Women who challenge - Nacro

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CHAPTER 3women shown by the statistics to have beensubject to disciplinary sanctions, it appearslikely that, in at least some cases, this rule wasnot adhered to. Women prisoners’ reported lackof confidence in the prison justice systemseems understandable in this light.Patterns of prescribing in women’prisonsThere is plenty of anecdotal evidence to suggestthat there are high levels of prescribing ofpsychotropic medication within women’sprisons. Devlin (1998) 45 , for example, quotesnumerous reports from prisoners about theprescribing of anti-psychotic drugs, such asMelleril and Largactil, to an extent where sideeffects become visibly apparent.Concerns about the level of prescribing,especially of combining anti-depressants, majortranquillisers and night sedation, wereexpressed by the Chief Inspector in his ThematicReview 46 . He recommended that:‘Clinicians should agree a sensible protocol inconjunction with an independent specialist forprescribing drugs. This should be co-ordinatedcentrally through the professional Head ofWomen’s Health who should regularly audit theresults.’Disappointingly, there is no reference in hisfollow-up report 47 to indicate the extent towhich, if at all, this recommendation has beenimplemented. His concerns were, however,shared by the Prison Reform Trust (PRT)Committee on Women’s Imprisonment 48 , whichrecommended the undertaking of:‘… an audit of drug prescribing in prison andthe development, in collaboration with the NHS,of a protocol for prescribing for womenprisoners which should be monitored by NHSpersonnel.’In both cases, doubt was expressed aboutwhether unacceptable prescribing patternswithin prisons were wholly attributable to thestaff within the prisons themselves or whetherpoor prescribing by GPs in the community mighthave had a part to play in establishing patternswhich were then simply perpetuated in prison.For example, one prison medical officer hassfound 17 year olds coming into prison withlegitimate prescriptions for drugs such asdiazepam, temazepam, methadone anddihydrocodeine 49 . She found many of those whowere being detoxified from benzodiazepines andheroin while in prison were returning to theirGPs on release and being put straight back on tothe prescribed drugs. A different light is shedon this issue by the survey carried out by theOffice of National Statistics 50 . This found that asubstantially higher proportion of women inprison (50%) were being prescribed drugs actingon the central nervous system (CNS drugs) thanhad already been receiving prescriptions forsuch drugs before entering prison (17%). Thefigure for women prisoners was alsoconsiderably higher than that for maleprisoners, of whom only about 20% werereceiving such prescriptions.In their survey, Maden et al (1994) 51 found lowerlevels of prescribing of psychotropic medicationin prison – at 26% for women and 8% for men –though the much higher prescribing level forwomen prisoners is still apparent. Thisinformation is reported under the sub-heading‘Psychiatric treatment within prison’, thoughthere is no mention of any other forms oftreatment other than medication. They state thatnone of the prisoners reported being givenmedication against their will – which is perhapsto miss part of the point. In order to be able togive informed consent to treatment, patientsmust be provided with sufficient informationabout what is involved, such as the details oftheir diagnosis and its prognosis, uncertaintiesabout diagnosis, the likely benefits of theproposed treatment and the probabilities of itssuccess or otherwise. Prisoners should be nodifferent to other patients in this respect. Thisis particularly important since, as the HealthSelect Committee 52 points out, treatment inprison is not covered by the terms of the MentalHealth Act 1983, which means that patientstreated without consent are also not covered by45 Devlin A (1998) op cit46 HM Chief Inspector of Prisons (1997) op cit (page 106)47 HM Chief Inspector of Prisons (2001) op cit48 Committee on Women’s Imprisonment (2000) Justice for Women: theNeed for Reform London: Prison Reform Trust (page 21)49 Nelson-Owen M (1997) ‘A doctor’s dilemma’ British Medical Journal315: 553-55450 O’Brien M et al (2001) op cit51 Maden A et al (1994) op cit52 Health Committee (2000) op citpage 24
