A Review of Survivors Group in HMP Risley

If I’m the problem, then I gotta’ be the solution.

A review of the ‘Survivors Group’ in HMP Risley November 2013—March 2014

Contents Foreword...................................................... 3 Duncan Craig, CEO: Survivors Manchester Stewart Hopkinson, Head of Reducing Re-Offending: HMP Risley Foreword...................................................... 4 Mark Stanley, Belief in Change Programme Manager: HMP Risley Lorna Edmondson, Belief in Change Reintegration Manager: HMP Risley Introduction.................................................. 5 The Partnership..............................................6 The Research..................................................7 The Membership............................................ 8 The Contract..................................................9 The Outcomes............................................. 10 IES-R (Impact of Event Scale – Revised) WEMWBS (Warwick Edinburgh Mental Well Being Scale) Outcome Measures Outcomes Summary PO4’s Testimony PO1’s Testimony PO2’s Testimony PO3’s Testimony PO9’s Testimony Case Study: Luke..........................................16 Conclusion.................................................. 18 References...................................................19

2

Survivors Manchester

In spring 2013 I was invited to attend a morning meeting of the Belief in Change community to talk about the work of Survivors Manchester. I never thought for one second that 10 minute talk to 20 or so prisoners in HMP Risley would result in such an incredible journey of the silence surrounding sexual abuse being broken.

For years, I have been told by a variety of professionals that male prisoners wouldn’t ever truthfully talk about their issues, especially in relation to sexual abuse and traumatic childhood experiences. Their hypothesis have ranged from “it’s too much of a male environment”; “it would cause more suicides and be far too dangerous”; “there isn’t enough staff to manage the risk” and even “prisoners don’t have the emotional intelligence to do that”.

But I didn’t listen (something I’ve been accused of many times throughout my life) and right now I’m glad I didn’t! I stood firm in my belief that if you create the right conditions and facilitate a safe space, then boys and men will use it positively which will aid change. Despite the frustrations, I’m glad I never gave up on the idea of creating support for male survivors behind bars.

I’d like to thanks the Belief in Change team, particularly Mark and Lorna, who listened to me and shared my belief in the ability for a person to change. Thank you to Stewart Hopkinson at HMP Risley that realised having a duty of care to reduce risk sometimes involves allowing people a safe space to talk and for embracing the theory that silencing those that need to speak is a risk inflator.

But most importantly, thank you to the men of the first ever Safe Room in a UK prison. The graduates of the 2014 Survivors Group in HMP Risley...you are all my inspiration.

Duncan Craig. MA Couns (Dist). MBACP Acred.

Chief Executive / Psychotherapist Survivors Manchester

A review of the ‘Survivors Group’ in HMP Risley

“You can’t do that Stewart; you’ll open up a can of worms and we don’t have the resources to deal with the fall out”.

Such was the instruction issued to me many years ago when, as a main grade Probation Officer, I was supervising an alcohol dependant offender whose offending was clearly related to his experience of systematic sexual abuse as a young boy in care.

This instruction, whilst not rooted in policy, raised two fundamental barriers which remain just as prevalent today. Firstly, the notion that to avoid the painful and far reaching consequences of abuse for victims, or to deny victims the necessary space and opportunity to speak, is somehow healthier than to ‘open the door’ and enable them to speak and to be heard. Secondly, there is the ever present issue of ‘resource limitation.’

My first encounter with Duncan Craig, and a subsequent meeting with a prisoner on the Belief in Change programme, served to highlight these barriers as simply that – barriers that have been traditionally imposed as a result of benign ignorance and expedience. I was quickly persuaded to take what I considered to be a ‘controlled risk’ in agreeing to the implementation of the pilot ‘Survivors Group’ at Risley.

The pilots proved to be tremendously successful.

I am therefore very grateful to Duncan Craig for his drive and perseverance and for his professional guidance and support for the Survivors Group. I am equally grateful to the Belief in Change managers, Lorna and Mark, and to their staff. Not least, I am grateful to the Survivors Group members who not only believed in this pilot but demonstrated the necessary commitment and courage to see it through and to reap the concomitant benefits.

Stewart Hopkinson. MA. Head of Reducing Re-offending HMP Risley

3

When we first started this group, I hoped this would be an initiative that participants took seriously and didn’t just sign up to for a week or two for the novelty value; the participants would manage to keep up high levels of respect at all times with their contributions and listening; the challenge of maintaining confidentiality wouldn’t be too much for some of the participants; the participants would grasp this opportunity to address some difficult and taboo issues (as I knew that they may never get a better chance in life to do so); and that this pilot project may even demonstrate that by getting men to deal with these core issues, it might contribute to a reduction in risk of re-offending – a very big ask I know!...

What can I say! The men have been completely bowled over by the support of Survivors Manchester and how we have collectively been able to implement the survivors’ group within a prison setting and make it a positively safe environment.

...But I also knew that a lot of courage would be needed for this group to go ahead.

Others have spoken about how the group has made them reflect more on the present day impact of their experiences of being abused and are now wanting to engage in more therapeutic work to address this as one of the main causes of their drug and alcohol related offending behaviours and address the use of violence in their lives.

What’s been achieved now is that from an original 12, a core group of 6 have kept going and appear to have put huge trust in the team within the Belief in Change programme, in Duncan and Survivors Manchester, and more importantly in themselves.

All my hopes for this group have come good and their success has given a feel-good boost to the whole Belief in Change community and staff.

Participants are demonstrating they can make some sense of their past trauma and abuse and now move forward with an increased level of acceptance, understanding and increased selfesteem and confidence.

Much bravery has been shown by all in seeing this pilot group through to its conclusion.

Mark Stanley Belief in Change Programme Manager HMP Risley

4

In a recent graduation event, one of the men mentioned in his reconciliation speech that he can now, for the first time in his life and during a 20 year sentence, talk openly about the abuse he suffered in his early life. Another of the men has grown in confidence and self esteem so much, that he is able to share his thoughts and feelings with his peers and supporters which he did during his graduation.

