number of those women have severe and enduring mental illness. A large number of people with mental illness do not necessarily require in-patient care, in the health care sense; they require care in the community of varying levels, including quite intense care. The international statistic is that up to 12 per cent of women in prison require high levels of almost in-patient care for their mental health problems.
We understand from the written submissions that at least 80 per cent of the women in Cornton Vale have mental health problems.
Yes.
Of that proportion, how many should not be there? How many of those women could be treated in the community and how many would require support at various levels?
I am picking numbers out of the air. Broadly speaking, of the 70 or 80 per cent with mental health problems, 1 or 2 per cent should be in hospital rather than prison. A further 8 or 10 per cent would, I would hope, be satisfactorily dealt with in the community, highly supported by the NHS and other agencies. For them, their mental health problem is the more prominent problem—it is an offending problem. For the rest—the majority—their offending is more prominent than their mental health problem. The problems co-exist—they might drive the offending but they are not what made the person do the crime. It is a chicken-and-egg situation—it is sometimes quite difficult to detect which comes first. However, prison is there for people who have committed crimes, and one of the many complex problems that they have can be a mental health problem.
Are you saying that that is the case for about 11 or 12 per cent of the 80 per cent?
Yes. Their cases would be negotiable between the health and criminal justice sectors. The remaining offenders would definitely be in the criminal justice sector, although whether they should be in prison is another issue.
There is a concern that prison is an easy option when dealing with people with various problems such as mental health problems. We are not quite sure what to do with them, so we put them in prison—the figures indicate that.
I subscribe to that view and I am concerned about that, too. However, I think that the problem affects a minority of cases, not the majority.
In your experience, do some women with mental health problems experience a deterioration in their mental health while they are in prison, or do you think that the opposite happens because of the care that you provide for them?
It is a mixed picture. For many women, the experience of losing their liberty for the first time is traumatic, although it is less traumatic the next time that they come into prison because they know what they are coming into. The experience is more traumatic for women than for men because of their loss of place in their social setting. The majority also have children, and if there is one relationship that means a great deal to many women it is their relationship with their child. That should be a much more important consideration in sentencing decisions.
You talk about children in the context of whether prison makes the mental health of prisoners better or worse. What do you think might be the effects on the mental health of the children of prisoners?
The experience is universally devastating unless the relationship between the mother and the child is an abusive one, which it is in a small minority of cases. Lesley McDowall could talk to you about that. The experience is dreadful for a child who cannot understand what has happened. Often, the women are young with very young children and it is not a situation that can be explained to the children, as they are below the age at which they could understand it. A substantial number of children lose their mothers to prison each year—the number runs from three figures into four figures. That is a remarkably damaging statistic for which prison is responsible.
Is any help offered to those children at the time?
Families Outside does a great deal to ameliorate the situation, but the majority just have to get through it. The children go to live with their grandparents or their aunts or they go into care. A very small minority—about 11 per cent—go to live with their fathers. Often, that happens at very little notice.
Is it possible that such a traumatic experience can affect the offending behaviour of those children when they are older?
Definitely. I cannot enumerate that, but there is definitely a possibility that it can create another generation of offenders.
Would you say that it is important to provide a more effective system of help for those children when their mothers are jailed?
Yes. That is paramount.
I want to ask about medication. The committee has been told that there can be a delay between women coming into prison and contact being made with their general practitioner to obtain details of their medication needs. Are there any means by which inmates' medication needs can be established more quickly, so that there is no risk of their health being jeopardised?
The current process is a facsimile process, as a paper trail is needed for prescribing decisions; however, it is slow and cumbersome. A quick response is sometimes received, but that does not always happen and there is progress chasing to be done, among all the other things that the health centre does. There are frustrating delays in finding out about people's medications.
Is it the case that the women will often not have been in contact with the health service previously about mental health issues? Does lots of new medication need to be prescribed for mental health issues?
That happens in a very small minority of cases, but mental health treatments are usually started in the community and continued in prison. We do not get to know people well enough—especially short-stay prisoners—to be confident enough to prescribe a course of mental health treatment for them that might last quite a long time. If their needs are acute, we will certainly assess and treat them early, but one would want to wait before prescribing for longer-term needs, such as fluctuating depression or anxiety. For instance, the majority of our prescriptions for anti-depressants continue treatment that was started in the community. That is why it is so important to know what medication people are on and the accurate dose of that medication when they first enter prison.
