Women in the criminal justice system – the forgotten voice of NHS reform?

Since the intensely debated radical reforms of the NHS began, many have voiced concerns about how different service user groups will fare under the new GP-led commissioning structures for healthcare services.

One voice unlikely to be adding itself to the clamour is that of women in the criminal justice system, specifically those with mental health needs. The specialist community services that provide support to women diverted from custody will now be commissioned by the same bodies in charge of gallstone removals and hip replacements. With much progress still needed in this area, there is a real risk that this voice will remain unheard.

Despite the much hailed Corston report and the positive work done since, the number of women being incarcerated is still not significantly reducing. Those of us that work with women offenders know they can easily become lost within a system that has been designed for the needs of its overwhelming majority: men. From the moment a woman comes into contact with the system through to her eventual rehabilitation, the structures that have evolved over time are likely to be of little or no support for her complex and specific health and wellbeing needs.

What do I mean by this? Imagine this scenario:

Alison had never done anything illegal before being arrested for credit card fraud. Things were really tight and lately her boyfriend had begun having outbursts and hitting her. He forced her to use a credit card he had stolen and she didn't want to upset him, especially with her little girl Molly at home. In a room full of people at the police station, she didn’t know how to say that for months she’d been feeling really low and having suicidal thoughts. She was given a suspended sentence after a brief probation interview at court. The officer did ask if there was anything important he should know but the thought they might take Molly away was unbearable, so Alison said “No”. The condition of her sentence was that she keep regular probation appointments, but she missed three. She was too scared to explain that she couldn’t attend because her partner hadn’t let her leave the house. Alison was taken into custody during which time her mental health deteriorated and she began to self-harm to cope.

Too many cases like this mean that women get stuck in the revolving door of reoffending and short term jail sentences that only compound their mental health problems. Even when support is available in the community, too many women are still inappropriately kept in custody, adding to the trauma that so often underlies the original offence, making them more likely to reoffend and breaking up families. Over 17,000 children are separated from their mothers by the criminal justice system each year.

And it’s not just the system that’s against them. In the general population, women are more likely to report symptoms of mental ill health and seek help, while men have a tendency to self-stigmatise or be too embarrassed to admit their problems. In justice settings, this situation can be reversed. Men are more likely to express their needs, perhaps through their behaviour, and thus their symptoms are generally more apparent compared to those of women, who may hide or play down a mental health problem while grappling with issues relating to housing, debt, employment, children and family.

To make matters even worse, the short and long term effects of being incarcerated are significantly greater for women, with higher incidences of self-harm, suicide and mental illness. 90 per cent of women within the criminal justice system have a mental health or substance misuse problem. Over half have suffered domestic violence and one in three sexual abuse. Until women’s mental health and wellbeing needs are properly addressed by the system, none of this will change.

So why is it so difficult to get it right? Together for mental wellbeing recently held an event bringing together experts from the voluntary sector, the NHS, the Ministry of Justice and most importantly female ex- offenders. The picture painted was one of limited local provision specifically for women, a counterproductive commitment to the idea of ‘equal treatment for all’, evidence of over-criminalisation of women due to prejudice, and examples of sentencers’ decisions differing hugely according to their varying degrees of interest in or awareness of women’s needs.

The reasons, then, are many and varied, but so are the solutions. Early identification and assessment by a mental health practitioner can pick up a mental health issue that might otherwise go unnoticed, court reports prepared by experts can highlight a woman’s particular needs and circumstances, training for probation officers and sentencers means greater awareness of the most suitable provision or sentence, and good joint working between criminal justice services, healthcare commissioners and voluntary sector organisations means the right provision is in place for women who simply shouldn’t be in custody.

Remember Alison? Things could have turned out very differently for her:

The female police custody officer noticed Alison was withdrawn and had unexplained bruises. She made a note of this so that when Alison got to court, she was immediately assessed by a specialist women’s mental health practitioner - someone who had the skills to ask the right questions, in the right way, enabling Alison to open up about the domestic violence she was suffering. The practitioner informed the judge, who could see her relationship issues were clearly at the root of her first-time offence. She was granted a community sentence and referred to her local women’s centre, which found her and Molly housing at a refuge.

So health and social care commissioners really do need to take notice of women in the criminal justice system if we are to stop luck and circumstance dictating whether they become entrapped in a cycle of offending, or are given the chance to work towards better mental health and a life away from crime.