Being part of the survivors group has demonstrated to us the increase in self esteem, confidence and trust put in others which allows them to talk about their past experiences and how that has affected their unhealthy behaviours, emotions and relationships.

These men have never had the opportunity to be involved with this type of group before, especially as a group of men, and for some this is the first time they have worked with the system in a positive way. The survivors group has been an invaluable part of the Belief in Change programme enriching us all Lorna Edmondson Belief in Change Reintegration Manager HMP Risley

Survivors Manchester

Introduction In spring 2013, Survivors Manchester founder and CEO, Duncan Craig, was invited to attend a community meeting within the Belief in Change (BiC) programme at HMP Risley to introduce the work of the organisation and answer any questions regarding the support services on offer.

Four weeks later Duncan was invited back to HMP Risley by BiC Programme Manager, Mark Stanley, to help support the ‘Healthy Lifestyles’ group members and discuss support strategies with the BiC team. A disclosure had been made by a group member about his experience as a sexual abuse victim that had resulted in a number of other men in the group men also disclosing their experiences of childhood sexual abuse. Mark was concerned about this and asked Duncan for some professional support through this difficult time.

Duncan jumped at the chance as he had always held the view, and one that is fundamental to the ethos of Survivors Manchester as an organisation, that given the right space and conditions boys and men will talk in an honest way that promotes their own positive and healthy self-development and growth in healing.

Duncan’s view was founded as someone who had already engaged in healing work as a child abuse himself, but the view was heightened during the research phase of his 2009 masters degree when he read Ian Bank’s paper “No man’s land: men, illness, and the NHS” (2001)i.

Bank’s stated that there are: “Many myths surround men’s health, the greatest of which is that men do not care about their health. The fact is that men worry about health but feel unable to talk about their concerns or seek help until it is often too late.”ii Banks’ hypothesised that if we are to address the disparity in men’s health then we need to begin to change the way we think about men’s health and change the way we deliver services.

Duncan realised quickly that this ethos is at the heart of the BiC programme, changing the way we address the rehabilitation of offenders and therefore believing in their ability to change.

a holistic and informed approach to positive changes in behaviour.

It focuses on the positive and adaptive reintegration of prisoners into society and encourages them to build the skills they will need and develop their support networks in preparation for release.

Using a range of methods, including community living, structured group work, individual coaching and mentoring; the programme places a high emphasis on challenging those who volunteer for the programme to change their thinking and behaviour so that they can develop into people who can make positive contributions to society and desist from offending. It promotes the building of links in the wider community with the aim of increasing prisoners’ employability.

The shared ethos of both Survivors Manchester and the BiC programme at HMP Risley could easily be viewed as empowering men to make healthy, adaptive changes that will positively enhance their futures and reduce the patterns of behaviour that usually result in re-offending.

Following on from Duncan’s second visit, the BiC Programme Managers Lorna Edmondson and Mark Stanley, began discussion with: Survivors Manchester; HMP Risley Head of Reducing Re-offending, Stewart Hopkinson and a prisoner whom had experience of living within a therapeutic community and was a group facilitator with the BiC Programme, a scoping meeting was had.

Duncan discussed the Survivors Manchester peer support group model, presented a number of outcome measures, and gave a commitment to support HMP Risley and BiC to undertake a six month survivors’ peer-support group pilot by giving his time, experience and utilising his supervision skills.

In October 2013, eleven members of the BiC community were assessed and accepted into the group and so began the first ever known male survivors peer-support group in a UK prison.

This report takes a qualitative and quantitative review of the pilot, which ended on 5 March 2013.

The 26 week voluntary BiC programme, for medium to high risk general offenders, adopts

A review of the ‘Survivors Group’ in HMP Risley

5

The Partnership The Safe Room in Risley ‘Survivors Group’ was made possible because of a multi-agency partnership of Survivors Manchester, Belief in Change and HMP Risley.

Survivors Manchester Survivors Manchester is a survivor-led organisation (Company No: 06811096) and a registered charity (Charity No: 1144941) in England and Wales.

The organisation supports adult (18+) male survivors of sexual abuse, sexual exploitation and rape in the Greater Manchester area.

The aim of the organisation is to promote and protect the good health of male survivors of sexual abuse by providing qualified counsellors, psychotherapists and general support workers to support and advise survivors on how to cope with and move beyond their unwanted sexual experiences.

These aims are achieved by delivering a threetiered service consisting of online, telephone and face-to-face support, in both 1-2-1 and group’s settings.

Since being founded in 2009, the organisation has directly supported over 450 male survivors and receives on average 15 new referrals per month.

HMP Risley HMP Risley opened as a male/female Remand Centre in 1964. It was re-roled to a male category C Training Prison In 1990, retaining on the same site the Female Remand Centre and a Male Allocation Centre. The female facility closed in April 1999 and the Male Allocation Centre closed in March 2000, at which time Risley wholly reroled to a Category C Training Prison.

The prison is currently run by Governor Jerry Spencer and is made up of modern three-tiered single cell accommodation units with integral sanitation, showers on all landings, purpose built Serveries and association facilities. In-cell mains power and in-cell TVs installed throughout the prison. PIN phones on all units with access reported as good. The current operational capacity of the prison is 1095.

6

Belief in Change (BiC) Belief in Change is a programme run by the Achieve North West Project – a consortium of the five North West Probation Trusts, headed

by Merseyside Probation Trust (MPT).

Achieve North West project runs in all five Probation Trusts and in fifteen prisons across the region until 31 December 2014, and it is hoped that more than 8,300 offenders will become participants during its three-year period.

The delivery model focuses upon a case management approach to the offender journey towards employment and is designed to bridge the gaps between offenders and existing mainstream education, skills and employment services. The project complements, rather than duplicates, existing provision.

There is a project manager within each of the 5 trusts and across the North West region there are a total of 44 case managers located in community and prison based settings, with HMP Risley being one prison setting in particular where the BiC programme is delivered.

This programme for medium to high risk general offenders focuses on reintegration and building skills and support networks for release.

It uses a range of methods including community living, structured group work, individual coaching and mentoring.