On the same issue, I have a tighter and perhaps more narrowly focused question about time-contingent medications, such as those for Parkinson's disease. Such medications can vary depending on the patient and where the condition is within the cycle. How does the prison medical service cope with such individualised requirements?
We try our best. Certainly, nurses pick up very early on whether people need critical treatments—such as for diabetes, which is another example—for which it is essential to get treatment established early. However, I have come across instances in which there have been critical delays and harm has resulted. Interestingly, about 18 months ago I had an inquiry from the wife of someone with Parkinson's disease who was likely to come into prison. She wanted assurance that he would continue to receive treatment. In such exceptional instances, we can tip off the prison that the person is likely to enter to ensure that the prison staff are aware of the issue. Any communication like that is very welcome. We do our best to address individual needs. Parkinson's disease is quite unusual because it is typically associated with old age. Few people of that age come into prison without our knowing about them.
I have a question for Ruth Parker about drug addiction. In her opening remarks, she said that just over half the women who come into the prison have drugs in their system when they are admitted. Are we winning or losing the battle against drug addiction during their stay? To what extent does the availability of illegal drugs within the system undermine the efforts to tackle the problem?
Let me just correct your first statement. I said that 71 per cent came into the prison with illegal drugs in their system and 53 per cent reported that drugs were linked to their offence.
Did you say that around 30 per cent of women leave prison with illegal drugs still in their system? Have I picked up correctly what you said?
Yes.
I understand what you say about a regime that is too prohibitive, but what additional things can or should be done to reduce that figure further?
It was said earlier that we do not track individuals from admission into the prison estate to liberation. We probably need to concentrate more on tracking people and on who accesses our interventions and programmes. We should concentrate much more on working in partnership with community services, continuing in the community what has been done in prison and bringing into prison services for those who are already in treatment on admission.
If I understood you correctly, you mentioned a 39 per cent reduction in the number of women who leave Cornton Vale with drugs in their system. It seems to me that if Cornton Vale has been successful in reducing the quantity of drugs that is available there, there is a possibility that that 39 per cent reduction could be due to fewer drugs being available as opposed to the effectiveness of addiction services in tackling addiction. Without follow-up data on women's behaviour six months down the line, say, it seems to me that there is no way of knowing whether your addiction-tackling services have been effective. Is that overstating the situation?
No. We need to take into account not only drug treatments and the deterrents that we have in place to stop drugs getting into the prison, but the complex issues that contribute to people's addictions and offending behaviour and the wider essential services that are available. It is difficult to make measurements, but I agree that we need to do so alongside our colleagues in the community and to track individuals not only throughout their prison term, but after they have been liberated. We need to consider the successful cases.
The SPS would like prison to be the place where people decide to give up their drug habit, but for a large number of prisoners, prison is quite a short-stay setting. We would like to be part of the solution, and we are certainly working more and more closely with community-based drug agencies to deliver that. However, it must be recognised that we are talking about a chronic condition for many prisoners that props them up while they deal with all the other things going on in their lives.
We have heard the fairly shocking statement that many women prefer to go into Cornton Vale, as it is almost a respite from the chaotic and pretty horrific lives that they lead outside. To what extent is that true, in your experience?
It is very true for a defined number of women—I hope that Lesley McDowall, who is on the next panel, will help you out with a more accurate figure. It is not just a Scottish phenomenon—which is not to deny that it is a very disturbing phenomenon—that people find prison to be a place of asylum as well as punishment, where they can get away from and restructure their lives. They can seek the help that they have found difficult or have not had the time or presence of mind to find. In many cases, help comes to those who are in prison whether they like it or not, whereas much more effort is required to get in touch and stay in touch with services in the community. The equation is different. People come to prison, and sheriffs send them there in a patrician way, because they think that help is at hand there.
Is there a lack of alternatives to prison that provide one-stop respite and prevent people from reoffending?
Yes. There is a lack of personal security in the community and of quality in people's lives. There is also a lack of community-based—perhaps residential—alternatives. It is striking that the pile of submissions—or the electronic equivalent—that the committee has received reveal that in Scotland, the 218 centre is the only show in town. We need many more services like it. They may be costly, but there must be something other than prison for people who need time out, respite and residential care.
