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4.1 In her briefing at the start of the inspection the Governor highlighted a range of issues. These were largely concerned with the characteristics and changing nature of the prisoner population, and often reflected the problems being experienced in the wider community.
4.2 The establishment caters for all sentence ranges, security classifications and categories. There had been over 1,825 admissions in the 12 months prior to the inspection and the population had risen to record levels. [ During the 1996 full inspection, the population was 183. On the first day of the current inspection that figure had risen to 225 and at the time of going to print, numbers had reached 256. Projections by the prison indicated that this could reach 314 by the end of September.] On the first day of the inspection there were 167 adults and 40 YOs (five of whom were aged 16 or 17 years) in custody.
4.3 The population of Cornton Vale remains complex, damaged and demanding and is characterised by:-
- Social exclusion, poverty and lack of opportunity
- Poor educational attainment
- Chronic addiction/poly drug abuse
- Chaotic lifestyles
- Single parenthood
- Low self esteem
- Dysfunctional family backgrounds
- Poor physical health
- Mental health problems
- Unemployment
- Insecure tenancies and homelessness
- Poor social and coping skills
4.4 In addition to this, high levels of anxiety and depression are common with 88% of all admissions scoring at least two out of five predictive factors for potential self harm.
4.5 Along with the fact that 50% of prisoners had committed "petty" crimes, the following characteristics illustrate the complex nature of the problems faced by the prisoners and the establishment:-
4.6 To address some of these problems, an holistic approach has been adopted to provide:-
4.7 Prior to inspection we were provided with a table which monitored the continuous progress in addressing the Recommendations and Points of Note which were made in the 1996 formal inspection report. Extracts are reproduced at Annex 6 and we highly commend this approach to other establishments.
4.8 The majority of women in Cornton Vale continue to come from either the Greater Glasgow area or the Lothians, though there are early signs that women are also being admitted from other communities where drug taking is on the increase. In October 2000, a study showed that on admission, 94% of women were testing positive for illegal substances.
4.9 A Drug Strategy Co-ordinator has been in post on a temporary basis since February 2001 (prior to this the work was carried out by the Health Centre Manager). The Co-ordinator has extensive experience of working with illicit drug users in the community.
4.10 In May 2001 a Service Improvement Plan to the Cornton Vale Drug Strategy had been produced. This is consistent with the SPS Document, 'Partnership and Co-ordination, SPS Action on Drugs' which was published in March 2000.
4.11 In common with other SPS establishments, the local response to the drug problem has been the creation of the Drug Strategy Co-ordination Group. This Group, which meets monthly and is chaired by the Deputy Governor, is multi-disciplinary and consists of the Drug Strategy Co-ordinator; Heads of Operations, Residential, Regimes and Health Care; Social Work Team Leader; and Psychologist. A representative from 'Turnaround', (a community based agency), also attends.
4.12 The Service Improvement Plan is an impressive document and provides a robust approach to tackling drug misuse within the prison. Key issues which are covered include:-
4.13 A local strategy for family and user involvement was also produced in April 2000.
4.14 On admission, all prisoners are given a healthcare addictions assessment. If a woman requires medical detoxification she is assessed by the medical officer and appropriate treatment offered, including maintenance, subject to urinalysis and confirmation of prescription by a community prescriber. Prescribed medications are also confirmed by fax, which we commend as an example of good practice.
4.15 If methadone maintenance has been commenced in the community it will be continued in Cornton Vale for prisoners serving less than three months. If the sentence is longer than three months a methadone detoxification will then be commenced. The medical officer is also able to offer other treatments such as diazepam, dihydrocodeine, lofexidine and naltrexone.
4.16 Individuals will be retoxified only if a prescriber is identified in the community who will continue to provide prescription on release. The rationale for this is that with certain individuals it is safer to stabilise within the establishment prior to release than to wait for relapse in the community and risk overdose and possibly death. This is also an area of good practice.
4.17 Overall, we consider that the detoxification programme was operating in a humane way and was helping individuals deal with withdrawal symptoms. From June 2001, a urinalysis machine will be available, which will allow for detailed urinalysis of all admissions and enable individualised prescribing.
4.18 The most difficult period for the long-established drug user is invariably the months that follow drug period of withdrawal. Many drug users have poor coping strategies and are unable to deal effectively with daily pressures and so relapse into drug usage. However, programmes to identify and enhance coping strategies for those individuals who have been physically/ psychologically dependent on a substance are known to be effective.
