~ Before ~
Joanne* speaks calmly and gently, despite discussing some of the most traumatic events of her life.
After the birth of her first son, she went through a bout of severe post-natal depression (PND), which went undiagnosed. She links it directly to long-term domestic abuse from her violent ex-partner – the father of her son.
Her depression, coupled with an increasing dependence on alcohol, led to a mental breakdown. In 2015, at 28 years old, she was charged with child neglect and abandonment. “My world literally caved in around my ears,” she says. “I felt like a terrible human. I had let my son down. I pleaded guilty to everything.”
The judge was understanding and gave her a 12-month community probation order. But when her first probation officer left, Joanne fell through the cracks. Her PND had still not been addressed and she returned to her abusive relationship.
One alcohol-fuelled night, she says, someone had invited two men over who seemed intent on stealing her possessions. She insisted they leave. When they refused, there was a serious violent interaction. She prefers not to discuss it in detail, but the police were called and Joanne was charged with violent assault with intent, later reduced to without intent. She spent three days in custody and six days at a women’s prison.
She describes the experience as “hell”: while there, she was given no support for her addiction or mental ill health. And though her sentence was only six days, it would have a dramatic impact on the following months.
All art featured in this piece was made by women in prisons, with thanks to the Koestler Trust (Credit: Koestler Trust)
Joanne is one of hundreds of thousands of women sent to prison each year. Globally, there are more than 714,000 women and girls in prison, with the highest number in the United States – about 219,000.
And female offenders are more likely to have mental health issues compared to men. In the UK, almost half have anxiety or depression, 25% report psychosis symptoms and the majority have substance abuse issues, often in addition to other mental illness. In the US, 66% of women reported a previous mental health condition.
The majority of women are serving short sentences for non-violent crimes
Female offenders are also more likely to be first-time offenders, and less likely to reoffend, compared to men, 2015 statistics from the UK show. The majority of women (84%) are serving short sentences for non-violent crimes. This means only 16% are sentenced for violent crimes compared to 29% for men.
Many of the issues that contribute to imprisonment are interlinked. Like Joanne, for example, a high proportion of these women have been victims of crime themselves – more than half of those given prison time in the UK in 2017, which may even be an underestimate. There was a similar trend in the US. This has led some researchers to call out that imprisoning these women is “victimising the victimised”, especially considering that in many cases, the crimes against them were worse than what they were sent to prison for.
Often, the women have experienced domestic abuse, child abuse – or both, including physical, emotional and sexual abuse. Victims of abuse are more likely to suffer from mental health issues. The evidence also shows that victims of childhood abuse are more likely to end up in abusive relationships later in life, which can exacerbate or even cause mental illness. Such a situation can lead to substance abuse as a ‘coping mechanism’ – which can have other knock-on effects, such as homelessness.
An offence can be linked to any one of those things. Claire Cain of the charity Women in Prison heard of one woman doing time for stealing a bottle of vodka. She recalls another woman who was given time for an Asbo (antisocial behaviour order) when she shouted at someone in the street.
But once in prison, resources for mental health issues can be stretched or scarce. At the same time, the realities of day-to-day life – whether being separated from loved ones or subject to potentially traumatising experiences like solitary confinement or strip searches – can exacerbate problems even further.
In the UK, the majority of women are serving short sentences for offences that can include non-payment of court fines or council tax. Theft is one of the most common convictions. In fact, in its 2017 report, the charity Prison Reform Trust found that many women are being locked up for offences less serious than the crimes against them. The charity cites one woman, Mary, who used cannabis to cope with her anxiety and depression following years of domestic abuse. She was convicted for driving while under influence.
Depression is a strong predictor for excessive drinking
Worsening the situation, if an offender is seen as an addict their mental health issues may be overlooked. “In some cases, it’s not even recognised as mental health as [support services] think someone is high, so often the key to unlocking the substance abuse lies in the mental health and trauma that someone has experienced. That is so often ignored,” says Cain.
Studies show in fact, that depression is a strong predictor for excessive drinking. And those who drink too much are also more likely to become depressed. Joanne says that some charities first said she had to seek help for her alcohol addiction before she could get help for her depression – even though her drinking, she says, was directly caused by her “mental pain”.
This goes in line with what is now well understood by psychiatrists, that mental illness and substance abuse often go hand in hand. Judith Edersheim, a psychiatrist and director of the Massachusetts General Hospital Center for Law, Brain & Behaviour, has worked with offenders in the US. She found those who showed the characteristics typical of a personality disorder often featured a combination of depression, substance abuse and PTSD.
