Trapped Without Hope: The Hidden Mental Health Crisis in Women’s Prisons
From self-harming in groups to starvation and self-immolation, women are overwhelmingly more likely than men to hurt themselves while incarcerated. So why isn't the prison system responding?
Illustration by Grace Wilson
Maria, 29, is a disability rights activist who uses a wheelchair. She also has borderline personality disorder and a history of self-harm. In 2013, she was convicted of an antisocial behavior charge, and sentenced to time in prison.
"I was in Holloway for ten months," she said. "I went through lots of self-harm episodes there, including setting myself on fire and trying to hang myself."
Penny Bennett, a charity caseworker who supported her, said Maria frequently used a dressing gown robe or socks to form a ligature, which she left hanging around her neck. Prison staff took it off her initially, before realizing that she was not tightening it. Maria said just having it there made her feel better.
Although her mental health was bad when she was sentenced, Maria believes prison made it much worse. "When I came out, I just couldn't cope at all," she said. "I was constantly, for maybe a year, being sectioned by police everyday. I was overdosing, cutting, throwing myself under trains. I just think [prison] really messes your head up."
Recent government statistics show just how damaging prison is for women: despite women constituting only 5 percent of prisoners in the UK, more than 10 percent of the prisoners who killed themselves last year were female. This is in sharp contrast to the population as a whole, where men are 3.5 times more likely to die by suicide than women.
At least 30 percent of women in custody self-harm, according to the same figures, compared to 10 percent of male prisoners. People who work with women in prison say that the actual number could be higher.
And things are getting worse: female deaths in prison classed as "self-inflicted" rose by 1,100 percent last year.
According to experts, the reasons prisons are failing women particularly badly are complex. More women enter prison with pre-existing mental health conditions than men, because women without mental illnesses are less likely to offend, said Maureen Mansfield, who works for the charity Women in Prison."There are people in prison who should not be in prison, they should be in hospital," she said.
Bennett, who works for Wish, a user-led organization supporting women prisoners with mental health problems, agreed. "Women's routes into offending are different [to men's]," she said. "Women's offences are less often violent, more often related to mental health, and more often come with a history of trauma."
The statistics back Bennett up. While 81 percent of women in prison are there for a non-violent crime, 46 percent report having experienced domestic violence and 53 percent report having been abused as a child.
Cuts to community-based services like domestic violence shelters and mental healthcare, in addition to social housing, mean that nobody often intervenes to help mentally ill women who have survived violence until they commit a crime.
"The women we work with, they're in prison for the most minor things. I probably know maybe ten women in prison for dialling 999 too often," Bennett said. (Under UK law, misusing 999 lines is a criminal offence.) "Self-harming in public is another big one."
Often, women have no choice but to be arrested if they want to access mental health services. "In the last two years beds [in mental health hospitals] have been cut dramatically," she said. "You actually have to go and do something [that obviously endangers yourself or others, and breaks the law] to get treatment."
Bennett added that women who are sent to prison will eventually see mental health professionals after a phase of becoming more distressed and often self-harming, "[but] you shouldn't have to get a criminal record to get treatment."
For some women, prison time isn't even enough to get their problems taken seriously. Bennett said she knew one woman who desperately wanted to be hospitalized because of her serious mental health problems. Instead she faced being released from prison and into homelessness. Despite threatening suicide, she wasn't taken seriously by prison staff, so she said she was going buy a knife and stab the first person she saw when she was let out. Only then was she sent to hospital.
Staff numbers in prisons have been reduced by a third in recent years as part of Tory austerity measures. Bennett said this may have contributed to the increased suicide rate in custody—understaffing makes it difficult for guards to adequately care for inmates, especially in the case of prisoners with poor mental health who need far greater support.
Maria said this reflected her experience. Wait times to access mental health services were "diabolical" in prison, she said. Self-harm and suicide attempts were almost incentivized, she added, because there was no other way to get help.
"You had to do such extreme acts of self-harm in order to be listened to," she said. "I don't think that's fair, that you have to literally try to take your own life to have your voice listened to."
I walked out [of prison] with nothing. I was just devastated. I had literally nothing except what I was standing up in.
On occasion, Maria said, self-harming even became an explicit form of protest against neglect by guards.
"Other girls who were self-harming, they would all get together and plan self-harming at the exact same time to pump it up, to say look, you're not listening," she said.
