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Sunday, 31 January 2016

Post 8 - Abuse, Ignorance or Arrogance? - No "Medical In Confidence" for Anyone Previously Detained in the UK!

Many people claim they fight for the marginalised, the stigmatised, the voiceless people within societies around the world and they are admired by me for their efforts.  However this particular episode is startling for me as it has occurred here in the UK, where we know better.  We understand as a Nation all about Institutional Conditions regarding stigma, bullying, marginalisation and how these issues and their effects can create victims to the extent it has sometimes led to suicide. 

This is a factual account of one recent experience brought to our attention, it raises so many questions it is difficult to know where to start, so I suppose the best place is the beginning of the issue at hand and you can form your own views?  

It involves a person living their life on Life licence in the community for a crime many years ago who had occasion to attend their doctor.  The client has regular quarterly meetings with the probation services who obviously are aware of all life events and in particular the client had been discussing matters with them regarding Mental Health and well being etc, so no secrets and an open transparent relationship was in place.

This is not an "oh woe me" story on behalf of our client so the details of why they were ill and what events transpired within their family resulting in this situation are in the main irrelevant to the implications of this account.

During their attendance at the appointment with the doctor, they engaged in a completely frank and candid manner during the conversation with their doctor, to the extent they explained about their past and all connected events.  The doctor diagnosed Depression, in fact he was of the view the client had been depressed for many years and expressed surprise that Depression had not been identified during incarceration and that help had not been offered previously.   It cannot be stressed enough the sense of relief and hope felt by the client regarding the situation now that the Doctor had intervened.

The doctor concluded the client was in 'crisis' and following thorough assessments offered a treatment programme involving medication, however the client preferred to try 'Talking Therapy' with the CMHT (Community Mental Health Team) before opting for medication.  The doctor agreed it was a viable option and the client was referred as an emergency.

The process involved a telephone call that afternoon to the client from the CMHT who conducted an hour long 'Triage' interview on the telephone where again the client was open and candid about their past history, they agreed 'Talking Therapy' was an option and told the client the case would be passed to a psychologist who would telephone and arrange an appointment for the client to go in and have a face to face meeting with the psychologists who were also the facilitators.  A few days passed, a time which the client endured (and possibly survived) only with the compassion and active intervention of close friends.

The first "bombshell"!         
I should say at this point that fortunately all telephone calls to and from CMHT are recorded.

The client received a further telephone call from the CMHT, in fact the same person who had conducted the 'Triage' interview for over an hour, they asked if permission could be granted for the Psychologist to approach the clients probation officer!  The client asked why that was necessary when the current situation was directly relevant to other issues and not to an event many years ago, the client also asked why the psychologist could not discuss matters with them in person when they met.  The response was in our view absolutely shocking.

The client was told access to 'Talking Therapy' (thus NHS services) would ONLY be granted in circumstances whereby consent was given for the psychologist to approach the probation officer for discussions prior to meeting with the client (don't forget this is someone diagnosed to be in crisis and in need of support).  Needless to say the client felt this was outrageous as Lifers are already a marginalised group (as there conviction is never spent so will always appear on a Criminal Records Bureau (CRB) check (now known as DRB Disclosure and Barring check), and felt this was also an example of blatant discrimination.   Permission was expressly withheld by the client without any opportunity for misunderstanding or ambiguity, the call was terminated with the client in tears and distressed. The impact on the client at this point was devastating and brought back overwhelming feelings of helplessness, isolation, loneliness and desperation - and again it may be that it was only due to the intervention of close friends that the client survived this period.

The second "bombshell"!                    
The client went along to a regular quarterly meeting with the probation services, within minutes to the complete shock of the client the probation officer raised the subject of the appointment at the doctor and the subsequent decision to opt for 'Talking Therapy'.  Before expanding in response to the question the client asked how the probation officer knew he had been to the doctor and what had been discussed, and in response was told the Psychologist from CMHT had telephoned probation to ask questions regarding the client etc.  The probation officer was quick to point out that he had asked for a copy of the consent form the client had signed to be emailed or faxed over and when the CMHT psychologist stated they did not have one the probation officer claims they terminated the call.

