Blog: International Women’s Day – if we know the answers, what’s stopping improvements for women in prison?

Last week, Susannah Hancock published the Ministry of Justice commissioned review “Delivering the Best for Girls in Custody”, producing recommendations to pursue the outcome of “a safe, supportive, gender responsive placement that delivers positive outcomes for girls” in England and Wales. Recently formed for England and Wales, the Women’s Justice Board also aims to send fewer women to prison. In Scotland, Community Custody Units have been created to provide gender-specific secure accommodation for women, and the end of detention of under-18s in YOIs was implemented on 28 August 2024 with the Children (Care and Justice) (Scotland) Act. All under-18s have now been moved to secure care settings. These are positive steps; while long-needed attention is now being paid to the causes and experiences of women’s detention, there is still a crisis in women’s support and gaps in understanding the interaction of crime victimhood, trauma and offending. In Northern Ireland, increasing numbers of women are entering its women’s prison, especially with complex mental health needs, with a high proportion on remand.

NPM bodies frequently remark on women and girls detained in settings designed by men, for men, in justice and health systems that cannot deliver for their needs. We see difficult but important steps being taken to prevent the ill-treatment of women through design of establishments and their regimes or care provision. There is still, of course, a lot of work to be done to ensure that the OPCAT mandate works to prevent torture, cruel, inhuman or degrading treatment for all people deprived of their liberty. The physical, as well as behavioural needs of women need more consideration across all deprivation of liberty settings.

Figure 1 The British Psychological Society, 2018: ‘Our system appears to have been designed centuries ago by men, for men’ | BPS

Various international instruments, such as the Standard Minimum Rules for the Treatment of Prisoners (Nelson Mandela Rules) outline human rights based minimum standards for conditions in detention. The United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (the Bangkok Rules) outline supplementary standards more specific to women’s experiences. The Bangkok Rules provide a human-rights based set of minimum-standards for prisons, and should be considered alongside instruments including:

• The United Nations Body of Principles for the Protection of All Persons Under Any Form of Detention or Imprisonment
• The United Nations Convention on the Elimination of All Forms of Discrimination Against Women

The core principle of the Bangkok Rules is that distinct considerations apply to women prisoners and offenders, recognising that:

OPCAT guidance for women

Since the last International Women’s Day, the NPM has produced, in partnership with ICVA, a Menopause Toolkit for all NPM inspectors, monitors and visitors. It applies to all detention settings and explores the risk factors and impacts of perimenopause, menopause and post menopause for women deprived of their liberty. People deprived of their liberty are recognised as inherently vulnerable. In addition, there is less awareness of menopause and its impact on detainees than for other health conditions. This can lead to people deprived of their liberty going without their health needs met, with impacts on their physical and mental health and behaviour. Without proper awareness this can mean they are further treated unfavourably.

The prohibition of torture and cruel, inhuman and degrading treatment imposes an obligation on the State to ensure that the health and well-being of detainees are adequately secured, by providing the required medical assistance. Of course, stigma around the biological functions of women’s bodies is a society-wide issue which impacts on prisons, rather than a prison-specific problem. In 2020, the Scottish Government launched the campaign “Let’s Call Periods, Periods” to reduce period shaming and the personal, social and medical problems this can cause. However, the nature of being deprived of your liberty, and dependent on those detaining you to deliver your basic needs, means that menopause and menstruation stigma is a more significant problem for women in prison. The NPM has also contributed to a global report on women in prison by the Association for the Prevention of Torture (APT). The UK NPM contribution focussed on the concern areas of body searches, use of means of restraint, solitary confinement and isolation, access to healthcare, mental health, contact with the outside world, accommodation, food and resettlement. It emphasised that:

NPM body scrutiny: what we find

In England (noting that there is no women’s prison in Wales), HMIP reported in May 2024 that, two decades after the Corston Report, there was still little evidence to suggest any progress on the radical changes recommended to improve the way women are treated by the Criminal Justice System. Few women had the opportunity to participate in evidence-based interventions to address their needs.

More recently, HMIP highlighted the rocketing rate of self-harm among women in prison in the last ten years. A thematic inspection found that rates of self-harm in women’s prisons are 8.5 times higher than in men’s jails, a clear sign that women are not safe and are not yet adequately supported. Across Council of Europe member states, women are often held in a small number of locations, given that they usually represent a minority of persons deprived of their liberty. This can mean that they are far from their homes, their children and their support circles. Nelson Mandela Rule 59 requires that “prisoners shall be allocated, to the extent possible, to prisons close to their homes or their places of social rehabilitation.

HMIP found that, in prison, UK women face a “paucity of regimes” and where officers lack the training and support they need to help women cope with trauma, mental health issues, and the challenges of being in prison. Shortages of staff in prison teams reduced the chance of any meaningful support being provided during their sentence, undermining the purpose of a prison sentence.