4.19 The Lifelines Programme, an adaptation of the Drugs Relapse Prevention Programme specifically for women and young offenders, was being piloted in Cornton Vale. It is a five days per week programme of four weeks duration and is delivered by Programmes staff. Group sessions are delivered in the mornings with structured activities in the afternoons. Selection is based on psychometric testing, a selection board and one negative drug test. Testing is conducted throughout the programme, a positive test resulting in deselection though no disciplinary procedures. (A review and evaluation of the Programme's effectiveness is likely to be undertaken in due course.)
4.20 The MDT Co-ordinator is the Deputy Governor. At the time of inspection the Unit was staffed full time by two officers with a further six trained staff as reliefs.
4.21 The SPS Mandatory Drug Testing policy requires a random sample of 10% of the prison population to be tested each month. In the year April 2000 to March 2001, a total of 768 mandatory drug tests and 18 voluntary reception drug tests were carried out. A summary of the results is shown in the tables below.
DRUG TESTING STATISTICS 2000 – 2001 SUMMARY
Final Positive - tested positive for drugs of abuse - medical positives not included.
Underlying Positive - removes from figures those whose positive results may have been due to drug abuse before entering prison.
TEST RESULTS – NON-MEDICAL
(Total test results may differ from number of positive samples due to poly-drug abuse.)
4.22 The Unit was well organised with recordings and statistics maintained to a very high standard, thus providing valuable quality information of the scale and type of drugs used. Staff were quick to respond to requests for suspicion tests, which reinforced the constant challenge to the drug problem within the establishment.
4.23 Due to staff shortages and an imbalance on one Division, staff were frequently removed from the Unit at weekends. This results in little if any weekend testing being conducted - thus women returning from home leave are not being screened. This seriously undermines the other good work carried out by the Unit and requires to be addressed as a matter of priority.
4.24 A number of observations may also be made following analysis of test results. Most striking is the absence of voluntary testing - no voluntary tests other than the October 2000 admissions study were carried out. This study showed a 94% positive rate on admission for illicit drugs.
4.25 The majority of individuals testing positive do so for opiates. This accounts for 71% of positive random tests; 83% of positive suspicion tests and 88% of positive frequent tests. This is very high compared to recent results in male establishments – for example Greenock 58% and Edinburgh 43%.
4.26 An encouraging feature is the high number of suspicion tests conducted. This shows staff awareness and the confidence to tackle drug taking behaviour.
4.27 From our findings, and what we were told, it would appear that injecting is not endemic within the establishment.
4.28 Presently the establishment has 22 drug free places – although the SPS Corporate Plan 1999-2002 states that 'Cornton Vale should have 62 drug free voluntary testing units by 2002'.
4.29 To address the absence of voluntary urine testing, new guidance was issued in April of this year encompassing a Voluntary Testing Unit (VTU), MDT, treatment and care planning and a VTU action plan. It is proposed that 10% of individuals within the VTU will be urine tested monthly (although a random or suspicion test could be conducted at any time). Following confirmation, a positive urine result will mean removal from the drug free area.
4.30 The establishment had two addictions nurses who conducted detailed assessments. However, both members of staff have taken up new community based posts, with their old posts being filled from within the establishment's nursing team. By November 2001, it is envisaged that new addictions workers will be in post via funding from the Scottish Executive. Hopefully, these appointments will allow for many more detailed addictions assessments to be undertaken than at present (where only those who have tested positive are assessed).
4.31 A family addictions helpline is to be established in the near future, giving families a named contact person - Family Forum. Staff then plan to respond to anxieties and queries on a regular basis.
4.32 One of the newly appointed addictions nurses also plans to develop the role of Family Contact Addictions Development Nurse by ensuring he is available in the visiting area for family queries/concerns.
4.33 A worker from Turnaround operates in Cornton Vale 3-days per week, carrying out specialist addictions assessments for women from the West of Scotland. This worker is able to offer one-to-one counselling and liberation day lift service, and also liaises with community prescribers and agencies. A welcome development is the inclusion of this worker in the 'Drug Strategy Co-ordination Group'. This is a further example of good practice.
4.34 A Urinalysis Machine is due to be introduced shortly, and will provide quick individualised urine testing allowing for individualised prescription. Running costs at approximately £13,000 per annum will ensure that admissions can be screened.
4.35 Addictions Awareness Focus Groups have been established for staff and prisoners -another example of best practice.
4.36 We commend the work being carried out by a committed team who have made rapid progress and who hope to expand and improve the service still further.
4.37 The expected arrival of new addictions staff in November 2001 will offer further possibilities for development. It is also envisaged that some uniformed staff will become part of the 'Addictions Services Team'.
