Effective social work in prisons and high-security hospitals

Three social workers tell Gordon Carson about the professional skills and attributes that are necessary to practise effectively in prisons and high-security psychiatric hospitals

Maureen Stratton (pictured), manager, Islington Council’s Holloway Prison, Finsbury child in need and Whittington Hospital teams

Maureen Stratton has just finished a multi-agency meeting to discuss applications by four women for places on Holloway Prison’s mother and baby unit. One woman scheduled to appear in court this month is due to give birth in September. Stratton will work with the woman to identify a carer so the baby can move into the community after four or five months at the Holloway unit.

Stratton’s small social work team is commissioned by Holloway to work with women seeking a place on the unit, which is staffed by prison officers and looks after babies until they are nine months. Social workers spend much of their time liaising with the home local authorities of women prisoners, which retain responsibility for the welfare of prisoners and their children.

Though social workers do not need specialist qualifications to work in this niche of the profession, it can present its own unique challenges. In particular, the environment of a prison can be disorienting for professionals accustomed to work in the community.

“Prisons can be quite isolating,” Stratton says. “You also have to be completely security conscious – for example, you have to lock the toilet after you’ve used it – and you are out of your comfort zone. It’s a whole shift into an institution.”

Stratton, who has worked in children’s services since qualifying as a social worker in her 40s, says social workers have to be “experienced, assertive and solution-focused” to work effectively in this setting.

“You need a wide knowledge of family law, the Children Act and supporting guidance, and you must know about attachment theory and critical periods for separating children from their mothers,” she adds.

Stratton is clear that her role is for the child, particularly in cases where children are removed from their mothers after birth at Whittington Hospital, whose maternity unit is near Holloway. “The [home] local authority may have said that this woman is a risk to children and we need to separate her from her baby and the mum needs to go back to prison as soon as possible,” she says.

Despite these challenges, Stratton says the job lets her use her knowledge of attachment and separation theories, and work with home local authorities to encourage contact between prisoners and their families on the outside. That, in turn, reduces the risk of prisoners reoffending. “I like the hands-on nature of the job,” she adds.

Clive Pearce, forensic social worker, Broadmoor Hospital

As a forensic social worker at Broadmoor Hospital in Berkshire, one of three high-security psychiatric hospitals in England, Clive Pearce works with some of the country’s most troubled offenders.

A former probation officer and probation service manager, he moved into forensic social work in 2005 and two years later joined Broadmoor, where he carries a caseload of 18 patients with personality disorders.

Pearce has a social work qualification and did not have to take any additional specialist training or become an approved mental health practitioner to work at Broadmoor, although some of his colleagues have AMHP status. However, he did take an MA at the Tavistock and Portman NHS Trust which looked at the behaviour of organisations. This, he says, has been valuable in helping him to understand the system at Broadmoor and the pressures faced by staff.

Pearce says experience in criminal justice work, as well as an awareness of mental health legislation and tribunals, is important for social workers looking to move into high-security psychiatric care.

As a forensic social worker, he uses relevant legislation to assess patients’ needs and rights. Many are under restriction orders and are subject to multi-agency public protection arrangements, which assess and manage the risk posed by registered sex offenders.

One of the most positive aspects of the job, says Pearce, is the chance to learn from professionals in other disciplines and contribute a social work perspective to their practice.

Due to the risks posed by some of Broadmoor’s patients, who stay in the hospital for six years on average, Pearce says security can be extremely tight; it can take up to three months for visits by the children of patients to be approved, for example. “We are focused on the progress and treatment of patients but public protection is paramount,” he says. This is important when decisions are made about transferring patients to medium-secure facilities.

Pearce believes social workers need to be “very resilient” to work directly with some of Broadmoor’s patients, and within what is a “very powerful institution”. But he adds: “We have to advocate for the patient to help ensure their needs are heard.”

Lex Greig, social work team leader for HM Prison Open Estate, Perth and Kinross Council

Prisoners can move to Scotland’s Open Estate – formerly two separate prisons, Noranside and Castle Huntley – up to two years before they qualify for parole and if they no longer need the highest levels of supervision. These include some who have been sentenced for serious assaults or sex offences and continue to present child protection or domestic violence risks, says Lex Greig. This leaves prison-based social workers with a key role in planning how these offenders are integrated back into the community.

Greig says her social work team, who are employed by Perth and Kinross Council and commissioned by the Scottish Prison Service, must be willing to work with a range of agencies, including the police, health services, education and the voluntary sector. This multi-agency working is at the heart of Scotland’s integrated case management model, which aims to support prisoners so they are less likely to reoffend when they are released.

Prison-based social workers must be able to “work on a range of levels and with a range of different people, up to prison governors”, says Greig. “This increases your own sense of self and having a strong professional identity. There are so many agencies that can challenge what you are saying, but if you can stand up to that you can work anywhere.” They must also constantly balance the profession’s traditional values, such as the welfare model, with risk management.

“It’s difficult to reconcile the two at times,” admits Greig. “You need a person-centred approach even if you might abhor what the prisoners have done.”

Beth Myring, senior parent support worker, Styal Prison mother and baby unit

While Holloway’s mother and baby unit is run by prison officers, its equivalent at Styal Prison in Cheshire is staffed by social workers and other child care professionals employed by the charity Action for Children, which has the contract to manage the unit.

Beth Myring, a qualified social worker and senior parent support worker at Styal, says her move to the unit two and a half years ago fulfilled a long-standing desire to engage in early intervention work with the most troubled families, after an early career which included spells in child protection and working for Sure Start.

“It’s fantastic because the intervention we can do with mums and the time we can work with babies is so much more intense,” she says. “In the community we would go in for an hour or two a week then go out of their lives. But here, we’re with them 24/7.”

Styal works with mothers aged 18 and above and their babies aged 18 months and under. Myring oversees parenting support for women and children on the unit, as well as the application process for pregnant women or mums with young children seeking places.

This includes liaising with women’s home local authorities to determine if they are suitable for a place on the unit, as well as taking part in multi-agency meetings to consider applications. Myring says social workers in this environment need to be “very reflective” and should “think through their decisions on a daily basis”.

“You have to accept you have a degree of power and control over these women but you need to be empowering them,” she adds. 

The intensity of the working environment might not be suitable for every social worker, Myring says, adding: “There are many competing demands on your time and for some people it would feel like a very intense environment to work in. Some people might prefer to have a break from families.”

Social work careers in secure settings

Careers for social workers in the secure estate vary across the UK, but the good news for those considering such a move is that the standard social work degree will usually suffice, though significant experience is often preferred. The main options include:

● Scotland: The Scottish Prison Service funds social work services in Scotland’s 15 prisons delivered by local authority social workers.

● Northern Ireland: The Probation Board for Northern Ireland provides probation officers to perform social welfare duties in the country’s prisons and young offenders centres. Probation officers are qualified social workers, so anyone with a social work degree can apply for this role.

● England and Wales: The Youth Justice Board is funding 22 social worker posts in young offender institutions, initially until April 2014. Local authorities will recruit and supervise the qualified social workers.

Social workers are also based in mother and baby units, though recruitment and management processes vary locally.

In addition, forensic social workers are often based in secure mental health hospitals such as Broadmoor, where they support the assessment and treatment of people with mental health problems who commit serious offences. Some have approved mental health practitioner status, but it is not an essential requirement. Many forensic social workers have prior experience of the criminal justice system.

This article is published in the 4 August 2011 edition of Community Care under the headline “An inside job”

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