How the last man to see Sylvia Plath alive was punished for his quiet homosexuality

Christopher Bissell and Avi Boukli, The Open University


At the start of LGBT history month in February, the government announced it would pardon 49,000 men of sexual offences for homosexuality. While this is an important nod to justice, it is also a reminder of everyday injustices suffered by LGBT people in Britain when it was still a crime to be gay.

Nearly 50 years ago, in July 1967, the government voted to partly decriminalise homosexuality for men over 21-years-old. The illegality of homosexuality had ruined countless lives and careers – even of those who were not actually convicted of a crime.

One of those who fell foul of the law two decades earlier was the distinguished art historian and curator of Leicester Art Gallery, Trevor Thomas. His story is indicative of how others were treated and cautionary of how current injustices inflict harm.

Thomas was a great supporter of German expressionist art, which ultimately resulted in Leicester possessing the best collection in the UK – around 500 pieces. In 1944, he organised a renowned exhibition at the Leicester Gallery. He had helped Tekla Hess, who was persecuted in Nazi Germany and her son Hans, who became Thomas’s assistant, to settle in Leicester. The Hess art collection formed the core of the exhibition. Patrick Boylan, director of Leicester Museums between 1972 to 1990, recalled that the exhibition was highly unusual and one of the first in the UK to show the work of German Expressionist artists, some of whom were in exile, during World War II.

Falling foul of anti-gay laws

But Thomas’s quiet homosexuality soon got him into severe trouble. By 1946 there was a significant, very discrete, gay community in Leicester, including prominent people in public life and the arts. Most of the time, gay men were ignored by the police, but at times “cottaging” – anonymous sex between two men – could be severely punished. In an interview with the LGBT Oral History Project, Boylan recalled that Thomas and another man were arrested for allegedly looking at each other in a local public lavatory.


Source: Leicester Arts and Museums Service, URL:


Thomas was ill-advised by his lawyers to plead guilty to “corrupting a young man”. But he was given a glowing character reference by Kenneth Clark, director of the National Gallery, who had expected Thomas to succeed him. But it was to no avail. Thomas was subjected to a tirade from the bench and thrown into a cell for four days. He was not actually convicted of any offence, though he was “bound over” – a punishment similar to an antisocial behaviour order today – to keep the peace for 12 months. But he lost his job.

Simon Lake, the gallery’s current curator, has explained how quickly Thomas was ostracised, receiving his dismissal notice from the assistant town clerk on the steps of the town hall.

Following his brush with the law, Thomas, like many gay men at that time, visited a psychiatrist, who advised him to marry – or, like the mathematician Alan Turing undergo “cure” treatment. Thomas did get married, and had two sons, though he later divorced.

Thomas lived abroad from 1949 to 1960, holding a number of prestigious posts, including with UNESCO in Paris and professor at what is now University at Buffalo, part of the State University of New York. Returning to England in 1960, he became art director for Gordon Fraser greetings cards and from the early 1970s an active and respected figure in the Campaign for Homosexual Equality.

Plath’s neighbour

Thomas lived for a time in the flat below the American poet Sylvia Plath and her two children in north London. Their relationship was uneasy to begin with – partly, at least, because Plath had secured the larger flat that Thomas had hoped to rent.


The flat in north London where Sylvia Plath died.By Anosmia via flickr, CC BY


Later, though, they developed a friendship of sorts. One afternoon, Thomas recalls in a short, privately published memoir, that they were reading the Observer, when Thomas chanced upon a review of The Bell Jar, by a certain Victoria Lucas. When Thomas said he thought it looked interesting, and that he intended to get a copy, Plath owned up to the authorship.

Thomas was the last to see Plath alive. She borrowed some airmail stamps from him on the eve of her death, but he was not aware of the tragedy until the arrival of the emergency services the following day, as he had himself been overcome by gas fumes. He died in 1993. His life reminds us of the invisible persecution suffered by LGBT people in the UK.


Prison Abolition in Question(s): Part One


Deborah H. Drake and David Scott, The Open University


Prison abolitionists question the moral and political justifications of imprisonment and call for the radical reduction or elimination of the use of prisons as they are currently constituted.  Abolitionists are concerned about the harmfulness that prison causes to those imprisoned, victims, families, prison staff and society at large.  They are also concerned with the continued failure of prisons to fulfil any of their stated aims or purposes.  Below we consider a range of questions that often arise whenever the idea of prison abolition is raised and offer some detailed, but concise, responses that may be used as a resource for those who are new or wish to learn more about abolitionist ideas.