Figure 2 HMIP “Time to care: what helps women cope in prison?” Time to care: what helps women cope in prison? – HM Inspectorate of Prisons

In women’s prisons in England, despite commitments to remove courts’ power to use prison as a “place of safety” (under the Mental Health Act 1983) or to remand people to prison for their own protection under mental health grounds under the Bail Act 1976, the number of women deprived of their liberty under these provisions has actually increased in some prisons. The IMB at HMP/YOI Bronzefield wrote in November 2024 of “a growing number of women experiencing severe mental health crises…under the label of “place of safety, due to a shortage of beds in psychiatric hospitals”, exacerbating the distress of already vulnerable women. Women sent to this prison under the Mental Health Act increased by 110% during the reporting year.  

In Northern Ireland, NPM subgroup members have noted with concern the increasing numbers of women in Hydebank Wood Women’s Prison. However, an unannounced inspection carried out in May to June 2024 observed encouraging positive practice. Hydebank Wood Women’s Prison had not only maintained but improved its performance since the last inspection and was the first prison in Northern Ireland to achieve “good” against all four healthy prisons tests (safety, respect, purposeful activity, and preparation for release).

Inspectors noted highly effective leadership from the Governor and a strong team of senior leaders, working in partnership with leaders from partner organisations, the prison staff and the women living there. A high percentage of women were engaged in purposeful activity and creative opportunities.

RQIA remarked that the South Eastern Health and Social Care Trust, responsible for primary and mental health care and substance use services in Northern Ireland’s prisons, provided a resilient team which worked well with prison staff to drive improvement through innovative, motivated teams in prison, promoting health and wellbeing in the prison and keeping waiting times for improvements in line with community waiting times. Despite this, there was a high number of women who did not attend their primary and external healthcare appointments.

A step forward in Scotland

In Scotland, two women’s community custody units (CCUs) are operational, providing an alternative facility to the traditional (male) prison model, designed as a therapeutic environment with a gender-specific approach. The two units opened in 2022 to fulfil some of the recommendations in the Commission on Women Offenders Angiolini Report reviewing the experiences of women in prison, which was published in 2012. HMIPS conducted a full inspection of each in 2024, and while there were of course concerns still to raise, the tone of these reports marks a clear difference from the overall picture for women in England and Wales. HMIPS also inspected HMP & YOI Stirling, which opened in July 2023, in February last year.

The Bella and Lilias centres, designed as “shared houses”, provide specialised support through close collaboration with community services, giving women access to the community to constructively develop independent living skills to support them after their sentence.

Figure 3 HMIPS “The Lilias Centre; Full inspection 2024” Report on Full Inspection of The Lilias Centre | HMIPS

At the Lilias Centre, for low supervision women, inspectors found a calm, relaxed and good humoured environment, including a 2024 International Women’s Day event showcasing community services and entrepreneurial workshop. Women felt safe, respected and supported.

The Mental Welfare Commission for Scotland’s announced visit to the Lilias Centre, reporting on mental health support, emphasised the increased access to local services and amenities closer to women’s own communities. Despite staff shortages due to absences, women at the Lilias Centre told MWCS that the centre was a significant improvement to living conditions in prisons and had easier access to psychological therapies to develop an understanding of their diagnoses and the impacts these had on their lives. Women described dealing with responsibilities, straightforward access to mental health services, and available medication.

A main issue at both sites was the use of routine body searches, which failed to live up to the trauma-informed approach of the CCUs, where intelligence-led-only body searching would be more appropriate to the lower-secure settings. At HMP & YOI Stirling, HMIPS found “many positive aspects” of the modern accommodation, including windows without bars, a therapeutic campus design, and adherence to the trauma-informed ethos of Scotland’s National Strategy for Women in Custody. It is encouraging that, where a strategic approach to improving treatment and conditions for women deprived of their liberty is adopted, positive inspection findings have followed.

The stepped back view

The routes for women entering prisons are different to those for men, and across the UK women in severe mental crisis are placed in prison when they should be in a hospital. What NPM bodies have seen working well is based on a public-health approach, with close community links and collaboration between interdisciplinary teams. While prison staff would benefit from targeted training and enhanced support, this is an area that demands close strategic work between health and justice sectors. A shortage of secure psychiatric beds and competition between health trusts over funding and responsibility creates significant delays transferring women from prison to hospital. According to the Board at Bronzefield, this delay is at the root of a large proportion of the high incidence of self-harm. Amendments to the Mental Health Act will be welcome to ensure that women are cared for in a mental health, rather than criminal justice, setting, but improved outcomes for women will rely on a longer-term public-health approach and partnership between health and justice bodies.

Engagement with recommendations from reports that have raised serious concerns in the past show that there is hope that conditions and treatment for women in prison will improve. Many staff are committed to supporting women and implementing evidence-based approaches to improving outcomes for them. However, staff face an under-resourced environment in which many of them are not provided with the training they need to deliver the best outcomes for women in mental health crisis.

Prisons do not operate in a vacuum, and the safety and quality of their environments rely on sensible sentencing decisions and legislative developments, such as those expected in the upcoming reform of the Mental Health Act. The UK NPM will continue to proactively monitor the treatment and conditions of women deprived of their liberty, report on findings and raise our concerns directly with UK ministers and international treaty bodies, to make sure that all forms of torture, cruel, inhuman or degrading treatment or punishment are prevented in the UK.