Women Offenders and the Talking Therapies

In my nine years working for the National Probation Service I didn't have the opportunity to work with women offenders. I worked in a residential setting with high-risk male offenders; there were never any female residents staying with us. The other Approved Premises in Lancashire had four female beds at one time but they were rarely used and before I was employed that hostel also became male only. Just recently, a couple of years after I took voluntary redundancy, a regional facility opened in Preston: a female only residential unit for women offenders from across the North West. They employ women workers only, some of them are friends of mine. I don't know how the place is running but I can imagine it's challenging work.

According to the Centre for Mental Health (2011) and their briefing, Mental Health Care and the Criminal Justice System, as of August 2011 there are 4289 women in custody (out of a total prison population of 86,821). Women in prison are five times more likely to suffer from a mental health problem compared to the general female population. Women tend to serve short sentences, which do little to address their criminogenic needs, but often result in their children being taken into care, loss of employment and housing, and increased risk of further offending and worsening mental health. As a result of these poor outcomes, policy makers have asked for alternatives to prison for women. Maybe that has resulted in the opening of the residential unit for women offenders in Preston I mentioned earlier. Usually probation hostels take high-risk offenders on conditional release from prison. I'd be interested to know whether or not the facility in Preston performs a similar function or is it in fact a community based alternative to custody.

I'm writing about women offenders today because I've just read an article by Toby Chelms in CBT Today the magazine of the British Association for Behavioural and Cognitive Psychotherapies (BABCP). Chelms writes about his own experience at Leeds Counselling, where he says it's very difficult to reach women offenders with cognitive therapy. Let me provide a summary of the interesting things he says.

Chelms says that talking therapies for female offenders in Leeds have traditionally focused on counselling, an approach suited to the kind of 'wellbeing' issues that affect women offenders: domestic violence, sexual abuse and childhood abuse. In addition to these issues Chelms says women may also develop mental health problems whilst in prison or have pre-existing conditions made worse. He cites depression, panic disorder, obsessive compulsive disorder and agoraphobia. Chelms points to the high rates of depression and anxiety amongst the female prison population. It's easy to see why these conditions might be a response to the chronic stress of prison life; but it's worth mentioning that for some women prison may meet the basic physical and psychological needs more than the outside world.

Evidence based practice suggests and the National Institute for Clinical Excellence (NICE) recommend cognitive behavioural therapy for depression and anxiety. It would make sense, therefore, for female offenders to be referred (or to self-refer) to the Leeds IAPT service for free CBT for their depression and anxiety problems. 

Chelms makes the point that whilst CBT is advertised in local GP surgeries there is little done to promote the intervention in probation offices. This is a problem because on release from prison few women offenders are in touch with primary health services whilst most of them are in touch with the National Probation Service. In fact the problem is a little more deeply rooted than this. Reading Psychological Therapies in Prisons and Other Secure Settings (reviewed here) it's clear that problems exist with the way that mental health services in prison communicate with mental health services in the community and that referrals, joined up work and hand-overs just aren't happening. That female offenders are not accessing primary care services is a systemic failure that points to their marginalised status and contributes to their social exclusion.

To Chelm's credit he has tackled this particular issue in a number of ways. First of all by promoting his IAPT service (and other mental health services) within and outside prisons, distributing a 'directory of mental health services' to the probation service. Secondly, he has recognised the importance of female friendly spaces when promoting mental health services to women. He refers to the Corston Report (2007) which recommends female-only environments, arguing that: 

'By encouraging women to feel physically and emotionally safe, less marginalised, and therefore more able to feel confident and express themselves in a way which is needed for progress, female-only environments would in turn lead to higher attendance and engagement levels, while increasing access to support and rehabilitation'.

In my own area there are two very good Women's Centres in Accrington and Blackburn, which offer a range of interventions, including low intensity and high intensity IAPT work; as well as counselling, support groups, employment advice and family interventions. It seems like a good model, 'women friendly' and a range of services under one roof so that a package of support can be tailor made for each woman. Now GPs and the Probation Service are referring clients directly and these two Women's Centres, under the leadership of my friend, Sarah Swindley, have become important service providers for women and families in East Lancashire.

Chelm's third intervention to broaden participation amongst women offenders was to set up a pilot project at the Together Women's Project in Leeds. Promoting the service to the probation service generated nine referrals. Of those nine referrals, all attended and were assessed as suitable for talking therapies. But of those only one went on to attend CBT sessions. Clearly it's not enough for women offenders to be aware of services, those services must be accessible; but even then other priorities take over and motivation shifts to basic needs and coping.