“The overlap between these categories was really speaking to the deprivation, victimisation, physical and sexual abuse that these women were enduring,” she says. Research shows that individuals with several mental health issues at once (also called comorbid mental disorders) are more likely to have substance abuse issues, which can lead to violence and other criminal behaviour.
There is an important caveat to note here. People who are mentally unwell are actually far more likely to be victims of crime rather than perpetrators. “There’s a tremendous misconception that mentally ill people are responsible for significant crime. It’s a stereotype, a scapegoat, and a stigmatisation that they don’t deserve,” says Edersheim.
In 2016 there were 12 self-inflicted deaths of female prisoners in England and Wales (Credit: Koestler Trust)
For those victims who experience abuse or neglect at a young age, the consequences can manifest as not only behavioural issues but physical changes, etched onto a victim’s biology. This can be seen on brain scans. One change is a smaller hippocampus on the left side of the brain, an area which helps people respond to stress. Another change of chronic childhood abuse is a smaller amygdala, an area important for emotions and decisions, such as processing fear.
“You’re looking at a neurodevelopmental, social and psychological trajectory that puts [victims] at risk and keeps them at risk,” says Edersheim.
“Moving parts get broken,” she continues. That is, childhood is a time when the brain is rapidly developing and learning complex social skills and behaviours. When those key developmental stages are disrupted, important skills may not develop properly. “If children get traumatised in those years… with a lack of attachment, they will be fundamentally and irretrievably harmed,” she says.
Leah* is one example. Today, she attributes her mental health disorder in part to emotional neglect from her father in childhood, recalling suicidal thoughts even before puberty. She has always heard voices, she says, and is now diagnosed with “mixed emotional, unstable personality disorder”, as well as post-traumatic stress disorder (PTSD ) from two abusive ex-partners. Her second partner was also violent towards her son, something she says she was too ill to realise. She was charged with child-neglect and abandonment.
Her sentence took two years to come to trial. Leah recalls receiving little support during this time, which meant that during her court case she was unwell. “When I was in court they didn’t put my mental health into my case. I didn’t know in my own head, did he do it… what’s going on…” she says. “They made me feel the worst person of all – and I couldn’t explain [what was going on in my head], so I decided to hide it and ignore it.” She was sentenced to 3.5 years in prison, and served just under two, while her ex-partner received 14 years for grievous bodily harm.
~ During ~
Unfortunately, magistrates facing women like Leah can be left with little option but to give prison time – especially if there is nowhere else to place those convicted of crimes. Mental health facilities for offenders have faced significant cuts the UK and there are few secure mental health hospitals. Psychiatrists in 2017 also warned that they are sometimes unable to “deliver adequate mental health services” in prison. This could mean, says Cain, that magistrates believe that women will get the psychological help they need behind bars instead.
Criminal psychologist Tammi Walker has seen this too. “There’s an idea that they are in a better location by being in prison than being out of prison,” she says. That’s if their mental health issues have been previously identified – many are not. Cain recalls one instance where a woman was sentenced for an antisocial behaviour order (Asbo) and was only diagnosed with a mental health disorder once she entered Holloway prison – a women’s only prison that closed in 2016.
The magistrates aren’t always wrong. Leah stresses that, for her, prison was a refuge: were it not for her time in prison, she “would have been dead”, and it was only when she went to prison that she received any help. As soon as she entered she was seen by a mental health team.
“From that [first] day they supported me by having my own therapist, going to groups, putting me on the correct medication and teaching me about mental health and that it would be okay,” she says. Her probation officer continued her care and helped her get support upon release. “Crime can actually help people who really want help,” she says, a fact she still finds astonishing a year since her release.
But not every prisoner is so lucky. Another woman, Sarah Reed, was charged for grievous bodily harm while she was a patient at a secure mental health hospital. She was remanded into Holloway prison to undergo psychiatric assessment to determine if she was fit to stand trial. “For some reason prison was seen as a safe space but her health deteriorated rapidly,” says Cain. Reed was found dead in her cell in January 2016. Her history of mental illness was known, but her family says she was not given any support. A jury at an independent inquest concluded that “unacceptable delays in psychiatric assessment and failures in care contributed to her death.”
Another factor preventing adequate mental health support in prison is that the majority of sentences for women are short, or brief custodial stints before court hearings. Short sentences can leave little time for intervention – but they do have negative long-term consequences.