I endorse Dr Fraser's comments. One of the key factors is an individual's motivation to become involved with residential facilities. The 218 centre in particular is key to achieving success when people are willing and realise that the time is right to address their problem.
To what extent has there been a reduction in the number of illegal substance finds in Cornton Vale? Have the finds involved illegal substances or prescription medication that was being used by the person to whom it was issued?
I will make a general comment while Ruth Parker ferrets through her papers. Of the drugs that are found in people's possession or in their system, most is cannabis. However, when people come in, the balance is much more heavily tipped towards class A drugs, such as heroin and cocaine. Quite a significant number continue, in and out of prison, to use illegally acquired prescription drugs such as diazepam. The profile in prison is that diazepam and drugs like it are almost a constant, whereas heroin and opiates largely disappear—the rump comprises prescribed opiates such as methadone. Cannabis is much more commonly evidenced in prison and when people are on the way out. It may not be a particular comfort to look at the whole profile of drug use, but in prison the balance is much more heavily weighted towards cannabis and—to my mind—less hazardous drugs.
That is surprising. My understanding—to return to the old MDT terminology—was that class A substances remain in the bloodstream for a short period of time and are therefore chosen over cannabis, which has a longer lifespan and is more readily identified with MDT. However, you seem to be saying that it is the reverse in Cornton Vale.
There are two reasons for that. One is that drugs services have addressed the class A problem through methadone substitution and other means of addressing opiate addiction. The other is that the removal of mandatory testing and the sanction that came with it removed the perverse incentive that you mention to go to class A drugs and away from cannabis. Because the consequence of being found with cannabis aboard is not what it was, we are finding more of it.
That completes our questioning.
Ruth Parker was going to give me some figures.
Sorry, Ruth.
I have a couple of points. A recent snapshot revealed that 26 per cent of all prisoners use methadone prescribing in response to opiate addiction, which is a fairly high figure. I do not have the details on seizures, which I think Hugh O'Donnell asked about, but the number of drug finds has reduced significantly in recent years. That is partly to do with our positive and robust security systems, which involve working with law enforcement agencies. We take a twin-track approach by working on security and intelligence, as well as on treatment and reducing demand and harm.
I am interested in those figures, so perhaps you could get them to us.
Would you like the figures to be sent to the committee?
That would be helpful.
That completes our questioning. Do the witnesses have anything to say in conclusion?
In relation to Bill Wilson's questions, I want to underline the importance of putting children into the equation in sentencing women, no matter whether the women have drug and mental health problems. I was surprised not to see that point in a submission to the committee from a children-centred non-governmental organisation—I think that it was Action for Children Scotland. The effect on children of imprisoning their mothers is profound and damaging and ensures the creation of the next generation of offenders. One way of cutting into the inequalities cycle is to tackle the critical element of parents and people who are about to be parents, and to deal with people who are separated from somebody who means a huge amount to them, usually a young child.
The larger the number of short sentences, the less able we are to involve staff in treatment and rehabilitation interventions. Sometimes, we have to take staff from that crucial work to manage the custody and order side of the business and to support transitions to court or throughout the estate. Short sentences have a detrimental effect on drug rehabilitation, as they divert staff from that intervention work.
That goes back to resources.
Yes. The issue is resource allocation. We have to deploy staff to service prisoners who serve very short sentences. There is churn as people go to and from court, in and out of prison, and through the reception process. Our resources would be far better employed in delivering treatment and rehabilitation programmes and other interventions.
I thank both our witnesses. We have had a comprehensive session and the committee is grateful for your attendance.
Meeting suspended.
On resuming—
It is my pleasure to welcome our second panel of witnesses, who will cover sexual abuse, domestic abuse, prostitution and addiction. We have Naomi Robertson from Open Secret; Lesley McDowall, who is the head of care at Cornton Vale; and—sitting in the middle—Heather McCabe, who is a prison liaison officer with Alcoholics Anonymous.
As Dr Fraser and Ruth Parker said, programmes—and especially the female-specific programmes that are offered in Cornton Vale—are intended to address addictions and offending behaviour. Those are the main programmes that are delivered by programme staff who are employed by the Scottish Prison Service. Other programmes of shorter duration are delivered by non-governmental organisations and other staff in the prison, including the mental health team.
