Social distancing in a social therapy environment

Geraldine Ann Akerman (HMP Grendon, Aylesbury, UK)
Emily Jones (HMP Grendon, HM Prison Service, Leicestershire, UK)
Harry Talbot (HMP Grendon, Aylesbury, UK)
Gemma Grahame-Wright (HMP Grendon, Aylesbury, UK)

Therapeutic Communities: The International Journal of Therapeutic Communities

ISSN: 0964-1866

Article publication date: 31 October 2020

Issue publication date: 4 December 2020

279

Abstract

Purpose

This paper aims to describe the impact of the COVID-19 pandemic on a prison-based therapeutic community (TC).

Design/methodology/approach

The paper takes the form of a case study where the authors reflect on their current practice, using the findings of research on social isolation and the overarching TC principles to explore the effect of the pandemic on the TC at HMP Grendon. The authors consider how the residents and staff adjusted to the change as the parameters changed when the social distancing rules were imposed and how they adapted to the prolonged break to therapy. Sections in the paper were written by a resident and an operational member of staff. The authors conclude with their thoughts on how to manage the consequences the lockdown has brought and start to think about what returning to “normality” might mean.

Findings

The paper describes the adjustments made by the residents and staff as the UK Government imposed the lockdown. The authors, including a resident and an operational member of staff comment on the psychological and practical impact these adjustments had. The thought is given to the idea of “recovery”, returning to “normality” and how this study can be best managed once restrictions are lifted.

Research limitations/implications

At the time of writing, there are no confirmed cases of COVID-19 at HMP Grendon. The measures and commitment from all staff and residents in the prison to keep the prison environment safe may in part account for this. This paper explores the effects of lockdown on the emotional environment in a TC and highlights the consequences that social isolation can have on any individual. To the authors’ knowledge, there is currently no research undertaken on the impact of lockdown/social isolation on a TC. This research would be useful, as the authors postulate from reflections on current practice that the effects of the lockdown will be greater in a social therapy environment.

Originality/value

HMP Grendon started in 1962, as this time there have been no significant events that have meant the suspension of therapy for such a sustained period. It is, therefore, important that the impact of such is considered and reflected upon.

Keywords

Citation

Akerman, G.A., Jones, E., Talbot, H. and Grahame-Wright, G. (2020), "Social distancing in a social therapy environment", Therapeutic Communities: The International Journal of Therapeutic Communities, Vol. 41 No. 3/4, pp. 113-127. https://doi.org/10.1108/TC-05-2020-0009

Publisher

:

Emerald Publishing Limited

Copyright © 2020, Emerald Publishing Limited


Introduction

In March 2020, things as we knew them changed drastically with the advent of a virus, which spread quickly across the world causing an international pandemic known as the Coronavirus or Covid19. The advice from the UK Government on how as a country we were to manage the pandemic was brought in gradually and the risk and danger the virus posed soon became apparent. As the virus crossed national and international borders, much more quickly than could ever have been predicted, it became evident that this was like nothing experienced before. Each day rules changed regarding the safety of social interaction. This was important for all public health sector organisations in reviewing how to keep their service running safely. For the prison service, there was the concern that the nature of the enclosed environment provided a “hotspot for COVID-19” (Burki, 2020). HMPPS took a strict approach to contain the spread within jails using “compartmentalisation”. Prison staff isolated those with symptoms, and many prisons were able to shield the vulnerable and quarantine new arrivals. Separating those with symptoms had been ongoing, as early February and coupled with the wider action this has limited the spread of confirmed Coronavirus cases in jails (Press release, April 2020).

In April, O’Moore (2020) commented that Public Health England (PHE) data showed there had been 227 laboratory-confirmed cases of COVID 19 diagnosed in prisoners in England and over 1,385 possible/probable cases. Further, 29 people had been hospitalised for complications of Covid-19 infection, and 14 deaths were attributable directly or indirectly to COVID 19 infection. PHE and HMPPS made the assumption that by maintaining physical distances they had reduced contacts across HMPPS by up to 50% compared to the pre-pandemic regime.

HMP Grendon is a category B men’s prison-based in Buckinghamshire. In line with the rest of the prison estate, HMP Grendon was subject to a change in regime due to the pandemic. HMP Grendon is a unique establishment in that it is the only whole prison that runs with the therapeutic community (TC) model. The staff team at HMP Grendon is comprising employees from HMPPS, and other partner agencies such as NHS England, (NHSE), Offender Personality Disorder (OPD) Pathway, PHE and students on placements from the university. There were guidelines issued from each of these agencies, which as an establishment we had to make sure we were incorporating into the changes made.

In this paper, the authors reflect on the impact that the changes made had on the establishment and the TC ethos that has been living within the walls of Grendon for over 60 years. In the first section of the paper, the authors describe the overall impact of COVID and the subsequent lockdown changes on the regime, ethos, relationships and climate at HMPO Grendon. Consideration is given to the various approaches adopted, with a particular focus on the compassion focussed approach. The authors then look at the available research on the impact of quarantine and social isolation. The authors reflect on the way through which staff and residents work together to maintain the TC, with specific sections on staff and resident support. The latter is put into context with an account written by a resident, who writes first-hand about how the lockdown has had an impact on his therapeutic journey. The paper concludes by highlighting the importance of the changes, support mechanisms and processes put in place at HMP Grendon, where we are now and what we plan for the future. The authors conclude in highlighting the importance of maintaining the sense of community within the residents and between the staff and residents.

The authors of this paperwork on separate units/wings in the establishment. The first author works on the Enhanced Assessment and Preparation Unit (EAPU) where work focusses on the here and now, rather than the past. The second author, at the time of writing the paper, worked on one of the main TC wings where therapy work takes place encompasses all aspects of a resident’s past, present and future life. The Third author is a resident on a therapy wing. The fourth author also works on the EAPU. Throughout the paper, the authors comment on the overall impact on the establishment, however where important, distinctions are made between the EAPU and the main TC wing.

