LEVELS OF VIOLENCE AND MEDICATION IN A SPECIAL PRISON UNIT, 1986–1995.
Several followers, esp @KKSoodLaw have recently shown interest in my 1990’s prison work — this paper was unpublished till now. Thanks.
LEVELS OF VIOLENCE AND MEDICATION IN A SPECIAL PRISON UNIT, 1986–1995.
Dr Bob Johnson, Consultant Psychiatrist, dated Monday, February 13, 1995
INTRODUCTION
Violent disruptive prisoners pose a sharp challenge to any prison system. Society locks violent citizens away, the prison service itself has fewer options. For, as one Home Secretary put it, “the mood and temper of the public with regard to the treatment of crime and criminals is one of the most unfailing tests of a country . . . [being the] sign and proof of the living virtue in it” [Winston Churchill 1910, Hansard].
Violence is an increasingly serious social disease. Murder is already the commonest cause of death in woman at work, and the second commonest for men in the USA [US Dept of Labour Report 1994 in The Economist Dec. 3rd 1994, p 67]. It is set to rise inexorably in the UK, according to a recent monograph [Oliver James, “Violence against the person”. Free Association Press 1995]. A great deal more is known about its origins than is generally supposed, as Oliver James [op cit.] makes clear.
In England in the early 1980’s, an enlightened penal policy lead to three Special Units being established, whose principal objective was to remove especially disruptive prisoners from the general system, while obviating the need to condemn them to long periods of segregation or solitary confinement. The Special Unit at Parkhurst Prison (UK) was opened in December 1985, and provides the data presented here.
Barlinnie was a Special Unit established in Scotland in 1973. Professor David Cooke’s analysis [Brit J Criminol, Spring 1989, 129–143] showed that the regime there reduced assaults from an expected 105 to 2. The Barlinnie Special Unit was closed in December 1994.
From July 1991 to present, every prisoner in the Parkhurst Special Unit who consented was seen on a weekly basis by the consultant psychiatrist ( currently all of them). The approach deployed was to pursue and attempt to disentangle the long term effects of Child Abuse (trauma), essentially an extension of Post Traumatic Stress Disorder (PTSD), along similar lines to those pioneered by Alice Miller [ ”For your Own Good”, Virago, 1980]
METHOD
Research was regarded from the outset as an important component of these Special Units. Detailed records of inmates’ ill-discipline were recorded on a monthly diary sheet. These form the basis for the data presented. Although “diary data” is inevitably incomplete and inaccurate, actual physical injuries, either of inmate or staff, are significant enough to attract notice and ensure greater accuracy in recording.
Medication records are less complete, only since late 1992 has the pharmacy kept dispensing data on computer. The 1990/91 figure is therefore an extrapolation from the prescribing patterns as recorded in June 1991; the 1992/3 data is based on the first six months of 1993; 1994/95 is an extrapolation of drugs dispensed to the end of January 1995. The 12 month periods run from July 1st in each year.
RESULTS
assaults per year;
1986 — — — — 17
1987 — — — — 6
1988 — — — — 5
1989 — — — — 2
1990 — — — — 5
1991 — — — — 3
1992 — — — — 3
1993 — — — — 1
1994 — — — — 0
1995 — — — — 0
Table 1 Assaults
Table 2 Medications & costs
Year: — — Drugs in Kgs: — — costs
1990/91 — — 3.5 — — — — £5500 est.
1991/92 — — no data — — — no data
1992/93 — — 1.4 — — — — — £3125
1993/94 — -—- 1 — — —- — £1050
1994/95 — — 0.15 — — — — £254
Table 2 Medications & costs
The numbers of inmates in the Special Unit throughout this period did not vary widely, usually in the range of 14 to 16, with a maximum of 18; a total of 54 men passing through in the 9 years. Currently there are 15, all lifers except one serving 16 years, and all for murder or attempted murder, except one for firearms offences.
The incidence of actual physical assault on another person is shown in table 1. Graph 1 [not shown here] groups this data into two year bands. Attacks on property are omitted.