Open Secret supports women who have experienced sexual abuse and other forms of abuse. We know that a high percentage of women in prison have experienced sexual abuse. We take a person-centred approach to what has happened to them, the impact that it has had on them, how they have coped and how they want to cope more positively in the future. We examine the whole package—we do not consider just the history of abuse, because abuse affects all areas of a woman's life. We must examine the impact of that abuse and consider a package of support to move those women forward.
Will you quantify the percentage, which you said is high?
The most recent report estimated that between 80 and 85 per cent of women in Cornton Vale had experienced abuse. I am not sure, but I do not think that that percentage has been reviewed.
That percentage is very high.
Our aim is to bring the message of Alcoholics Anonymous to the still-suffering alcoholic. Many women in Cornton Vale have problems with alcohol. With many of the people who are identified as drug users, we find an underlying alcohol addiction. Our aim is to strike while the iron is hot. Many such women are in crisis and are discovering things about themselves that they did not know. We also support members who have relapsed or who have engaged in offending behaviour off their own bat and have ended up in prison. We support an abstinence programme and we try to improve people's lives.
How realistic is it to expect the services that you provide and other services to have a significant impact on reoffending?
The approach must be holistic. As Naomi Robertson said, we cannot consider somebody just as a survivor of childhood sexual abuse or as an addict; we must address every part. As the committee has heard, many of our women have mental health problems and an addiction and are survivors of childhood sexual abuse. They also have children and have family and parenting issues. All those issues must be considered together to reduce reoffending. Addressing just a single part more than likely will not succeed; we need to consider each part to achieve a solution that reduces reoffending.
We must hope that it is realised that what is done will be effective. That is not to say that everyone who looks for support because of a history of sexual abuse will stay out of prison. When we consider people's past, we appreciate that there is no magic wand, plaster or quick fix. If prisoners ask for support and a referral comes from them, we must hope that their motivation to participate in counselling and support, to make positive changes and to look at their history will have an effect and that they will succeed on the road to recovery.
I must shed a ray of light and say that the majority of women who follow our programme and stay within Alcoholics Anonymous do not reoffend. However, the majority of women who turn up do not stick with us and are not, at the time, willing to put in the work. Nonetheless, we hope to plant a seed so that, when they really hit rock bottom later on in their lives, they come back. The main idea for us is that when somebody stops drinking and using drugs alongside drink, the behaviours that go along with that stop.
Is it possible to measure objectively whether your services have, over time, improved inmates' behaviour or attitudes upon release compared with their behaviour or attitudes on admission?
I do not have statistics on that, because we do not follow the women once they go into the community. However, of the women who come back to us—for example, due to outstanding warrants—who were with us for less than a year, we have noticed an increase in the number who engaged with services and who come to us clean. As a result, they are aware of what is required of them when they return to custody, and they continue with their methadone scripts and continue to engage with services while they are in custody. There are therefore some measures of success, but we do not follow the women for a significant period after they leave us to quantify which interventions are the most successful.
The difficulty is quantifying the effect of the services that we deliver, because much of the data are qualitative. They are about improvements in self-esteem and confidence or the difference between someone believing that they will achieve and assuming that they will fail. They are about the difference between somebody looking for an abusive relationship and understanding that they are worth more than that and looking to make appropriate connections in the community.
Obviously, as Alcoholics Anonymous is an anonymous fellowship, we do not track people or keep numbers in the way that other services do. However, if the girls want, we can arrange to pick them up at the gate or meet them at the nearest transport venue and take them to an Alcoholics Anonymous meeting. If they decide to stay with us and practise the programme and principles that are laid down, they have a 24-hour support network that is absolutely free and is available in every town and city throughout the world. Because we are just a group of people—it is like a massive group of friends who have a common aim—there is a lot more support and nurture, which helps with all the other things. Once somebody gets sober, they are more able to think for themselves and deal with all the other issues than if they are trying to deal with things while they are still covering up the problem. It is a bit of a chicken and egg situation at times, but they give themselves a sporting chance.
It was interesting to read in your submission that the process is not just about getting off drugs but about giving something back by helping other people, which is how you developed the 24-hour support network.