  1. Why call for abolition and not prison reform?

Over the last 200 years, many societies have experimented with various prison reform interventions.  Yet no reform initiative has ever improved the effectiveness of the prison.  Moreover, the foundations on which imprisonment is based are fundamentally flawed.  Prisons are designed to exact particular kinds of punishment: loss of liberty and rights, social isolation, and austere material living conditions.  They are coercive environments in which genuine treatment/rehabilitation/care cannot be provided because they are incompatible with the delivery of punishment. Additionally, pain infliction – no matter how lenient or harsh – is an ineffective means of changing behaviour.  There is no evidence it works under any circumstances but much evidence that punishment (especially severe punishment) encourages violent or otherwise undesirable behaviour.  Thus, the idea that the particular punishment that prisons deliver will transform people and encourage (or force) them to lead better lives upon release is fundamentally flawed.  In an intentionally punitive environment, reform measures are futile.  Through easing moral concerns about the inevitably negative impact of pain infliction, penal reform can actually make it easier for governments to reinforce a given society’s reliance on the prison and increase prison expenditure and expansion. The important lesson is that no measure of reform can ever remedy the harms generated by the prison. 



  1. What about all the dangerous people that are currently held in prisons?

It is important to recognise that, for the most part, prisons aren’t ‘filled’ with dangerous people.  In England and Wales, around 60% of the prison population are held for non-violent offences.  And, of the 40% who have committed a violent offence, very few indeed have been deemed so dangerous that they cannot be released (as of 2016 only 54 people were serving whole life sentences).  The imagined monsters of our nightmares – that is, the serial killer or the otherwise wildly dangerous individual – are exceptionally rare.  The average person who enters prison has low educational attainment and poor literacy/numeracy skills, is unemployed and comes from a lower income or impoverished background.  There is a stronger link, therefore, between poverty and prisons than there is between dangerousness and prisons.  In the U.S. around 16,000 people die each year as a result of street crime.  Contrast this with the 55,000 who die as a result of corporate criminal negligence.  A similar story can be told in many other countries around the world that promote the interests of (Neo-liberal) capitalism above the needs of their people. The way we all think about dangerousness and the structures we put in place to protect ourselves from various dangers needs to be reconsidered.  Prisons, and the harms that prisons respond to, distract us from thinking more carefully about a wider range of dangers that are more imminently and universally harmful than ‘street crime’.




  1. Don’t we have to lock up violent people, murderers and people who sexually offend in order to keep those most vulnerable in society safe?

Serious interpersonal crimes are, of course, a grave concern for any society.  The reduction of violence (in all its forms), harm and unnecessary human suffering sit at the centre of abolitionist thought. Placing people in prison to punish them for what they have done has been repeatedly proven NOT to work and, in fact, frequently stimulates rather than calms violence.  If heightened public protection and reduction in violence and harm is what we hope to achieve – particularly for women, children and other vulnerable groups – then we first need to consider why acts of violence, such as domestic and sexual violence (for example), occur in the first place.  These types of crimes are associated with power imbalances and social structures that objectify, demean and treat women, children and other vulnerable groups as less than fully human.  Societies that tolerate inequalities or that refuse to fully recognise the rights and autonomy of all social members are complicit in the violence that is then perpetrated against these groups.  When horrendous interpersonal violence against vulnerable people happen our first priority must, of course, be to ensure the safety of the person concerned.  However, removing a perpetrator of interpersonal violence from society altogether and placing them in isolated, brutal conditions is surely the worst action to take if the goal is for them to learn to live more safely alongside other social members.


  1. But what about those who perpetrate “hate crimes”, shouldn’t they be locked up?

Similar arguments put forward in the previous response also apply here.  Additionally, if the goal of a justice system is to denounce or condemn particular actions and to try to prevent them happening again, then imprisonment is not the most efficient means of achieving these goals.  Prison environments are full of power imbalances, racial and sexual violence, discrimination and hierarchical social relationships.  All of these elements of the prison environment can, therefore, reinforce the same ideas and social divisions that those who perpetrate hate crimes bring into prison with them in the first place.  Prisons utilise and reinforce imbalanced and harmful power relations and are more likely to exacerbate hateful ideas rather than challenge or reverse them.


