22 February 2021

CNWL’s Dr Catherine Durkin, a forensic psychiatrist at the women’s prisons HMP Downview and HMP Send has been talking about the work she and the wider In-reach Mental Team carry out.

The women they assess have often experienced significant trauma that has not been previously disclosed in full.

These will be very vulnerable women, often from marginalised groups and who have been separated from their children in often distressing circumstances. Immigration issues as well as having to navigate their way through the Criminal Justice System will all add to the stress that they are dealing with. 

Many of the women that they work with are also overrepresented in their experience of Adverse Childhood Experiences (ACEs), such as abuse, neglect and exposure to familial mental ill health and substance misuse.

There is increasing evidence of the impact that exposure to ACEs can have on mental health and there is an association between traumatic experiences and the development of a range of psychiatric illness such as: PTSD, Complex PTSD, anxiety disorders, depression and personality pathology.

She says: “Rather than focus on a diagnosis, it’s often about creating a formulation – understanding how this individual came to be in prison and trying to build up a narrative to help understand their mental health presentation.”

As a Multi-Disciplinary Team (MDT) the emphasis is on working in a psychological and trauma informed way when thinking about how best to meet the needs of the women. It has a range of psychological services it can offer the women including 1:1 trauma work, art therapy as well as robust care and support from care coordinators.

Dr Durkin says that one of the most important roles they do can come from simply giving the woman time to talk about what they’ve been through.

“You assume that people have had the opportunity to sit down and talk about what’s happened but often they haven’t. Being able to disclose what has happened to someone and to not feel judged is very important. Being able to listen to what someone has said and to say that you are sorry about what they have been through can be very powerful for the women,” she says.

And it’s once that trust is built up, that the team can support women in a number of interventions.

She adds: “In addition to specific psychological work and prescribing appropriate medication, a lot of what we do is about supporting women and liaising with all of the different partnership agencies that exist in custody. We also try and safeguard their onward journey with services after they leave custody, but we are very aware how little is available to support women after leaving prison.

“The nature of what we deal with and also the environment in which we do it can be very challenging. However, I am lucky enough to be supported by a fantastic team and being able to support each other and share experiences, good and bad, is what helps us provide such a good service to our patients.”

Dr Durkin was quoted recently in The Guardian in relation to research conducted on behalf of the Centre for Women’s Justice; a report called Women who Kill, which can be read here.