Therapeutic Communities in English Prisons

Past, present and future

Barbara RawlingsLjubljana June 2007

The Two Models

• Democratic – a total of 12 communities

• 1960’s to present day

• Hierarchical – a total of 5

• Mid-1990’s to present day

This presentation

• Part 1: Some interesting differences• Accredited programmes• Target group• Emphasis of treatment

• Part 2: TCs in the Prison Context• Prison Service Management Practices• Recruiting clients• Provider partnerships• Audit

An accredited programme needs:

• A theory manual• A management manual• A programme manual• A training manual• An evaluation and assessment manual

It needs to demonstrate how the programme will reduce reoffending

Accredited programmes

• Democratic TC – based on a model developed in British psychiatric hospitals in the 1940’s and afterwards.

• Hierarchical TCs – based on a model developed in the USA, first at Synanon and then at Phoenix House and Daytop, and then others

Target groups: democratic TCs

• Likely to reoffend• Personality disorder• Often psychopathy• ‘Major’ risk factors eg:• Association with criminal groups• Anti-social beliefs and attitudes• Substance abuse• ‘Minor’ risk factors eg:• Low self esteem• Emotional problems

Target groups: hierarchical TCs

• Severe problematic drug use

• Drug use clearly related to offending

• Likely to reoffend

In democratic TCs we find….

• Offence paralleling• The ‘story’ of each resident’s offence is

known

• Links made between the offence and behaviour in the TC.

For example

• Offence: During a time of great stress from family and work, a man stopped talking to his friends, seemed to cut himself off from people and started to believed he was being criticised and laughed at.

• One day he exploded with anger and attacked his next door neighbour who had come round to complain about the noise of his television. The neighbour suffered a heart attack and died.

On the TC

• He shouts and swears at a fellow resident on the landing.

• There had been no indication before this that he was upset

• A special crisis meeting is held with the man.

• A parallel between the offence and this incident is identified

• Helpful coping strategies are suggested

And later…….

• The man is observed becoming quiet.

• A special crisis group is held.

• Others help him see that this could be another lead-up to an explosive outburst

• He talks through his feelings of anger instead of acting them out.

In prison drug abuse TCs we find…….

• “Act as if”

• Residents act how they should behave rather than how they want to behave

• “Blind faith”

• Residents encouraged to believe the programme will work for them – and wait for proof of this.

The behaviour comes first

• Residents can experience the benefits

• Positive behaviour elicits positive feedback

• The positive behaviour starts to come more easily.

• New attitudes are internalised

• New behaviours are adopted

But underneath……..

• It’s hard to act positive

• So there are negative sanctions

• And positive sanctions

• And peer groups

• And positive role models

• And encounter groups.

Part 2: The prison context

• KPTs (Key Performance Targets)

• Overcrowding (25% increase since 2001)

• How does this affect the TC?

• the example of lodgers

3 types of lodgers

• Type 1: Therapy completers• positive role models• Type 2: Early leavers • can be disruptive• can regret leaving• Type 3: No prior relationship to the TC• can be a negative influence• can decide to make an application to join

Other issues

• Length of treatment

• Cost of treatment

• Recruiting and keeping trained staff

• Waiting lists

Recruiting residents to the democratic TCs

• A cluster of characteristics

• OASys – a new computerised national system for assessing the risks and needs of offenders – all offenders.

• Indeterminate sentences (currently 2000)

• Competing with CBT programmes

Recruiting residents to the Drugs TCs

• Transport to prisons

• Sentence length

• Competing with CBT programmes

• Location of the TCs

• CARATS

• (Counselling, Assessment, Referral, Advice and Throughcare)

Other issues for the drugs TCs

• Vacancies in the work hierarchy

• Finding opportunities for re-entry residents

• Re-tendering for the contract

Audit• Prison service Audit (both TCs)• Community of Communities Audit (DTCs)• TC quality standards• TCs visit each other• Peer assessment• Separate standards for drugs TCs• Potential for prison drugs TCs to join

Community of Communities