  1. Prisons work because they provide an effective deterrent. Shouldn’t there be serious consequences when someone breaks the law?

Of course there should be a proportionate response when somebody does something wrong.  No prison abolitionist would disagree with this idea.  But, the logic that ‘prisons are there because they threaten a consequence or act as a deterrent for crime’ is false.  Firstly, there is no evidence that deterrence works – we simply cannot measure an action which does not happen.  Secondly, on the basis of the evidence we do have – over 200 years of experimenting with the use of imprisonment – no matter how lenient or harsh the punishment given, there is no discernible deterrent effect on rates of crime.  This holds true at different points in history and in different jurisdictions.  It is even true in places that continue to use the death penalty.  In States that retain the death penalty in the U.S. the murder rate is HIGHER than the States which do not use this ultimate form of punishment.


  1. We can’t just let people go free – what about the victims and their desire for revenge?

The needs and desires of victims are not well served by current criminal justice practices or by the use of the prison.  Many victims want a) never to be harmed again by the perpetrator and b) for the perpetrator never to harm anyone else in this way again.  Very few victims of crime actually call for revenge.  Moreover, revenge itself can be profoundly damaging for victims who may become “consumed by the wound”.  And, in this way, a response to crime motivated by revenge can fail victims as much, if not more, than it fails perpetrators and society at large.  There is no doubt that when a serious harm occurs something must be done in response.  There must be some attempt to realign the imbalance and the injustice that has occurred.  But this should be tangible and meaningful and, crucially, not produce further harms – to anyone – including the perpetrator.  Most importantly – for victims – sending someone to prison certainly does not ensure that person will never commit the same crime again.  And, in fact, in some cases it can make it more likely for the person to return to crime upon release.   So, if the goal is to prevent a perpetrator from ever committing further crimes, prison is not the answer.




  1. But aren’t prisons proven to be an effective means of rehabilitating offenders?

No.  They aren’t.  Prisons have continually failed to ‘solve’ people’s problems through ‘treatment’ or other ‘rehabilitation’ strategies.  Prisons are, first and foremost, places of punishment.  Rehabilitation and punishment are incompatible.  As the saying goes: ‘you cannot teach people to be free in captivity.’  This means that the basic structure of the prison is ill suited to showing people how to live safely in a free society.  The idea of rehabilitation is also too narrowly focused on trying to change or ‘treat’ an individual.  Prisons are more closely linked to poverty than they are to dangerousness (see Question 2 above).  The individualised focus of prisons mean that they are unable to address any of the social conditions – education, limited employment or housing options, community support structures – that need to be met for people to be able to live better and more safely in society.


  1. Should we not just lock people up and throw away the key to keep them off our streets?

We cannot lock our way out of the crime problem.  The ‘crime of the streets’ is generational – many lawbreakers desist from ‘street crimes’ as they get older and another group of people (the next generation) become lawbreakers. Following a policy of incapacitation therefore requires disproportionately long sentences and a constant influx of new and younger prisoners.   Where would indefinite detention ever end?  Locking people up for short or long periods of time may only delay, intensify or displace crime problems.  It can also create ‘capacitating’ effects in the sense that new lawbreaking skills can be learnt in prison, in response to the damaging and anti-social environment of prison life.  Additionally, when a family member is sent to prison it increases the chances that further family members will also follow the same path.  Prisons are part of the crime problem, not a solution to it.




  1. Aren’t prisons an essential part of modern society that helps to reinforce the rule of law?

It is sometimes argued that protecting the rule of law requires that the guilty are punished.  However, should the rule of law not be accountable first and foremost to those it is intended to protect, as opposed to those it rules against?  By focusing on actions against perpetrators as a measure of the law we lose our focus on compensating, responding to and caring for victims.  Thus a major reconfiguration of the way the legal system works would be the first step towards abolition.  This is especially urgent in the modern world where prisons – more than ever – are little more than symbols of an older, antiquated, bleak, inefficient and technologically backward time.  The time when inefficient practices that do little to protect victims and even less to address the complex needs of perpetrators (and in most cases worsens their needs) is rapidly slipping away and should be consigned to the past.  A new approach to thinking about how a modern society manages harm, crime and victimisation is long overdue.