Placing a high emphasis on building links in the wider community and increasing employability, BiC encourages participants to think about their personal faith and spirituality and how this might support their process of change.

Groups within the BiC programme at HMP Risley include: •

Healthy Relationships

•

Healthy Lifestyles

•

Care Leavers

•

General Support

•

Graduate Mentors

To date, 53 Men have completed the BiC programme with a new cohort, No 10, starting in April 2014.

Survivors Manchester

The Research Whilst research into the emotional wellbeing, mental health and psychological needs of prisoners is growing, it is still very much in its infancy. Many health and wellbeing professionals working in this field have suggested that the prison population is one of the most vulnerable and that many prisoners have suffered traumatic early life experiences – arguably probable cause of current offending behaviour.

A recent paper by Kao (2014) proposes that the prison community has higher rates of trauma than community populationsiii whilst Pettus-Davis (2014) provides evidence of lifetime trauma experiences being strongly linked to prisoners problematic behavioural and psychiatric outcomesiv.

The mental health needs of individuals in secure settings are usually met by the prison healthcare provision and in a very small number of settings, this is supported by a psychological therapies or counselling service.

However, the effort of the healthcare teams is often focused on the delivery of support to those prisoners with diagnosed mental health disorders and those exhibiting extreme behaviour.

According to the Mental Health Foundation, over 70% of the prison population have two or more mental disordersv.

Whilst these mental health services are stretched to capacity to ensure the safety of those particular prisoners, it leaves few opportunities to the general prison population to address their own early life/childhood psychological trauma and often leaves a person suffering in silence.

Psychological Trauma Psychological trauma occurs when a person is involved in a traumatic event they experience as a threat, actual or perceived. Common emotions the individual may feel in these circumstances involve fear, helplessness, shock or horror.

When the trauma is not given the time to be processed, it is held in ‘state specific form’vi.

Then when a current event which has an associated ‘condition’ to the original trauma is activated, e.g. authority figure asserting power over the individual, the individual will often

A review of the ‘Survivors Group’ in HMP Risley

psychologically and physiologically react to the past trauma rather than the present event.

The Impact of Sexual Abuse In early life, when the trauma is that of a sexually abusive/exploitative nature, it is common for the child/young person to be silentvii, whether that is due to a direct instruction from the perpetrator or due to the unconscious messages received by the child regarding the silence within society.

This silence is often then carried through young adulthoodviii into older adulthood and the adaptive coping mechanisms that were deployed at the point of trauma to ensure the child survives are developed into maladaptive behaviours that perpetuate the individuals trauma, e.g. alcohol use, drug use, deliberate self harm, societal withdrawal, violence, etcix.

Self Help and Peer Support Peer-support groups allow individuals to talk in a ‘safe’ space with others that have the same issues, illnesses or experienced similar events.

This breaks the social and internal isolation often associated with past distress and enables individuals to learn from each other, through respectful conversation and listening, which in turn promotes a positive group healing experience. Male survivors of child abuse and sexual violation, research frequently indicates that men often seek support from “men like me”x.

The Ministry of Justice’s own document, PSI 64/2011 (updated) supports that “Peer support schemes can be an effective tool”.

Utilising models of peer supportxi could aid the improvement of prisoners’ wellbeing whilst professional support to initiate trauma-informed interventions could improve post-release wellbeing of releasing male prisoners with trauma historiesxii. It could easily be argued that not addressing these experiences and issues increases the mental ill health of individuals and equates to not reasonably addressing offending behaviour and therefore not working towards reducing re-offending. The current support programmes in place within the system need to be aware that individuals who have experienced interpersonal trauma may have additional interpersonal challenges, and may need strategies to address interpersonal deficits related to trauma exposurexiii.

7

The Membership The Safe Room in Risley ‘Survivors Group’ membership was solicited directly from the BiC community.

All members self-identified as having experienced significant traumatic experience(s) at point(s) in their earlier lives, whether sexual, physical or emotional abuse.

An explanation of the group’s purpose:

“to give BiC community members a change to work in a safe space to explore the impact of early life trauma with a specialist and each other” ...was explained to the full community at a number of the morning meetings and those interested were able to speak with an individual that had been identified as the group facilitator.

Survivors Manchester CEO, Duncan Craig, also attended a morning meeting to promote the group and answer any questions or concerns.

BiC community members were then assessed

by Duncan, using the Survivors Manchester assessment tools and outcome measures, and were accepted for group membership.

18% 36% 46%

A number of members had gone through the criminal justice system as victims and been involved in a case against the perpetrator of the abuse they experienced; whilst others had only disclosed the experience of trauma to a very small number of professionals in their lifetime – some only once.

The member’s offending behaviour ranged from drug and alcohol misuse and tertiary/ associated crimes to violence and offences of a serious nature.

The length of time already served by individual members varied from 6 months to 4 years; whilst the number of previous convictions ranged from 1 to 10.

All members volunteered to enter into the ‘The Safe Room’ in HMP Risley ‘Survivors Group’ and it was explained at point of assessment that this was a six-month pilot programme that will be reviewed and a report written to submit to the authorities for further discussion on outcomes.

All eleven individuals assessed were assigned an identifying code by Survivors Manchester; risk assessed using Survivors Manchester’s own assessment tools; asked to complete an IES-(R) and WEMWBS (see page 10) and agreed to adhere to a group contract/terms of reference (see page 9).

Members were at various stages of their BiC programme and many were also involved in other activities, including:

Membership Age

46% of members were aged in their 30s; 36% were in their 40s; and 18% in their 20s.

To protect the future anonymity and confidentiality of each member, no other identifying demographical information will be recorded or analysed within this report.

8

•

Healthy Relationships Group

•

Healthy Lifestyles Group

•

Care Leavers Group

•

General Support Group

...and a Graduate Mentors scheme for those that had graduated from the programme and were now supporting others or working towards becoming, peer-mentors on the BiC programme.

Survivors Manchester

The Contract 1. Confidentiality

3. Conduct

Each member of the group has a responsibility to keep confidentiality on behalf of the group and its members.

All members agree to keep to time and will endeavour to let the facilitator or another group member know if they are to be absent or late.