Women who challenge: women offenders and mental health issuesthe safeguards which the Act provides.Treatment in prison health care centres iscovered only by common law and, as such,when it comes to prescribing psychotropicmedication and to the possibility of pressure orincentives to accept it being applied, it lackstransparency. A survey establishing the extentto which prisoners have given informed consentto medication with CNS drugs might prove afruitful area for research.The PRT Committee on Women’s Imprisonment 53expressed understandable concern that theapproach to prescribing in women’s prisons wasliable to perpetuate or even increase addictionamong women prisoners. This is not to say thatthere is never a case for prescribingpsychotropic medication to women prisoners.The concern is to get away from the mindsetwhich automatically reaches for the prescriptionpad as a response to a cry for help and insteadto promote adherence to the principle ofprescribing according to therapeutic need.It is interesting to compare the approach toprescribing in women’s prisons with that inspecial hospitals. For example, at Broadmoor,Bland et al (1999) 54 found that anti-psychoticmedication was prescribed to 96% of women,even though only 72% were diagnosed as havinga mental illness, which suggested that antipsychoticmedication was being prescribed tosome women who had no diagnosable mentalillness. Even in this environment, which should,after all, be therapeutic, only 32% of the womenhad received or were receiving psychotherapy.While recognising that psychotherapy may beprecluded in some extreme cases, Bland et almake the point that, given the background oftrauma, abuse and deprivation experienced bymany of these women, psychotherapy could bea vital element of their treatment.Substance misuseViews differ about whether drug or alcoholdependency should be regarded as a psychiatricdisorder. In effect, whether it is or not matterslittle, since there is no dispute about the impactit has on the physical and mental health andwell-being of women prisoners. The figuresincluded in Chapter 2 give an indication of thescale of the problem and a comparison betweenthe findings of Maden et al’s survey 55 , conductedat the end of the 1980s,and the findings of theONS survey, conducted in 1997, show that it isgrowing. The concerns of the Committee onWomen’s Imprisonment 56 , referred to above, inrelation to the possible impact on addictivebehaviour of prescribing patterns in prison caneasily be understood in this context.In his Thematic Review 57 , the Chief Inspector ofPrisons referred to research suggesting thatwomen prisoners’ use of drugs and alcohol ismore likely to be for the purposes of ‘numbingout’ or as a coping mechanism than forpleasure. He made the point that womenoffenders with substance misuse problems havedifferent needs to those of their malecounterparts and suggested that the PrisonService should have a separate strategy for maleand female offenders. He highlighted concernsthat there was no central strategy for womensubstance misusers and no consistentdetoxification strategy across the female estate,which led to very different levels of provisionwithin different establishments. Herecommended that there should be greater coordinationin a drugs treatment policy forwomen so that counselling and treatment needscould be properly met across all establishments.There have been considerable changes since theThematic Review, with the introduction ofCounselling, Assessment, Referral, Advice andTreatment Services (CARATS), which are aimed atachieving follow-up care in the community postrelease,and which are now available in most,though not all, female establishments. In hisfollow-up report 58 , the Chief Inspector foundthat these, together with services provided byeducation departments and outside drugagencies, had helped to ensure the availabilityof drug education programmes focusing onmultiple high-risk behaviour and the risks forthe women themselves and their unbornchildren.There is, however, clearly still a long way to go.The ONS survey 59 found that 54% of female53 The Committee on Women’s Imprisonment (2000) op cit54 Bland J et al (1999) op cit55 Maden A et al (1994) op cit56 Committee on Women’s Imprisonment (2000) op cit57 HM Chief Inspector of Prisons (1997) op cit58 HM Chief Inspector of Prisons (2001) op cit59 Singleton N et al (1998) op citpage 25
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Page 22 and 23: CHAPTER 32% had a child with foster
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Page 28 and 29: CHAPTER 3remand and 41% of female s
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Page 42 and 43: CHAPTER 5Where do we go from here?I
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Page 46 and 47: CHAPTER 5Evidence from the CARAT pr
Page 48 and 49: BibliographyAllen H (1987) Justice
Page 50 and 51: APPENDIX 2Service modelsForensic me
Page 52 and 53: APPENDIX 2Community-based servicesB
Page 54 and 55: APPENDIX 2The SamaritansThe Upper M

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