Overall experience of COVID and the impact on HMP Grendon

Generally, in HMP Grendon each community meets twice a week as a community for meetings, and these comprise of 40 residents and approximately 5/6 staff [1]. These meetings organise how the wing can run on a day-to-day basis. In small groups (8-10 people) residents explore aspects of their functioning in the past or present, which is causing disruption to them or others. In addition to these meetings on a daily basis, there would be additional groups, such as core creative psychotherapy, there would be assessments of progress, college classes and work. On the EAPU there are psych education groups. For further details of how the regime runs see Akerman (2019) and Shuker and Sullivan (2010). So, it soon became apparent that to meet as a whole community would breach advice of not to gather in numbers. Therefore, the decision was made that community meetings would cease with the last meeting being held on or prior to, the 20th March. In these early weeks, it was decided that small groups would continue with the clinical focus needing to reflect the changes in community structure and this may require a more “here and now” approach, in contrast to the usual more diverse subjects, such as past relationship difficulties, offending, conflict within the community and so forth. All groups had to take place within the required social distancing advice, this being a minimum of 2 metres apart. Instead of the community meeting after small groups to feedback the content to all, it was decided that a representative of each group would meet with staff and the chair and vice-chair to undertake this task. The Monday and Friday space, which had been used to hold a community meeting could then be used to introduce a range of additional forms of delivery, such as trauma focussed, compassion, mindfulness practice.

In line with TC principles, residents were consulted at every step of the way and encouraged to offer suggestions as to how the regime could function within the constantly evolving situation and guidelines. Initially, this was done through meetings with the Chair and Vice-Chairman [2] and then through the use of the weekly newsletter as a communication channel. On the EAPU a whiteboard was used as a shared communication resource between staff and residents to ask and answer questions, share thoughts and meaningful quotes. The senior clinical management team met on a weekly basis to review practice, share ideas and provide support to each other.

Every opportunity was taken to think with the staff and residents of the impact of the constant alarming news that was being heard, seen and read. Being in a constant threat state could cause people to respond in an impulsive manner. Staff spoke to residents about how our body can respond when in a state of threat, and the impact on the Vagus nerve, thus allowing residents and staff to be mindful of how they were feeling and what behaviour they may exhibit in line with a trauma-informed and compassion-focussed approach. The natural response is to fight, flee or freeze. While that is required in times of clear and present danger it is less helpful in a situation when you cannot move past the threat.

Feeling a continuous level of threat can be damaging to health, and many of those in custody grew up in such conditions and so painful memories can be evoked. Akerman and Geraghty (2016, p. 102) reported that of those in HMP Grendon at the time of their research “50% report having had acts of self-harm, 52% have experienced physical abuse and 32% having a history of sexual abuse. In addition, 69% reported having had a significant separation from their primary caregiver”. This indicates that the residents would have a lived experience of disturbance and trauma. The Collins English dictionary (2013) defines trauma as “an emotional shock”, which the pandemic certainly caused. The threat and drive systems are meant to activate and respond quickly for a short space of time, but maintaining a high level of threat can be exhausting. Gilbert and Basran (2018) suggests we have a “regulate” system (rest and digest) to slow down the body and evoke the parasympathetic system to relax. Such instruction is extremely useful when feeling under threat and can be accessed through increased awareness and breathing exercises. Residents and staff were encouraged to acknowledge their feelings, frustration/anger, anxiety and lack of personal control and grief through talking about them in the available, albeit limited spaces available.

To help support staff and residents’ thought was given as to how we could reduce the impact by considering if there was anything in the practices that helped manage stress, and opportunities were provided to enable people to come together to reduce stress, by offering space to discuss them and share workloads. To comply with standards for TC interventions thought had to be given to how this could be achieved. There was concern about how difficult it could be to predict what might happen on a day to day basis, so this was discussed with residents and staff. This is explored later in the paper with a specific focus on the impact for both staff and residents.

The imposed lockdown meant that the regime had to be changed with immediate effect. Initially, it had been decided to hold community meetings by dividing the wing into two, so as to have reduced numbers in meetings. It was planned that while there was limited therapy available, all the wings adopted the model by which the EAPU works. This was so that, if the decision had to be made to suspend groups, for instance, due to staff shortages, the men would not have opened up issues which they would then be left to contend with alone. Therefore, much of the group work focussed on feelings evoked by the current situation such as fear of death that was being evoked, angst about potentially dying in prison, concerns for family members and the feelings around not having physical contact with their loved ones. Yalom (1980) in his seminal work on “existential psychotherapy” believed that death anxiety permeates life and is a cause of many psychological symptoms and conditions. Yalom believed that being confronted with one’s own personal death could have the benefit of leading a fuller and richer life thereafter. However, to reach this final destination of a more fulfilled life one had to process all the fears around mortality; the fear that one will miss out on parts of life they have not managed to live yet (not fulfilling goals), fear over those who will survive them, fear of pain and fear over not knowing how the various storylines currently being lived will end. As is reflected upon later in the paper, the very experience of being incarcerated in prison is social isolation, residents are removed from the lives that they once lived. The fears of not being able to fulfil goals and of missing out on life may be familiar to those in prison, which they may experience daily. Therefore, the risk of death posed by COVID-19 could exacerbate any feelings of death anxiety already present in residents.

As with the rest of the world, there were feelings of death anxiety being brought up in the staff team. Despite the heartache and anxiety, this brought up in both residents and staff at HMP Grendon, the experience was shared in that staff and residents were all feeling “death anxiety”. A shared experience between staff and residents helps to foster relationships, diminish conflicts and weaken the barrier between authority and residents. This is very much in line with the universality principle of TCs.