4.38 Between 1995 and 1997, the number of deaths in the Institution had risen sharply – three remand prisoners in 1995, two remand and one convicted prisoner in 1996, then one convicted prisoner in 1997. A further fatality (remand) had then occurred in 1998. (Over this same period a number of serious suicide attempts had also taken place; see also paragraph 1.5 for self harm statistics).
4.39 Despite the fact that some of these suicides have been the subject of the longest running Fatal Accident Inquiry in Scottish legal history it is not possible to isolate common factors which have led these women to end their lives. However, the following may have some relevance:-
4.40 More importantly, however, is the context in which women end up in Cornton Vale. Female offenders are a disproportionately vulnerable group and may be at greater risk of self destructive behaviour while in custody: also if a female prisoner in another Scottish prison shows suicide tendencies, she is usually transferred to Cornton Vale.
4.41 Given the various factors above, therefore, what has been achieved since 1998 is all the more remarkable. Specific measures which we would draw attention to include the introduction of the new ACT Strategy, the strengthening of the induction process, improved mental health support, the Listener Scheme and prison officer awareness training.
4.42 The Acting Health Care Manager is the ACT Co-ordinator responsible for implementing the policy, with the Deputy Governor having overall responsibility. Membership of the ACT Group includes representatives from all the Houses; Medical Officer; social worker; psychologist; occupational therapist and a listener. The Co-ordinator also attends national meetings.
4.43 Clear procedures for dealing with any serious situations resulting from self harm or suicide attempts have been instituted (included the debrief of staff following any incident). Prisoners placed on ACT are allocated a member of the mental health team to monitor their progress and give support.
4.44 At the time of inspection there were 21 prisoners on ACT. Analysis of the data over the preceding 12 months showed that the number of prisoners on High Risk ACT observations ranged from between 2 to 12 on any one day, whilst the numbers assessed at Low Risk during the same period ranged from 8 to 30. (The workload which these at-risk prisoners generated was considerable with as many as 200 case conferences each month.)
4.45 Data on hospital admissions indicated that there had been 14 occasions during 2000 when episodes of self harm were sufficiently serious to warrant urgent hospital referral. For the current year (2001) to the end of April there had been 7 such incidents, (though these prisoners were not necessarily on ACT at the time).
4.46 The ACT strategy has been effectively and sensitively implemented within the institution, taking account of the nature of the very troubled women which the prison has to look after. Women on observation are allowed out of their cells during the day whenever possible, and are also allowed as many possessions or facilities in their cells which are commensurate with their safety in an attempt to integrate them into a normal prison environment. We saw two examples to illustrate this approach during inspection. In one case, a prisoner on ACT was working in one of the workshops. In another case, a woman considered at High Risk was seen in one of the establishment's 17 anti-ligature cells; however the door had been left open.
4.47 It is also clear from the data that incidents of self harm have begun to show a dramatic fall. In 1999 there were 115 incidents, 72 incidents in 2000 and 13 incidents so far in the year 2001.
4.48 The reasons for this dramatic reduction are not entirely clear: however the general implementation of ACT and the role of the mental health team are likely to have contributed. Certainly, as numbers have fallen, the workload and referrals to the mental health team have risen. It is of further note that the 115 incidents in 1999 involved 74 prisoners (rate of self harm = 1.6). The 72 incidents in 2000 involved 54 prisoners (rate = 1.3) and so far up to the time of our visit in May 2001 the 13 incidents had involved 13 prisoners (rate = 1). This clearly indicates that staff are being effective in preventing women repeatedly carrying out acts of self harm, which is a very encouraging trend.
4.49 It is also apparent that there is a pool of women who engage in serious attempts at self harm - the challenge is how to try and deal with this residual group. Here, the comments of the psychiatrists on the need for clinical psychology input must be taken into account (see paragraphs 6.25 – 6.28).
4.50 We interviewed the prisoner who co-ordinates the activities of her fellow listeners within the prison. She was pleased that her group had representation on the ACT Group and said that the work of the listeners was valued by prisoners and by staff. Nevertheless the number of listeners was falling and currently there were only four active. We therefore recommend that every effort is made to recruit and train more listeners as soon as possible.
4.51 There were two other causes for concern; the first was the length of time it could take for a listener to be contacted and hence render help. The second was the long lock up periods at weekends from 1700 hours on Saturdays to 0800 hours on Sundays, during which times it was not possible to respond to requests. We would suggest that both these arrangements be urgently reviewed.
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