Sleepless in the slammer

Charlotte Randall, Higher Assistant Psychologist and MSc student, Northumbria University

The current prison population is 85,641 and around 50% of this population suffers from symptoms of insomnia. While this is similar to the general population there are a limited amount of resources to help treat this disorder in prisons.

Having worked in prisons for seven years, I am all too familiar with the problems that a lack of sleep can have on an offender's ability to engage with the prison regime, and the impact this has on their mental health. Due to the high prevalence of mental health problems, substance misuse and personality disorders in the prison population, the issue of sleep is often side-stepped and the importance of obtaining and having a healthy sleep practice can be forgotten about.

I am part of the Mental Health In-reach team in a prison in the North East, and have witnessed first-hand the effect poor sleep can have on an offender’s mental health. As this is an under-researched area, I decided it would be interesting and beneficial to conduct research on insomnia in the custodial setting. The aim of the study was to see whether a 60-70 minute session of Cognitive-Behavioural-Therapy for Insomnia (CBT-I) with an accompanying self-help pamphlet was an effective treatment in reducing the symptoms of insomnia in male prisoners.

As I work in the prison Mental Health Team full time, I thought this would be a simple project to undertake, however there were several hurdles along the way. Firstly I was required to gain ethical approval from several different organisations; NHS; National Offender Management (NOMS); and the University. Offenders are classed as a vulnerable population for research purposes, and therefore there is heightened scrutiny from ethic boards as a result of this. This process was lengthy; I had to complete three separate documents explaining the project’s benefits for each organisation. Once submitted, I was required to attend a full Research Ethics Committee (REC) where the research protocol and IRAS (Integrated Research Application System) form were discussed and additional questions were asked. It was then a waiting game to see whether the study had been granted ethical approval. As with any research project there was a deadline of September 2016, in which my dissertation needed to be submitted. Ethical approval was granted in June 2016, after recommendations had been made by the NHS and NOMS ethic boards and an amendment report was submitted.

On the other hand, recruitment for the study was relatively easy, which surprised me! Although it also identified the need for insomnia interventions in the custodial setting and confirmed that this research was important. The offenders were keen to engage, due to the lack of pharmacological (drug related) and psychological interventions for insomnia they were eager to find something that helped them sleep.

Results from this research were positive and highlighted that there was a significant reduction in insomnia related symptoms after completing the 60-70 minute session of CBT-I, with the accompanying self-help pamphlet with category C adult male prisoners. This research is the first of its kind to assess whether an adapted versions of CBT-I is effective in the prison population, where there are limited interventions and resources to help aid sleep disturbances. Although the results were positive, they have to be taken with caution as the prison where this research was undertaken has a unique regime and all prisoners are in single-cells which allowed them to complete certain aspects of CBT-I e.g. sleep restriction.

My experience of completing this research was positive; I enjoyed the prospect of analysing an undiscovered area and hopefully informing academia and practice within a public health setting. I did however find it hard in the early stages of this project, specifically going through the ethics process and length of time this took. A written report has been disseminated to NOMS highlighting the findings of this research. It also identifies how this research could be taken forward and inform future research opportunities. The single session of CBT-I is being delivered in the prison where the research was completed, more data is being gathered and will hopefully be published in 2017.


Photo attribution:

1. “sans horizon” by poirpom via Flickr.com, copyright © 2015: https://www.flickr.com/photos/poirpom/16479845789/
2. “prison” by erin via Flickr.com, copyright © 2007: https://www.flickr.com/photos/insunlight/1037277952
3. “Insomnia” by Ben Harrison via Flickr.com, copyright © 2011: https://www.flickr.com/photos/48755144@N02/5564362009

Dealing with emotions and breakaway training: reflections on collecting survey data in a prison

Guest post by Jennifer Ferguson, Research Associate (Alcohol Team), Teesside University

“Wear tracksuit bottoms, bring your trainers and be prepared for Judo style moves” – not something you hear every day when trying to set up data collection. Working in a prison has been an eye opener, in ways I expected, and in ways I could never have anticipated. I sit on F wing, the wing that prisoners are brought on to when they arrive. It is in the middle of this wing that I carry out surveys about brief alcohol interventions with each new prisoner for a research project at Teesside University.

When I think back to the phone call I received about “breakaway training” and how I felt on that day, (being told how to physically hurt people should I be attacked, and kicking grown men) it was all very useful and I believe necessary when working on a prison wing. However, what I should have been preparing for was how mentally challenging it is. Prison staff become hardened (through lack of choice) to what happens in there, they have to become emotionally disentangled from each prisoner, and some literally make fun of the inmates. Of course we need to know how to hide our keys, get out of basic holds, locate the alarms and know basic breakaway techniques. But the awful feeling I felt in the pit of my stomach for a vulnerable new prisoner who enquired as to where everyone was going with their towels (they were lining up for the showers), and who was told by another inmate: “swimming mate, you wanna go? Just go up there and ask ‘Mr Jones’”, will stay with me for a long time.

Prisoners don’t expect you to be nice to them, and no one uses first names. It is surnames for prisoners and Sir and Miss for staff. They don’t touch you, even to shake your hand. The language is horrific. This is just the way it is. So in my first few weeks - hearing ‘Thompson’ tell me about how he misses his wife and kids, ‘Scott’s’ emotional breakdown because he is terrified of being inside, and ‘Smith’s’ heartbreak about his childhood and battle with drink and drugs - I soon realised I didn’t need to know how to defend myself against anyone. What I needed to learn, and fast, was how to switch off emotionally in front of these grown men. I am an emotional person and could easily fill up with tears in an instant at some stories. In my time as a researcher, when writing papers, collecting data in various formats and spending hours inputting it into a statistics software package, I have never had to deal with grown men crying. That being said, I am told every day by the peer prisoners not to believe everything I am told. I will learn how to deal with my emotions and what prisoners tell me… and by then be finished data collection. I wonder if my perspective will change the more time I spend in there? 

I guess my point is that I am learning that you cannot understand everything in public health research from articles and text books. A class room cannot prepare for you for the mental challenge of working in prison setting. However, this difficult piece of data collection will be vital to our study and my development as a researcher.

Photo attribution: “Jailed.” by disastrous via Flickr.com, copyright © 2008: https://www.flickr.com/photos/bienaventurada/2912658697