Prison nursing support team transforms care of inmates with learning disabilities
Posted 07 October 2020 - 11:00
Learning disability nurses at HMP Parc are ensuring service-users’ needs are met in a custodial setting
- People with learning disabilities and autism face many additional barriers in a prison setting
- Specialist nurses have addressed clients’ complex health and sensory needs at HMP Parc’s new Cynnwys unit
- The team of nurses have won the Learning Disability Nursing category of the 2020 RCNi Nurse Awards
A team of nurses is transforming the care of prisoners with a learning disability or autism spectrum conditions after setting up the UK’s first dedicated prison wing to meet their needs.
The learning disability nursing team at HM Prison & Young Offenders' Institution Parc in Bridgend, Wales – managed by G4S Health Services – is addressing clients’ complex health and sensory needs with its new Cynnwys unit.
Outcomes have been so positive that the HMP Parc inclusion team has just been named winners of the Learning Disability Nursing category of the 2020 RCNi Nurse Awards.
Identifying needs to reduce health inequalities and support behaviour management strategies
Lead learning disability nurse Natasha Castellini says her team identified a need for specialist nurses who could reduce health inequalities, give support with person-centred behaviour management strategies, as well as provide training to prison staff.
Ms Castellini adds that people with learning disabilities face additional barriers in prison settings: ‘It is not easy to meet their sensory needs and they struggle to manage activities of daily living without their normal support systems.’
‘Complex prison systems create barriers to even simple tasks and they are at risk of exploitation by their peers. We needed an environment to safeguard this vulnerable group.’
A 2019 Prison Reform Trust briefing shows that one third (34%) of people assessed in prison in 2017-18 reported having a learning disability.
Suitable wing ‘with less drug traffic’ could change the lives of people with learning disabilities in custody
The Parc inclusion team of Chloe Salter, Natasha Castellini, Sarah New, Arianwen Selway and Sophie Prosser, successfully put a business case to the G4S Health Services managing director explaining the need for a specific wing and how it would change the lives of people with learning disabilities in custody.
A suitable wing ‘with less drug traffic’ was identified and clients were involved in creating the first prison sensory room in the UK. Community services, families and the person in custody can all make referrals to the team.
On admission every prisoner completes a web-based screening which flags up any challenges they may have with daily living. A low score prompts an immediate referral to the team.
Referrals are discussed at twice-weekly multidisciplinary team meetings on how best to support the individual.
‘We knew that people with learning disabilities were typically housed in high-risk areas and used these to measure our impact,’ says Ms Castellini.
Selway giving training to prison staff
Picture: Stephen Shepherd
Since the Cynnwys unit opened, reportable incidents have fallen by 36%, use of force by 19%, incidents of violence by 32%, and incidents of self-harm by 76%.
Adjudications – hearings inside prison when rules have been broken that can affect parole – have also fallen by 28%.
Vulnerable patient group exploited by some inmates to test out illicit drug
She adds: ‘We found this vulnerable group of patients were being used by their peers as guinea pigs, exploited to test out the strength of the illicit drug Spice.
‘We were regularly having emergencies, where patients were found unconscious or in a coma, and leading to psychosis and drug dependency.
‘But since the Cynnwys unit, we have seen a 56% reduction in these incidents.’
There has also been a 300% increase in appointments for people with a learning disability.
There are education programmes and activities, where the nurses have protected time for their caseloads and the team has built excellent links with outside autism and sexual assault groups.
Learning disability nursing team offers prison staff debriefing and developed trans pathway
The team offers debriefing and supervision of staff following incidents, ceremonies to celebrate achievements and has developed a trans pathway.
‘Prisons endorse a punitive approach to prisoner rehabilitation, but for those who have learning disabilities and/or autism, this does not help with rehabilitation and can increase behaviours that challenge’
Chloe Salter, GS4 Health Services lead nurse
‘We look after all their health needs in the unit, including mental health, and we have had massively positive outcomes.’
The nurses have also been successful in ensuring prison systems have been adjusted for their clients.
GS4 Health Services lead nurse Chloe Salter says: ‘Prisons endorse a punitive approach to prisoner rehabilitation, but for those who have learning disabilities and/or autism, this does not help with rehabilitation and can increase behaviours that challenge.
‘Person-centred behaviour plans were needed, and this meant challenging attitudes from staff who did not want people getting “special treatment”.
‘We introduced staff training and have now achieved consistency for vulnerable prisoners and a better understanding of why behaviour plans are needed.’
The team has also successfully pressed for the incentive earned-privileges system to be changed to include reasonable adjustments for people whose learning disability makes it harder for them to comply with prison rules.
Patient feedback proves that learning disability nurses help with adjustments to life in prison and preparing for parole
And patient feedback attests to the nursing team’s impact.
One man who had been in custody for 16 years said: ‘I couldn’t complete the courses for parole because they didn’t make sense. I didn’t even know that the [high street chain] Woolworths had closed down
‘Thanks to the learning disabilities nurse, I have had help with my life in prison, planning life after prison, parole boards, substance misuse and an autism diagnosis.
‘I am finally moving on with my life and getting released.’