Absolutely. The first step of the 12-step programme is to stop drinking and using. The programme is abstinence based. The next 10 steps are about sorting your head out, adjusting how you react to things and becoming a valued member of society. Those steps help you to sort your life out, so that you do not fall into debt or resort to drink, drugs, sex, chocolate, shopping or any of the other things that can be extremely addictive and are a danger for anyone who is an alcoholic. The last step involves giving away what was given to you. That is what enables you to maintain your own sobriety, and it is an enlightening process. You might think that you would become a teacher, but you actually learn more about yourself and help yourself more than the person you are trying to help.
Earlier, we talked about the fact that many female offenders have multiple problems. Various agencies and people interact in different ways in their efforts to help those women. You might not keep figures, but you have relationships with various groups. Does Alcoholics Anonymous face any particular barriers in dealing with people's issues in the prison system? In Scotland, women do not face difficulties in relation to being moved between institutions, because there is only one institution for them, but are there problems when they leave prison? I know that you have said that you pick up people and help them out, but some people who leave prison lose touch with the organisations that helped them when they were inside. If they decide that they want to get back in touch, do they face any problems in doing so?
I can speak only for AA. Our telephone number is in every phone book and on the walls of every doctor's waiting room. If they want to come back, they are free to do so at any time.
Confidentiality is a crucial part of the work that Open Secret undertakes. At the beginning of their first session, the women are advised that confidentiality will be maintained unless they are at risk or someone else is.
We encourage external organisations that work with women to continue working with them when they are sent to prison, especially when they have been given a short sentence. The last thing that we want to do is destabilise someone who has a therapeutic relationship with a key worker or organisation, so we engage with them to get as much information as we can when we are caring for those individuals.
Would it help women to continue to access services if community prisons were spread throughout the country, or at least if there were an additional couple of prisons, in the north or in Greenock, for example? Support can be disjointed if a woman is in Cornton Vale one day and back home the next, where services are not necessarily available. If prisons were more community based, would services be more likely to be available locally?
There are definitely benefits to short-term and remand prisoners of remaining in the area from which they come, in that services that are already working with them find it much easier to access them. Access to families also brings benefits. It has been shown that women are more likely to succeed if family links are continued or strengthened, and it is easier to do that if a woman remains in the area that she comes from. For women serving longer-term sentences, I would be concerned about the capacity to mirror the expertise that there is in Cornton Vale. It might be hard to mirror female-specific programmes on mental health, for example, in very small groups.
Might there be resource implications for long-term prisoners if there were more community-based prisons, because the sizes of the groups involved would not allow for expenditure on services?
Yes.
I am concerned by what you said about the postcode lottery that means that some women have moved house so that they can access services. Can the committee have more information about such service gaps?
We can certainly compare the addresses that people give on admission with the addresses that they give on liberation, and we can explore the reasons why people move. The situation that I described applies especially to people who go back into the community on a methadone programme. It is not unheard of for people to move so that they can access a prescriber.
It would be useful to have information on that.
We have heard much about prisoners who serve short-term sentences of less than six months and prisoners who are on remand. Many services are available to them, but some services are not. That was explained in part when we were told that it is not possible to intervene unless the service has a good understanding of the individual—leaping in with one's big tackety boots might do more harm than good.
Any contact is good contact. In my experience—I have worked in Cornton Vale for 12 years—in the first month of their sentence prisoners are still coming off illicit substances, and it is difficult to make assessments at that point. In the next two months, they are usually fighting their own demons—their main focus is on seeking drugs, so it is difficult to get them to engage. However, if community services have sufficient resources to send someone into prison to make the first contact with an individual, that will benefit the person when they leave prison.
We heard from the previous witnesses this morning that illegal substances are still getting into prisons. Is alcohol getting into our prisons?
It does not come in—it is made in prisons. That does not happen often—the process is quite technical—but the girls have creative ways of making what is referred to as hooch. Because the fermentation process is so long, hooch is usually captured before prisoners have had a chance to consume it. Alcohol does not come in—the only alcohol in prisons is stuff that is made there.
I guess that you know whether there is a still from the amount of rice and potatoes that are purchased in the canteen.
Yes—the potatoes and sugar start to go missing from the cookhouse.
That is fair comment.