  1. If not prisons, then what would we do instead?

There is no single solution.  The idea that there can be one is another myth that the use of the prison perpetuates.  There are a number of alternative responses that could be utilised, including, for example:

  • Focusing on victim needs, compensation and care
  • Adopt a ‘do no further harm’ principle in any new policy decisions taken
  • Non- punitive detention (for perpetrators who have extreme and complex needs)
  • Intensive community supervision
  • Intensive therapeutic intervention
  • Civil law measures
  • Peace bonds, enforced by strict supervision

Relying on the idea of imprisonment to solve our social problems has made us lazy and thoughtless.  Creating and living in a peaceful society takes a significant amount of on-going work.  It requires that we build social justice and community capacities, investment in the economy, education, housing and in human beings.  Removing the prison from the social equation must be a starting point, not the end goal.  Once we relinquish our reliance on these harmful and ineffective institutions, we can then begin the building process of finding fairer, more just and equitable solutions to our deepest and most fearsome social problems.

Learning lessons from the past: What the Government can do right now to do to radically reduce the prison population


David Scott, The Open University


The prison system is now widely considered to be in crisis, with the most recent damning revelations coming from a BBC documentary about Sodexo run jail HMP Northumberland



Prison does not work. Prisons are antiquated institutions that are particularly ill-suited to dealing with people with complex social needs or in response to people who have perpetrated acts of violence.  More than half of adult prisoners are reconvicted within one year of release; there were record numbers of self-inflicted deaths in 2016; and there have been a spate of highly visible prison disturbances across the country in recent months.


These and other intractable problems – such drug taking, mental ill-health, demoralised staff, violence, fear, insecurity and difficulties in maintaining order / control – were all exposed in the BBC Panorama programme on HMP Northumberland earlier this week.


Reducing prison populations in the past

The Average Daily Prison population in England and Wales stands today at 85,000 people and this is more than double what it was in December 1992.  The current prison population is also an incredible eight times higher than that of the late 1930s.  In 1908 more than 200,000 people were sent to prison that year, largely for very short sentences.  The Average Daily Population was 22,029 that year.  Yet, by 1918 the Average Daily Population had more than halved to 9,196.


By the late 1930s the Average Daily Population had stabilised at around 11,000, significantly with less than 40,000 people sentenced to prison each year.  The Average Daily Population was to fall below 10,000 again shortly after the start of World War Two.


The prison population in England and Wales was dramatically cut through diversion schemes; genuine alternatives in place of prison sentences; the abolishment of imprisonment for debt; and by allowing time for fines to be paid by offenders.


Lady Constance Lytton, a suffraggette, prisoner and sister in law of Liberal prime-minster



The main reason the prison population collapsed, however, was because there was a political commitment to do so.  There was recognition among politicians that prisons were brutal institutions that did not work.  In the late nineteenth and early twentieth century a number of wealthy and influential people experienced imprisonment – suffragettes, prisoners of war, conscientious objectors to World War One, political prisoners and those imprisoned for their (homo)sexuality.


Rich and influential former prisoners, like the suffragette Lady Constance Lytton, who was sister in law to a former Liberal prime-minster, talked openly and wrote about the pain and unnecessary suffering generated by prisons.  As such a bad conscience about using prisons was created among the political elite.  Despite many changes in prison policy over the last 100 years, prisons remain in many ways the same today.


The current government agenda

The Conservative government will shortly release its new Prisons and Courts Bill.  It is set on the path of building five new ‘super-sized’ prisons and increasing capacity of the prison estate by 10,000 places over the coming years.


Yet, the historical and contemporary evidence overwhelmingly shows we cannot build our way out of the humanitarian disaster unfolding in our prisons on a daily basis.  What is required are policies, like those of 100 years ago, that can immediately reduce the prison population.


HMP Berwyn under construction in 2016



Alternative policy proposals

The policy suggestions are simple but not easy.  A starting point would be to halt plans to build the five new mega-prisons.  There should be an immediate prison building moratorium.  A clear and unequivocal message should also be sent to the judiciary that in cases of relatively harmless offences or where the person who has broken the law has considerable vulnerabilities, that a prison sentences should, if at all possible, be avoided.


The call for penal reductionism is sometimes referred to as “playing the get out of jail free card”



The age of criminal responsibility should be raised as soon as possible to 16 years and diversion schemes introduced which keep young people out of the criminal process.  Petty but persistent property offenders should be dealt with in their own community through schemes that help build a collective sense of safety and redress for the harm done, as well as fostering notions of respect and responsibility for all.