Context in which the lockdown was imposed

Soon after the first change of regime, the guidelines changed dramatically. In line with government guidelines, the wings had to be locked up, with residents only coming out for exercise, meals, showers and phone calls. In contrast to when there is a lockdown for security reasons, residents were able to come for one-to-one meetings if they maintained a physical distance of 2 metres. The residents were told they could not have social visits as everyone in the country had been told they could only leave home to make “essential journeys”. The direct impact of the changes implemented is commented on by a resident later on in the paper. The lockdown happened following weeks of wet weather, which had meant that families had not been able to go out together due to storms on consecutive weekends. Ironically, the instructions to self-isolate were followed by a sunny weekend, which caused lots of people to think it was safe to meet outside, and thus gather in beauty spots.

As was happening outside of the fence, inside there was also confusion. The definition of “key worker” caused much consternation, as it was unclear who fell into that category, family and friends were being kept home from work and those who were self-employed feared for their income. Against this backdrop, the staff was continuing to attend work in prisons. However, as the days progressed the term “essential” was starting to be questioned.

Colleagues in other prisons and psychology departments were told to work from home as their guidelines changed. It seemed their work was deemed not “key” for the running of their respective establishments. With the focus being on reducing the spread of the virus they were working from home. For staff across all TC sites, this was not as clear. At HMP Grendon it was felt strongly that we had to look at the two aims of the established when considering how to manage the lockdown with the least amount of disruption. The first aim, as with all other establishments, was the need to protect all who live and work there as far as possible from the danger of contracting Covid19. Secondly, to protect the primary role that HMP Grendon has had, as its inception: therapy. The non-operational [3] staff is essential in carrying out this latter aim alongside their uniformed colleagues. Every effort was and has been made to support the residents and staff through this time to help prevent further disruption. The non-operational staff helped maintain morale with staff and residents and maintain the structure of the day filling in where they could undertake joint tasks. This is explored later in the resident and staff considerations section of the paper.

Those staff at HMP Grendon continuing to go into work were acutely aware that they could be a carrier of the virus and so high levels of hygiene and maintaining safe distances were practiced. This included, as was seen throughout the UK 2 m markings on the floor and cleaning stations before entering the prison for keys and hands. Furthermore, the staff was concerned about the risk they posed to their family by leaving home, going to work and returning home. So, this too placed additional pressure and anxiety on them.

As the whole country was placed in quarantine lots of emotions were evoked, as described previously. Quarantine is described by the Centers for Disease Control and Prevention (2017) as separation and restriction of movement of people who have potentially been exposed to a contagious disease to ascertain if they become unwell, so reducing the risk of them infecting others. On both the EAPU and main wings residents were unlocked in small numbers with those they lived close to and given the opportunity to express how they felt. They were reassured that if they needed to they could come out and speak to staff, and residents were asked to still maintain their sense of community, even if now it just extended to those on their landing. They asked if they could be allowed out to associate on their landing, (approximately 8 people) but because of the fear of the potential for the lack of physical distancing, this could not be permitted. A similar process was followed on the main wings, and the communication of decisions and the ever-changing routine was of utmost importance. Wing teams ensured that they were communicating with their communities via letters, newsletters and boards sent out and updated each day (more information on “supporting residents”).

One of the issues for society, and for the communities at HMP Grendon was the term “social distancing”. The term caused anxiety, which was not always in conscious awareness as fear of the unknown can cause generalised anxiety. Many aspects of this would stimulate our threat sensitive, competitive, self-focussed and tribal impulses (Gilbert and Basran, 2018). It can lead to feelings of powerlessness that in the past had been discharged with dramatic outcomes. As social beings, most people became acutely aware that they could not hug their friends and they were watching friends and family in distress and were told they could not get close to them, which evoked the threat response in most people. All were acutely aware that it is difficult to think clearly when in a heightened state. As the staff was going through the same experiences, for instance, Mother’s Day occurred and those with adult children who did not live with them were unable to see them in person and as the residents, they were missing contact with their families. As the lockdown progressed Easter and Ramadan came and went, as did birthdays and anniversaries, each one poignant to those involved. The staff was able to relate their shared experience. Finally, the authors give thought to the title of the paper, and the fact that a “TC” is a form of social therapy. The concept of “social distancing” in an environment that foundations lie in social theory was a difficult concept to grasp. Every effort was made to use the term physical distancing rather than social, so the contrast could be made and not exacerbate an already difficult situation. As an established and individual community, ways were found to stay connected socially but maintaining a physical distance that ensured safety. In the early weeks, much time was spent calming each other and passing on information to relieve stress levels. The authors discuss the measures implemented in the later sections of the paper.

The research was sought to help give accurate information. The British Psychological Society provided guidelines to Applied Psychologists as to how they should work during this period (Raczka, Akerman, Bunn, Fraser, Green and Girffiths, 2020) and NHSE (National Health Service Guidelines, 2020) also published papers and advice to help keep healthy and safe. It was important that these guidelines were followed and shared with the staff teams to ensure that everyone was kept healthy and safe. In the next section of the paper, the authors discuss other relevant research around the impact of social isolation and quarantine.

What is known about the impact of social isolation and quarantine?

Recent research on the impact of social isolation, (Wang et al., 2020) used functional magnetic resonance imaging (fMRI) to measure neural responses in participants who were socially isolated for 10 h of total social isolation or mandated fasting. After isolation, people felt lonely and craved social interaction. Midbrain regions showed increased activation to food cues after fasting and to social cues after isolation; these responses were correlated with self-reported craving. They described how in the brain, motivation – i.e. the sensation of “wanting” something has been consistently linked with dopamine (DA) transmission in the so-called “brain reward circuit”. Wang et al. described how being isolated, even for a short time, made them seek more social interactions. They had induced isolation, which ethically had to be brief and with the participants knowing when it would end, so contrast to the current situation. Wang et al. found that isolation even though it only lasted 10 h and the participants knew when it would end, evoked more loneliness and social craving at the end of the day than they did at the beginning. The participants had been highly socially connected, so having a day apart was very different for them. Although most people do not mind being alone when it is a choice, participants found it very difficult and they felt more uncomfortable and less happy at the end of the day.

Being incarcerated in prison is the acme of social isolation. For those in mainstream prisons, this can mean 23 h locked up, and many residents who have been in such establishments will talk about the experience, saying that acclimatizing to that level of social distance is difficult but, as it becomes an expectation, so it turns into normality and time they spent with others can become more difficult. In TCs there is much emphasis on social interaction and forming relationships with the community, residents and staff alike. This means that much time is spent associating and time alone in a cell is discouraged. For some, arriving from establishments with limited association time this is difficult to adjust to. In thinking about how each prison and their respective populations handle a government-enforced lockdown, it is possible that those incarcerated in a TC would deal with the social isolation differently; perhaps, feeling more lonely and craving social interaction just as the participants did in the Wang et al. (2020) study. Brooks et al. (2020) completed a rapid review of the impact of quarantine and found the negative impacts could include post-traumatic stress symptoms, confusion and anger. They reported that if the quarantine was prolonged people could suffer from boredom, frustration, fear of infection and lack of information. They suggested that informing those in the quarantine of the benefits of it for self and others helped alleviate symptoms.

A survey measuring the effects of the COVID-19 lockdown on the general adult population was carried out in the UK and a parallel survey in the Republic of Ireland. The results of both found that a significant proportion of the general adult populations of the Republic of Ireland and the UK are being affected by COVID-19 related traumatic stress and that rates of traumatic distress increased (Karatzias et al., 2020). Shevlin et al. (under review), found higher levels of anxiety depression and trauma symptoms slightly during the initial lockdown period. These findings had been highlighted early in research into how people respond when separated, and this can depend on their internal model of relationships and how dependable they are. Attachment can link very closely with the threat response, as both are based on survival reactions. The attachment response can be seen as a strategy for protecting yourself, often done unconsciously. If an individual has an attachment style, which views others as unreliable or unpredictable they can go through phases of protest, despair and then detachment (Robertson, 1989). As the Robertson’s, and later others, (Ainsworth et al., 1971; Bowlby, 1973; Crittenden and Landini, 2011; Crittenden, 2015) noted that when individuals are separated from those they look to for care and support, they react in an emotional manner and when reunited, depending on their attachment style, respond in various ways. Some may seem more clingy, and others more aloof. The research indicates that when the threat system is activated the tendency is to seek safety, if isolated the drive is to seek closeness to others and in chaos to predict what might happen. Those who have had this in the past are more likely to respond in a calm manner than those who have not had a responsive caregiver. They may find it more difficult to adapt or use unhelpful strategies, such as being too rule-driven or may try to gain control in other ways. Some will use food, sex, alcohol, drugs, etc., to help regulate their emotions and so this needs to be kept in mind.

In an attempt to combat the loneliness and the fears around the residents being locked up with only the TV for company and the risk that they could be constantly being fed disturbing news, distraction packs were handed out across the prison. The feeling was that those outsides could offload their feelings and regain some control by helping others and volunteering, which can offset anxiety. It was important that a space could be created for residents to do this too. Included in the packs were a variety of Mindfulness techniques, coping strategies, crosswords and puzzles. On the EAPU the residents were encouraged to maintain the journal they had already started and note things they should be grateful for. The establishment is set in the countryside and so many have views of open fields, birds and wildlife. Discussions and precautions were taken with mindfulness as, research has shown that practiced without an awareness of trauma can exacerbate symptoms of traumatic stress, namely, flashbacks, dissociation and even re-traumatisation (Treleaven, 2018).

Recent research following the severe acute respiratory syndrome (SARS) outbreak found that those who had been quarantined (for 9 days) showed signs of acute stress disorder. In the same study, the quarantined staff was significantly more likely to report exhaustion, detachment from others, anxiety when dealing with febrile patients, irritability, insomnia, poor concentration and indecisiveness, deteriorating work performance and reluctance to work or consideration of resignation. The effect of being quarantined as a predictor of post-traumatic stress symptoms in hospital employees 3 years later. Those who had been quarantined out of fear that they had been in close contact with someone who had SARS described feeling fear, nervousness, sadness and guilt.

Caleo, Duncombe and Jephcott (2018) noted that undergraduates had shown little effects of quarantine due to the risk of Ebola contamination, but notes this may have been because they did not have dependents, whereas most of those in the prison staff could have. DiGiovanni, Conley, Chiu and Zaborski (2004) spoke to those who had been quarantined due to a SARS outbreak and found the majority avoided all public spaces in the weeks following the quarantine period. Further, (Caleo et al., 2018) indicated that longer durations of quarantine were associated with poorer mental health specifically, post-traumatic stress symptoms, avoiding contact with others and anger and this was particularly evident when quarantine was for more than 10 days. Brooks et al. (2020) reported that individuals were also very concerned about infecting others, which added to stressors and dilemmas so as to whether it was better to attend work or not. Furthermore, Reynolds (2008) found that health care workers amidst a pandemic felt greater stigmatisation than the general public, exhibited more avoidance behaviours after quarantine, reported greater lost income and were consistently more affected psychologically: they reported substantially more anger, annoyance, fear, frustration helplessness, loneliness and were less happy. A further finding of Reynolds’ study was that the return to normality after periods of quarantine was extremely difficult.

Participants found that the period of readjusting back to normal was significantly longer than anticipated. The confinement, loss of usual routine and reduced social and physical contact with others are going to have an effect in all prisons across the UK. However, returning to “normality” for most mainstream prisons across the UK may not look too dissimilar from the current lockdown state. For those in a TC “normal” is something so different from the current state, and serious consideration is needed when we start to think about how to get back to the routine of therapy.

This was being thought about at HMP Grendon with a working group known as the “Recovery Working Group” (RWG). The group was made up of both operational and non-operational facilitators, who meet each week for a video conference. Each week is themed with literature and questions set relevant to the weeks’ theme. Themes centre on the psychological impact of isolation, recovery of TCs’ and staff teams. The group collated their learning, discussions and ideas into recommendations to be made to the senior management team to inform the strategy of how best to return to therapy. A survey was undertaken for the residents and staff on all the communities in the prison, who are not able to attend the video conference to capture their thoughts and ideas on the topic, to ensure inclusivity, democracy and a collaborative approach to the TC work.

Resident considerations – personal account written by resident at HMP Grendon

The Coronavirus pandemic and resulting lockdown have had a significant impact on our therapeutic work. The need to maintain social distance has meant all group-based therapy has ceased. Considerable efforts have been made to help residents maintain a therapeutic mind-set and some have made use of the provisions that are available. Feelings of uncertainly have been combatted with regular, communications from therapeutic staff. There is no substitute for our community meetings but every day we have received a good-humored, authentic, single-page bulletin compiled by one of a variety of staff members. We are a democratic community and this bulletin has maintained informational equality.

Boredom is undoubtedly a factor for all of us undergoing isolation both inside and out of prison. Community-wide initiatives involving staff and residents have helped to maintain a spirit of unity and attempted to alleviate the boredom. Under normal circumstances, we have access to a library, which is now shut. The staff has helped enormously by providing DVDs from their own collections. This shows a good level of trust and empathy along with an openness I have not experienced in other establishments: you can gauge an awful lot from someone’s taste in the film! In addition to this, as already noted above, distractions packs compiled by staff including crosswords, word searches colouring exercises and the like are produced frequently. Many of us have projects to invest time in such as painting, drawing or practicing musical instruments and occasionally staff take pity on us and ask for help in producing an academic paper!

We do not exist in a vacuum here. All of us have access to a television and are able to stay abreast of how the pandemic is progressing in the wider community and the human response to it. Volunteering initiatives have been mirrored to help alleviate pressure on essential workers. Staff and residents worked together to devise a rota for the key tasks such as manning the laundry, serving our meals and cleaning. I volunteer as a servery worker and it has helped me maintain a sense of belonging and purpose in our community, others doing similar tasks report feeling the same. This scheme has a secondary parallel with society in general as it mimics fairness. During this pandemic, systems such as queuing to enter the supermarket and restrictions on time outdoors ensure fairness. Being allowed out of our cells even just to clean can feel like a privilege and we appreciate how staff applies the principle of fairness here. There are aspects of our usual therapeutic existence that I miss dearly. Unlike other prisons, we tend to eat together and I long for the chance to share a meal with friends with the buzz of our wing going on around us. It is frustrating not having the freedom to make a phone call when I choose to and is limited to 5 min per call.

Throughout my time in therapy, I have benefitted from being able to express my feelings when I have been displeased with a decision. Often it has been possible to explain me to the decision maker. Although the outcome has rarely changed, I do believe that being listened to has value and I am concerned about losing this during the lockdown. Our community meetings serve as a vital space to communicate and work through our feelings and without these, there have been times, where such issues have been dealt with in a manner that was less than optimal. These have tended to be decisions made by senior operational staff. Most of the wing became angry when lodgers from a neighbouring prison were transferred on to the wing, especially when one lodger was under quarantine. On this occasion, a number of senior managers were present and supported the wing, for which I was grateful as despite having no influence over such matters, I, as chairman4 tend to be held responsible if only as a proxy! Regrettably, not being able to meet as a community to discuss and share our feelings means negative emotions are not expressed, and therefore not properly challenged. At times like this, with unexplained, unexplored decisions being made without any consultation the wing feels more like a mainstream prison than a TC. I am hopeful that our wing will get the opportunity to redress this balance in perception following the lockdown.

Some residents have expressed concern about being able to demonstrate progress during the lockdown particularly if important reviews or even parole dates were approaching. Our wing therapist has provided us with a journal to record our thoughts and feelings in addition to a paper that outlines the TC Model of Change and the target areas such as “Emotional Management” and “Anti-social Attitudes” which most of us are used to discussing from our assessments. Events that happen or behaviours that arise can be recorded on these worksheets for discussion in therapy later. This has been complemented with the provision of one to one session with our wing Therapist or Psychologist if needed. Clearly, the physical distancing protocol is observed during these meetings and I have appreciated these on an ad-hoc basis.

It is impossible to comment on the state of the wing in anything more than the broadest of terms. The physical distancing protocol means I am only ever in regular contact with about a third of the wing. On the whole, most of us are concerned about the well-being of our loved ones. Those that have been in therapy the longest appear to have better-coping skills. Amongst these senior members, some have gotten so close to finishing therapy that they may not return or will return to work through an ending. The newest residents tend to be relying on survival-based strategies typical in a mainstream prison. Such strategies can veer towards antisocial behaviour and some of these newest members may choose not to return to therapy. Such is the impact on our community. Between these two extremes are the residents that have been in therapy for around a year. Some of these are responding well and putting into practice skills they have developed, others have struggled at times and may not return to therapy. One resident explained to me how he would cope better with the prolonged lockdown if he had done something wrong to warrant it.

We are still currently in lockdown and have got through the transitional teething problems. It is unclear how long this situation will continue; so far I believe our safety has been well protected. Initial feelings of anxiety have been replaced by a sense of loss of our normally vibrant community. Upon reflection, I have coped much better than I believed I would especially at managing feelings of anxiety and depression. The lockdown has, thus, provided me with an unintended positive, as in some areas my progress seems to be more advanced than I believed. I wish I could share these feelings with my group and benefit from their input. The act of sharing and exploring my feelings in-group has facilitated this progress and realising this is a potent fuel for my future therapeutic work.

Supporting residents

As was referred to by the resident above, there were some transitional teething problems with the lockdown. The change in regime required to follow the government’s guidance was a drastic change from the TC regime that had been in place for over 60 years at HMP Grendon. Changes had to be made to ensure physical safety but also to ensure emotional safety. As part of the advice sent from Psychological services, one paper discussed “Psychological First Aid (PFA)”. This term describes “human, supportive responses to a fellow human being who is experiencing distress as a result of the impact of COVID 19 and who may need support”. Many meetings were held to consider how best to support the residents. The overarching consideration was that non-operational staff were to have a presence on the wing to talk and support the residents and staff (PFA). The role of the staff on the wing was to provide emotional support to help the residents address their basic needs, to help them cope with their problems, feel safe, feel connected to others and to give information and connect with their community. It was important that we were responding to the issues of isolation as identified in research and practice.

In practice, the staff was offering this support in various ways. Firstly, the staff was encouraged to walk around the yard with the residents. The time in the yard was an opportunity to connect and talk with the residents while getting some fresh air. Due to the restricted regime, which meant residents were allowed out of their cells for such a limited amount of time it was important to seek opportunities to talk in a safe way wherever possible. Secondly, on some wings more formal check-ins were introduced. For some wings, this took the form of 15 min with the available member of non-uniform staff and their personal officer if available. As the resident commented above in his section, this offered the opportunity for some to demonstrate the progress they had made against their therapy targets and to think about their current behaviour (positive or difficult). Along with distraction packs, which included information about breathing to help support the Vagus nerve, journals and art materials were offered to residents on each community to give them another avenue of expressing themselves or combatting the boredom. As with those outsides of custody, residents can be very creative and resourceful and so ideas were sought as to how we could make this more tolerable. Finally, as commented by the resident and the reference to the change in regime communication between residents and staff was felt the most important factor to harness during these times. The relationship between staff (most commonly operational staff) and the resident is arguably the most defining factor of TCs as an effective tool for dynamic security (Parker, 2007). The therapeutic alliance and collaborative working between residents and staff make the therapy work. Clearly, during a lockdown and a return to mainstream regimes, which residents have come to Grendon to get away from, the therapeutic relationship inevitably experiences some strains and ruptures. It was important that each wing considered how they could best protect this. The list above of processes and support put in place shows some of the methods put in place.

Staff consideration – a personal account from an operational member of staff

I can only talk for myself when it comes to hugging people. It is something I like to do and something I have missed, as the lockdown has been in place. Reminding myself not to come into someone else’s space, and trying to insure the 2 metre distance is maintained. This was difficult to start with, the movement of people has to be negotiated just to make a cup of tea! All of a sudden people were aware of how closely we work together, whether that be sitting in an office, dining room or landing. Initially there appeared to be an increased level of awareness and staff were putting arms out so others did not get too close. Staff guessed a lockdown could happen but we were still shocked when it happened so quickly. The uniformed staff did what they did best “got on with it” and thought about, designed and implemented a structure for the men so the basic needs were met. It was difficult at times when direction came from above and changes to how things ran changed quickly without giving a lot of time for notice. Some of the residents were more demanding than others, wanting to know when will they be out for a phone call, when will visits start again, when will exercise happen. The staff team both uniformed and no uniformed worked hard to set out a timetable, which allowed basic needs to be met and openness regarding how things could change. The relationship between the staff group and the residents on the wing was varied in some cases. With some residents new to the prison and straight into a lockdown situation it was difficult to be able to give them the support, guidance and care they could have received if they arrived in a “normal” climate. Over the weeks of the lockdown, some relationships between staff and residents have developed well. There has not been the opportunity to discuss concerns in a small group setting but conversations have developed in the exercise yard or in the office. This has given the men some taste of what therapy involves and also how we are very much working in the “here and now”. In other cases, residents are feeling dismissed by staff due to them not having the time to engage in conversation as they did in the past.

Due to the depleted uniformed staff team on the wing, it has meant officers based on other wings have been detailed. This has gone smoothly when the regular staff has been present as there is still a clear direction of what happens and when. On one occasion there was no regular staff and this led to boundaries being pushed. This leads me to how standing too close to someone can be seen as boundaries now. Other boundaries can be seen to lapse whether it be wearing flip flops off the landings, wearing shorts into the office. Some of the men respond well when they are challenged, some look for an argument. At other times the men are not challenged and may find this confusing or leave them feeling they have broken boundaries.

The different staff has responded differently to the impact social distancing has had. Some have said it has not made any difference and they have adapted to the regime changes. Others have said it can feel hypocritical, when unlocking and locking the residents it is not 2 metres, members of staff walking in groups and not being 2 metres apart, time in the tea room often sees the guidelines broken. Enforcing something staff is not doing themselves can be difficult and could potentially have an impact on relationships in the future. If residents see staff as being hypocritical now, how could they view them in the future?

Anxieties within the staff team regarding lockdown due to COVID 19 varied. There were people worried about friends and family outside of the workplace, people who were ill, people whose jobs were at risk, not being able to see friends and family to either give or receive support and of course where will toilet rolls be available. Tensions in staff can arise from this as not everyone is able to share what their concerns are. Uniformed staff is spending the majority of the day thinking how many men we have out at one time, what time the men need to be opened, how long they will be out for, who cannot mix with who. While all this is going on the thoughts of how a partner, parent, friend is are still there. Staff is having to manage their thoughts, dealing with men who are experiencing similar thoughts about their loved ones. The anxiety for all staff appears to have lessened to an extent, but this may not be true, are staff or prisoners masking what is going on for them? There is some despondence in how both staff and residents are feeling about the future – what will happen, what will happen, what will happen first?

I guess everyone is thinking about what the future holds, and there are many different questions on people’s minds. Residents thinking and complaining about how their therapy has been delayed and the impact this has on their sentence. Other residents keen to get into or back into therapy so they are able to work on lowering their risks and have a better understanding of themselves. Some staff are very focussed on the here and now and are not thinking about coming out of the other side. Working with what is going on is easier than thinking about how to return to what was there before. Finally, there is other staff who are keen to look at the return to therapy and are thinking about how this can be done. This movement forward however is directed by the Government and restrictions being lifted. How soon will I be able to hug a friend and start to work closely with my colleagues will be something I have to wait for, be patient, while still working to ensure the distancing applies at all times. It is not until you are stopped from doing something that you realise how much you miss it.