In my experience, that happens on occasion. When women have a single addiction to alcohol, it is usually directly related to the crime that they have committed—they state that they were drunk when they committed the crime. The majority of those women just want to get on with their sentence. However, a minority may look to use illicit substances, especially if alcohol is a coping mechanism. If we remove alcohol and give them nothing else, they may seek another coping mechanism. The majority of women who are addicted only to alcohol tend to seek help through programmes and AA, which visits Cornton Vale, instead of seeking another addiction.
Lesley McDowall has provided a great demonstration of what we do. If we take alcohol away from an alcoholic and they have no coping mechanism, things really start to fall apart. The purpose of the AA programme is to provide such a mechanism. That is why every alcoholic who comes on to the programme is on it for the rest of their life.
When people first look at the question of female offenders, they are struck most by the statistics on sexual abuse that Naomi Robertson quoted. We must seek to understand that issue as much as possible. The situation is complex, so I am probably asking an impossible question, but is the problem usually the combination of sexual abuse with the drug or alcohol addiction that follows from that, or is there something about the experience of sexual abuse that can lead to offending irrespective of whether drugs or alcohol intervene?
The answer to that probably has two prongs. It is an extremely complex question, to which there is no direct answer. Many women who have been abused will use drugs and/or alcohol to cope because they are not aware of other supports that are available. As a result of trying to cope with their sexual abuse, they might get a drug addiction, which has to be paid for, so they move into offending; because the memories of the abuse remain, they need more drugs, which leads to more offending. It becomes a vicious cycle.
To a large extent.
A lot of the women will have made a previous disclosure, usually to a family member. They might not have been believed, or the issue might have been swept under the carpet. The attitude is, "Child abuse is a dirty subject—we don't talk about that", and people do not like to hear terms such as "rape" and "sexual assault". A lot of the time, the women in question come from very difficult backgrounds—they might have had drug-abusing parents or lived in poverty. Many of the women in Cornton Vale come from such backgrounds, although abuse happens across the spectrum.
Could I get your definitive view on the community prison option as opposed to the one-stop shop, which, in effect, Cornton Vale is? If resources were not an issue, where would you fall on that?
I do not think that there is a requirement to have lots of community prisons. As has been said, women who come from the north-east and do not get visits very often really struggle. When Inverness took women prisoners and there was an area in Aberdeen to which women could go back to receive accumulated visits, they lived for that—it was what kept them going. We do not currently have that, and I see the effect that that has on women. Giving women the opportunity to access more visits from their families can only be a good thing, especially if they are short-term prisoners or are on remand. I still have concerns about whether the same level of expertise could be provided in other prisons as is provided in Cornton Vale.
That is for long-term prisoners.
Yes.
I reiterate what Lesley McDowall said. The difficulty with community prisons is to do with resources, expertise and long-term care. In an ideal world, money would not be an issue, but we all know that it is.
Will the view vary from woman to woman? You heard from some women that there would be a lack of motivation because community prison would be too easy. However, could it provide motivation for others? That is what we heard from the first panel.
There is no definitive answer. If we want to know what female offenders want, we should talk to them, because the women are honest. They are clear about what is right and wrong for them. Some will prefer to go to Cornton Vale because it offers so much support and expertise in one place. Women come into Cornton Vale because they know that they can get support that is not in the community or for which they would have to wait a long time in the community. Resources in Cornton Vale are offered free and the women come in to get help and get better, as they put it, and to go out again. They will not necessarily sustain their improvement in the community, but they think, "Cornton Vale has everything I need—all the services and the expertise." As Lesley McDowall said, it is difficult to replicate that service across Scotland.
If I understood you correctly, Naomi, you said that some women feel that they have a greater incentive to sort out their problems because they are isolated from their family by being in Cornton Vale. However, we heard evidence earlier that imprisoning women can have a damaging effect on their children. Being isolated from her family might provide an incentive for a woman, but it could have a greater effect on her children.
Absolutely.
A balance must surely be struck between the view that the mother will be back more quickly because she has the incentive to solve her problems and the potential for her imprisonment to cause so much damage to her child.
Oh God, absolutely—we must consider the global picture. The impact on the child must be foremost in the mind when considering what supports are in place. I am simply trying to impart some of the women's views, which stunned me when I heard them. I said that being close to their families is surely better, but they said that, although they want to be closer to their families, they are not convinced that they would be as motivated in that case to access resources and that they are concerned about the level of resources in the community.
