In this blog Dr Fiachra Byrne (UCD) and Associate Professor Catherine Cox (UCD) reflect on the project’s recent policy event, Inside Reform, held at the National Gallery of Ireland, 2 June 2017. This policy event was co-convened by Catherine and Professor Hilary Marland (Warwick) and hosted by the UCD Centre for the History of the Medicine in Ireland. For further details about Inside Reform, please see the following pages: an introductory page on the event; the policy event’s agenda; the list of speakers; the speakers’ podcasts and slideshows; and, the background reading for the workshop.
On 2 June 2017, we hosted our project’s second policy workshop, Inside Reform: Prison Healthcare Campaigns, Past and Present. The one-day event was held at the National Gallery of Ireland, Dublin, and drew on UK and Ireland-based speakers and participants from reform groups, the Irish prison service, voluntary service providers, academics, as well as our own project members. Co-convened by Associate Professor Catherine Cox (UCD) and Professor Hilary Marland (Warwick), the day was a great success and allowed for real dialogue and discussion between researchers, campaigners and practitioners.
Opening address by Associate Professor Catherine Cox (UCD)
Prison Healthcare Campaigns
The theme for the workshop was contemporary and historical prison healthcare campaigns and we hoped to address the methodologies used in such lobbying efforts and to ask how successful they had been in raising awareness and driving policy change. As Cox noted in her opening address, the project team seeks to relate our historical research on prisons to contemporary concerns and to explore the relationship between history and policy.
Prisoner Health and Prison Reform
Issues around prisoner health, of course, have long been of concern to prominent prison activists and reform groups. From the late eighteenth-century, early campaigners for reform have sought to raise awareness of unhealthy prison conditions in Britain and Ireland. Today, due to the significant incidence of mental illness, physical ill-health, and substance misuse among the prisoner population, health issues continue to be of relevance for contemporary prison reform groups, such as the Prison Reform Trust (UK) the Howard League (UK) and the Irish Penal Reform Trust (IPRT). Prisoner health and access to medical services has featured prominently in numerous prison reform campaigns of the recent past. Advocates for prisoners’ health have variously highlighted the poor physical and mental health of those entering prisons, the challenge to health inherent in the prison environment in addition to the demanding roles of prison medical staff and sometimes their inability to meet these needs.
Fíona Ní Chinnéide (Irish Penal Reform Trust): Improving Prisoner Health
In assessing contemporary and historical prison-reform health campaigns, the workshop examined the methodologies that they have adopted. Key questions for consideration included: how important have specific health crises been in promoting systematic health reforms in prisons? Could a focus on prisoner health marginalise other equally important reformist goals, such as prisoner education or socialisation? Can campaigns have unforeseen consequences? How effective are campaigns in changing public perceptions of prisoners’ entitlement to health? Does the emphasis on health hold the promise of reframing the overall purpose of the prison?
Dr Rachel Bennett (Warwick): The Duchess of Bedford’s 1919 Holloway Prison Enquiry
Session One. Out of Sight: Making Health Visible
The day was divided into two sessions: Session One, with Margaret Charleroy (University of Warwick), Janet Weston (LSHTM), Kimmet Edgar (Prison Reform Trust (UK)), Fíona Ní Chinnéide (Irish Penal Reform Trust), explored how reform groups and advocates have identified and conceptualised either specific health issues or groups with specific health needs in prison. Through the use of case studies on diet, mental health, and medical care for the elderly prison population, the presenters explored the approaches adopted by reform campaigns to improve prisoners’ health and well being and the importance of discrete health crises in prompting more systematic health reforms in prison.
Dr Janet Weston (LSHTM): The Impact of AIDS
Anita Dockley (Howard League): New Media, Old News
Session Two. Reform 101: Effective Communication Strategies
Session Two, with Anita Dockley (The Howard League); Rachel Bennett (University of Warwick); Holly Dunbar (University College Dublin) and Victoria Williams (Food Matters), focused on specific lobbying strategies employed by reform groups and other activists and how the need for change is communicated in an effective way. They examined a range of lobbying strategies. Bennett discussed the Duchess of Bedford’s 1919 Committee of Enquiry into Medical Care in Holloway Prison for Women. Dunbar investigated the campaign embarked on by the Prison Medical Reform Council in England for ‘Prisoner ‘Alpha’, an anonymised man suffering from epilepsy and incarcerated in Wandsworth Prison in 1943; Williams reflected on campaigns working with prison staff to support healthy eating strategies within prisons. Finally, Dockley pondered the relevance of new and traditional media in advocating for policy change. A key question considered was how best to forge effective partnerships and relationships with those working with the prison populations.