It can impact on their sleeping, feeding, looking after themselves
Particularly for someone with a mental illness, prison can feel extremely alienating, says Walker, who frequently speaks to inmates about their experience. The psychological impact can exacerbate mental health issues on a number of levels. It can lead to a lack of motivation and withdrawal from others, she says: “It can impact on their sleeping, feeding, looking after themselves.”
Even if the women already had little control of their lives before going into prison, “the prison regime is a place they end up having less control,” Walker says. “That again can have an impact on self-esteem, on high levels of hopelessness and helplessness.”
Segregation can cause additional anxiety for those with or without previous mental health issues (Credit: Koestler Trust)
Prisons around the world also continue to use segregation, where individuals can be kept in solitary confinement for 22 or more hours per day. In Peterborough prison in the UK, for instance, women were segregated when challenging behaviour needs “could not be met”. One inmate interviewed by the Prison Reform Trust commented that she could not sleep while in segregation “because there are women with mental health problems who bang and shout and keep you up.”
Even some prison staff agree that segregation is detrimental. “Sometimes we get from court women who shouldn’t be here. You see them coming in a state and you see them deteriorate here. Ultimately she’s a human being and we lock her up in a tiny room,” one staff member anonymously told the Prison Reform Trust.
Independent reports undertaken by Justice Inspectorates also found that some women’s prisons used too much force on inmates. For example, a 2017 report from Peterborough prison (in the female section) – found that the use of force was “more than double” the usual, and that strip-searching was excessive, citing that it should “only be used when current intelligence indicates the need for it”. Being searched, restrained and subjected to confinement is wholly unsuitable for people who are vulnerable – particularly those with a trauma disorder, Edersheim says.
It didn’t matter that Joanne’s sentence was only six days. It would have a dramatic impact on the following months. Now officially classed as homeless, she was sent to bail hostel accommodation, full of individuals with hard drug problems, complex mental health issues and physically violent tendencies. “That in itself was scary. My relationship with my parents completely broke down,” she says. “I was so chaotic at this point.” The thought of the trial – which would happen six months later – was crippling: “I was potentially facing six years”.
Suicide crossed her mind many times, she says.
Leah underwent something similar. In her two years of awaiting sentencing, she tried to take her own life several times and was sectioned under the mental health act for six months.
Almost half of women in prison have at some point attempted suicide. Women in custody are more likely than men to physically self-harm, according to reports, and 21% of all incidences of self-harm in UK prisons are inflicted by women – despite the fact that they represent just 5% of the prison population.
Of course, a prison sentence has other consequences too.
Due to the nature of her charge Leah was not able to see her son. It has now been three years. Like her, the majority of female inmates have children, about 80% in the US and 66% in the UK. They are usually the sole caregivers. A sentence can therefore immediately break up a family, especially so if the children are taken into care.
Leah was fortunate that her brother was able to become her son’s guardian. But even if another family member can step in, visitation is not always easy as prisons tend to be a long distance from home. There are fewer women’s prisons than men’s so the likelihood of one being near to a woman’s family is therefore slim.
While they are in prison, the lack of contact with family on the outside deepens the feeling of a lack of control. That is especially true for women on remand, some of whom remain in custody until trial – as was the intended case for Sarah Reed. “What they talk about is a high level of uncertainty,” Walker says. “Obviously, this has an emotional impact.” Walker found that prison time results in a lot of guilt. It doesn’t go away when the women are released: both Leah and Joanne say they carry guilt with them on a daily basis.
~ After ~
This speaks to the irony at the heart of imprisonment. One aim of prison often is rehabilitation. But without a home, away from relationships or contact with their children, how can someone begin to rebuild their lives?
If adequate mental healthcare is not given, it makes reoffending highly likely, Walker says.
Overall, within one year of leaving, 48% of women are reconvicted with another crime, a figure that rises to 61% for those who receive sentences of less than 12 months. Joanne for instance was reconvicted after her first charge. She says if her mental health issues had been addressed while in prison, her story would have been very different. Leah, on the other hand, feels that she can now start to rebuild her life – though she has still not attempted to see her son, now aged 13, as she wants to “feel fully well” first.
Once outside, another real issue is homelessness. If a woman lives in social housing and is imprisoned, she is likely to lose that home while away, even if the sentence is very short. What makes this harder is that local authorities can categorise someone who has left prison as a person making themselves homeless”, says Cain. “The reasoning is, you committed a crime, you knew you’d go to prison, and knew you’d lose your home. Once you are considered intentionally homeless the council is under no duty to find you a home.”