I am sure that the women are aware of the effect on their children, but are they aware of how great the effect might be? If they are keen to get back to help their family—that is clearly a major issue for most of the women—I presume that an awareness of the effects on the children would be an incentive for them, too. Or would that just cause depression and more problems for the women?
No. Part of my work is helping women understand the impact that their offending behaviour, irrespective of whether it was precipitated by sexual abuse, has on everybody else. For example, we consider positive and negative relationships and how the woman's behaviour has impacted on her and her family. In the beginning, some of them do not realise what the impact is. They will say, for example, "Mummy is in hospital" or "Mummy is away on holiday" and think that they have dealt with it. The issue is getting them to understand the impact that their imprisonment has on their children. The understanding is immediately apparent with some women, who say, "I can't believe I've done that to my children and I need to get back to them now", but it takes longer for others.
Do you want to add anything, Lesley?
We do parenting work through the Aberlour Child Care Trust. We have a joint programme with it for women to consider the impact of their drug taking and offending behaviour on their children.
I would like to be reassured about one thing—I am sure that the answer will be yes. I take it that, if a woman says to you that she is relieved to be in prison as she is away from the area where she has come from—she is away from the abusive partner—some action is taken immediately with social services regarding the protection of the children.
Yes.
Absolutely.
Clearly, the children will now be considered to be with a possibly abusive—
That situation does not arise on many occasions. In a survey about six or seven months ago, we asked every woman who came in whether her partner was in prison or had ever been in prison. More than 80 per cent of the women said yes. A similar survey was done at Glenochil, and only 13 per cent of men said that their partner was or had ever been in prison. That shows how big an impact there can be.
That applies across the board among different services—everyone operates on that basis, according to a public protection policy.
Scotland is becoming an increasingly culturally diverse country, with substantial immigrant populations. What special facilities, if any, do you provide for black and ethnic minority women, particularly with regard to cultural expectations and requirements? The question is for any of the witnesses.
We have a business improvement manager who is responsible for all black and minority ethnic women and any foreign national women to ensure that, where possible, the appropriate services are put in place, such as interpreting and translation. Work on all our documents is under way—health care documents, certainly, are now translated into about 18 different languages, and much of our induction paperwork is now being translated into several different languages.
Our literature can be accessed in many different languages. Because we deal with only one issue, it does not matter where you are from or what language you speak—none of those things is especially relevant to us.
At the moment, our literature is in English only, which we will need to address. As yet, I have not come across a referral of someone who did not have a good enough command of the English language to undertake the counselling process. Counselling is all about communication, and research shows that trust, rapport and an appropriate relationship need to be built for it to be effective. If an interpreter is involved with the counsellor and the client, the loop is lost and the situation can become difficult. We need to consider that scenario. Potential clients are foreign national women who have experienced significant abuse abroad, and the difficulty is that they are unable to access the service because of a communication barrier. I have dealt with a couple of women whose command of the language has been good enough to start a rapport, and we have just taken things more slowly—it is a slower process to ease them in.
You say that counselling is about communication. Concerns have been raised by speech and language therapists that there are not enough of them in prisons. Do you have a view on that?
That has not been an issue for me. As I said, it is for the prisons and outside agencies to communicate with one another. If I identified a need, I would approach the mental health team and ask for some support to be set up. I am sure that that would be well received.
I agree that we need to develop speech and language therapy services in prison, especially because of the number of people with learning disabilities and a very low intelligence quotient who enter prison. I would like to develop those services further, and we have been looking at engaging with some providers, but the problem is that not many have the funding to come into the prison setting.
Once again, we are lucky because we are so massive: we use sign language interpreters if required and we produce our literature in a dyslexic-friendly style and on tapes and compact disc, too. We cover that issue.
Again, it comes back to funding and how far you can stretch the budget. As a service, we want to do everything that we can to facilitate counselling and support. The question is whether we can fund producing material in different languages and using interpreters.
I have a question for Lesley McDowall. Dr Fraser and many others said that by far and away the biggest proportion of repeat offenders comes from the groups of women—and indeed men—who receive sentences of six months or less. If in the prison service we cannot tackle reoffending among those serving short-term sentences, how best can it be done? Are there any lessons from or parallels with Europe in how other countries deal with reoffending among those serving short-term sentences?