All members agree to refrain from discussing the membership outside of the group to third parties.

All members agree to remain silent and refrain from questioning or engaging in conversation whilst other members ‘check in’ or ‘check out’.

All members have the right to remain anonymous outside of the group.

Discussions that begin and take place in the group should be ended in the group.

Survivors Manchester’s Service Director will attend the group on a monthly and agrees to adhere to the contract confidentiality.

Every member has the right to ‘check in’ or ‘check out’ and be heard.

Group members agree to not engage in side conversations whilst someone else is speaking.

Each member has the right to be respected in their opinion, regardless of whether another agrees or not.

Confidentiality will only be broken by the facilitator in the event of concerns about safety of group members (individually or collectively) or others in accordance with BiC and HMP Risley protocols.

Each member will be respectful of another’s right to participate or disengage.

2. Safety

All members will respect another’s personal space and physical boundaries and each member has the right to refuse any physical contact without prejudice.

All members agree to inform the facilitator of any concerns regarding the safety of group members (individually or collectively) or others.

4. General

The facilitator has overall responsibility for holding and containing the safety of the group, however each member is responsible for keeping the group safe collectively. The facilitator, and/ or Survivors Manchester Service Director agrees to inform BiC staff of any concerns for a group member’s well-being.

The group is only active between set times on set dates. Members must contact the facilitator before 11.00am on the day of the session if they are unable to attend and nonattendance of two consecutive sessions, without prior agreement, must result in re-joining at an appropriate official ‘opening’.

All members agree to comply with the organisation zero tolerance to physical violence (actual or perceived) and threats of physical violence/intimidation. Any threats of intimidation or violence within the group will be reported to the relevant authorities.

The facilitator is not responsible for facilitating or mediating between membership contact with other members outside of the group.

Any individual is welcome* and oppressive practices and attitudes will not be tolerated (*except those that have a conviction for sexual offences). No member will be admitted into the group if they are under the influence of alcohol or drugs and will be asked to leave immediately.

Survivors Manchester Service Director will attend the group on a monthly session to facilitate group supervision.

A review of the ‘Survivors Group’ in HMP Risley

In the interests of the positive and healing experience of the whole group, members may be asked to leave, temporarily or in extreme circumstances permanently, if the contract is not adhered to.

5. Complaints Members have the right to make a complaint.

Complaints procedure can be found in the office of BiC.

9

The Outcomes All members of The Safe Room in Risley ‘Survivors Group’ completed two self-reporting outcome measure tools throughout their work with the group in an attempt to capture any change that may occur, both positive and negative.

The two outcome measures used within this pilot were IES-(R) (Impact of Event Scale – Revised) and WEMWBS (Warwick Edinburgh Mental WellBeing Scale), both chosen because they were self-completing and had a clinical evidence base.

IES-(R) The IES-R was developed in 1997 by Daniel Weiss and Charles Marmar to reflect the DSM-IV criteria for post-traumatic stress disorder (PTSD).

The scale measures key criteria for PTSD:

The Warwick-Edinburgh Mental Well-being Scale (WEMWBS), developed by Warwick and Edinburgh Universities in 2006, is a scale of 14 positively worded items, with five response categories, for assessing a population’s mental wellbeing.

3 3 3 3 3

4 4 4 4 4

0 0 0 0 0 0

1 1 1 1 1 1

2 2 2 2 2 2

3 3 3 3 3 3

4 4 4 4 4 4

0 0

1 1

2 2

3 3

4 4

0 0 0 0 0

1 1 1 1 1

2 2 2 2 2

3 3 3 3 3

4 4 4 4 4

0 0 0

1 1 1

2 2 2

3 3 3

4 4 4

I’ve been feeling optimistic about the future I’ve been feeling useful I’ve been feeling relaxed I’ve been feeling interested in other people I’ve had energy to spare I’ve been dealing with problems well I’ve been thinking clearly I’ve been feeling good about myself I’ve been feeling close to other people I’ve been able to make up my own mind about things I’ve been feeling loved I’ve been interested in new things I’ve been cheerful

Often

2 2 2 2 2

All of the time

1 1 1 1 1

Rarely

0 0 0 0 0

The respondent is asked to reflect on the past 14 days and score the form accordingly.

Theoretically, the higher the overall score the more positive the individual’s mental wellbeing, whereas the lower the score the less positive the responders wellbeing is.

Some of the time

Any reminder brought back feelings about it I had trouble staying asleep Other things kept making me think about it I felt irritable and angry I avoided letting myself get upset when I thought about it or was reminded of it I felt as if it hadn’t happened or wasn’t real I stayed away from reminders of it Pictures about it popped into my mind I was jumpy and easily startled I tried not to think about it I was aware that I still had a lot of feelings about it, but I didn’t deal with them My feelings about it were kind of numb I found myself acting or feeling like I was back at that time I had trouble falling asleep I had waves of strong feelings about it I tried to remove it from my memory I had trouble concentrating Reminders of it cause me to have physical reactions, such as sweating, trouble breathing, nausea or a pounding heart I had dreams about it I felt watchful and on-guard I tried not to talk about it

WEMWBS

None of the time

Hyper arousal (anger and irritability, heightened startle response, difficulty concentrating and hyper vigilance).

Extremely

•

Moderately

Intrusion (automatic re-experiencing or trigger induced flashbacks)

Quite a bit

•

The maximum mean score on each of the three subscales is ‘4’, therefore the maximum ‘total mean’ IES-R score is 12. A total IES-R score of 33 or over from a theoretical maximum of 88 signifies the likely presence of PTSD in the respondent. Therefore the lower the score the better and less likelihood of presence of PTSD.

Each of the 14 item responses in WEMWBS are scored from 1 (none of the time) to 5 (all of the time) and a total scale score is calculated by summing the 14 individual item scores.

The minimum score is 14 and the maximum is 70.

Little bit

Avoidance (numbing behaviours or isolation)

Not at all

•

The respondent is asked to reflect on the past 7 days and record his score the form accordingly.