Number crunching: UK inmates with a learning disability
One third of people (34%) assessed in prison in 2017-18 reported that they had a learning disability- 7% of people in contact with the UK criminal justice system have a learning disability, compared with 2% of the general population
- More than half of prisons inspected in 2016-17 were actively identifying and supporting prisoners with learning disabilities — a marked improvement on previous years
- Four fifths of prisoners with learning disabilities report having problems reading prison information
- Prisoners with learning disabilities are three times more likely to spend time in segregation and experience clinical depression
- They are also five times more likely to experience control and restraint techniques
One third of people (34%) assessed in prison in 2017-18 reported that they had a learning disability
Improvements to the transitional process from custody to the community
The team has developed relationships to improve the transitional process from custody to the community, to implement safeguarding measures, where appropriate, and ultimately reduce the risk of reoffending, harm, and behaviours that challenge.
‘Towards the end of their sentence we start preparing for their return to the community,’ says Ms Castellini.
‘We find a lot of people with learning disabilities will be a MAPPA level 2 or 3 [Multi-Agency Public Protection Arrangements], which means they are at risk of harm to themselves or others.’
MAPPA is the process through which various agencies such as the police, the prison service and probation services work together to protect the public by managing the risks posed by violent and sexual offenders living in the community.
‘We do a lot of work with probation and MAPPA before they are discharged to make sure there are adjustments and that their diagnosis is understood and supported housing is arranged.
We set up placements for the community team and their care plans go out with them into the community. We also liaise with families.’
Building on the unit’s successes, the team has ambitious plans for the future that include further sensory rooms, gardens and a kitchen to promote independence.
It is also going to be an on-call service for G4S establishments throughout the UK. The nurses are passionate about driving change in the wider criminal justice system.
‘We want to continue this work and support HM Inspectorate Services to develop a standardised national framework so that all people with a learning disability can have their needs met in a custodial setting‘
Arianwen Selway, learning disability nurse
Learning disability nurse Ms Selway believes that – before an audit of the team’s work – the HM Inspectorate of Prisons (HMIP) thought learning disability nursing was a side branch of mental health.
Standardised national framework for people with learning disabilities in a custodial setting
‘The inspectors did not understand that we are a separate nursing branch with our own National Institute for Care and Excellence guidelines.
‘We ran with the opportunity to educate HMIP about learning disabilities nursing, showing them our behavioural management plans, the unit, the assessment that we use, and our vital role.
‘We want to continue this work and support HMIP to develop a standardised national framework so that all people with a learning disability can have their needs met in a custodial setting.’
‘Great creativity’ and ‘positive outcomes’ in a setting with significant limitations
RCNi Nurse Awards judge Dave Williams says the winning Parc inclusion team had shown ‘great creativity’ in a setting with significant limitations.
Mr Williams, who is Salford Care Organisation’s head of service for learning disability and complex needs, says: ‘This creativity has had positive outcomes for people while in the prison service and also when they start to move back into community living.’
He adds: ‘The standard of submission has increased year on year and this year has been the hardest to separate the shortlisted finalists.’
RCNi non-executive director Caroline Shuldham was also on the judging panel.
She says: ‘This project is a wonderful example of team work, with the winners working together on many fronts to improve the life and opportunities of people with a learning disability and/or on the autism spectrum in a prison.
‘Their tenacity is remarkable and the success of their approach is demonstrated with excellent data showing positive feedback and decreases in factors, such as incidents of violence, self-harm and use of force.’
One of the Parc’s inclusion team success stories
A young man who had struggled with the prison’s incentive system is one of the HM Prison & Young Offenders' Institution Parc‘s team success stories.
Following a traumatic childhood, he had been in the criminal justice system since the age of 13, and was misdiagnosed with attention deficit hyperactivity disorder at 15.
He would engage in significant self-injurious behaviour, and would tend to do short sentences and be released for no more than a period of two weeks.
During his most recent sentence the learning disability nurses identified he had autism.
‘I used to manipulate staff by self-harming… I don’t need to do that anymore’
Working with behaviour analysts and the Western Bay Integrated Autism Service they managed to get him a diagnosis, building a therapeutic relationship and creating a behavioural plan.
‘Operational officers were trained and supported to adhere to it,’ says lead learning disability nurse Natasha Castellini.
‘As you can imagine this required a lot of cultural change working in a prison with the incentive earned-privileges system.’
During this time, the young man fed back: ‘I used to manipulate staff by self-harming to get me off units that I didn’t feel safe on. I don’t need to do that anymore.’
As his release date approached, the nurses worked tirelessly with other agencies to achieve an appropriate placement for him and he is now in a 24-hour supported living home. ‘This month he will have been out for a whole year, which is amazing,’ says Ms Castellini.
‘This is the longest he has been out of a custodial setting and it is one of our biggest and proudest achievements that we have been able to support him and stop the path that he was on.’
Find out more
- G4S – HMP and YOI Parc
- NHS Wales – Cynnwys Specialist Services
- Prison Reform Trust (2019) – Prison: the Facts. Bromley Briefings Summer 2019
- Prison Reform Trust (2008) Prisoners’ Voices. Experiences of the Criminal Justice System by Prisoners with Learning Disabilities and Difficulties
- Salford Care Organisation Creative Support