Supporting staff

In teams, the impact of stress can be damaging and a significant amount of research has accumulated supporting the idea that teams can self-destruct in stressful situations (Can-non-Bowers and Salas, 1998; Driskell and Salas, 1991; Driskell et al., 1999 in Ellis and Pearsall, 2011). There are two main themes emerging from the research regarding the problems teams’ can face when under stress: inaccurately differentiating roles and tension. When a job becomes demanding, individuals within a team and the team, often confuse roles and responsibilities with that team (Ellis, 2006). Existent splits within the team can be exacerbated in times of stress and so need attention. Specifically, research has shown that a direct by-product of stress within the team is a shift in attention from team members’ interdependent responsibilities (Ellis, 2006; Driskell et al., 1999). As job demands and the consequent stress associated with this increase, so too does the level of tension amongst team members. Empirically, the effects of tension in teams have been well established and the associated panic and heightened emotions tend to spread within the team, breeding a shared level of tension amongst team members (Ellis, 2006; Gladstein and Reilly, 1985). Key components of the TC working ethos is the multi-disciplinary, democratic approach and how the teams work and support each other. While there are clearly defined roles (operational vs non-operational) the teams and the community function at their best when working interdependently. It is, therefore, of utmost importance that teams have the opportunity and space to talk about the stresses this lockdown is having on them, and to hopefully relieve some of the tension. Overall, the psychological impact of quarantine on the staff/key workers was wide-ranging, substantial and long-lasting and so the emphasis on staff well-being was of utmost importance at HMP Grendon.

Staff needed outlets for their anxiety as they too felt generalised emotions for themselves, their family and for the residents while soaking up the feelings from those on the wing. Anstiss et al. (2020) described how compassion has evolved from the mammalian caregiving system in place. Parents would be sensitive to the distress and needs of their infant and work out how to distress, by protecting, feeding, comforting or rescuing. Applying this theory to the current situation, staff would be seeking to protect themselves, their family and those in their care, needs which could be in competition. Additional support was offered, with an opportunity given to talk about the impact the virus and its’ consequences were having personally and professionally. It should be noted though that giving and receiving compassion can have major beneficial impacts on human physiology, including on the immune and cardiovascular systems, neuro-physiological pathways and even epigenetic profiles (for reviews, see Seppälä et al., 2017), so this may help spur staff to continue their work. When writing the weekly regime timetable to accommodate the residents’ phone calls, exercise and collection of food, thought was also given to finding the space for staff to have sensitivity/group supervision/reflective practice. However, the demands the new regime placed on staff resourcing and capacity meant that this space could not function in the usual pattern in terms of time and attendance. The change in practice/regime meant a consequent change in roles. Operational staff in particular had a focus on running a different regime and this filled their time and thinking space. It was seen as vitally important that staff were offered the space to talk about the personal and professional impact of the virus and the lockdown. Supervision was still available for members of staff and focussed more on personal well-being. Plans were put in place to support staff, such as the possibility of phone supervision if the supervisor or supervisee were self-isolating, to help contain the staff team and their feelings. Supervisors highlighted the need to focus on increasing cohesion and boosting morale through providing advice to operational colleagues around communication, maintaining a therapeutic culture, structuring expectations and managing difficult behaviour. Morning briefings were extended to allow more time to express emotions and acknowledge how everyone was feeling while allocating tasks for the day. Every effort was made to maintain the reflective spaces and support the staff team. The EAPU organised an “away morning” for their staff team, to look at urgent business items and have space away from the wing to talk about their feelings. The time away was gratefully received by all.

Conclusion and future thinking

At HMP Grendon residents and staff are adjusting to the impact of it and working to have as humane an environment as possible while keeping each other safe and healthy. At the time of writing there were no confirmed cases in the resident population and as tests began to be introduced for staff and some were tested a small minority tested positive and observed the restrictions in place. Every effort is being made to apply what has been learned from previous research so as to lessen the impact on all and the development of the RWG is a helpful resource in furthering this. O’Moore (2020) noted that while the level of prevalent infection in the community would be likely to reduce over the summer months as the pandemic wave plateaus and then decreases, the COVID 19 virus would still be circulating and epidemiologists predict risk of a second wave or even a third wave before a vaccine was created. It was acknowledged that once restrictions are lifted it will be important for staff and residents to have the time and space to voice their feelings about what has happened to help the recovery phase to begin.

To the author’s knowledge, the topic of how a TC responds in a pandemic has not been researched before. Therefore, this paper should be read as the author’s experience in light of nothing to compare it to.

In this paper, we have considered the principles of a DTC and how they can be maintained in a restricted regime. Residents and staff have reflected on the initial impact and the on-going effect the Covid-19 pandemic is having. Research into quarantine and isolation was explored and the findings applied to the current community. Consideration was given to how in a compassion-focussed, trauma-informed environment the theories may be applied in extraordinary circumstances. The use of language was considered to be important, as was the use of education to help explain how humans respond in threat-inducing situations. The importance of supporting all those who live and work in the establishment was attended to. This will continue as we move into the recovery stage, even though there is no certainty as to when that will be.

The authors intend to write a follow-up paper that captures the experience of moving into the recovery stage. The follow-up paper will encapsulate the overall experience of recovery at HMP Grendon, the theory regarding recovery processes and again the individual accounts of residents and staff. In the follow-up paper, the authors will reflect on the implications and learning taken from the overall experience.

Notes

1.

The exception to this is TC+, the community for men with learning difficulties, which houses 20 residents.

2.

A chairman is elected by the community to manage the meetings and act as a bridge between residents and staff.

3.

In the prison service prison officers and operational managers are described as “operational” staff. All others are referred to as “non-operational”.

References

Ainsworth, M.D.S., Bell, S.M. and Stayton, D.J. (1971), “Human attachment and exploratory behaviour of one olds”, in Schaffer H.R. (Ed.), The Origins of Social Relations, Academy Press.

Akerman, G. (2019), “Communal living as the agent of change”, in Polaschek, D., Day A. and Hollin C. (Eds), (Chapter 37) The Wiley International Handbook of Correctional Psychology, Wiley Blackwell.