Medication levels are shown in kilograms of tranquillisers dispensed per annum. Drugs included are essentially those psychotropics in Chapter 4 of the BNF, [British National Formulary] omitting anti-depressants and analgesics as these are not commonly used to modify violent behaviour.
DISCUSSION
This data is interesting for two reasons in particular. Firstly though measurement of mental health is essentially subjective, happiness for instance being notoriously difficult to define, weighing the drugs dispensed in this relatively closed Special Unit (only 4 newcomers per annum on average) comes close to objectively measuring the subjective mental health of the inmates.
Secondly the conventional view that symptoms of violent disorders should be tackled by increasing medication has been stood on its head. Here a group of violent, unstable, ill-disciplined lifers have had their tranquillising medication consciously cut by 95%. This has not lead to an increase in violence. A reduction from 1 assault per inmate per annum in 1986, to zero in 1994 should do more than encourage the team currently working on the Unit. A reduction of around £5000 in sedative drug costs annually for 15 patients would, if applied nationally, represent savings of several million pounds.
It is clear that staff on the Special Unit are now adept at defusing violent incidents, and for the most part containing them within the Unit. They provide an indispensable supportive ethos which alone permits the weekly psychiatric therapy sessions to function. Sensitive areas could simply not even be discussed let alone explored without it.
Psychopaths are widely regarded as untreatable — and clearly they commonly are, when the treatment offered is either unfocussed psychodynamic counselling, or sedative medication. The fantasies, symbolisms and “free association” favoured by Freud have little relevance to the harsh realism of maximum security prisoners — indeed, on occasion, they can be counter-productive.
What Severe Personality Disorders require is a positive emotional involvement, together with a proactive approach to undoing the buried terror remaining from childhood trauma. This terror distorts thinking, and is therefore difficult to resolve unaided. It freezes the individual at the emotional age of five or thereabouts. By gently teasing out the implications, ”Value Therapy” demonstrates that the original trauma is now over, and will not recur in adult life. Mature social strategies therefore become available, and violence is seen to be both socially maladaptive, and emotionally immature. The target is to eliminate it altogether, an aim shared by all participating inmates, who now, for the most part, co-operate with the Unit staff in reducing it.
Subjective clinical impressions are that most prisoners once over their initial shock, warmly welcome the opportunity to disentangle their childhood traumas, in the safe supportive atmosphere that this Special Unit currently provides. The results suggest the possibility of a method to reverse the rising tide of violence which besets society at large, and prisons in particular.
Dr Bob Johnson
Consultant Psychiatrist,
MRCPsych (Member of Royal College of Psychiatrists), MRCGP (Member of Royal College of General Practitioners). Diploma in Psychotherapy (Psychiatric Inst New York), PhD(med computing), MA (Psychol), MBCS, DPM, MB, BChir, MRCS.
In 1995, at a private hospital, since closed. Now at P O Box 49, Ventnor, Isle of Wight, PO38 9AA UK
Acknowledgements. I wish to thank Mike Christmas, Parkhurst Prison Principal Pharmacist, for his help with the computerised drug data; and of course the staff on C-Wing Special Unit without whose support this work could not have taken place.
This paper was completed and circulated widely, and entirely unsuccessfully, on Monday, February 13, 1995.
Note: today, Saturday, 28 January 2017, this Special Unit was closed peremptorily, in early 1996, — the then UK Home Secretary ‘knew’ that prison “didn’t work”, and was content to leave this view undisturbed by irrefutable clinical data. A national UK scheme, designated DSPD units, was established, costing an estimated £500,000,000, [Sainsbury Mental Health Centre Report] which bore no resemblance to the regime established so successfully at Parkhurst Prison as above. This paper was widely circulated for publication at the time, with no success, so the author judged the zeitgeist to be contrary, and desisted further, moving on to more fruitful pastures. Latterly, the same approach has proved notable in clarifying psychotic symptoms. Thanks for reading.