Holly Dunbar: The Case of Prisoner Alpha
The discussions following the two sessions and during the final round table were wide-ranging, extremely well-informed and greatly enhanced by the expertise and knowledge of the audience. While it is not possible to cover in this reflective piece all the topics raised, specific themes that emerged included a consideration of the rise of humanitarian thinking in prison reform and the effects of the developing discourse of human rights upon campaigns for prisoners’ entitlement to health. Charleroy contextualised this in her examination of early-nineteenth-century prison reformers, who, influenced by enlightenment ideas, deployed humanitarian polemic when advocating for better treatment of French prisoners-of-war in Liverpool Gaol. However, in response to Weston’s paper on HIV/AIDS in English and Irish prisons during the 1980s, it was noted that humanitarian concerns were often distinctly lacking in campaigns for policy change. It was suggested that the stigma attached to HIV/AIDS was intensified by perceptions of prisoners as less deserving of healthcare and treatment options. The ‘status’ of prisoners, in terms of their ethnicity, gender, sexuality, behaviour or political motivation, could influence the effectiveness of campaigns that sought improved health care, with some groups tending to be deemed less worthy of sympathy and support. It was, however, noted that negative perceptions of the prison population within society can be exaggerated and should not always be assumed.
Prison Reform Groups: Defining Success
There was discussion of the aims of reform groups and how success is and was delineated. Defining the IPRT as an independent campaign organisation focused on progressive policy change, Ní Chinnéide stated that in terms of prison healthcare the organisation has focused on the equivalence of care principle, the promotion of preventative services and continuity of care following discharge. The work of the Howard League is also focused on policy change, and one such campaign highlighted by Dockley was their ‘Books for Prisoners’ initiative, a response to the decision to ban the sending of books to prisoners in England.
The discussion on the importance of hearing about experiences from those incarcarated highlighted additional aims for reform groups. Kimmett Edgar’s and Sharon Shalev’s report Deep Custody (2015) drew on interviews with sixty-seven prisoners together with unit officers and managers. They visited fourteen segregation units in England and Wales, which they argued were characterised by social isolation, inactivity and the increased control of prisoners. Despite the fact that segregation had adverse effects on mental health, they found that a high proportion of people were held in solitary confinement notwithstanding the evidence that they were too vulnerable to endure it or had deteriorated during a period of segregation. Potential symptoms arising from solitary confinement, and noted in the report, are anxiety, depression, anger, difficulty in concentration, insomnia, and an increased risk of self-harm.
While the reform of mental health services was the aim of Deep Custody, many workshop participants suggested that for some of those incarcerated the opportunity to recount their experiences of healthcare facilities in prisons was highly valued. This had been the experience of those working with women who gave birth in prisons, as well as that of campaigners seeking improved mental health services for prisoners. Earlier in the day, speakers had emphasised the centrality of robust statistical data in supporting campaigns, but there was also a recognition that such approaches could elide the voices of those experiencing prison healthcare. This debate on the aims of reformers and their campaigns highlighted a theme that straddled many of the presentations, most notably Dunbar’s, namely, that reformers’ aims did not always align with the priorities of the men and women incarcerated.
Victoria Williams (Food Matters): Food Matters Inside & Out
Time and again, the importance of building relationships was stressed; while penal reform groups and prison staff could appear to be on opposing sides, they were often working toward similar goals. The success of Food Matters’ campaign to improve food and eating strategies at Wandsworth Prison was, according to Williams, a result of the organisation’s use of less adversarial methodologies that necessitated engaging and working with prison staff and recognising the achievements of prison caterers in providing meals on extremely limited budgets.
Inside Reform was, from the perspective of our project members, a hugely successful policy event that underlined the importance for us as historians of engagement with reform groups, service providers, the wider academic prison community and those working in the prison service. The information, viewpoints and experiences shared by those who presented at and attended the workshop constitute an invaluable resource for our project team, allowing us to trace the connections between the historical genealogy of prison health and contemporary policy and practice. We look with genuine excitement at the opportunities that the creation of such networks of prison knowledge and expertise provides.
For further details on Inside Reform, please see: