Bangkok Rules

GIRL POWER

Today, International Women’s Day, we decided to calculate just how much Girl Power we possess…

Founders: 50% female

Governors: Philippines 43% female, UK 20% female

Managers: 100% female

Staff: 67% female

Long-term volunteers: 75% female

Current short-term volunteers: 100% female

Previous short-term volunteers: 95% female

If you’d like to read what our ladies have got up to lately, we’re pleased and proud to introduce you to Healthy Bonds, our 2023 impact report.

GIRL DisEMPOWER

And it’s a good job we are such a female-dominated organization, because the number of female prisoners across the world is increasing fast - up 20% since 2000!

How many women are behind bars right now, do you think…?

100,000?

250,000?

500,000??

No, it’s well in excess of 750,000! That’s an awful lot of female disempowerment.

GIRL RE-EMPOWER

But there is one tool that is helping to shine a pink-ish tinged light into this feminine doom and gloom…

The so-called Bangkok Rules are United Nations rules on the treatment of female detainees and non-detaineed offenders. If you haven’t read them, please do! And if you know someone who works with female detainees, shove a copy under their nose!

No, they don’t make the problem of female detention go away. But, where they are properly implemented, they make a significant difference to the re-empowerment of female detainees.

Dr Rachael Pickering is our co-founder and Chief Medical Officer.
Her views do not necessarily represent those of Integritas Healthcare

Alexei Navalny

One day

My 16th February 2024 started out as a pretty standard Friday, doing my job as a doctor within the UK’s prison system. Sadly, it ended in tragedy with the unexpected death of one of my detained patients. After leaving the prison, I sat in my car for a while, thinking and praying for my late patient’s family. And as I drove out of the prison car park, I noticed two parked up police vehicles…

Investigation

Of course, the police were there because - whether expected or unexpected, self-inflicted, accidental or murderous - all UK deaths in custody are subject to extensive investigation by multiple agencies:-

• the police

• the coronial system

• the health service

• and the Prisons and Probation Ombudsman.

In addition to all these measures, the Council of Europe’s Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), which is responsible for monitoring member states’ compliance with Article 3 of the European Convention on Human Rights, also takes a keen interest in deaths behind bars.

Two deaths

In the busyness of managing the immediate aftermath of my own detained patient’s death, I missed the breaking news about another custodial tragedy - that same day but thousands of miles away, in the frozen Artic Circle…

Prisoner Alexei Navalny, the fiercest and most enduring critic of President Putin, is dead.

Investigation?

• He died just one day after being well enough to laugh and joke with his judge.

• There is the usual confusion about the cause of his death and the location of his body,

• The Investigative Committee of the Russian Federation, whose agency executive is (according to Wikipedia) a certain President Putin, is on the case.

• And so it remains to be seen whether the United Nations has engaged in a spot of wishful thinking, in calling for his death to be rigorously investigated.

One judge

UK detainees are relatively blessed compared with those held in many other parts of the world. UK conditions of detention are regulated, monitored and - when found to fall short - investigated. Yes, I know full well that there are many problems behind my nation’s bars - and the CPT highlights these failings on a frequent basis. But compared with many places in the world, UK places of detention sit within a veritable Garden of Eden where the Rule of Law presides.

Yet viewed through the long lens of eternity, whether a free President in the Russian Federation or a detained person in the UK, one day every one of us will die and face judgement by the same Judge.

From His courtroom, He examines all the goings on in our world, with notable concern for detainees:-

The Lord looked down from His sanctuary on high, from heaven He viewed the earth, to hear the groans of the prisoners and release those condemned to death.
(Psalm 102:19-20)

And to those who ignore the visible suffering of others, yet alone those who cause it, He will say…

 Depart from me, you who are cursed, into the eternal fire… For I was hungry and you gave me nothing to eat… I was sick and in prison and you did not look after me…

Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.
(Matthew 25:41-45)

The author is one of our spokespeople
Their views do not necessarily represent those of Integritas Healthcare

Will nitrogen enter the death arena?

So once again, death penalty demonstrators are gathering outside a USA prison. This time though, things are a bit different: the execution agent is gaseous, and the condemned man is a repeat attender…

Who and why?

Kenneth Smith is one of two assassins-for-hire who in 1988 killed Elizabeth Sennett, the wife of a pastor who hoped her life insurance could ease his financial troubles. Shortly after the killing though, the pastor killed himself - rather than face earthly justice.

A long 22 years later, in 2010, Kenneth’s partner-in-crime received the stiffest penalty meted out by the US Justice System - execution. And Kenneth himself is sentenced to the same punishment, yet he’s still on death row - at least until later today, 25th January 2024, when he is scheduled to become the first person in the USA to be executed through nitrogen asphyxiation.

Why gas and why now?

But why are the authorities using nitrogen gas rather than lethal injection, and why have they waited until now - almost 36 years after the murder - to execute him? Well the answers to these two questions are linked…

The USA’s capital punishment appeal system is notoriously slow and convoluted. It’s common for condemned people to spend around 20 years on death row. Some argue that this long wait for almost certain death is itself a form of psychological torture. And it’s not uncommon for death row prisoners to die of illness rather than by the executioner’s hand.

In Kenneth’s case, it was 33 years between conviction and the authorities first taking him to the death chamber in November 2022. But things didn’t go to plan…

As is common to many botched executions, his would-be executioners lacked sufficient skill in venous access to get the necessary needles into him. After several hours of trying, his death warrant expired and so they had to abandon the execution and return him to death row, his home for the previous three decades.

And in the aftermath of that debacle the authorities promised not to try to use lethal injection on him in the future.

So that is why Kenneth has been rescheduled to die - at another time and in another way.

Why worry?

Right now, more than the usual amount of last minute legal appeals are going on. And this is due to at least two key factors…

Firstly, no-one can reasonably deny that surviving a botched execution is a traumatising experience. And Kenneth’s legal team is arguing that it’s cruel to do this to him all over again.

And crucially, the UN High Commissioner for Human Rights is alarmed at the prospect. Quoting an extract of their full statement:-

We have serious concerns that Smith’s execution in these circumstances could breach the prohibition on torture or other cruel, inhuman, or degrading treatment or punishment, as well as his right to effective remedies. These are rights set out in two International Human Rights treaties where the United States is bound by – the Covenant on Civil and Political Rights and the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment [CAT].

So, will the execution go ahead and - if so - will it go as ‘smoothly’ as the authorities hope? All eyes - and many hearts and prayers - are fixed on that death chamber right now. We’ll be updating you soon.

Dr Rachael Pickering is our Chief Medical Officer
Her views do not necessarily represent those of Integritas Healthcare

Easter suffering down the ages

This Easter in the Philippines

This Easter I’m in the Philippines, the most incredibly beautiful and diverse South-East Asian archipelago nation with complex religious traditions partly rooted in Roman Catholicism. Since 2015 and barring the first two years of the COVID-19 Pandemic, I’ve spent approximately a fifth of my working life based out here. I even have a second home here.

I absolutely love the Philippine people. Their warmth and respect are second to none. And although I still have much to learn, I’m now very comfortable with many of their perspectives and customs - save for one…

Volunteers for flagellation

Self-flagellating Filipino

This is the third or fourth Easter I’ve celebrated out here. And although I appreciate much about the Roman Catholic Church’s celebration of Easter, one thing I have not adjusted to is the non-orthodox yet widespread practice of voluntary self-flagellation and even voluntary crucifixion every Good Friday.

This practice jars with me most particularly because I have expertise in the detection and prevention of torture and ill-treatment, and so sometimes I have to examine torture victims who have been flogged. And a severe flogging was just part of the barbaric execution method inflicted on Jesus at the original Easter…

The original Easter in Israel

The Roman form of crucifixion was the ultimate control mechanism: feared by everyone within the Roman Empire, it acted as both deterrent and punishment…

Victim of crucifixion

The very first Easter saw God the Son, Jesus suffering and dying at the hands of others. He did so not because he wanted to - he wasn’t a masochist. Rather, he begged God the Father to spare him from his forthcoming ordeal:-

My Father, if it is possible, may this cup be taken from me.
(Matthew 26:39)

But it was not to be. Jesus was arrested, tried, sentenced, tortured and executed. This makes him history’s most famous torture victim.

SENTENCED FOR US

So, why was Jesus sentenced to death? Not because God the Father was a cosmic child abuser - a charge levelled by some modern-day liberal theologians. No, Jesus was executed in our place for our sins.:-

But he was pierced for our transgressions, he was crushed for our iniquities;
the punishment that brought us peace was on him, and by his wounds we are healed.
(Isaiah 53:5)

All we have to do is accept this incredible gift…

For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life.
(John 3:16)

… and follow the teachings of Jesus, our incredible Saviour:-

Then Jesus said to his disciples, “Whoever wants to be my disciple must deny themselves and take up their cross and follow me.
(Matthew 16:24)

With no disrespect intended, try as I might, I cannot understand why anyone who has truly understood Easter would perform self-flagellation. As I often say, ‘Jesus was tortured and died - so we don’t have to’.

Taking up our cross

So what did Jesus mean when he said we should take up our cross and follow him? Did he mean that we should self-harm every Easter? No! Did he mean that we should look for ways to goad those who are in a position to torture and execute us? Again, no!

No, by ‘follow me’ he meant that we should decide to follow his teachings. And by ‘take up his cross’ he meant that committing to follow him was not a nice, vague concept but a profound and self-denying lifestyle decision.

And yes, both then and now, following Jesus may lead to punishment and death. It is thought that the vast majority of Jesus’ original disciples met violent ends. But they did not volunteer to suffer and die, and they did not hurt themselves. No, they merely carried out their Lord’s final set of earthly instructions - with fatal consequences:-

Then Jesus came to them and said, “All authority in heaven and on earth has been given to me. Therefore go and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, and teaching them to obey everything I have commanded you. And surely I am with you always, to the very end of the age.”
(Matthew 28:18-20)

Almost two thousand years later, crucifixion is rare (though still crops up from time to time) and so thankfully I have yet to be asked to examine a case - fatal or otherwise. Yet there are many other ways to become a martyr…

WarTime Easter in Germany

The date on which Easter is celebrated fluctuates, as it is tied to the lunar rather than solar calendar. And by macabre coincidence, this Easter Sunday (9th April 2023) marks the 78th anniversary of the 1945 martyrdom - just eight days after that year’s Easter Sunday - of a great Christian hero…

Victim of hanging

Pastor Dietrich Bonhoeffer
(Image provided by Encyclopædia Britannica)

Pastor Dietrich Bonhoeffer was German born and raised. Yet he steadfastly opposed Nazi dictatorship and championed Christian discipleship, despite the unwelcome yet inevitable cost.

He participated in rescuing Jews. He refused to cooperate with the Nazification of the German Church. And he was linked to attempts to overthrow Hitler.

He didn’t want to suffer and die. Even though he was doing these incredibly dangerous things, which he knew risked capture and death, he was also planning for the future of the church after World War II. He even planned for his personal future - by getting engaged to be married!

Finally though, the inevitable happened: he was arrested in April 1943. He spent the last two years of his life in detention. Firstly, he was put in Tegel Prison, Berlin awaiting trial. Next he was sent to Buchenwald concentration camp. And then finally he was transferred to Flossenbürg concentration camp for a quick show trial. He was hanged the very next day, on 9th April 1945, just one month before Germany surrendered. During his detention he suffered both physically and psychologically; the manner of his death by hanging was also possibly more cruel than some biographies state.

During his years as a prisoner he lived a life devoted to Christ, sharing God’s offer of salvation with fellow prisoners and prison officers. He also wrote fervently to friends, family, and his fiancée. Posthumously his letters and some of their replies were compiled into a well-known book, Letter and Papers From Prison. Reading these letters is both encouraging and humbling.

CONSIDERING the suffering

Bonhoeffer had lived experience of Matthew 16:24. He also witnessed much suffering of others, and during his imprisonment he wrote:-

We must learn to regard people less in the light of what they do or omit to do, and more in the light of what they suffer.
(Letters and Papers from Prison)

How true. Yet how often do we fail to evaluate people in light of their past, their trauma and their suffering, rather than reacting directly to their words and behaviour?

JamMING The Wheel

Also whilst behind bars, Bonhoeffer wrote what may be his most famous quotation:-

Medieval torture wheel

We are not to simply bandage the wounds of victims beneath the wheels of injustice, we are to drive a spoke into the wheel itself.
(Letters and Papers from Prison)

This sentence encapsulated all that he lived for. He did not simply write and teach on the morals and ethics of the Christian life. He lived it too. His firm belief was not just in helping those crushed by the weight of this world’s injustices, but in radically intervening for the oppressed and averting the course of injustice so as to stop ‘the wheel of injustice’ from moving on to crush others in the future. And it cost him his life.

Future easters behind bars

Logo of our expertise and advocacy services

As a Christian faith-inspired organisation with a heart for detainees, we are inspired by the life and words of Bonhoeffer. All too often, we discover modern-day victims with wounds that need bandaging and wheels that need jamming.

Speak up for those who cannot speak for themselves, for the rights of all who are destitute. Speak up and judge fairly; defend the rights of the poor and needy.
(Proverbs 31:8-9)

May God bless you this Easter.

Dr Rachael Pickering, adapted from the 2019 article co-authored with Dr Esme MacKrill

PS we always welcome prayers and donations for the Gerry Serrano Centre.

All alone

This week we are discussing solitary confinement…

Isn’t it freaky how online platforms seem able to predict our interests? Last week, I turned to Disney+ for a crime & punishment film I needed for work purposes. And then this week on a mini-break I logged on to find a nice relaxing movie, only to be confronted by the platform’s 'because you watched' suggestion of yet another crime saga! And the thing is, both on duty and off duty, I am interested in all things crime & punishment. So in for a penny, in for a pound...

Bronson

A biographical film armed with a hefty degree of artistic license, Bronson tells the story of Charles Bronson, the well-known muscled and mustachioed fixture of the solitary cells within Britain's high secure prison estate (HSE). First imprisoned in 1974 aged 22 under his birth name of Michael Peterson, excepting a handful of days he’s been under various kinds of lock and key ever since. How can this be though? After all, his original sentence - for armed robbery - was just seven years!

Mainly it’s due to his behaviour whilst inside prison. Attempted murder. Grievous bodily harm to fellow prisoners and staff. Taking hostage an art teacher, a doctor, and governors. And massive wanton destruction of prison and special hospital property and buildings. Acts like this do not go hand-in-glove with timely release.

Rehab

Proponents of the benefits of imprisonment talk about its potential for rehabilitation. Yes, some prisoners can and do learn useful things behind bars - reading & writing, the wrongness of their offending behaviour, and practical skills for gainful employment after release. Creative avenues of self-expression are also taught within some secure environments. Mr Bronson, for example, attended art classes behind bars and has become a notable prison artist: despite being in solitary, he turns out some impressive pieces.

Still, a key question posed by Bronson is this: are such rehabilitative benefits mere silver linings within a de facto harmful black thunder cloud? Were it possible to write Mr Bronson into a sequel to Sliding Doors, we could rewind his life back to just before the events that led to his first imprisonment. A longitudinal criminal justice case study could then follow, potentially with incredible answers to deep questions. Was he always destined to go down the same disturbing life trajectory - regardless of whether he was imprisoned? Or could he have turned out far more benign and productive, like so many other young men born and bred in post-war Luton? And did his earliest years in solitary confinement and other forms of detention do him significant and lasting psychological harm, mould his longer-term behaviours, and beget his whole life story?

Warning

I'm a HSE healthcare professional (HCP). Mr Bronson has been detained within the HSE for ever so long. And in Britain, Prison Service Order PSO 1700 mandates a nurse visiting all solitary prisoners daily and a doctor every three days. As a result, like many other HSE HCPs I have met and cared for Mr Bronson. So I voice no personal opinion about his case other than noting that the safe housing of such an unusually violent prisoner must pose a fiendishly difficult dilemma for any prison governor.

Leaving him aside though, I have formed definite conclusions about solitary confinement per se - views honed during countless 72-hourly 'Doctor's Seg Rounds' in the UK as well as many visits to various other countries’ solitary confinement units. [1]

So what do I think? Whilst a degree of separation from the rest of the prison population is sometimes necessary, never have I seen solitary confinement produce lasting improvement in a prisoner’s mental and physical health. On the contrary, I often see mental and physical health deteriorate. And for certain, I think that its longer-term use should come armed with a health & safety warning every bit as serious as those emblazoned across modern-day cigarette packets: ‘Solitary confinement is bad for your health'. And I’m far from the first to say this…

COVID

The world has just been groaning under the weight of COVID lockdowns. Though undeniably bitter, our own ‘pandemic sufferings’ have been just a small taste of the horrific suffering endured week in, month out, even year in, decade out by prisoners held in long-term solitary confinement. And solitary confinement wasn’t exactly rare before the pandemic:-

… it [solitary confinement] continues to be used across the globe – including for vulnerable groups such as prisoners with disabilities and children – in contravention of international standards. This is despite increasing recognition of its detrimental psychological and physiological effects, and of the economic costs… New Zealand, for instance, saw a 151 per cent rise in the use of solitary confinement over the five-year period up until 2016, compared to a 16 percent rise in the prison population… In the US, a report detailed how blind and deaf prisoners in solitary confinement experience a heightened form of sensory deprivation as a result of their disability...
(Global Prison Trends 2018, Penal Reform International)

Sensory distortion is a key feature of solitary confinement syndrome. This syndrome is a very real thing. I have seen it in some of my patients around the world and it’s most upsetting to witness. How much worse must it be to experience it?

United

So what does the United Nations (UN) have to say about solitary confinement? Actually, quite a lot. The Nelson Mandela Rules read as follows:-

Rule 43

1. In no circumstances may restrictions or disciplinary sanctions amount to torture or other cruel, inhuman or degrading treatment or punishment. The following practices, in particular, shall be prohibited: (a) Indefinite solitary confinement; (b) Prolonged solitary confinement...

Rule 44

For the purpose of these rules, solitary confinement shall refer to the confinement of prisoners for 22 hours or more a day without meaningful human contact. Prolonged solitary confinement shall refer to solitary confinement for a time period in excess of 15 consecutive days.

Rule 45

1. Solitary confinement shall be used only in exceptional cases as a last resort, for as short a time as possible and subject to independent review…

2. The imposition of solitary confinement should be prohibited in the case of prisoners with mental or physical disabilities when their conditions would be exacerbated by such measures. The prohibition of the use of solitary confinement and similar measures in cases involving women and children, as referred to in other United Nations standards and norms in crime prevention and criminal justice, continues to apply.

At this point we could ask, ‘The UN is so down on it, so why is solitary confinement still such a strong feature across the globe?’

Europe

Leaving the effectiveness of the UN aside though, let’s return to Europe, which of course is the continent within which the star of Bronson is confined.

European detainees benefit from extra protection over and above UN guidelines. That’s thanks to the Council of Europe (CoE) and its European Convention for the Prevention of Torture and Inhuman or Degrading Ill-treatment or Punishment, which itself builds on Article 3 of the CoE’s founding legal instrument, the European Convention of Human Rights:-

No one shall be subjected to torture or to inhuman or degrading treatment or punishment.

The CoE’s European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) monitors compliance with the convention bearing its name, and its position statement on solitary confinement makes persuasive and sombre reading:-

Solitary confinement… can have an extremely damaging effect on the mental, somatic and social health of those concerned. This damaging effect can be immediate and increases the longer the measure lasts and the more indeterminate it is. The most significant indicator of the damage which solitary confinement can inflict is the considerably higher rate of suicide among prisoners subjected to it than that among the general prison population… In addition, it can create an opportunity for deliberate ill-treatment of prisoners, away from the attention of other prisoners and staff.

… ensuring that there is a positive doctor-patient relationship between them is a major factor in safeguarding… medical personnel should never participate in any part of the decision-making process resulting in any type of solitary confinement, except where the measure is applied for medical reasons. On the other hand, health-care staff should be very attentive to the situation of all prisoners placed under solitary confinement...

The CPT’s assertion that solitary confinement is associated with long-term damage to ‘somatic’ or physical health received a boost recently with the publication of the results of a European public health study. A review of over 800,000 person-months spent in Danish solitary confinement showed such incarceration to be associated with a significantly higher chance of death within five years of release. [2]

So the European Prison Rules do right to include a focus on solitary confinement:-

The medical practitioner shall report to the director whenever it is considered that a prisoner’s physical or mental health is being put seriously at risk by… conditions of solitary confinement… Such visits [by healthcare professionals to prisoners in solitary confinement] can in no way be considered as condoning or legitimising a decision to put or to keep a prisoner in solitary confinement.

Statements

In addition to these legal instruments and codes of practice though, groups of international experts have gathered to ponder the best available evidence about the pros and cons of solitary confinement.

In 2007 at the International Psychological Trauma Symposium, the Istanbul statement on the use and effects of solitary confinement was issued. [3] And it's particularly interesting to note that three groups of detainees were picked out as being especially high risk for solitary conditions:-

The use of solitary confinement should be absolutely prohibited in the following circumstances:

- For death row and life-sentenced prisoners by virtue of their sentence.

- For mentally ill prisoners.

- For children under the age of 18.

Then around a decade later, a summit in Santa Cruz was convened to review the interplay between solitary confinement and health. The resulting Consensus Statement from the Santa Cruz Summit on Solitary Confinement and Health includes eight guiding principles:-

1 The Santa Cruz Summit on Solitary Confinement and Health reaffirms the Istanbul Statement as an appropriate framework for reforming solitary confinement… solitary confinement subjects prisoners to significant risk of serious harm and it therefore should be used only when absolutely necessary, and only for the shortest amount of time possible.

2 The Summit reaffirms that the use of solitary confinement should be absolutely prohibited for certain groups of especially vulnerable persons, including the mentally ill, children, older adults, people with chronic health conditions… and pregnant women…

3 Reduction in the use of solitary confinement should be further informed by the growing evidence-based knowledge that prolonged isolation accomplishes few if any legitimate penological purposes…

4 Solitary confinement reform is consistent with ongoing efforts to address and enhance correctional officer health and wellness…

5 The unique ethical challenges faced by correctional medical and mental health care providers who work inside solitary confinement units are not easily resolved…

6 Meaningful forms of independent external and internal monitoring and oversight are essential…

7 As more prison systems significantly limit or eliminate solitary confinement, it is important that stakeholders document and disseminate evidence about the impact of these reforms…

8 Because the overuse of solitary confinement reflects and is related to dysfunction in the larger correctional systems in which it is deployed, its reform should be recognized as part of the broader movement to reform prisons…

Ill

I am struck that both these statements use the term ‘mentally ill’ in their descriptors of those who should not be held in solitary confinement, rather than more detailed phrases such as ‘permanently psychotic’ or ‘severely or enduringly mentally ill’.

This wider bracket of ‘mentally ill’ may be argued to include those with:-

• psychiatric effects from withdrawal from alcohol or drugs,

• psychiatric effects from drug taking,

• personality disorders,

• significant difficulty adjusting to prison life,

• even mild degrees of anxiety or depressive disorders.

Applying this wider definition would bar the vast majority of Club Solo’s regular patrons - certainly in the prisons I visit or work in, and I suspect in the vast majority of prisons worldwide.

N G

It’s taken the best part of two decades to formulate my own opinions about solitary confinement. That’s quite long enough! So I’ll close now with the best, oldest and thankfully shortest conclusion I’ve ever read on this subject:-

“It is not good [N G] for man to be alone...”

God (Genesis 2:18)

And our Creator should know what’s best for us, His creations, shouldn’t He?

Dr Rachael Pickering is our voluntary Chief Medical Officer. Her personal opinions are not necessarily the same as those of Integritas Healthcare. We are always grateful for support.

Notes

[1] ‘Seg’ is short for ‘segregation’, which is the name that solitary confinement goes under within the UK prison system.

[2] Wildeman, C et al. Solitary confinement placement and post-release mortality risk among formerly incarcerated individuals: a population-based study. Lancet Public Health 2020: Feb;5(2):e107-e113

[3] This statement should not to be confused with the Istanbul Protocol, which deals with the documentation and evidencing of torture in general.

Life after Death

This week we are reflecting on the need to care for relatives of murder victims…

Described by his court judge as 'wicked beyond belief', the late Ian Brady and his accomplice the late Myra Hindley are regarded as two of Britain's most depraved criminals. Back in the 1960s they abducted, tortured and murdered five children. They buried their first four victims on Saddleworth Moor in West Yorkshire, but then were caught before they could bury the final child. Two of the buried children were discovered soon afterwards before The Moors Murderers, as Brady and Hindley became known, were jailed on whole life sentences.

Bodies

I first became aware of these horrors, which took place a full decade before I was born, during a 1980s school trip. It was a biology field trip requiring us to drive through the West Yorkshire Moors, but our bus was not allowed to go the way the driver had planned. In the distance we noticed lots of police officers. What was going on? That night's TV news provided the explanation: one of the notorious Moors Murderers had been taken back to Saddleworth Moor to assist police in locating the two missing bodies. Indeed, that search was partially successful because later that year a fourth body, that of Pauline Reade, was discovered.

And now, 35 years later and acting on information regarding the recent discovery of possible human remains, police officers have returned once more to Saddleworth. Will the final body, that of Keith Bennett, now be discovered? We won't know for some time. And while we wait to hear the police's conclusions, I have been reflecting on the long-term consequences for the relatives left behind...

Living

This particular atrocity - the killing of Pauline Reade, John Kilbride, Keith Bennett, Lesley Ann Downey and Edward Evans - happened in 1963-1965. From then on the perpetrators were tucked away in prisons and a psychiatric hospital, until they died in 2002 and 2017 respectively.

The five children's families though remained in the real world, having to get on with the business of living…

Not having a body to grieve over may be tremendously hard: Keith's mother spent the rest of her life searching for his remains until her own death in 2012 when her mission passed onto her surviving son, Keith’s brother; and Pauline's mother ended up in a psychiatric hospital.

Although finding a body may help the grieving process, it does not necessarily stop the pain and stress. John's parents divorced. And Lesley Ann's mother had persistent nightmares requiring medication for years, though she still campaigned tirelessly to ensure that Hindley remained in prison; when she died in 1999, it is said that she vowed to haunt Hindley who survived her by three years.

Sequelae

Several of these relatives tried to communicate with their children’s killers. They wanted information. What might or might not have been communicated each way is outside the scope of this article. Yet, even if Hindley and Brady had seen fit to cooperate fully in what these days is often termed restorative justice initiatives, it may not have been enough to end the relatives’ distress.

Living in the knowledge that a loved one has been killed in a brutal fashion can have dreadful long-term sequelae for one's mental, physical and social functioning. So we healthcare professionals need to keep a special lookout for the health and wellbeing of patients known to be living in the shadow of such trauma.

Be merciful to me, Lord, for I am in distress; my eyes grow weak with sorrow, my soul and body with grief. My life is consumed by anguish and my years by groaning; my strength fails because of my affliction, and my bones grow weak.

Psalm 31:9-10

Dr Rachael Pickering is our voluntary Chief Medical Officer. Her personal opinions are not necessarily the same as those of Integritas Healthcare. We are always grateful for support.

The smiling queen

This week’s reflection is a tribute to the late Queen Elizabeth II…

Sombre silence

It was right and proper that the United Kingdom (UK) marked the funeral of Queen Elizabeth II with a bank holiday. We Brits needed a dedicated day to mourn our beloved monarch who reigned over us for an incredible 70 years.