The client then pointed out that an element of investigation must have taken place on the part of the Psychologist because at no time were the CMHT or the doctor made aware of which probation area/office/officer was responsible for their supervision in the community, and that by engaging in conversation at any level the probation officer had essentially confirmed collateral data which was a breach of their confidentiality, and clearly others associated with probation had done likewise for the Psychologist to have eventually got through to the supervising office/officer.  The only circumstances where such discussions could take place with complete disregard to patient confidentiality were in circumstances where there was a public risk issue, and both parties have since AGREED that did not apply.  It was made clear to the probation officer by the client that permission/consent had not been given to discuss these issues, and that in fact had the Psychologist suggested in an interview that a tri-party meeting would be useful from their perspective it was highly likely the client would have agreed, however that had not occurred.

So not only had the CMHT in the form of the Psychologist breached the medical in confidence of the patient (client), but the probation service had also breached the clients confidentiality ergo the DPA 1998 and this was a cause for concern.  Needless to say a heated discussion took place about stigmatisation, professional standards, bias, prejudice, discrimination, public perception of ex-offenders, medical codes of practice, patient confidentiality, rights to privacy etc and the Lifer shared the experience with us.

An approach was made initially by telephone to the CMHT to raise a complaint, their head of complaints is involved and in communication and meetings are underway to address the issue.

The third "bombshell"!              
Despite all of the above currently being investigated the CMHT Psychologist failing to learn his mistake has since emailed the probation officer to "ask one simple question" which according to the client who spoke with his probation officer on the telephone was "is the patient 'safe' to be alone in a room with us"?  

Do people know we have a Rehabilitation of Offenders Act or the Data protection Act 1998 or The Mental Health Act and that everyone except in very specific circumstances has a right to have their medical history protected? Probation have expressed their support of the client in his complaint, but what does this say about the perception of people regardless of their profession regarding anyone with a Mental Health concern who approaches their doctor, and especially so if they happen to be an ex-prisoner or detainee?   

Do they in fact regain any rights upon release, are they actually free, do they have any level of autonomy in their life outside or is the truth they are permanently marginalised with the stigma which ignorance bestows upon them?  In this case was it abuse?  Was it ignorance?  Or despite being in knowledge the third time Is it arrogance?

You tell us, please comment below by clicking on 'comments'. Please raise the debate, discuss this over dinner, talk with colleagues and friends, or post on our website.

Wednesday, 20 January 2016

Post 7 - The Collective Power of Shame, Remorse, Guilt and Sacrifice

As many of you will be aware when a person is taken through the UK criminal court system and found guilty they may have occasion to be "sent down" and be sent to prison.   

Prison, well first we have to decide what is a prison without stating the obvious and offending all of you before we get to the bones of this Blog post. Yes we have the physical prison with the road around it which is patrolled at night by vehicles ( HMP Belmarsh), then walls around it, then the internal fences which allow for a guard dog patrol in between them, and finally the administration and accommodation buildings.  

Though there are different types of physical 'prisons' (and I don't mean HMP), there are also the 'prisons' managed by the NHS (Broadmoor) though they would say it is a hospital.  Broadmoor Hospital would say "it is a specialist service that provides assessment, treatment and care in conditions of high security for men from London and the south of England.  It’s one of three high-security psychiatric hospitals in England, and is internationally recognised, both for work with patients and for our extensive research activities" (some may say on people who may not have the ability to consent?).  Then there are of course the privately run institutions for children called STC's such as Medway (recently in the news), and also Immigration Removal Centres where people (asylum seekers/migrants) are taken to be processed and deported despite the fact they are not all convicted criminals but many are fleeing war zones or persecution.  Though now throughout Europe they are blamed for any upsurge in crime statistics or criminal events without having undergone due process such is the fear rampaging across the world of ISIS and their infiltration of Europe using the war in Syria and the subsequent refugees as camouflage for their operatives to gain entry.  All a subject for another Blog post.

They are all in our opinion a form of 'prison', but there are many more and some not so obvious.  The obvious aside from physical environments could be said to be the person confined to a wheelchair (though they may disagree), or a blind person (again may disagree), or someone with Alzheimer's disease, Cancer, a terminal degenerative disease, or a Mental Health condition, the list is endless as they all are human tragedies and effect millions on different levels across the world not just here in the UK so have good reasons to be included.

