Suicide attempts show need for stress management in prisons

Press, 9 May 1985, Page 13

Suicide attempts show need for stress management in prisons

By

GARRY ARTHUR

Prison suicides and attempted suicides are on the rise in both New Zealand and Australia. The growing incidence of suicide at Paremoremo Prison and the lack of psychological help for prisoners have brought expressions of concern from the Minister of Justice, Mr Palmer.

Psychological help for prisoners is minimal in Christchurch prisons, too, a fact which is attributed to the official view that psychological counselling is not effective in changing the behaviour of prisoners.

But some professionals in this field believe that it has not been proved either way, and that there is nothing to lose by giving it a chance, because the present treatment of prisoners is certainly not preventing reoffending or reducing the crime and imprisonment rate. Dr Robyn Hewland, visiting consultant psychiatrist to Paparua Prison, and president of the New Zealand Association of Psychotherapists and Counsellors, strongly believes that many prison inmates could be helped to change through proper support and counselling, and that prison officers should be

trained to facilitate this. Other professionals working with prisoners have told her they are convinced that many prisoners would not attempt suicide if they had someone with whom to talk and work out their problems. At Addington remand prison, says Dr Hewland, about every fortnight another prisoner has to be put under special observation following suicidal comments or attempts. Recently, too, there seemed to be a significant proportion of prisoners on remand who had had previous contact with various psychiatric or drug treatment services, or who appeared to be emotionally disturbed. Dr Hewland’s work at Paparua is limited to her one visit of less than four hours each week. She sees about 50 new cases a year — about one a week, plus two or three follow-ups on each visit. “It’s very hard for prisoners to get to me,” she says. “They are

referred by a prison officer to the classification committee and it has to agree they can come to me.” This screening process was brought in by the prison authorities because the waiting list to see the psychiatrist had grown to the extent that the inmates were starting to complain. Dr Hewland says she is not really there to treat prisoners, but to be consulted about them by the staff and the medical officer. However, she does take on some volunteers for psychotherapy. “I only see those who have been allowed to be referred,” she adds, “but I frequently learn that prisoners have asked to see me and been told that I’m too busy. I’ve also heard that some have written to the Ombudsman seeking permission to see me."

Dr Hewland says the prison authorities are right to screen prisoners, because some just want her to prescribe Valium or addictive drugs, which she will not do. “Mainly I use anti-depressants,” she says, “because some do get depressed.” At Paparua Prison there are not enough psychiatric and psychological services to meet the requests of staff and inmates. “The official wisdom is that psychotherapy in prison does not work,” she says, “but there is no research proving it either way. I think there is room for a lot more specialised counselling and therapy.” She considers that prison actually provides distinct advantages for effective psychotherapy, because it stops people from running from themselves. “But it is a lost opportunity if they do not learn how to manage stress and to think constructively.”

Institutions lose chances to assist prisoners when they do not provide consistent good substitute parent relationships, Dr Hewland says. “Impersonal isolated educational programmes are not as effective as the guidance and interest during daily work taken by the respected and consistent prison officer boss.”

She asks which kinds of treatment are more likely to produce positive results — techniques that are rejecting, quick to condemn, and despairing, which produce fear, helpless blind rages and loneliness, and which destroy self-worth, hope and motivation for personal changes; or those which include listening, caring, guiding, encouraging, and giving of new information, and which arouse hope of being able to make positive changes. Dr Hewland explains that she is talking about prisoners who have personality and emotional problems and tensions which neither they nor the prison staff can cope with.

Prisoners who have a psychiatric illness are committed to a mental hospital, where they usually respond to medication. She says the prison staff are not trained in communications and human relations; they are just custodians. There is potential for the staff to provide the good parenting role that most inmates have not had, and which would help them develop their individual potential and learn how to talk, act and interact in normal, positive ways.

“They’re immature,” says Dr Hewland. “I see a huge guy with tattoos all over him, and within minutes I’m relating to an eight-year-old or a 10-year-old or a 14-j’ear-old that’s inside him, in a positive developing way.” She says that what many prisoners need is someone taking the role of a firm, guiding parent. “Prison staff who are like that get along very well.”

Dr Hewland says it is because of prisoners’ arrested development that they are in prison. “It’s really like an adult orphanage, or like sending a two-year-old who has a temper tantrum to his room. If you teach him and give a positive response after that he learns.”

Dr Hewland thinks the most important step forward would be for prison staff to be trained in understanding feelings, and in positive relating skills, so that they would not feel threatened. “If they feel threatened they fall back on the rule book. All prison officers could benefit from practical inservice training in these areas.”

Remandees need to talk . . .

Suicide attempts have increased in prisons everywhere, says Dr Hewland. Those involved are either young remandees who have just arrived and have not adjusted to prison and cannot cope with not being in touch with their outside supports, or older prisoners on long sentences for violent offences.

In the case of the young remandees at Addington their telephone calls are restricted and yet they may want to make various urgent arrangements about their financial and personal affairs. “They need to talk,” says Dr Hewland. “If they can’t talk it out, they cut out. The more tense they are, the more anxious the staff get, and the more likely the prisoners are to be isolated.

“So the tension produces the opposite of what they need — social contact in prison and with someone who can contact the outside world.”

She adds that it is quite understandable that prisoners are not given free access to the telephone because of the likelihood of ar-

rangements being made for smuggling in drugs. Addington Remand Prison could do with a full-time counsellor, she says, in addition to the welfare officer who makes occasional visits, and the part-time general nurse.

"Prisoners need someone they can talk to during the day, and who would also give the staff help in understanding them.” Dr Hewland says the presumption is that prisoners are in jail because they will not behave, but many of them just cannot behave at all times, especially under stress.

“They can be taught stress management, but you’ve got to build a personal relationship with the prisoner first, and there are good prison officers who can get across to the guys. A lot of the prison officers out there are really good; others are more likely to get hit — they could benefit from more learning too, just like the prisoner.” Many prisoners need teaching about ways to cope with their feelings, and about self-control. “These are things we learned at our mother’s knee. They didn’t, because their parents hadn’t been taught themselves.” If some prisoners could be helped to express their problems and tensions verbally, this would reduce their acting them out through suicide attempts, physical aggression or prison escapes, says Dr Hewland. Such counselling should include concerns about their relationships and families. “Such ‘first aid’ in counselling could be provided by any person with the appropriate personality attributes — especially non-judg-mental — maturity and basic skills such as the prison’s nurse, social workers, visiting minister of religion, or selected prison staff.” Dr Hewland says prison officers could be helped in their work by basic on-the-job training in such things as • How to identify the inmate who can not, from the one who will not, behave as requested;

• First-aid management — not therapy — of inmates' tensions and reactions.

• How to prevent and de-escalate explosive situations;

• Principles and practice of personal communication skills and positive interactional techniques; • How to teach inmates the stress management skill that most missed out on learning from their parents. Training in communicating and relating skills could be given by the Justice Department’s psychologists. She emphasises that if prisoners are going to want to listen to prison officers, each officer would have to earn the inmate’s respect and trust. “Officer selection is therefore important too.”

Similar skills are needed, she says, for those involved with persons on community sentence orders who are emotionally disturbed. “They may be requesting more back-up services from the specialist counsellors and psychotherapists too.” When a prisoner’s disturbed reactions are not a symptom of a treatable mental illness, but arise from uncontrollable tension, he should be transferred to a special area of the prison where he can be helped by psychiatrists, psychotherapists, psychologists, nurses, social workers, or occupational therapists, says Dr Hewland. Debate continues as to whether such a special area should be in the prison, in a hospital, or somewhere else.