The long road to a trauma-informed criminal justice system
The whole prisons system has been overcrowded every year since 1994 (Alamy)
While both the Conservatives and Labour pursue a “tough on crime” rhetoric in their local election campaigns, in the background, Labour is working on a review on how to deliver the world’s first “trauma-informed criminal justice system” if it gets into government.
The need to tackle crime is front and centre of both recent government and opposition messaging. Meanwhile, Labour has its own plan to reform what it calls “our broken criminal justice system”. At Labour Conference in 2022, shadow justice secretary Steve Reed promised that the Blairite slogan “tough on crime, tough on the causes of crime” would “meet the future”, and shadow prisons minister Ellie Reeves visited Rochester Prison in early April to see whether its rehabilitative services for inmates had improved.
“It means reforming the system to use learning from the science of childhood trauma to ensure we support families and schools where children are most at risk of offending by intervening to tackle trauma at its source,” Reeves told The House when asked what “trauma-informed” means. “We will work with the courts, youth offending institutions, prisons and probation to cut reoffending by tackling the deep-rooted trauma that often lies behind it.”
But while Labour want to tackle trauma at its roots, experts and practitioners are crying out for better mental health provisions for the 87,000 offenders already in UK prisons. More than half of people in prisons inspected between July 2020 and March 2021 reported having mental health problems, according to Ministry of Justice (MoJ) figures, and only around a fifth said it was easy to see a mental health worker.
The whole system has been overcrowded every year since 1994, with almost two in every three prisons in England and Wales overcrowded in 2021 – putting healthcare provisions under further strain. As the government pursues tougher sentencing laws, the prison population is projected to increase in England and Wales by nearly 20,000 by 2026.
The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment published a report in 2022 which exposed failings in the UK prison system, including chronic overcrowding, poor living conditions and a lack of purposeful regimes. The report detailed how inmates can be locked up in isolation for 23 hours a day and warned that a high proportion of staff have less than two years’ experience working in prisons.
The term “trauma-informed” is not new: academics have been researching it for years, but it remains a concept that is far from realised in many UK prisons. This practice acknowledges that a large number of individuals entering the criminal justice system have come from backgrounds of traumatic early childhood experience, including physical, emotional or sexual abuse.
According to Pia Sinha, the new chief executive officer at Prison Reform Trust, a trauma-informed approach could train staff to work with people in the criminal justice system in a way that does not re-traumatise them and reduces the likelihood of later reoffending. Sinha has decades of experience in the prison sector, as a higher psychologist, a governor for multiple prisons and then director of women at HM Prison and Probation Service in 2021.
The MoJ published the Prisons Strategy White Paper in 2021, pledging to invest £37m over the next three years to make prisons safer with prison helplines, ligature-resistant cells and training for staff. However, Sinha tells The House she believes much of current criminal justice policy “works against a trauma-informed approach”.
“It’s actually very simple things that can make an environment trauma-informed, which is about consistency and the way regimes are managed on a day-to-day basis,” she says. Others agree that a trauma-informed system would only work if embedded consistently throughout. Giving evidence to the joint committee on mental health last year, consultant psychiatrist Dr Shubulade Smith CBE argued that mental health services in prisons are “piecemeal” across the country. The chair of the Independent Advisory Panel on Deaths in Custody, Lynn Emslie tells The House that a “holistic” and “purposeful” regime is the only way to reduce the high rates of suicide in prisons.
While welcoming Labour’s pledge, Sinha is cautious in her optimism: “It was really pleasing to see, but it’s worth having early discussions with practitioners and experts who can inform that and put flesh onto the bone so it doesn’t end up being tokenistic. When you don’t have the foundations of an approach embedded all the way through the system, you will have a piecemeal system. When it’s not consistently applied, it can be dangerous.”
“There is real mileage in this approach, but it needs to be done right”
Sinha believes the starting point for trauma-informed practice is around early intervention to divert traumatised individuals away from crime – just as Labour proposes. “Sometimes, by the time they enter prison, it feels too late because the trauma is so much more embedded and harder to root out,” she says. “If you’re trying to get trauma-informed approaches from the outset, you might have a better chance of making them realisable. If the strategy is for the next 10 years, it’s worth being really ambitious. There is real mileage in this approach, but it needs to be done right.”
With prisons traditionally seen as places of discipline, order, and punishment, there are questions surrounding how such environments can truly rehabilitate and support inmates. Dr Ailbhe O’Loughlin, a senior lecturer at York Law School who specialises in mental health law and criminal law, warns that trauma-based approach must be handled carefully. “There’s a possibility for harm to be caused to prisoners if the trauma-informed approach is done badly,” she says. “If people are given therapy that asks them to talk about their traumatic experiences, that can be more damaging if they’re not given the right kind of support.”
Labour framed their trauma-informed pledge as a way to cut offending and reoffending, in line with their “tough on crime” stance. However, according to O’Loughlin, there is little proof that tackling trauma reduces recidivism, mainly due to a lack of studies.
There was a small US study in the 2000s with female prisoners that found a reduction in arrest rates, and other studies with women and young people have shown that a trauma-informed approach led to improvements in behaviour within the institution. There are some notable precedents for trauma-informed care in prisons: HMP Send, a prison for adult females, has an NHS-funded PIPE (psychologically informed planned environment) unit. A long-serving prisoner told SurreyLive in 2019 that she had only been able to properly address the causes of her offending after transferring to the PIPE unit.
Considerably more work has been carried out in this area in women’s prisons, as O’Loughlin explains: “There’s recognition that women prisoners tend to come into prison with much higher rates of traumatic experiences, mental health issues, self harm, and having been victimised.”
O’Loughlin adds that Whitemoor Prison set up a specialist unit for male prisoners with dangerous personality disorders, which took “five or six years to get fully up and running”. If the government tried to introduce a trauma-informed system across all UK prisons, she predicts it would take “decades”: “If you want to make a difference into the future, intervening with children now is a good idea, and that involves more social welfare type coordination.”
To make Labour’s pledge a reality, O’Loughlin argues the basics must be tackled first. “Trauma-informed care would be like a cherry on top,” she says. “Setting that as the goal is probably over ambitious. On a practical level, I would like to see much more concrete pledges to highlight how they would address problems that we already know are there and are quite long-standing basic problems.”
Sinha also thinks there is a long way to go: “Ten years ago, there were very few of us talking about a trauma-informed approach, but now, it’s become much more understood. We have moved quite a way, but it’s still quite piecemeal and tokenistic. At least we’re talking about it, but we have some way to go before it actually feels genuine.”
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