The consequences of women prisoners feeling that they have to hurt themselves to get help can be deadly. Inquests into several self-inflicted deaths in custody have found the victims did not want to die; instead, the suicide attempt was a cry for help which went too far.
Linda, 53, was released from prison two years ago. She slept rough for a while, and now sleeps in a borrowed car in North London. She lives on £20 a week, paid to her by Wish. She has been told she doesn't qualify for social housing.
"When you come out of prison it's very traumatic, you feel very alienated," she said. "For women it's particularly difficult, because if you are homeless you are much more at risk—of abuse, sexual abuse, violence—if you are on the street."
Linda was first left homeless after separating from a violent and coercive husband in 2011. He hit her and threatened to kill her. When she left him, Linda said he falsely alleged that she was mentally ill and neglecting their children. As a result, he was given custody of their son and daughter.
Eventually, Linda was arrested on suspicion of breaching court orders that her husband had taken out against her and of assaulting his au pair, whom she claims was abusing the children. She was later found not guilty on most of the charges, but she was convicted of the assault. Linda maintains that she is innocent.
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Shortly before she went to prison, the police took the van she had been living in as evidence and then gave it to her ex-husband with all her possessions inside, including legal documents, her passport, and her driving licence.
"I walked out [of prison] with nothing," she told me. "I was just devastated. I had literally nothing except what I was standing up in."
In April, it was revealed that other women released from HMP Bronzefield, where Linda was held, were given tents and sleeping bags because staff knew they had nowhere else to go.
Linda spent eight months in custody awaiting trial. She was punished for staging a protest against her incarceration. She refused to eat, or to co-operate with staff, so they denied her access to 'luxuries' like books. One guard even refused her sanitary towels.
Linda said some aspects of prison were particularly distressing to her and others. "A lot of women, their whole lives they've had to put up with coercive behaviour from men, so [it's extremely damaging to them] having to experience that again," she said.
Bennett agreed. "Women who have been attacked or sexually violated can re-experience that in prison by being restrained, or locked up, or pushed around by male guards," she said.
She added that staff need more training in dealing with mental health problems and self-harming behaviours, which she said are poorly understood and take many different forms—including refusing food, which is often not noticed.
Staff who are not trained in self-harm often start making inappropriate remarks like 'serves you right because you did it.'
"Staff who are not trained in self-harm often start making inappropriate remarks like 'serves you right because you did it,'" Bennett said.
When asked about this, a Prison Service spokesperson said: "Our hard-working prison staff provide vital support to prisoners with mental health issues every day and last year we invested in specialist mental health training for officers."
They added the safety and welfare of prisoners is a vital part of reform plans, and emphasized their commitment to "making sure our prisons are safe and are places of rehabilitation."
Bennett and Mansfield agreed the best mental health team worked in Holloway prison, which was one of the oldest facilities in the UK and the largest women's prison in Western Europe.
Holloway was shut down in July, in what the Ministry of Justice branded a move to improve prisons, and to hold women in smaller and more modern facilities.
Mansfield is sceptical of the stated motive. "What the government were suggesting—which was that Holloway prison was not fit for purpose and the women would be better in Downview [a women's prison in Surrey]—was probably more to do with the value of the land," she said.
The prison site in Islington, north London, which is publicly owned, has been put on the market for sale to a private investor. The value of the land is estimated to be £200 million, with a potential redevelopment value of £2.25 billion.
A group of activists from the Reclaim Justice Network and Women in Prison are campaigning to reclaim the space, and instead to turn it into new social housing and facilities for women's charities.
Investing in community support services to help women before they reach prison would not only be better for women, Mansfield and Bennett point out it—it would also save the government money. Locking people up, after all, is expensive.
Maria's mental health reached an all time low after she was released. But she's doing far better now, thanks to a good GP and consistent support from Wish.
Linda, however, has not moved on. She says she has no intention of doing so without her children, who are still in the custody of their father.
Bennett believes the domestic abuse that Linda experienced and her time in the criminal justice system have left her with post traumatic stress disorder. Her refusal to eat when she was in prison and insistence on not rebuilding her life could be seen as a form of self-harm, Bennett said.
Linda is unwilling to accept this, although she admits to "changes in her thinking caused by stress." She only really feels safe in North London now, where her borrowed car is parked and where she has made friends. She avoids any contact with the police or other authorities, and said she feels extremely vulnerable.
"It's not a good change [in me]," she said, "but it's a consequence of what happened to me and how unfairly and illegally I was treated in the system."