But I want to tell you about one prison I visited the other day, and the shame it engendered within me so much so that I was reduced to tears and resolved to refer the situation to you the public for Judgement.

It was a particularly cold wet and windy day when I drove into town just going about my business food shopping, as I live alone it allows me to buy fresh stuff daily and if you pick the right time of day you get the 'deals' in the supermarkets so I have a routine and always go in the hope I get a warm chicken every other day and it lasts me for curry, salad the next day etc.  Usually I park my car in the multistorey car park get the lift and straight into the food hall on the ground floor, however this day there were limited spaces so rather than wait in the queue I parked in another car park which meant a short walk over a bridge (in the rain with my brolly) and into the shops.  On crossing the bridge I couldn't help but notice a figure sitting huddled on some blankets, on the floor against the wall, knees to his chest cuddling a Jackrussell dog. The reason he was easy to see was the stream of pedestrian traffic on the bridge was on the opposite side jostling through each other obviously avoiding this person huddled by the wall.  Most of us in our minds would see a 'tramp' and that's exactly what I saw, he had the stereotypical towel over his head as a scarf, tucked into what looked like a heavy military overcoat, (a technique employed in prisons on the exercise yard to keep out the wind), dark thick fleece type tracksuit bottoms, boots with huge soles on, thick socks outside with his tracksuit bottoms tucked into his socks.  As I got closer I bolstered myself and thought to myself I will give him some coins in his tin poor sod.

But as I got closer I couldn't see a tin and he wasn't holding his hand out, this guy (as I could see now it was a man) was absolutely filthy, his beard made Bin Laden look like a clean shave, I mean he was filthy, his clothes were filthy with mud and grease, his face was red with cold and pockmarked skin, the hair matted - but he wasn't begging, he was whispering to his dog and feeding him what turned out to be a roll.  Next to him was a military rucksack which had also clearly seen better days.  As I came level he glanced up at me (probably because everyone else was avoiding him) and we had eye contact...but this guy was not broken, this guy had clear blue eyes and a straight gaze (not a user or a drinker as I've seen many of them in my day) "alright mate" I asked expecting his hand for money, "seen better days" he replied... and I stopped "so what's going on then how come your sat here in the rain"...

This isn't about me so I won't repeat the whole conversation... 

I spent over 2 hours sat in the rain with this guy well into the dark, he was born in 1970 but looked 65, his dogs name was Tom, he had fought in the first gulf war and left the Army in 1995, married with a little girl.  Due to his behaviour his wife left him and they divorced, he lived rough around Colchester for some years, he said initially friends helped him out with a couch or a night here a night there but eventually he moved on as he felt embarrassed! A military war veteran embarrassed!  One of the hardest things I have done in a long time was walk away and leave the guy there in the rain, but I did, cold hearted I went and got my shopping, grabbed a coffee in the Costa and went home, not looking at him as I went past.

When I got home and got sorted I started to tweet and for some reason he stayed in my thoughts and eventually after an exchange with someone in New York on twitter (roisinmurphy) I decided to go back and find the guy and take him and Tom some food.  I stopped at McDonald's and bought a Chicken sandwich meal and a coffee and I went into town to the bridge, he'd gone, but not too far as I could see him in the doorway of a bakery just of the bridge out of the rain now the shops had shut.  He recognised me but resisted my offerings at first until I assured him he could wash my car for me on Saturday, I gave him some mince for Tom which he wolfed down sharpish, and he ate the chicken meal I had brought along.  I offered to pay for a travelodge so he could clean up and he refused (he'd rather be homeless), I offered him money (only £20) and he also refused, the guy was a completely decent man, bright, articulate, but tired of everything.  My guess is most of all he's tired of being taunted and tormented by his memories as he explained that he had beaten his wife, but it was the Iraq war not him, and I know this is trite but I believe him.  I have heard of PTSD I don't know enough about it but from what little I have read this guy definitely has it and it is with him every moment, as is his loss and pain. 

If anyone felt genuine remorse for what he had done it was him, he was punishing himself for it everyday and in my view he too is in prison!  I felt so impotent and so ashamed (still do in fact), and I have problems too in my life but I was astonished at the resilience and determination he displayed, not to succeed or to progress his life, but to remain on the streets and be anonymous because that's what he "deserves" according to him.