The vast majority of women prisoners have been sentenced for petty and non-violent offences and could be released through probation, home monitoring or amnesties.  Sentencers could also pilot the introduction of prison waiting lists for women offenders.


Residential therapeutic communities have been shown to work in addressing problematic behaviours and drug usage and could be expanded to help deal with the estimated 45,000 ‘problematic drug users’ in prison.  There should also be further priority given to diverting people with mental health problems from the criminal process.


Politicians and members of the public need to once again recognise that prisons are places of intense pain, harm and suffering.  Rather than defending the size of current prison populations, our high ranking politicians and members of the judiciary should profoundly regret the existence of the prison at all.


Public education, informed rational debates and deep-seated reflections on exactly what the prison is and what it does to people, are urgently required.  Perhaps then, calls for a radical reduction in prison population will be warmly welcomed.

Anaesthetising the Pain: Prison chaos and the enormous demand for drugs

David Scott, The Open University





The revelations from Panorama (BBC, 8.30pm 13th February, 2017) on HMP Northumberland have put the problems of drug taking in prisons firmly into the spotlight. The terrible harms psychoactive drugs create for both prisoners and prison officers are laid bare: secretly recorded footage shows prisoners overdosing on drugs, a prisoner threatening an officer with a weapon and a prison officer collapsing after inhaling fumes from the psychoactive drug ‘Spice’.


Seen through the eyes of an undercover BBC journalist who joined the Prison Service as prison officer, the chaos and harms of the privately run Sodexo jail are revealed for all to see.  Concerns around levels of safety for both prisoners and staff and the ease at which psychoactive drugs are getting into prisons (such as by prison visits, ‘drones’ and prison officer smuggling) are raised by the BBC journalist – who illustrates part of the problem himself by being able to smuggle a camera into HMP Northumberland to record conversations and events.




It is little surprise that the media coverage following the Panorama programme has focused on the availability of drugs in prison and the apparent inability of prison officers to control their supply and use by prisoners (and indeed their control over the prison population more broadly).  Yet the debate should not be restricted to talk of staffing, security and prisoner violence alone.  It is important that we focus on the demand for drugs in prison and the need to increase safety by reducing the harm of drug taking for all who live or work in prisons.  .


Drug taking in prison should be situated within two of the most painful harms of imprisonment: the conscious experience of time and the loss of personal autonomy. It is well documented that prison life is both highly regulated yet filled with emptiness. Drugs distort time and prisons are all about the wasting and loss of time.  Many prisoners attempt to suspend time and find ways to manage life on the edge of this meaningless and dehumanising penal abyss.


Drugs, especially cannabis, can be a means of controlling unstructured time by inducing sleep, thus making time consciousness much less evident.  Psychoactive drugs, like Spice (a synthetic version of cannabis), alter perceptions, moods and can eve induce unconsciousness.  Though the psychoactive drug Spice presents serious damage to health and impacts negatively upon behaviour this should be weighed against the way in which it eases the pains of confinement for the prisoner.


Taking drugs in prison can provide sanctuary and be a means of self-medication and self-help. Drugs can help mask the harsh realities of penal regimes and ease the consequences of being exposed to low levels of mental and physical stimulation. They provide a ready-made anaesthetic and prisoners often take drugs to alleviate physical or emotional pain. Drugs can become ‘chemical comforts’ to deal with loneliness, trauma, isolation or alienation rather than for hedonism. Imprisonment is highly stressful and taking drugs may become a crucial coping mechanism to get through hard times and the mundane daily monotony of prison life.




Drug taking should be considered as a direct consequence of the processes of penal confinement itself and as an important survival strategy for many prisoners.  The problem of drug taking in prison is not new but something that has been present in the reformed prisons since the 1800s, albeit at that time the concern was around alcohol and tobacco and their relationship to prisoner violence.


Focusing only on supply and lapses in security, misses the crucial point that prisons generate on a daily basis enormous demand for drug taking.  We need to take the harms of psychoactive drugs seriously, as evidenced in the Panorama programme, but also acknowledge that a harm reduction approach is the most sensible strategy for moving forward.  In so doing we should acknowledge that the only effective way to increase safety and reduce drug taking by prisoners is by radically reducing the size of the prison population itself.


A slightly longer version of this article was published as “Why there is such an enormous demand for drugs in UK prisons” in The Conversation on the 14th February 2017.

