Science

Life inside a therapeutic prison: ‘Look, we’ve done some terrible things …’


As you go through the gates of Grendon prison in Buckinghamshire, past the raised garden – whose intricacy is still discernible in November – towards the main block, there’s a foundation stone laid by Rab Butler from when building commenced in 1960. “As home secretary, he wanted two things: to improve understanding of crime, and its treatment,” Simon Shepherd, head of the Butler Trust, a charity celebrating exemplary work by prison staff, tells me. “So he got the funding for the Cambridge Institute of Criminology. And he also got the funding for Grendon, the world’s first dedicated psychotherapeutic prison.”

The idea, radical in the 60s, and still radical when it’s applied to criminals, is that you re-child people, re-educate them. “Childhood is where you learn the skills to manage life. If you have a personality disorder, that is essentially because you didn’t get those skills in childhood. So you put somebody into a really intensive environment where they learn how to manage themselves and deal with people,” Shepherd says. The NHS reports that 60 to 70% of prisoners in the UK have a personality disorder; I’ve heard numerous forensic professionals put the figure as high as 80%.

Re-education is incredibly hard, painful work. As one inmate describes it, “You’re all challenging each other, all the time; we’re seeing ourselves in each other. It’s not a nice thing to look at. Look, we’ve done some terrible things.” Another inmate, Peter, murmurs in assent: “I’ve never cried so much in my fucking life.”

Mark Williams, the Prison Service’s former head of adult offender psychology and the author’s father.
Mark Williams, the Prison Service’s former head of adult offender psychology and the author’s father.

I’ve been trying to get into Grendon for, at a conservative guess, 20 years. There’s a personal connection: I used to be a trustee of the Butler Trust. My father, Mark Williams, who died in 2004, was head of adult offender psychology for the Prison Service for a good chunk of a career spent entirely in jails, so most forensic psychologists over 40 will have known him. Very often, they’ll have some story about him, which will end with them being the drunkest they’ve ever been. I have visited many prisons myself, including New Hall, High Down, Brixton, Wandsworth and Wormwood Scrubs. But never Grendon, which the Ministry of Justice is very cagey about, worrying (I imagine) that the outside world might find it too soft.

It was an incredible coup by the BBC, then, that it recorded leading forensic psychiatrist Gwen Adshead’s third Reith Lecture here last week, to an audience of mostly inmates, staff, and mental health professionals from the NHS. Its title: Does Trauma Cause Violence? The question vexes people of a punitive bent, because it sounds like a bleeding heart liberal’s bid to relieve guilty people of their moral responsibility. This is particularly sharply felt at Grendon – male prisoners volunteer to enter the therapeutic community (TC) from the general prison estate. “You want to spend at least two and ideally four years there,” one psychologist tells me. “If your sentence is only six years, you’ll be out in three, so you’re not going to go to Grendon. It’s mainly lifers.” So it’s safe to assume that most Grendon inmates have done something appalling, left the outside world pitted with tragedy.

‘It’s mainly lifers’ … the perimeter fence at HMP Grendon. Photograph: Graham Turner/The Guardian

Within the Prison Service, though, that question of where violence comes from is practical, rather than moral – because the second aim of Butler, and every thinking person involved in prisons since, has been to reduce reoffending. What gives prison its purpose, if not the ambition to send prisoners back into society no longer violent? So questions such as: what causes violence? Which psychological interventions work? How can you tell the difference between a changed character and a person who has simply grown older? – these are all live, central and urgent.

Rex Haigh, who wrote the textbook on TCs – The Theory and Practice of Democratic Therapeutic Community Treatment (jointly with Steve Pearce) – has a longstanding relationship with Grendon (as well as, coincidentally, Gwen Adshead – their kids used to babysit one another). He is a psychiatrist but became disillusioned: “It was all a bit hard-boiled biomedical, lots of pills, ECT [electroconvulsive therapy], not a lot of the therapeutic side of things, so I specialised in medical psychotherapy.”