Charities are functional tools that in some cases do deliver their aims but many are simply making money to provide inflated salaries, pay rent to 'mother' companies that gifted their office property in trust, public and self confirmation/recognition, public honours for founders etc what we need to do is mobilise as a people.  If every single person in the UK gave a pound there is a fund for good.  If every single person in the UK did someone else a kindness today what effect would that have.  If we all took 10 minutes in town to engage with the homeless who are all around us we will grow too, we will never know the effect we may have on them, but it can only be positive, a conversation.  Take them a coffee from Costa, or some food from home, gradually we can bring them back into society by showing them a simple kindness.  There are clearly MH issues with many of those people, but they are suffering in many ways and they need help, we all need help now and again.

For those of you who wonder I have gone back everyday since but he has disappeared, he was hungry but proud, that is why he let me believe he would be there to wash my car.  I had never seen him before and he has simply moved on, I walked the town centre all the nooks aand crannies, the doorsteps, everywhere and cannot find him.  For me he is a hero and one his daughter can be proud of, I simply didn't have whatever it took to persuade him there are other ways and I regret that.  The UK is a good place to live, a good place to bring children up and have a chance to build a fabulous life if you are of a mind - but it takes effort, a joint effort.

Regardless of what anyone says you cannot do it alone, care for others now because the day will surely come when you need help because life has a habit of throwing curve balls and you never know what is around the corner, so be mindful at every opportunity.

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Wednesday, 6 January 2016

Post 6 - To Live An Honest Life You Have To Be Dishonest

It has been said recently that people living in the community with convictions in the main are Liars...that most families of people living in the community with convictions, or serving custodial sentences are Liars...and most children going to school whilst a parent is 'inside' tell lies...we know many people with Mental Health conditions are Liars to avoid the stigma, but do they really have a choice if they want a chance at a full and rewarding life where they are "accepted" and allowed to flourish and develop their full potential on all fronts?

I recently had a twitter exchange with a prominent Academic In a UK university who was a complete stranger to me, he had tweeted regarding some research he was initiating and had recently received funding to conduct some research into the effects of long term imprisonment (if I have understood him correctly).  I had occasion to comment on a tweet regarding his research and as a result we arranged via DM to speak on the phone.

I am grateful and humbled that he gave me the opportunity to talk with him and express my feelings/observations/experiences regarding people living life on life licence post release.  For me personally it was an interesting exercise and an easy conversation to engage in as not only have I lived my own experience, but for many years I was directly involved in a personal and professional capacity as founder and CEO of one of the first (if not the first) exclusively Prison Law Consultancies in the UK (another story for another blog), which according to one prominent Judge was spectacularly successful.  Quite literally we worked with firms of Solicitors and hundreds of people who have received Life Sentences (still serving inside and the community having been released) and many more who had received fixed term sentences for various offences, so I do feel there may have been something to offer regarding the research in question.

Following that telephone conversation I was left alone in my kitchen together with my thoughts which have led to this blog post, which is essentially about Lies, Liars and the capacity of the powers that be to comprehend that by definition anyone who is subject to what I call societal stigmatisation must also live a lie and/or propagate lies in order to maintain their existence.  In my view experience and evidence shows there are very few people who are burdened with a stigma who have the luxury of being able to build and develop their life to its full potential within the paradox of the fear, embarrassment, humiliation, shame, or the guilt that comes hand in hand with public exposure in the UK of ones existence in those circumstances.  This is particularly evident if they are within a group which is stigmatised either openly (such as Ex Offenders, Trans genders or Transsexuals) or covertly (eg those Disabled or sufferers of Mental Health conditions) within our society.  It was not too long ago that being openly Gay in this country was illegal and it still is in 76 countries and yet the UK and the United States still recognise those countries, trade with them and conduct our affairs with them, so by definition and by omission is our country a paper tiger and are we not all liars?

The Parole Board and the National Probation Service, demand openness from offenders if they are to earn release on a parole or Life sentence, yet they release them into a life of lies.  If they are to source employment then they have to disclose their convictions in certain circumstances, and then are rarely employed when prior knowledge exists on the part of the employer unless their is some form of relief or benefit.  The fact is currently, society is not disposed to absorb the truth regarding offenders, release and rehabilitation, it also appears the media alongside the government have no interest in educating them.