1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5

1 1 1

2 2 2

3 3 3

4 4 4

5 5 5

The forms are completed at assessment and every 4-6 weeks thereafter.

IES-R Total

10

Survivors Manchester

P06

WEMWBS IESR

P05 P04 P03 P02 P01 0

Outcome Measures

10

20

30

40

50

60

70

80

P11 P10

All eleven participants were assessed using the IES-(R) and WEMWBS at the start and the following bar graph shows the assessment outcomes for the membership individually:

P09

IESR (End)

P08

IESR (Start)

P07 P06 P05 P04

P11

P03 P10

P02

P09

P01 0

P08

10

20

P07 P06

30

40

50

60

70

80

IES-(R) Pilot Start / End Outcome Score

WEMWBS IESR

P05

80% of the members that had an IES-R start / end score showed a decrease in the likelihood of the presence of PTSD when exiting the group, with the majority decreasing likelihood by over half.

P04 P03 P02 P01 0

10

20

30

40

50

60

70

80 50

P11

IES-(R) & WEMWBS Pilot Start Outcome Score

43

45

40 32

31

P10 30

The average IES-R score for the whole group was IESR (End) P08 45, signifying this cohort has a higher IESR likelihood (Start) P07 of a P06 presence of PTSD in its group members; whereas the average WEMWBS score for the P05 whole group was 43, evidencing that this group P04 fall below the national population score of 51xiv.

P03

26

P09

20 10 0

4

P01

P02

P03

P04

P05

P06

0

0

P07

P08

2 P09

P10

P11

-10 -11 -20

-18

-30

P02

BothP01scores show a significant difference in 10 20 30 40 50 60 mental0 health and wellbeing than that of70 the80 which correlates with the national population,

current peer-reviewed research from leading academics and clinicians.

P11

Evidence of Change in Likelihood of PTSD

P10 P09

Interestingly, two members showed an increased IES-R score which viewed alone could be(End) WEMWBS WEMWBS understood to mean that engagement in(Start) the group has increased their likelihood of the presence of PTSD. However, looking at the monthly scores, the WEMWBS scores, the narrative session reports and talking to the two individuals, the scores should be viewed in an extremely positive way.

P08

P07

P06

P05

A majority of IES-(R) scores evidenced high levels of ‘Intrusion’, meaning that it was common for this group to experience traumatic memories, momentary flashbacks and intrusive thoughts pertaining to the early trauma which certainly impedes the positive development of an individual. These intrusions often lead the individual to become automatically hyperaroused or hyper-vigilant, often displayed through aggressive or agitated mood swings, self-isolation, and increase in self-medicating behaviour such as drug and alcohol use.

Extrapolating and comparing the data gathered at the start and finish points of both the IES(R) and WEMWBS, it is clear that a significant change has occurred for the individuals involved in the group.

P04 P03

P02

P01

0

10

20

30

40

50

60

70

“at the beginning I wasn’t telling the truth to you, the group or myself, but now look, this graph shows how truthful I’m being now... I can admit this is a problem and I need to work through it” – Group Member

A review of the ‘Survivors Group’ in HMP Risley

11

32

31 30

26

20 10 0

4

P01

P02

P03

P04

P05

P06

0

0

P07

P08

2 P09

P10

P11

-10 -11 -20

-18

-30

“Ahead there were many challenges but through understanding the relationship between abuse and current behavior a process of change would begin.

P11 P10 P09 P08 P07

WEMWBS (End)

P06

WEMWBS (Start)

P05 P04 P03 P02 P01 0

10

20

30

40

50

60

70

WEMWBS Pilot Start / End Outcome Score

70% of individual’s with a start/end WEMWBS score evidenced a positive increase, taking 90% of members to equal/above the WEMWBS set national population score.

30

24

25

20 16

16 14

15 12

11

10

5

0

P01 -2

P02

P03

P04

P05

P06

0

0

P07

P08

-2

P09

P10

-2

-5

Evidence of Change in Wellbeing

It is important to note that of the eleven individuals assessed at the start, two did not complete any other outcomes measures as both left the group shortly after assessment – one due to being moved to a Cat D and the other having to attend another group which clashed with the survivors group day in order for him to be moved to Cat D.

Outcomes Summary The results of the outcome measures alone clearly evidence that positive change has taken place for the majority of individuals involved in the The Safe Room in Risley ‘Survivors Group’.

The behaviour of individual the members has been witnessed by staff with many reporting witnessing positive change:

“Being listened to by others and sharing similar experiences felt supportive and rewarding was just one of the positive statements made. I observed increased confidence and witnessed a sense of self belief linking this to progression on one man’s own personal change journey.

“Taking back control of parts of life he had once accepted as chaotic and not being afraid to ask for help/support was a challenge he faced and succeeded.

“Being aware of different emotions experienced led him to begin developing strategies to deal with these emotions in a pro-social way. I witnessed improved behavior particularly as life had once been about functioning in crisis mode and now we see a thought process.

“There had always been difficulties in developing “The significant changes wrought and sustaining attachments/ by the programme are clear and relationships and Duncan Craig were exemplified yesterday by encouraged, supported and PO3 who lit up the room with gave him hope that he himself his expressions of happiness” could change this. He has a fairly new partner and has – Graham Parry (BiC Facilitator) 12

Survivors Manchester

accepted that intimate feelings do exist and it is ‘okay’ to share them with people” – Samantha McFadden (BiC Programme Coach/Facilitator/Achieve Case Manager)

“the work that you have done with the Survivors group will have contributed in some way to a reduction in risk for all of those men. What a contribution that would be to the communities that they will be released back into” – Mark Stanley (BiC Manager) However, the it’s the words of the men themselves that hold the greatest power and evidence of change.

At the beginning, there was a reluctance from many of the men to be identified as members of the ‘Survivors Group’. But throughout the six months, many have spoken in the BiC morning meeting about their involvement and all have at some point spoken in front of their peers in the wider BiC community.

Shattering the silence that surrounds male survivors is one of the greatest challenges, yet rewarding experiences. In breaking the silence, an individual releases himself from the shame attached to being a victim of abusexv.

PO4’s Testimony Survivors Group has given me the opportunity to regain my self esteem, dignity, empathy and confidence to move forward towards a normal life filled with love and compassion.

It’s helped me to commit myself 100% to a productive future where i can deal with life’s set backs and problems.

For over 30 years, I was a confused heartless user, addicted to heroin and alcohol, full of anger and frustration. I have been able to forgive myself for who I was. I now know who, what, and where I’m going for the first time in my life.

A review of the ‘Survivors Group’ in HMP Risley

PO1’s Testimony I would like to take this opportunity to speak about a major achievement which has taken place over the last six months.

Today is the last day of our survivors group and although it is sad to be ending, it has also been one of the most inspiring things I have ever been involved with.

The kind of abuse that survivors deals with destroys lives and I’m not just talking about the direct victims of abuse, I’m also speaking about their families, friends and society as a whole.

It has a major effect on how you feel towards yourself, contributing to lack of confidence, self belief and it has the power to assassinate ones character and personality. I suffered many nightmares and flashbacks for years and the only way I could control my feelings, fears and emotions was to drown myself with heroin.

Twenty odd years it took me to gain the courage in speaking out and to do that I had to overcome feelings of embarrassment, shame, guilt and low self esteem. Before I spoke out I had no voice or confidence and I didn’t care whether I lived or died. I had to watch the suffering of my parents whilst they were witnessing their own son slowly killing himself.

It is difficult to put into words how grateful I am for such an opportunity but feel the need to give recognition to all involved because it has been the start of something very special.

PO2’s Testimony I’ve recently been on a 6 month group with Survivors with Duncan Craig.

When I first heard of the group I was unsure of how it would make me feel as I would be speaking of the things which were left unspoken.

When I started I was taken aback by actually being able to share my experiences with others who knew where I had been. As the group work progressed, I and the other lads opened up I/we were able to explore the things we’d built up over so many years with a positive outcome.

Survivors/Duncan were/are a group/person which I feel would be in demand throughout the prison estate and if I could sit in another group I would in the blink of an eye.

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PO3’s Testimony 7 months ago, I met a man called Duncan Craig. This was to be the start of Survivors. I was nervous at first and didn’t even think the group was for me. But by session 3, I was feeling like a new person as I had took on board what I had heard from my fellow group members and their stories. This gave me the strength to tell a room full of strangers my story.

For 15 years, I had carried my secret with me and was too ashamed and embarrassed to let it out as I thought people would judge me. I now don’t have this problem as I can now stand up and say yes, I was sexually abused and yes it shaped and altered my life. But with Survivors’ and Duncan’s help I now can move forward.

No one can change the past but we can all change the future. I will always be grateful and honoured to have been part of survivors group.

It’s given me the tools and reminder that not all life is bad and there is a positive ending.

A big thank you to Duncan and all the Survivors Manchester team. Forever grateful.

PO9’s Testimony I’m 45 years old and over 20 years into a life sentence for murder.

I stumbled across the survivors group by chance as I started BiC and at the time Duncan Craig was beginning a group alongside.

I’ve been asked if I’d like to write a bit about what I got from the survivors group I attended, which I can sum up in 3 words = Changed My Life. I don’t say that lightly or expect you (the reader) to fully understand what I mean by that so I’ll try to explain.

Before I met Duncan and started attending the survivors group, I was just an empty shell of a man, existing in the best way I could and getting through my life sentence on a day to day basis.

No future to plan or look forward to. Just a shit past weighing me down and causing me problems, mainly because growing up I was used and abused which made me think it gave me the right to follow suite and deal with any other issues I considered a problem via violence, any level, as I wasn’t too fussed... or so I thought or was led to believe it was OK to treat others however.

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Before survivors group, talking to Duncan and other group members has put so much of my past into perspective. I always blamed myself for what happened to me throughout my childhood and my early teenage years which caused me to carry around so much anger and hatred.

This inevitably had an impact on my behaviours.

I have a criminal record going back to my childhood for carrying/using offensive weapons.

It’s not that I can’t fight, it’s just that I weren’t into the touchy feely rolling around scrapping. Just bang and its over – I wasn’t taking any more abuse, physical, sexual, whatever!

I had many other issues also. I couldn’t hold down a relationship or friendship for too long as I either sabotaged it through trust or fear of rejection.

My loyalties and morals were also very misplaced as I didn’t know or understand love or the do’s and don’ts. I only really lived one rule and that was mine as that way I knew I wouldn’t get abused, hurt, let down, rejected, disappointed... ...I only had myself to rely on and so nothing could go wrong.

Speaking to Duncan and group members, I came to realise that it really is OK to talk!

There really is nothing to be afraid of. My abusers ain’t going to come back and get me or my family (I now understand that is a classic and often common line abusers use to silence you).

There is nothing to be ashamed of, but most of all, there’s other people in the same boat as I am...

I’M NOT ALONE! The help I got from Survivors Manchester goes beyond helping me with the abuse I suffered.

I also understand why I used and hurt others.

It helped me understand that all the anger and hatred I had was misplaced and in some ways misdirected.

Today I feel that I have a future to look forward to and plan for, without carrying my past around with me. As today I don’t live in the past, the past lives in me which is a lot better as I can control it instead of it controlling me.

I used to live by the saying ‘the sky’s the limit’ but thanks to Duncan and Survivors, that’s no longer true.

Survivors Manchester

Today I can pass the sky into eternity which is what I’ll be eternally grateful – for the help, support and friendship gained through the Survivors Group but not forgetting the one person who made it not only possible, but ‘safe’ and ‘easy’ to get involved – thank you Duncan.

A review of the ‘Survivors Group’ in HMP Risley

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Case Study: Luke

20 18

The following case study details one individual group member’s journey in the Survivors Group using outcome measures and session reports.

For the purposes of this section of the report, the group member will be referred to as ‘Luke’.

The first IES-R that Luke completed was on 19.11.2013. His scores evidenced that Luke was experiencing some intrusive thoughts, but at a lower level (scoring 14 out of a possible maximum intrusion score of 32); was in a medium state of hyper-vigilance and was actively engaged in avoidance of thoughts and memories.

Luke’s overall score was 47 out of a possible 88 which indicated that he had a likelihood of PTSD but not in the extreme end of the scale as would have been suspected from his psychology reports.

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by individuals, Luke tried to relate his own pain to14 theirs and therefore make a genuine and 12 congruent psychological/emotional connection.

This was obviously a big risk for Luke butAvoidance his 10 Hyperarousal small foray into connecting with others began Intrusion 8 to be rewarded.

6 4 his next IES-R, Luke’s scores increased, which On on2 the face of it, could be read that his likelihood of0 PTSD was increasing.

19/11/2013

30

25

20 Avoidance 15

20

Hyperarousal Intrusion

18

10

16 14

5

12 Avoidance 10

Hyperarousal

0

Intrusion

8

18/12/2013

6 4

IES-R Score Session 5

2 0

30

19/11/2013

IES-R Score Session 1

25

Luke’s psychological reports have included phrases such as “little or no capacity for feeling”, 20 “Luke can’t cry” and “doesn’t emotionally connect Avoidance with15 others”. Further reading of the reports over Hyperarousal Intrusion the past twenty years could easily be summarised as 10 Luke being someone who is ‘shut down’ with no capacity or ability to ‘feel’ or create change.

His overall IES-R score increased from 47 to 63, with sub-sections of ‘avoidance’ and ‘intrusion’ increasing the most.

By session 11, Luke’s overall IES-R score had increased from 63 to 72. However, interestingly, the level of ‘avoidance’ and ‘hyperarousal’ had roughly remained the same; it was the ‘intrusion’ sub-category that had significantly increased.

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5

On assessment, Luke stated verbally that he was 0 relatively OK, didn’t know if this group was for 18/12/2013 him and that he knew he had a few issues to sort

out but thought they were manageable.

30

25

20

Avoidance Hyperarousal

However, Luke’s closed and stiff body language told a different story, one of a frightened and extremely cautious man that is fighting with himself to maintain a hard facade to the external world.

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10

5

0

As the group began to form, Luke began to relax more and although to begin with he was a very quiet and observant man, session reports state that when disclosures were made

Intrusion

22/01/2014

10 9

IES-R Score Session 11

8 7 6

16

5 4 3 2 1 0

Avoidance

Hyperarousal Survivors Manchester Intrusion

At the same time, according to session feedback reports that are completed by the peer-facilitator, Luke was actively engaging in conversation in the group and revealing more about his past.

This was leading him to identify how the sexual and physical abuse he suffered as a child and teenager had negatively impacted on his view of the world and therefore created behaviours he had acted on and the maladaptive coping mechanisms that he had developed and deployed.

80

Sorsoli et al (2008)xvi state that “the challenges to disclosure might include the client’s own personal 35 readiness” and the development of “a therapeutic relationship conducive to disclosure”

10 50

70 60 50 Intrusion Hyperarousal

40 80

Avoidance

30 70 20 60

Intrusion

0 19/11/2013 40

18/12/2013

IES-R Pilot Lifetime Score

45

The changes in Luke’s IES-R scores, along with 25 the increase in his active engagement with his disclosures suggests he was actively building 20 Avoidance therapeutic relationships with the group and his Hyperarousal 15 ‘readiness’ to disclose was present. But, thisIntrusion new readiness meant he was being more truthful with 10 others, and therefore himself – he was becoming more congruent which is reflected in his IES-R 5 scores. This phenomenon could be explained as “it gets worse before it get’s better”.

0

20

0 19/11/2013 25

22/01/2014

05/03/2014

15 45 10 40 5 35 0 30

19/11/2013

18/12/2013

19/11/2013

18/12/2013

22/01/2014

05/03/2014

25 20 15

8

10 5

7

0

6

Avoidance

22/01/2014

05/03/2014

Hyperarousal

5

WEMWBS Pilot Lifetime Score

Intrusion

4 3

Luke’s initial score showed that his well-being was more positive than the national average.

This result was incongruent with Luke’s observed behaviour and his self described moods.

2 1

18/12/2013

20 50

9

0

In40 the same period, the WEMWBS forms were 3510 completed and showed a similar trend in the 30 development of congruence.

10

Hyperarousal 05/03/2014 Avoidance

50 30

30

22/01/2014

22/01/2014

05/03/2014

IES-R Score Session 16

On session 16, the final session of the whole pilot, Luke’s overall IES-R score had reduced considerably to 21. This score falls well below the ‘clinical likelihood’ score of 33 or above, and evidences the change in Luke’s post-trauma impact.

Over the 6 month pilot, Luke’s IES-R scores followed an upward trajectory, peaking at an overall score of 72.

A review of the ‘Survivors Group’ in HMP Risley

However, as the group formed a closer bond and people felt safer to disclose, Luke clearly felt safer to disclose his true feelings to them and himself and like the IES-R score, his WEMWBS score reflects this growing congruence between what Luke is feeling and what he is displaying.

The last score on 5 March 2014 shows Luke’s new found genuine sense of self, as he states: There is nothing to be ashamed of, there’s other people in the same boat as I me, I’m not alone after all...you don’t know how good that feels.

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Conclusion The reluctance to talk about sexual abuse in prison setting is something that is arguably an issue for the professionals and authorities.

A number of articles have been written concerning the issue of ‘talking about abuse’, most notably Draucker (1999)xvii, Becker-Blease and Freyd (2006)xviii and (2007)xix, Ullman (2007)xx who collectively concur that although practitioners and researchers have some cause for concern, more often than not they:-

“over emphasise survivors’ vulnerability and ignore the costs of avoiding asking about abuse”xxi ...which could be construed as colluding with the general population’s silence. They also agree that:

“the benefits of confiding a traumatic experience to a trustworthy other seem to outweigh the immediate distress that accompanies discussion of painful experiences”xxii Maybe in our so called ‘ethical caution’, we have missed the fact that not asking and not talking about abuse could be the real ethical issue – maybe it’s the silence that is unethical?