The main building, completed in 1962, at HMP Grendon. Photograph: Ben Gurr/The Times

He describes the “triumvirate of professions” in prisons, “psychology, psychiatry and psychotherapy,” and says, “The first two have a very uneasy relationship. They [psychologists] think we [psychiatrists] just prescribe drugs and don’t really try to understand people. Psychotherapists can be friends of both, but the split in psychological treatment is that therapists seek to deliver an understanding, whereas psychologists believe in behavioural programmes.”

“Uneasy relationship” is a tactful way of putting it; the psychologists often think the psychotherapists are “madder than a box of frogs” (as one told me, speaking on condition of anonymity): you could spend your life delving into inmates’ childhoods, they said, without ever necessarily changing their behaviour.

That doesn’t tell the whole story, though, as there’s also a lot of cooperation and comradeship within the service as a whole, so Richard Shuker, the head psychologist at Grendon, is fully committed to the psychotherapeutic model. It is, objectively, strange, with outbreaks of absurdity, trying to create psychotherapeutic conditions – the openness, the vulnerability needed – with very violent people. One psychologist described his first visit to Grendon: “If you go into a community meeting, you go round the room, everybody introduces themselves by their name, their position, how long they’re serving and for what. I remember I sat down in this room: ‘I’m Bob, I’m serving life for rape and murder’; ‘I’m John, I’m serving life for murder’; ‘I’m serving life for arson’; ‘I’m serving life for malicious wounding.’ Then two laid-back prison officers and me.”

Outside in the wider prison estate, the psychological model has always dominated offender management and recidivism, and for years, the system’s answer to the question of what worked was “nothing works”, to quote the doctrine of the US criminologist Robert Martinson, developed in 1974. There’s still a question mark over whether Martinson recanted before his suicide in 1979, but by then, the idea had really taken root in UK offender-management, that there was no useful psychological or psychiatric intervention; you just had to keep inmates locked up and your best hope was that their criminal tendencies dissipated with the passage of time.

How it started … Grendon Hall opened in January 1953 as an open prison for men and is now used as offices for Grendon and Springhill. Photograph: Smith Archive/Alamy

“That all changed on a research trip to Canadian prisons in the 90s,” Shepherd remembers, “where they did seem to be running programmes that worked.” This had an immediate effect on UK jails: courses such as Calm (Controlling Anger and Learning to Manage it) were imported wholesale; this is a classic psychological intervention, whose principles were to address the behaviour, not the person. A decade later, I shadowed five inmates taking the course in Pentonville, and, for some of them, it really worked. One guy was in for drug offences, but kept getting into fights, which had so far added 68 days to his sentence. By week four of the course, he was in visibly better control of himself, and said: “Before, I used to go everywhere with a sharpened pencil. Now I only ever take a pencil if I’m going to a lesson. Sometimes, I take a pen.”

But the approach did not work for everyone. Another man, inside for attempted arson, would reflect on his anger and take responsibility for it one week, only to deny that he had ever been angry – or even intended to set fire to anything – the next. The long-term evidence we have now is, as Shepherd describes, “Programmes work when they’re run by the people who develop them. Likewise, with psychotherapy, whatever the approach you take, the effect, in so far as there is any, seems to be about the relationship between the therapist and the client.”

Back in Grendon, waiting for the lecture to start, Peter is telling me about his first crime: he tried to burn down a Catholic school when he was 10. “The IRA were very big then,” he says. “I’ve been at this a long time!” Then he continues, “I’d internalised my father’s homophobia and his anti-Catholicism.” He goes on to describe, though quite elliptically, horrendous abuse at the borstal he was sent to after that arson attack. Now 60, with another 14 years to serve on a sentence for murder, he has been in and out of prison his entire life, “but I had jobs in between, while I was out. I’ve got children. My last job, you’ll like this … was working in construction, building prefab units for other prisons. And they were nothing like as nice as this one.”

Inside HMP Grendon … the NHS reports that 60% to 70% of prisoners in Britain have a personality disorder. Photograph: Martin Godwin/The Guardian

The material comforts of Grendon contrast starkly with the dark and chaotic atmosphere of many jails: prisoners have their own, individual cells, the buildings are nice, it’s quiet, the staffing is informal. Juliet Lyon, who was director of the Prison Reform Trust until 2016 (she’s now a member of the Commission on Justice in Wales) tells me: “Since I first encountered Grendon, all I could think was, ‘Why hasn’t it multiplied? Why hasn’t it thrived? Why aren’t all prisons like this?’”