Prison is not a safe place for people with mental health problems

Deborah H. Drake and David Scott, The Open University



Prison as a warehouse for mental health problems – Source:


In extreme circumstances or environments, psychological wellbeing can be precarious and effectively ‘under siege’ even for those with robust internal coping strategies.  Prisons are such environments.  They are places that can induce extreme stress and distress.  For those living in the extreme environment of the prison, the line between mental well-being and diagnosable or enduring mental illness can be blurred.  There are three distinct, yet overlapping, populations to consider when taking account of mental health within prisons:

  • Those who are committed to prison with a pre-existing (either diagnosed or not) mental health condition. Prisons are places that tend to confine a disproportionate number of people with mental health problems.  Mental health problems, for this population, are imported into prison with them.
  • Those who are committed to prison without a diagnosed pre-existing mental health problem but have a latent mental illness that can be triggered in the stressful or traumatic environment of the prison.
  • Those who are committed to prison without a pre-existing mental health problem and no history of mental health problems, but during the course of a prison sentence develop mental ill-health or experience extreme deterioration of psychological well-being.


The prison environment

Prisons are designed as ‘anti-social’ places.  They de-stimulate, create barriers to positive human interaction and deliberately promote conditions that exacerbate feelings of alienation, anxiety and despair.  This is part of their stated purpose as places of punishment.  Although the research literature on the enduring social and psychological impact of imprisonment is complex and, in some ways, inconclusive, it is well understood that the prolonged passivity and antisocial nature of prison life leads to individual and social isolation and, as a result, the prison place can present a serious danger to the mental health of those confined and those who work within its walls. Prison officer stress is a relatively well-researched problem in multiple jurisdictions and attests to the inherent damage of the prison environment.

Numerous aspects of the daily prison regime are harmful: separation from social life and from family and loved ones; over-crowding; loss of autonomy; frustrations in dealing with the minutiae of everyday life; limited mental or physical stimulation; negative relationships rooted in fear, anxiety and mistrust; physical, emotional, sexual or financial exploitation; inadequate ventilation, nutrition and care and a general culture of stigmatisation and distrust.  Sitting alongside these harms are the ever-present structured pains of confinement that characterise the loss of one’s liberty and, for many, the uncertainty of what they will face upon release.


The suffering and isolation of prison – Source:


Greater vigilance is needed amongst psychological and penal experts to avoid over-applying ideas about enduring psychological difficulties located within individuals when those individuals are living in the extreme environment of the prison.  Prisoners can be individually “pathologised” and, as a result, there is a masking of deeply entrenched iatrogenic harms and institutionally-structured violence that characterises the daily workings of the prison. We must remain observant of the way in which the label of ‘mental ill-health’ can be deployed as a means to classify, manage and disempower people within the existing perimeters of legal and medical authorities rather than reflecting the interests or needs of the individual labelled as such. In recent decades there has been an increasing readiness to recognise ‘pathological’ traits in prisoners who may formerly have been regarded as ‘normal’.

At the same time mental health may significantly deteriorate or only start to manifest itself as a problem once a person is committed to prison. Mental health problems and confinement may, in this sense, go hand in hand.  Prisoners in prison health care centres sometimes spend only 3.5 hours a day unlocked rather than the recommended 12 hours a day.  Prisoners have also raised concerns that not all staff understand their problems and that they do not have much time with highly trained medical staff.  Prisoners with mild symptoms are often dumped together with much more problematic cases.  The result of this practice is that many prisoners with complex needs are left with too little or no support. Evidence from a range of studies which have consulted prisoners with mental health problems have found that what prisoners need are ‘someone to talk to’; therapy and advice about medication; ‘something meaningful to do’; support from staff, family and other prisoners; help when facing a ‘crisis’ and support with future planning.  Such needs, however, are rarely met inside prisons.


The inappropriateness of prison for people with mental health difficulties

When understood in social and historical context it is apparent that the presence of large numbers of people with mental health problems in prisons is not an aberration but an enduring and essential part of the confinement project. Their constant presence in prison indicates that imprisonment has had a clear historical mission: to identify, classify, contain or transform ‘unproductive’, ‘distasteful’ and ‘unwanted’ elements of society.


