Therapy can improve the mental health of prisoners and reduce criminality.
Image: HMP Grendon and springhill
“Marc had taken part in his first armed robbery when he was 14 and got his first big prison sentence at 21. When he was released, five years later, he made half-hearted attempts to go straight, but deep down, still saw himself as a criminal. Before long, he was involved in another violent robbery. This time, he was given an indeterminate Imprisonment for Public Protection (IPP) sentence and feared he’d never get out. He’d heard that Grendon had helped lifers and IPP prisoners get released, so he signed up. He had no idea what he was in for…"
Prisons in the United Kingdom have three main aims, to protect the public by holding prisoners while they serve the punishment handed down by the court, for punishment and for rehabilitation. HMP Grendon is a unique establishment in that it is the only prison in the world which functions as a democratic therapeutic community. A democratic therapeutic community runs on four principles democratisation, communalism, tolerance (or permissiveness) and reality (or compassionate) confrontation. The regime incorporates social learning theory, a psychodynamic approach, and is compassion-focussed (Taylor & Akerman 2021).
“Many will have had adverse childhood experiences (ACEs), such as abuse and neglect, which impacted on their personality development.”
Residents at HMP Grendon apply from other prisons to transfer here, having completed an application to undertake therapy. Successful applicants stay at Grendon for a minimum of eighteen months, but generally stay for between two and four years. Residents have often experienced previous prison sentences, and their application indicates some motivation to change. They generally cite reasons for applying to Grendon such as feeling depressed, or wanting to understand why they offended. Many will have had adverse childhood experiences (ACEs), such as abuse and neglect, which impacted on their personality development. They would go initially to the Enhanced Assessment and Preparation Unit (EAPU), where they will learn more about Grendon, get used to being in a group and community living.
The Grendon model at its heart takes a trauma informed approach. Trauma-informed approaches can be thought of as incorporating three key elements: an understanding of the prevalence of trauma; recognition of the effects of trauma both on those affected and on those who work with them, and the service being developed with this knowledge in mind. There is a strong ethos of using person-first language and viewing people holistically, developing their strengths while they address factors related to offending.
Many residents will find it difficult initially that everyone is known by their first names, staff and residents alike, and there is an expectation that the residents will speak in groups about how they feel. On the EAPU the residents are encouraged to speak about the ‘here and now’ how they feel being in a group, in the different environment and so forth. Some will have been in high security prisons for many years, so the change can feel profound. There is a regime which involves community and small group meetings. On the EAPU the groups are mainly psycho-educational, for instance about trauma and how it impacts various aspects of their lives, on understanding emotions and so forth. If and when the resident considers it is the right time and place for them, they will be allocated to one of the wings.
There are five wings, one for those with sexual convictions (although there are men with such convictions on all the wings), one for individuals with learning difficulties and the remaining ones are for those with mixed offences. The therapy involves small groups (approximately 8 men and one or two facilitators) and community meetings, (approximately 40 men plus staff) on Mondays to Fridays. Once the individual is allocated to a group they remain in that group throughout their time in Grendon. The small groups do in-depth work addressing how the individual came to be in prison, their past relationships, attitudes, psychological and emotional disturbance. Examples of how their past experiences are being demonstrated in the present are discussed, and each incident is seen as an opportunity to learn. Community meetings address issues affecting the whole team. The therapy takes place largely in the morning, and in the afternoon the residents will work in various jobs on or off the wing, or attend the on-site college.
It is an intervention accredited by the Correctional Services Advice and Accreditation Panel (CSAAP), which consists of academics and experts who assist HMPPS to accredit programmes by reviewing programme design, quality assurance procedures and findings, and programme evaluations. It is overseen by His Majesty’s Inspectors of Prison and the Consortium of Therapeutic Communities, the latter of which is a professional body which is part of the Royal College of Psychiatrists Centre for Quality Improvement and ensures that TC standards are adhered to. Research on the intervention has shown a decrease in self-harm, breaking prison rules, anxiety, depression, and increased psychological wellbeing and other factors.
Grendon prison shows evidence of “reduced reoffending, improved health and well-being, and diversion from other more expensive services”
Image: HMP grendon
Families are an integral part of the work, and they are invited to twice-yearly days on the wing. This enables them to see the resident’s room, group room, and meet peers and staff. The Visits centre is warm and welcoming to them, and there are twice yearly ‘Visits with a difference’ at which family members learn more about how HMP Grendon functions. There are also regular Children’s days to foster these important relationships with the residents’ children. Each wing also hosts two events a year to which professional visitors are invited. This provides an opportunity to mix with people from outside of prison. The residents also organise fund raising events, and resettlement events. One recent event involved them inviting people from agencies who employ those who have left prison, develop relationships with those supporting them in the future, and plan for release. This is an integral part of one of the main principles of the democratic therapeutic community (DTC), developing hope for the future. There is a University Day, to which students are invited, and all events are arranged by residents and staff. There have been annual art exhibitions, with an art gallery having been developed and ties with the Ikon gallery in Birmingham developed. Exhibitions of art produced have featured in the Ikon gallery and in the annual Koestler awards, which is on the South Bank in London. Examples of art, poetry, music and sculpture are evident throughout the establishment. Visitors are met with a fully functioning grandfather clock made from matches as they go into the main body of the prison.
The staff at HMP Grendon is comprised of a multi-disciplinary team, with prison officers being the predominate group. They are trained to work with those with complex needs in a therapeutic manner, so that the therapy continues throughout the day, not just in set sessions. The prison is bound by rules applied to all prisons, so comply with mandatory drug tests, exercise regimes and so forth. Other staff include Forensic psychologists, art and psychodrama creative psychotherapists, therapy managers, and all staff involved in prisons, such as Prison Offender Managers. The residents are involved in many aspects of running the establishment, for instance interviewing staff, advising on policies, speaking at events, and so forth. They also consult on applications for research, education provision and healthcare.
In 2017 it was reported that a place at Grendon is £4,556 per year more expensive than a general category B prison place (£34,222). An approximate cost-benefit analysis has tentatively indicated that every £1 additional investment may yield up to £2.33 return, in particular through reduced reoffending, improved health and well-being, and diversion from other more expensive services such as higher security category prisons and specialist units, and forensic mental health services, including hospitals. However, HMP Grendon takes some of the most complex prisoners in the system – who might otherwise be at Cat A prisons, which cost well over £100,000 per resident each year. In addition, research has shown a reduction in violence perpetrated on others, and self thus providing a further reduction in cost.
Grendon is not an easy way out for prisoners. Remaining in an intense therapeutic environment for several years is a personally demanding and in-depth endeavour. HMP Grendon is a unique prison, and one which shows through its work a reduction in offending and increase in psychological wellbeing.
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Disclaimer: This article is for information purposes only and is not a substitute for therapy, legal advice, or other professional opinion. Never disregard such advice because of this article or anything else you have read from the Centre for Male Psychology. The views expressed here do not necessarily reflect those of, or are endorsed by, The Centre for Male Psychology, and we cannot be held responsible for these views. Read our full disclaimer here.
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