This pilot has without a doubt proven that if a space is provided; it’s deemed to be safe; and the space is facilitated in a congruent way by peers members with some external professional support and encouragement; then male prisoners will actively engage in conversation that is both healing and fundamental to creating change.

The peer-support model that has been developed, utilising monthly external professional support has proven itself to be effective and conducive with a prison setting.

Enabling these men to talk and congruently connect with each other has allowed them the opportunity to discover and reveal the often root cause of their offending behaviour and begin the process of ridding themselves of the shame that has been the fuel to maladaptive and unhealthy coping mechanisms.

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This process has impacted on their engagement with the prison estate as a whole with many staff members reporting seeing a visible difference in a majority of the men, with the men themselves talking about how much of a positive impact this weekly 2 hour session has on the rest of their week and their thoughts about short and long term goals.

If we are to truly increase the mental and physical wellbeing of the prison population; if we are to truly help prisoners reflect on their behaviours and develop better social and emotional intelligence; and if we are to truly address re-offending, then isn’t it time we addressed the root cause of many individuals’ negative and maladaptive behaviour.

Both the quantitative and qualitative outcomes of this pilot are clear evidence of the importance of providing this model of group support to male survivors in a prison setting.

Survivors Manchester recommends the following: 1.

‘The Safe Room’ Survivors Group is installed within the Belief in Change programme in HMP Risley.

2.

Survivors Manchester is commissioned

by HMP Risley / Achieve Northwest to undertake the monthly assessment and facilitation of ‘The Safe Room’ Survivors Group in HMP Risley.

3.

HMP Risley work with Survivors Manchester to identify other populations within the prison estate to further trial ‘The Safe Room’ Survivors Group, to positively support areas such the such as drug detox wing.

4.

HMP Risley commission Survivors Manchester to provide the prison workforce with further training and development of working with male survivors in handling disclosure, working with adult male survivors of childhood sexual abuse, etc, as part of continuous professional development.

5.

Survivors Manchester positively promotes HMP Risley as a centre of excellence when working with male survivors.

As the Office of the Children’s Commissioner stated in a recent reportxxiii, addressing sexual abuse is the responsibility of us all, professionals and public alike.

Survivors Manchester

References i Banks, I (2001). No man’s land: men, illness, and the NHS. BMJ Vol 323 3 ii Banks, I (2001). No man’s land: men, illness, and the NHS. BMJ Vol 323 3 iii Kao, J C; Chuong, A et al (2014).

Associations between past trauma, current social support, and loneliness in incarcerated populations. Health and Justice 2:7 iv Pettus-Davis, C. (2014). Social support among releasing men prisoners with lifetime trauma experiences. International Journal of Law and Psychiatry v Community Care (2013). http://www.communitycare.co.uk/2013/08/09/ the-ups-and-downs-of-working-in-a-prisonmental-health-team/#.U0lAgP00jGo vi Davidson, PR & Parker, KCH (2001). Eye Movement Desensitization and Reprocessing (EMDR): A Meta-Analysis. Journal of Consulting and Clinical Psychology 2001. Vol. 69. No. 2, 305-316 vii Sorsoli, L. et al (2008). “I Keep That HushHush”: Male Survivors of Sexual Abuse and the Challenges of Disclosure. Journal of Counselling Psychology. 2008, Vol. 55, No. 3, 333-45 viii Sugarman, L. (2004). Life-span Development: Frameworks, Accounts and Strategies. Taylor Francis. 2nd Ed. ix Kia-Keeting, M. et al (2010). Relational Challenges and Recovery Processes in Male Survivors of Childhood Sexual Abuse. Journal of Interpersonal Violence x Etherington, K (2000). When the victim is male: issues related to working with men who were sexually abused in childhood in Good Practice in Working with Victims (2000). Kingsley Pub. xi Dennis, C-L. (2003). Peer support within a health care context: a concept analysis.

International Journal of Nursing Studies.

Volume 40, Issue 3 , Pages 321-332. xii Pettus-Davis, C. (2014). Social support among releasing men prisoners with lifetime trauma experiences. International Journal of Law and Psychiatry

A review of the ‘Survivors Group’ in HMP Risley

xiii Kao, J C; Chuong, A et al (2014).

Associations between past trauma, current social support, and loneliness in incarcerated populations. Health and Justice 2:7 xiv Stewart-Brown, S & Janmohamed, K (2008).

Warwick-Edinburgh Mental Well-being Scale (WEMWBS) User Guide Version 1. xv Anderson, T. (2008). Speaking About the Unspeakable: Sexually Abused Men Striving Toward Language. American Journal of Men’s Health. Volume 2 Number 1. March 2008 25-36 xvi Sorsoli, L. et al (2008). “I Keep That HushHush”: Male Survivors of Sexual Abuse and the Challenges of Disclosure. Journal of Counselling Psychology. 2008, Vol. 55, No. 3, 333-45 xvii Dracuker, CB. (1999). The emotional impact of sexual violence research on participants.

Archives of Psychiatric Nursing. Xlll(4). 161-169. xviii Becker-Blease, K.A & Freyd, JJ. (2006).

Research participants telling the truth about their lives: The ethics of asking and not asking about abuse. American Psychologist, 2006 xix Becker-Blease, K.A & Freyd, JJ. (2007).

The ethics of asking about abuse and the harm of “don’t ask, don’t tell.” American Psychologist, Vol 62(4), May-Jun 2007, 330-332. xx Ullman, S.E. (2007). Relationship to Perpetrator, Disclosure, Social Reactions, and PTSD Symptoms in Child Sexual Abuse Survivors.

Journal of Child Sexual Abuse. Volume 16, Issue 1, 2007 xxi Becker-Blease and Freyd (2006). Research participants telling the truth about their lives: The ethics of asking and not asking about abuse. American Psychologist, 2006 xxii Dracuker, CB. (1999). The emotional impact of sexual violence research on participants.

Archives of Psychiatric Nursing. Xlll(4). 161-169. xxiii Office of Children’s Commissioner (2013).

“If only someone had listened”: Office of the Children’s Commissioner’s Inquiry into Child Sexual Exploitation in Gangs and Groups. HMO.

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