The “General Penitentiary”, Millbank, London (Opened 1816) – Source:


Prison management requires a relatively docile population if it is to discipline the able-bodied and the presence of ‘the mad’ disrupt this. The problem of mental health in prisons has never just been a result of ‘importing people’ with mental health difficulties. From the introduction of the ‘reform prisons’ in the early 1800s there is accumulating evidence of the detrimental impact on prisoner health. For example, at the special unit on mental health at HMP Birmingham from 1919 to the 1930s Dr Hamblin Smith came to the conclusion that prisons could not be an effective means of delivering psychological treatments because the punitive ethos and the deliberate structural pains of confinement were anti-therapeutic.


On numerous occasions since the nineteenth century prison authorities have claimed that not only are mental health problems largely imported but that the prison place could be a major opportunity to address them. The modern prison is often discussed as a “health promoting environment” where prisoners can expect to receive a similar level of care (in terms of health treatment, for example) as those in the community.  In practice, however, this is rarely the case.  Moreover, given the extreme environment of prisons the level of care within them would need to be significantly greater than that available on the outside merely to ameliorate the negative effects of the environment alone.  When we then consider those who enter prisons with serious mental health difficulties, some of whom may, arguably, require the very highest levels of care available, we see that prisons are profoundly inappropriate for responding to and treating those with extreme mental health needs.


Mental health services in prison face enormous obstacles

Mental health difficulties are undesirable, disabling and potentially frightening for all involved. When such difficulties present in a prison, the staff and other prisoners often feel ill-equipped to respond appropriately.  Prisons are sometimes utilised by well-meaning judges as ‘places of safety’ for people with mental health difficulties.  Prison staff on the landings (e.g. officers) and healthcare professionals alike are unable to manage these sorts of difficulties.  Moreover, psychologists in prisons are – in the vast majority of cases – not focused on the mental health and well-being of prisoners.


Source: National Health Service


At the same time, tangled up in the complexity of the prison environment and the baggage of chronic cynicism and risk aversion are those who have serious mental health difficulties – either that they came in with or difficulties triggered by the environment.  One of the key aims of the influential 2001 policy document Changing the Outlook was to introduce Mental Health In-Reach Teams [MHRIT] into prisons. Alongside an exceptionally high average caseload for MHRIT practitioners, MHRIT’s are also shackled by prison security, the inherent harms of prison life and the contradictory ideologies of punishment and care. With an emphasis on security and highly restrictive daily routines it is very difficult for MHIRTs to meet the needs of prisoners. MHIRTs were initially established to serve people with severe mental illness [SMIs] but many teams cannot focus exclusively on those with these difficulties because they are swamped by other cases. As a result of these difficulties and the range of other complexities associated with the prisons environment, outlined above, there is a huge amount of unmet mental health need in prisons that is unlikely to be addressed through a simple reform initiative or some other ‘programme of change’.


Learning lessons for the future

The lesson we need to learn is that prisons are places which systematically undermine well-being and health – for all who enter them (both prisoners and staff) – and for people with pre-existing mental health difficulties the prison is an especially unsafe environment to send them to.   When we consider mental health in prison in historical context we find that penal confinement has consistently been used as means of housing ‘unwanted’ people who have been failed by wider social policies.  People with mental health problems have been ever-present in prisons, as indeed have large numbers of deaths.  If we are to change this in the future there is only one policy option that can do this – a radical reduction in the prison population coupled with improved welfare provision for people in the community and public education campaigns which can promote a more caring and supportive approach to people suffering from mental health problems.  Tinkering with penal policies has been tried for decades if not centuries.  It is time for a bolder, evidence based approach to mental health problems in prison that acknowledges the true nature of both mental health and the demands and harms of the prison place.

We need greater commitment to listening to the wrongdoer and the democratic participation of all parties in a given conflict when deciding the best means of redress. There must be acknowledgement that psycho-medical labels and treatments can lead to an increase in harm and that people with mental health problems require detailed information about treatment options and help in developing skills, rather than being simply stigmatised as needing some ill-defined ‘treatment’. This requires consultative interventions rooted in respect, support, patience. On the ground there needs to be active engagement with service users; the development of services people actually want to use; recognition of legal rights; and real support for finding financial security, housing, jobs, and other initiatives aimed at ending social exclusion.

There are crises in mental health despite the fact that many people with such problems cope most of the time. If we are to take the mental health problems of lawbreakers seriously we need to deploy social policies that emphasise social justice and human rights. In essence we argue that state confinement is a major obstacle to the well being of those confined and largely exacerbates or even triggers mental health problems. Ultimately what is needed are creative solutions that look beyond the prison.