Leading change

Support workers within Her Majesty’s Prison Swaleside (HMPS) identified unwarranted variation in the availability of psychological support for prisoners experiencing lower level mental health problems. The support workers developed and implemented a dedicated Emotional Well-being (EWB) scheme involving peer mentors, which led to better outcomes, experiences and use of resources within the prison.

Where to look

Whilst working with prisoners at HMPS, support workers recognised that many of them were struggling to cope including maintaining their emotional well-being.  Although the prison had a mental health team there was no service for them to access before their mental health deteriorated at times this led them to thoughts of self-harm. Support staff recognised this as unwarranted variation in services as in other care settings services were available to support and promote positive health and emotional well-being.

Guidance issued by NICE (2011) identified that services should increase the range of supportive interventions available for common/low level mental health disorders with peer support being seen as an evidenced way to help. Peer support is a relationship of mutual encouragement, where people with similar experiences offer each other assistance, especially as they move through difficult or challenging experiences. It is reported to play a significant role in emotional wellbeing, by contributing to a culture change which is more strengths-based and works to empower people to play a central role in any care and support they receive (IRISS 2016).

What to change

HMPS support workers identified that for prisoners who exhibited low level mental health needs during their time in prison they at times reported they struggled to relate to professionals supporting them and sought support from other prisoners, as they had often experienced similar challenges to their emotional wellbeing. The support workers identified an opportunity to introduce a peer support service to provide a safe, accessible service building upon existing strengths of the prison’s work.

How to change

The support workers, with the backing of the HMPS senior managers and mental health team, developed an Emotional Well-being (EWB) scheme based upon the principles of peer support and other evidence based interventions.  It aims to support emotional wellbeing through prisoners helping each other to develop effective coping mechanisms, therefore preventing their mental health deteriorating.

The EWB scheme recruited peer mentors for the scheme, and prisoners applied to the prison managers to join the scheme. Applications were reviewed by the prison governor to ensure full approval and gain security clearance. Once approval was gained, peer mentors:

• Had a period of shadowing for a minimum of 3 months with another mentor
• Received training from the prison mental health nurse to ensure they are ready to support prisoners with mental health concerns, how to manage concerns, how to speak with people, what to do about worrying issues, how to facilitate a group etc.

Mentors are supported using an integrated coordination model between the prisons support workers and the HMPS mental health clinicians. Prisoners using the service are offered 1:1 sessions, group therapy work, cognitive behavioural therapy based initiatives, art therapy and holistic support focused on supporting day to day living in the prison environment.

Due to the success of the scheme the EWB service moved into a dedicated wing so that there was an allocated space for prisoners who required additional support to ensure accessibility to the peer mentors at all times of the day and night.

Adding value

Better outcomes – Initially the programme had 2 prisoners undertaking the peer mentor role. The scheme has now expanded to 10 prisoner mentors who support a cohort of 250 mentees.

Feedback from current prisoners who are being supported by the EWB mentors has shown a reduction in self-harm. From a sample of 60 mentees, 63% had self-harmed in the past and 24% were currently using self-harm as a way of coping. Of these prisoners 57% stopped or reduced their self-harming behaviour since working with the EWB mentors.

78% of the same sample of mentees stated that they had thought of, or attempted suicide recently (within the past 12 months). Since receiving support from the EWB mentors 66% of these mentees had reduced or stopped both thoughts and attempts at suicide.

Changes in emotional wellbeing behaviours of prisons have been noted by the team, with some of those who would previously ‘self-secluded’ now being well enough to leave the wing and engage within education and work programmes. Positive outcomes have been seen with many mentees moving on to full time work as well as becoming mentors themselves and in a reduction in generally disruptive behaviour with the schemes users.

The groups offered are well attended and the numbers of prisoners utilising the support services continues to grow.

Better experience – The peer mentors have been well received by prisoners and by clinicians alike. Feedback has been that mentees feel there is a sense of a supportive culture for emotional wellbeing as a result of the scheme and that is has enabled them to build confidence to access different services available in the prison. This in turn has improved the prisons self-care mentalities, contact rates and relationships with family outside of prison and general engagement levels.

Better use of resources – The reduced numbers of self-harm amongst mentees and episodes of disruptive behaviours have meant existing resources can be utilised more effectively and teams such as the Mental Health Team can be supported better.

Challenges and lessons learnt for implementation

It is important to stay determined and dedicated to programmes such as these as they can have some very beneficial rewards for your environment, staff and service users.

Resistance is normal as there it is normal for people to feel apprehensive when developing new ways of working especially where these are innovative.

The schemes successes have won it the High Sheriff of Kent’s award in 2016, meant it was highly commended in the Mental Health Category of the HSJ’s Value in Healthcare Awards 2017 and won it the Mental Health Category of the Patient Safety Awards 2017.

Find out more

For more information contact:

• Susannah Duthoit, Mental Health practitioner, susannah.duthoit@nhs.net