Psychological Therapy in Prisons and Other Secure Settings.PSYCHOLOGICAL THERAPY IN PRISONS AND OTHER
Harvey, J. and Smedley, K. (eds.) (2010). Abingdon: Willan Publishing Ltd.
pp.304 (hbk) 25[pounds sterling] ISBN 978 1 84392 799 0
Psychological services within prisons, and to a certain extent other secure settings, have traditionally been dominated by forensic practitioners who specialise in the assessment of risk and the delivery of accredited offending behaviour treatment programmes. A consequence of this is that the relevant prison-centric psychological literature focuses heavily upon these two areas of research. Unfortunately, there has been a paucity of relevant, robust and professional literature that focuses solely on the mental health needs of prisoners and the therapeutic practitioners who are increasingly recognised as playing an important role within the carceral world.
The editors of, and contributors to, this volume have done a remarkable job in putting together such an accessible volume that explores many of the issues surrounding the mental health problems of people held in secure settings and the scale and range of problems inherent to addressing their needs. Though in places the book is necessarily technical, it succeeds where some other psychologically themed tomes fail in that it does not alienate the lay reader. As such, the book is suitable for anyone, professional or otherwise, who has an interest in prisons and mental health services.
Though not explicit the book is divided into two broad sections. The first section, which encompasses chapters 2-6, contextualises the book by detailing the historical scarcity of mental health focused services in prisons, the changing nature of mental health services in prison, the policy changes that have occurred in order to attempt to address these issues and the various forms of therapeutic practice (such as Cognitive Analytic Therapy and Cognitive Behaviour Therapy) that are common to prison work. The second section (chapters 7-10) broadens the scope of the book and focuses upon the specific issues of therapy provision within prisons and other secure settings. This discussion involves an exploration of the sometimes delicate or fraught issues involved with working with traumatised prisoners, women prisoners / detainees and black and minority ethnic prisoners as well as the role and work of therapeutic communities. Finally, chapter 11 explores therapy in the context of the more traditional realm of offending behaviour courses.
Though extremely coherent and well-constructed there is a sense that the book is somewhat limited in its scope. This is, I suspect, partly due to it being something of an introductory volume and thus the editors had the thorny issue of deciding which of the fundamental issues to include for inspection and which to exclude. However, despite this sense of focal limitation, there are a number of interrelated thematic concerns that run throughout the book and which are supported by all the contributing authors. These are fundamentally the acknowledgement of: how the specialised environment of the prison / secure unit can affect the delivery of services and the need for practitioners / therapists to be aware of these issues and barriers and tailor their approaches accordingly; the need for therapists to be aware of, not only the power imbalance that is inherent in the therapeutic relationship, but also that which the prisoner is confronted by in the wider context of the prison and how this can affect the therapist / prisoner / prison trust nexus.
All of the chapters in this volume are of an exceptionally high standard being thoroughly researched and argued. There are however, a number of stand out chapters which any reader will find invaluable. One such is that by Mills and Kendall which gives a succinct but yet thorough overview of the policy changes that have affected mental healthcare in prisons in England and Wales, the advent of Mental Health In-Reach Teams and the limitations, barriers and benefits that MHIRT's are confronted with or represent. The evolution of these teams and the matrices of authoritative relationships in which they operate is obviously a complex and convoluted tale, yet they manage to unravel this Gordian knot in a clear, precise and easily digestible manner.
Another is by Rogers and Law which focuses on the varying forms of trauma found in forensic populations as well as the particular problems raised by working with traumatised prisoners, especially young prisoners, whilst they remain in custody. They also note and discuss the need for a 'systemic' and collaborative approach to this form of therapy highlighting, through the use of a case example, the importance of working with both the individual in question and the prison itself. What is of special note in this chapter is their discussion on the ethical implications of conducting this form of therapy in prisons and other secure / closed settings.
A further example is that of Lowe and Pearson who discuss the provision of therapy for BME prisoners and the importance in understanding, and safeguarding against, stereotyped thinking. They note that, perhaps, one of the main challenges in working with BME prisoners is undergoing the necessary process of self / professional development in order to understand, or acknowledge, the racialised assumptions and practices that can exist within forensic settings. Though challenging, they argue that this process, and the awareness that arises from it, is essential in order to facilitate the relationships of trust which the therapeutic process needs. Another important issue that they raise is a wider lack of understanding of how exposure to long-term racial abuse can affect mental health and subsequent therapy.
There is one aspect that is missing from this volume which would have been welcome and that is the voice of the prisoners / patients themselves. Any future book would have to include a chapter in which those who are subject to these interventions and therapies are able to detail the manner in which they experience the changes in policy, the MHIRT's and the other issues discussed above. However, despite this absence, this is a thoroughly well-researched, written and edited book that is fascinating, stimulating and informative. A good addition to the shelf of any person interested in either prisons or mental health practice.
Jason Warr, Institute of Criminology, University of Cambridge