It is true statistically speaking that it is an extremely high probability that an ex-offender (perhaps a violent one) lives in every single street within the UK - the numbers are that high.  9.2 million people in the UK have criminal convictions, and the number increases daily.  Not all released prisoners are fortunate enough to be released to work for a charity, or an organisation they have managed to develop links with whilst inside, in fact they are very few.  Most go out and are unemployed, released with £47.00 discharge grant and a train warrant regardless of how long they have served.  There are of course some exceptions who are clearly resourceful and talented individuals who go out and through their own efforts go on to start up and build highly successful commercial businesses such as The Prisons Handbook/Converse and Veritas-Vincit UK to name but two and in their own way discreetly 'give back', but they are rare and they are the exception.

However in the community following a long stay in prison or a Mental Health unit you can hardly lean on the garden fence and explain to the neighbours where you have appeared from.  It is a delicate operation to decide who you can allow into your inner circle, who you can entrust with your history as it does not just impact on the individual, but also their family, their victims family, friends, colleagues of family...some are of the view the fact that those more prominent are somehow seen as successful examples of reintegration is in itself worrying.  It is not hard to reintegrate when all around you know who you are, what you are, where you have been, what you have done regardless of how long ago, there is certainly very little of a 'stress test' in such circumstances.  Perhaps you have no choice but to lie unless you have no family and nothing to lose?

So the Academic and his research into the 'effects' of long term imprisonment?

Well clearly there are other 'learned' behaviours aside from sitting in restaurants with your back to the wall or where you can see the entrance, or noticing the CCTV wherever you go but especially in banks, shops etc, or walking along looking at the ground (as eye contact inside is confrontational in several circumstances), or eating your food faster than most (as food inside is often warm/cold depending on where you were in the queue), or being overly aware of your personal data and the DPA 1998 when asked for personal details in shops etc.  There is a form of protectionist paranoia upon release as you are subconsciously of the view there is a sign on your forehead where it is written "Ex-Con avoid at all costs - Detritus".

Who has responsibility to change this perception?  Does anyone with the exception of invested parties want to change that perception?  Is there a gain or benefits in attempting to change perceptions?  Who quantifies those gains/benefits and decides the cost benefit to us?  Is it moral or immoral not to attempt to change that perception?

Lets face it there appears to be very few people in power with the influence to change things that seem to care about the death rates in our institutions so why should they care about developing a Criminal Justice System that results in high percentages of rehabilitation and successful reintegration for those marginalised by their own actions many years before?  There is much rhetoric currently around these issues, many meetings take place, many people bank salaries on the back of this broken in reality how many want to effect real change? Who is going to step out into the spotlight and take all the flack they will surely encounter from the media, from their voters and from their peers if they champion real change and real reform and not just tinker with the system?  Likely - No one?

So here's the cycle (example not applicable to all of course).

Arrested (in the norm most Lie to one extent or another), The Police build a case (in the norm dress the cake, embellish/Lie as they are unaware of plea), Sentenced and imprisoned arrive prison reception (Lie to get a single cell or quiet wing or medication to sell), Sentence Planning (staff Lie exaggerate/embellish behaviour to meet criteria for OB work = £.  Con Lies as avoidance strategy), Parole Board review (Probation Lie/embellish risk to meet criteria for hostels or community based OB = £.  Prisoner Lies about levels of confidence regarding support he/she will need, anxiety regarding release), Released - Lie to everyone initially as standard tool for successful reintegration into the given community until considered assessment regarding disclosure takes place.

So who creates the liar?  Is it the system, or the need to be an honest member of society, or is it an entrenched criminal value?

Or are we just cynical, you tell us?  Do you really want change and a more open and tolerant society?  If so do something about it, contact your local MP, ask them when they last visited a prison in their constituency, become a peer mentor or a prison visitor as a volunteer, take an interest in community based Mental Health initiatives, get involved with homelessness, get involved in your local communities and literally effect change and make it a better place for everyone, including those who have stepped outside the law - help them find their way back.

Join us, take a look at our website and see what can be done.