Akerman, G. and Geraghty, K.A. (2016), “An exploration of clients’ experiences of group therapy”, Therapeutic Communities: The International Journal of Therapeutic Communities, Vol. 37 No. 2, pp. 101-108, doi: 10.1108/TC-12-2015-0026.

Anstiss, T., Passmore, P. and Gilbert, P. (2020), “Compassion: the essential orientation”, The Psychologist, available at: https://thepsychologist.bps.org.uk/compassion-essential-orientation

Bowlby, J. (1973), “Attachment and loss”, Separation: Anxiety and Anger, Hogarth Press Institute of Psycho-Analysis, London, Vol. 2.

Brooks, S.K., Webster, R.K., Smith, L.E., Woodland, L., Wessely, S., Greenberg, N. and Rubin, G.J. (2020), “The psychological impact of quarantine and how to reduce it: rapid review of the evidence”, Lancet 395, 912-20 Published Online February 26, 2020, doi: 10.1016/S0140-6736(20)30460-8.

Burki, T. (2020), “Prisons are in no way equipped to deal with COVID19”, Lancet, Vol. 395, pp. 1411-1412, doi: 10.1016/S0140-6736(20)30984-3 (accessed 2 May 2020).

Caleo, G., Duncombe, J. and Jephcott, F. (2018), “The factors affecting household transmission dynamics and community compliance with Ebola control measures: a mixed methods study in a rural village in Sierra Leone”, BMC Public Health, Vol. 18, p. 248.

Centers for Disease Control and Prevention (2017), “Centers for disease control and prevention. Quarantine and isolation”.

Collins English dictionary (2013), Collins English Dictionary, HarperCollins Publishers, Glasgow.

Crittenden, P. (2015), Danger, Development and Adaptation, Waterside Press, available at: www.cdc.gov/quarantine/index.html (accessed 30 January 2020).

Crittenden, P. and Landini, A. (2011), Assessing Adult Attachment: A Dynamic-Maturational Approach to Discourse Analysis, Norton, New York, NY.

DiGiovanni, C., Conley, J., Chiu, D. and Zaborski, J. (2004), “Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak”, Biosecur Bioterror, Vol. 4, pp. 265-272.

Ellis, A. (2006), “System breakdown: the role of mental models and transactive memory in the relationship between acute stress and team performance”, Academy of Management Journal, Vol. 49 No. 3, pp. 576-589, available at: www.jstor.org/stable/20159782

Ellis, A. and Pearsall, M. (2011), “Reducing the negative effects of stress in teams through cross-training: a job demands-resources model”, Group Dynamics: Theory, Research, and Practice, Vol. 15 No. 1, pp. 16-31 doi: 10.1037/a0021070.

Gilbert, P. and Basraan, J. (2018), “Imagining one's compassionate self and coping with life difficulties”, EC Psychology and Psychiatry, Vol. 7 No. 12, pp. 971-978.

Gladstein, D. and Reilly, N. (1985), “Group decision making under threat: the tycoon game”, Academy of Management Journal, Vol. 28 No. 3, pp. 613-627, doi: 10.5465/256117.

Karatzias, T., Shevlin, S., Murphy, J., McBride3, O., Ben-Ezra, M., Bentall, R.P., Vallieres, F. and Hyland, P. (2020), “Posttraumatic stress symptoms and associated comorbidity during the COVID-19 pandemic in Ireland: a population based study”, Journal of Traumatic Stress.

National Health Service Guidelines (2020), available at: www.nhsx.nhs.uk/covid-19-response/data-and-information-governance/information-governance/covid-19-information-governance-advice-health-and-care-professionals/

O’Moore, E. (2020), “Briefing paper-interim assessment of impact of various population management strategies in prisons in response to COVID-19 pandemic in England. National lead for health & justice, PHE and director UK collaborating Centre, WHO health in prisons programme (European region)”, Commissioned by: Jo Farrar, CEO, HM Prisons & Probation Service on April 17, 2020, available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/882622/covid-19-population-management-strategy-prisons.pdf

Parker, M. (2007), Dynamic Security. The Therapeutic Community in Prison, Kingsley Publishers, London.

Raczka, R., Akerman, G., Bunn, H., Fraser, J., Green, G. and Griffiths, H. (2020), “Adaptations to psychological practice: interim guidance during covid-19 pandemic”, British Psychological Society, available at: www.bps.org.uk/responding-coronavirus.

Reynolds, D.L., Garway, J.B., Dearmond, S.L., Moran, M.K., Gold, W. and Styra, R. (2008), “Understanding compliance and psychological impact of the SARS quarantine experience”, Epidemiology and Infection, Vol. 136 No. 7, pp. 997-1007.

Robertson, J. (1989), Separation and the Very Young, Free Association Books.

Seppälä, E.M., Simon-Thomas, E., Brown, S.L., Worline, M.C., Cameron, C.D. and Doty, R.R. (2017), The Oxford Handbook of Compassion Science, Oxford University Press, New York, NY.

Shuker, R. and Sullivan, E. (Eds) (2010), Grendon and the Emergence of Forensic Therapeutic Communities: Developments in Research and Practice, Wiley.

Treleaven, D.A. (2018), Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing, W W Norton & Co.

Wang, T.L., Thompson, K., Matthews, T., Takahashi, G., Tye, A. and Saxe, K.R. (2020), “The need to connect: acute social isolation causes neural craving responses similar to hunger”, BioRxiv 1 Published online, March 27, 2020, doi: 10.1101/2020.03.25.006643.

Yalom, I.D. (1980), Existential Psychotherapy, Basic Books, New York, NY.

Corresponding author

Emily Jones can be contacted at: emilyjones203@hotmail.co.uk

About the authors

Geraldine Ann Akerman is based at HMP Grendon, Aylesbury, UK

Emily Jones is based at HMP Grendon, HM Prison Service, Leicestershire, UK

Harry Talbot is based at HMP Grendon, Aylesbury, UK

Gemma Grahame-Wright is based at HMP Grendon, Aylesbury, UK

Related articles