Analysis

Delivering compassionate care in the criminal justice system

How do nurses care compassionately for someone locked up for violence, rape or murder? What if a prison nurse struggles to smile at the criminal with a chilling record? And what can be done to persuade the doubters in society that people in prison deserve the same level of care as those outside the prison gates?

How do nurses care compassionately for someone locked up for violence, rape or murder? What if a prison nurse struggles to smile at the criminal with a chilling record? And what can be done to persuade the doubters in society that people in prison deserve the same level of care as those outside the prison gates?

These and other challenges facing staff that deliver health care in the criminal justice system were explored at a one-day conference held in central London in July.

More than 200 delegates turned up at the event, ‘Compassion in health in the justice system: compassion, not judgement’, which was organised by NHS England. Delivering compassionate care amid the pressures of working in the prison environment was the dominant theme of the day.

Reflective practice

Keynote speaker Elizabeth Walsh, associate professor at the University of Leeds, pressed home the merits of clinical supervision and reflective practice to help staff address potential barriers to their ability to be compassionate at all times, both to themselves and others.

‘We have people who are really vulnerable as a result of their situation,’ Dr Walsh said. ‘So what influences your practice and potentially your ability to act with compassion?

‘I’m not saying you are not compassionate; I’m saying it can be hard to be compassionate, and sometimes if we can unpick why it’s hard, then we can look at making things a bit better.’

'Marmite environment'

Adam Horner, a lead nurse at Care UK, said that sometimes it is just that a nurse is not suited to working in prisons. He described prison as a ‘marmite environment’ and said that some staff leave within two weeks because they just cannot cope with the stresses and situations they are exposed to, whereas others thrive.

He recommended that potential staff visit prisons before they are appointed to allow them to assess whether prison work is for them.

Multiple problems

Also speaking at the conference was Pat Kenny, representing Revolving Doors, a charity that seeks to improve services for people with multiple problems, including poor mental health, and who are in repeat contact with the criminal justice system in England.

He said that an emergency department doctor had once told him to ‘draw the blade across the neck next time,’ after he had harmed himself.

Mr Kenny, whose issues with self-harming have caused him to be detained under section 136 of the Mental Health Act, also described being handcuffed by police despite ‘gaping wounds’ in his arms.

Positive experience

One positive experience he recounted was when a police officer sat with him in a cell and chatted to him. It made a difference, Mr Kenny said, but added: ‘On the whole, for me, compassion is lacking and that’s why I’m here today.’

Mr Kenny said that drawing on the experiences of people in the criminal justice system could help inform training for those thinking of working in this setting.

RCN professional lead for learning disabilities and criminal justice nursing Ann Norman said it is possible to tell if someone has ‘that spark, that interest generally, from day one’.

Reality

‘People expect to go into a prison and see some sort of Florence Nightingale ward, but it’s not like that,’ Ms Norman said. ‘So they need to get in touch with what the reality is before they dive in.’

Speaking after the conference, Ms Norman told Mental Health Practice that some staff just lack the right attitude. ‘If I’m honest, that’s still the reality,’ she said. ‘People in a prison still have an attitude and we need to weed out some of those people who do not have the core values.’

National lead for health and justice at Public Health England Eamonn O’Moore said prison care should be patient-focused, underpinned by a principle that people in detention are entitled to care equivalent to that available in the wider community.

Health and wellbeing

Mr O’Moore, who is also director of the UK Collaborating Centre for the World Health Organization Health in Prisons Programme (Europe), said: ‘We should always remember that our role in delivering health care to people in prisons is to look after their health and wellbeing.

‘We are not part of the prison regime and we do not have loyalty to the prison regime as a point of principle; our primary and only concern is with the health and wellbeing of the patients we look after.’

He said the prison population in the UK has a high burden of chronic illness, substance misuse issues, mental health problems and learning disabilities.

People in prison have a history of poorer access to treatment and services prior to entering the criminal justice system, as well as higher rates of homelessness, unemployment and basic levels of education. This creates a ‘perfect storm of need’, Mr O’Moore said.

'Community dividend'

He said tackling these health inequalities provides a ‘community dividend’ by improving public health for the wider community that offenders are part of before and after prison life.

‘This is why prison health is not just the nice thing to do – it’s the right thing to do, and it’s the wise thing to do, because it is more effective to engage in addressing health inequalities in this setting and supporting that change beyond the prison wall, than the way that we are currently trying to address it in the wider community.’

'Real achievements'

The conference, held on the same day that justice secretary Michael Gove announced plans to sell off ineffective Victorian prisons in large cities to fund more modern jails, marked some ‘real achievements, and good practice’, according to Ms Norman.

‘It is good to recognise what we have achieved, but actually there’s a whole lot more that needs to be done.’

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