Instinctively, it sounds expensive – you can’t get broken-down costs for Grendon because it’s a joint site with Spring Hill, the open prison next door, but prisoners across both cost £38,000 a year each. HMP Send in Surrey, a women’s facility with a women’s TC, is significantly more expensive: £65,000 per prisoner per year. (The most expensive per-prisoner unit in England and Wales is for male young offenders, and comes in at £129,000; but still nothing like as costly as placing a child in a private-equity-fleeced children’s home.) The real reason the therapeutic model hasn’t scaled isn’t money, or the length of time it takes, Shuker says: “There just aren’t 80,000 prisoners who are ready for this kind of therapy.”

Peter volunteered to go to Grendon earlier in his sentence, then referred himself back out, because the psychotherapeutic work was too hard. Inmates who can’t cope emotionally will end up back in a category B prison, and even though Grendon can kick prisoners out if it’s not working, “They tend to de-select voluntarily,” Shuker says, tactfully. When I come to leave, Shuker says he knew my dad: “He was my supervisor while I was training, used to take me out to lunch; but he meant the pub. The one time I tried to order a sandwich, he said, ‘You trainees, you’re emotionally labile.’” The phrase means “prone to rapid and uncontrollable mood swings”. My dad really didn’t approve of people eating in pubs.

Victoria Gavin, who ran the therapeutic community in Send from 2012 to 2019, says the manual is the same across both male and female estates, but women have different challenges: principally, they tend to be the main carers for their children, who are generally adopted outside the family when their mother is given a life sentence. “In the therapy, they realise that their own children were also the innocent victims of their crime. So they have to come to terms with that, and it’s very difficult.”

There are so few women serving a long sentence for violent crime that HMP Send has the only TC, with just 24 places – and no TC-plus, the programme for prisoners with learning difficulties. “I was always trying to make the case for TC-plus in the women’s estate,” Gavin says, “because a lot of the women have suffered brain injuries as children. They’ve been battered when they were small. So they grew up with that modelling, but also a reduced capacity to think things through, resulting from traumatic brain injury.” She’s got such a gentle way of speaking, and so much professional vocabulary, it can take a minute to process the brutality that she’s describing.

‘There’s an intrinsic value to Grendon that you can measure with your eyes’ … an entrance to the prison. Photograph: David Levene/The Guardian

But, going back to the premise of Adshead’s Reith lecture, even if we can be relatively sure that trauma does cause violence, can this intensive psychotherapy work eradicate it? It’s complicated. Inmates’ behaviour when they’re sent back to a general prison is better. The reoffending rate once they’re released is lower. “The criticism is that you can look at the reoffending rate, and it’s low,” Shepherd says. “But in order to complete Grendon, you’ve got to volunteer, you’ve got to pass a six-month assessment to show you’re engaging, and then you’ve got to do two years. So that’s a very self-selecting group, and they’ve got a much better chance of not reoffending, which makes it difficult to be sure how much effect Grendon actually has.”

The Prison Service hates this kind of ambiguity. “There’s a commitment to constant, continual development,” Shepherd says. “Where programmes aren’t working, they’ve been instantly pulled.” So a sex offender programme, a domestic violence programme, even that Calm programme, two decades in, have all been stopped because the data on recidivism wasn’t good enough.

But there’s an intrinsic value to Grendon that you can measure with your eyes. This is a really calm, humane way to manage some extremely difficult prisoners. Peter’s a red band on his wing, he tells me. “I didn’t even want it, they just gave it to me.” What does it mean? “It means when you go into hospital, you get one cuff, not two cuffs,” he says, laughing, then corrects himself. “No, it means you’re trusted. I’ve never been trusted before.”

Some names have been changed. The Third Reith Lecture, Does Trauma Cause Violence?, is available on BBC Sounds

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