As I said earlier, we need to take a much more holistic approach because women offenders have so many complex issues. We cannot deal with just one of those issues; we have to deal with them all. We need to look to community services, such as the community links centre in Edinburgh, which is a one-stop shop. The service that a woman is most likely to engage with when she leaves prison is for addictions. If, when she goes to access an addictions service, abuse counsellors, mental health and alcohol services are within the same centre, she is more likely to access all those services and therefore less likely to land up in prison again.
Might a community sentence be a more effective way than a prison sentence of six months or less of dealing with women in these circumstances?
Yes, because if attending those services was made mandatory, it would be more likely to happen. The males in the women's lives might want them to remain in the community for child care reasons or because they are providing income, so they will ensure that the women attend services in the community, because, otherwise, they will end up in custody.
It goes back to what I said earlier about sentences of six months or less. If women are given community sentences, with a stipulation that they link up with services, that allows for continuity of care and the establishment of trust with counsellors, which means that the same counsellor can provide the service on a long-term basis. Counselling cannot be never-ending, but, for a lot of these women, there is a longer timeframe for getting themselves sorted. We cannot just say to them, "That's our 12 weeks up; on you go." At that point they might just be getting to the stage where they can begin to deal with the abuse, get their head straight and move forward. If they are in the community, they can get the longer-term care that many of them need.
There have been increasing reports, particularly in the more lurid bits of the media, about consumption of alcohol by females. Are you seeing a change in the pattern of alcohol consumption by females? Is it age related? Is it connected with the types of crimes that are being committed? Is there more violent crime and less acquisitive crime?
I never ask the girls about the crimes that they committed. Sometimes they volunteer the information, but it does not matter to me why they are there. I do not know whether there is a big media drive to change the way that alcohol consumption by females is portrayed or whether that reflects exactly what is happening with younger women. I am not the person to tell you whether the pattern of consumption has changed. The people who come through our door are at the end of their tether and have the choice between getting sober, going insane and being locked up in a psychiatric institution for the rest of their lives, as opposed to having a short stay, which many of them have already had, going to jail or dying.
Thank you for that and for your honesty.
I can speak only about the past year. As an organisation, we are concerned not with what the person has done but with what has happened and what we can do to support them. Within the prison environment, we conduct a risk assessment that looks at the person's history and what they have been convicted of. There are a notable number of young women whose offences relate to substance misuse—particularly alcohol abuse. They get angry and get into fights, and the situation can get out of control very quickly. I would not like to say whether that is a cultural issue.
Indeed.
You are talking about people in the community and in the prison.
Yes.
I reiterate that we try to steer away from the word "victim" and talk instead about the survivor of abuse. "Victim" is a negative word and we are trying to empower the woman.
Although there are few sex offenders in the female prison population, certain individuals display predatory traits. They are good at seeking out the most vulnerable. We have a high number of survivors of childhood sexual abuse, who have low self-esteem and tend to be in unequal, unhealthy relationships. They can tend to migrate towards those individuals, who have quite a lot of influence within certain groups in the prison.
Lesley McDowall made the point that I was about to make. If somebody made that kind of suggestion in a counselling session, we would explore it with them: "What does that mean? How do you feel?" If there was any suggestion of risk, appropriate action would be taken.
Thank you. That concludes our questions. Would you like to add any closing remarks?
We do not ask our prisoners about domestic abuse as they come in. I do not know when would be an appropriate time to ask whether they have been victims of violence. However, we ask about prostitution.
Returning to the issue of addiction, using is only the tip of the iceberg. The real problem lies in the mental side of the issue. If you can fix that, the addiction will effectively be gone—or dealt with, rather than gone.
I reiterate the need for sustainability of the service. We are a voluntary organisation, funded through survivorScotland. Although that money has been well appreciated and well used, it will run out. These women have had extremely chaotic lives, extremely difficult experiences and significant trauma over many years. When they come to Cornton Vale, they are saying, "Yes, please help me. Give me support." We need to move towards some sort of stability or statutory funding. We need to be able to say, "Yes, we will be here for three years or six years." We need the women to know that the support is there and that it will continue.
Thank you. There was a powerful message there, not only about resourcing the services that you provide in the prison but—crucially—about maintaining that care when the women are released. The session has been extremely worth while and I thank the panels for attending.
Meeting closed at 12:46.