Jenny Earle of the Prison Reform Trust says that several women have told her that even a short prison sentence “may as well be a life sentence”. When they get out, they often are in a “catch 22 situation”: they won’t be offered family accommodation until they have their children living with them, but they won’t get their children back until they can show evidence of a suitable home.
Then there’s the stigma of a prison sentence. As well as stigma from other people, individuals also “self-stigmatise”, which makes it harder for them to reintegrate. Additionally, many employers will not meet or consider someone with a criminal record – especially in the care sector, which is predominantly staffed by women. Midwives for instance have been told they will “never practice again” if they have a criminal record, says Earle, even if the crime was minor and non-violent.
Nearly a third of women in UK prisons have spent time in care as children (Credit: Koestler Trust)
“There is an assumption in many quarters that if you’ve been sent to prison you must have done something really serious,” Earle says. “There’s an assumption that they must have a long, bad record before that [last crime] happened.” Yet as explored, women are more likely sent to prison for a first-time crime than men, and for a non-violent offence.
If help is given at the right moment, reoffending rates are drastically lowered. As is the chance of going back to a violent partner. Leah fits this picture. In prison she was offered “domestic violence support” and is now better able to understand when she is at her most vulnerable.
~ Future ~
I asked Joanne how she sees her future, and her response was startling. “I have one,” she says. There was a long time where she didn’t feel this way. But she made a conscious decision to seek help from the Women’s charity Anawim, who help rehabilitate female prisoners. “I never thought my life would go down the road,” she says. “But you have to move forward.” She’s now an advocate for changing how people view offenders and says it is so important that individual stories are heard: “nobody wakes up and decides, ‘Today I’m going to commit an offence.’”
With the right support for mental health, a report from Anawim says that first time offences could be reduced. That’s because a women’s centre as an alternative to custody has now shown proven success, with reoffending rates of between 1-6%. “Try as one might to make prisons and secure units enabling environments, they will never be as enabling as allowing women to remain in their communities with or near any children they may have,” the report states. The cost of time in prison far exceeds the cost of their preventative programme.
A high proportion of female prisoners are also victims (Credit: Koestler Trust)
Many other smaller charities exist to help women get back into work, or give them access to mental health therapies. If there was more investment by the government in mental health support and housing, Cain says that the prison population would naturally be reduced. The charity Women in Prison are campaigning to halve the female prison population by 2020. There is a view that prison time should be reserved for those who have committed violent offences, or who might pose a risk to the public. The charity has three women’s centres that can act as an alternative to custody. But they, like many others, struggle for funding.
Pamela Stewart says that she has lobbied the UK government for years to implement a women-specific strategy, but has received only failed promises. “The most important take home from this is – if there could just be early intervention, then that could reduce the crime rate.”
A spokesperson from the Ministry of Justice said that in May 2018 they will publish a female offender-specific strategy, to improve outcomes for women in custody and in the community. “We want to divert women from custody wherever possible, but where this isn’t appropriate we want to provide the highest standards of care.
"Early intervention is vital in tackling mental illness, which is why we increased support during the first 24 hours in custody, and invested in specialist mental health training for staff," the MoJ told the BBC Future.
For now, the UK government plans to build nine new prisons by 2020, with an expected cost of £1bn. “Once you are in there, it is very very hard to exit – they have their grasp on you for a long time,” says Cain. “By just building prisons you fill them and you bring more and more people into this endless cycle.”
As for Joanne, she is well today, back with her son and away from her violent ex-partner. Leah is also feeling more positive, and hopes to soon be well enough to regain access to her, now teenage son. Both are passionate about challenging society’s view of what an offender is. Women like them, and the charities that support them, are one small step to helping end the revolving doors into prison.
*Names have been changed.
Criminal Myths is a new series curated and edited by Melissa Hogenboom. She is @melissasuzanneh on twitter. Are there other factors or questions you think we should explore. Let us know your opinions on the social links below, or share your thoughts with the hashtag #criminalmyths.
BBC Future went to visit a prison in the Netherlands that houses women with some of the most complex mental health needs. There the prison has a separate section dedicated to mental health care. Read our follow-up later this week.
All art featured was made by women in prisons, with thanks to the Koestler Trust. In 2018 the charity will be displaying these works in sites across the UK. The Koestler trust helps offenders “lead more positive lives by motivating them to participate and achieve in the arts” and to challenge negative preconceptions of ex-offenders.