Sadly for me, key workers don’t always get bank holidays off. So I worked a normal Monday in a local prison and then drafted this tribute on the train on the way home. It was unusually quiet in jail that day. Yes there was the usual clanking of iron doors. But there was far less people noise - no calling out ‘Doc doc!’ as I passed by closed cell doors. No, the loudest voices were those of the television broadcasters commentating on the funeral service. Prisoners joined the rest of Britain in watching our Queen make her final journey.

Formative memory

Now that I think about it, Queen Elizabeth II is the focus of one of my earliest and fondest childhood memories. I remember it like it was yesterday. I guess it was her Silver Jubilee tour. My mother had dressed us in our 1970’s finest. My grandmother had packed a flask of orange cordial and a whole box of cheese crackers. My ‘grandpy’ had donned his military medals. And we had camped out on a grass verge, waiting for the royal motorcade to pass by as it headed into my home town of Kingston-upon-Hull, which back then was somewhat down-at-heel in places.

Cheerfully bright

The crackers ran out - so I guess we waited quite a while - but finally we got to see her! It was just a few seconds, but I remember her outfit being so pretty and colourful, and - thanks to her brightly coloured lipstick - her smile being equally sparkly. My childish take on the whole occasion was one of feeling really chuffed that the Queen had bothered to get dressed up and drive all the way up to see us in Hull!

Although I never got to see her again, I think that - likely subconsciously - I somehow incorporated that early memory into my attitude towards professional attire. Whether I'm in scrubs in an overseas jail, in smart casuals for a day in a British jail, or zipped into a skirt suit in some snazzy lecture theatre, I like to add a splash of colour to my outfit and my lips, and I try to remember to keep on smiling. A cheerful face does wonders for sick prisoners!

Social justice

It’s more than 40 years later and I no longer live in Hull. No I live in London, work in English prisons, and run Integritas Healthcare, an offender healthcare NGO centred on the principle of social justice. And over the intervening years I've evolved a working belief that social justice and hereditary privilege are mutually incompatible. As monarchy is the ultimate hereditary privilege, I guess I’m a republican - in theory. Yet I've always been a fan of the Queen. Her dying has brought all this to mind and so I’ve decided to re-evaluate my seemingly opposing beliefs.

On the one hand it seems perverse that the British Royal Family gets to live in a whacking great palace in the centre of London whilst countless roofless souls squat under its many surrounding bridges. That said, I have no doubt that the fact of homelessness saddened Queen Elizabeth. She was a devout Christian who loved and served both her Lord and her people in exemplary fashion. I’m sure she tried to promote justness in the manner of Proverbs 8:15: 'Because of me, kings [and queens] reign, and rulers make just decrees'. Yet it is true that she also reigned over the twilight years of the British Empire, an organism that was responsible for many unjust acts. And back in ancient times God Himself warned the nation of Israel of the injustices that would occur in response to their desire to create a monarchy to replace their established system of prophets.

On the other hand, many members of the modern-day British British Royal Family spend huge amounts of time on patronage of various socially just charities, and no doubt some of them are similarly generous with their personal wealth. Our new king, Charles III, has done enormous good for socially disadvantaged youngsters through his brainchild, The Prince's Trust. Moreover, in other countries the loss or long-term absence of a monarchy does not go hand-in-glove with progression towards more socially just societies. I've lived in and worked behind bars in many a monarch-less state and so know full well that things are often decidedly grim when a president rather than a monarch sits in the palace!

Give thanks

So is monarchy really incompatible with social justice? Or is the issue a whole lot more complicated than that? Whatever you and I come to decide, I give thanks to God for Queen Elizabeth II and I pray for Britain's new King Charles III. May he be an early adopter of his mother's lifelong habit of greeting everyone in his kingdom with a cheery smile. And may we all remember to smile more - because, no matter our individual problems, there is always something to be thankful for. And a happier heart is a healthier heart.

A happy heart makes the face cheerful...

Proverbs 15:13

Dr Rachael Pickering is our voluntary Chief Medical Officer. Her personal opinions are not necessarily the same as those of Integritas Healthcare. We are always grateful for support.

Send more marmalade!

This week’s reflection from our Chief Medical Officer is a somewhat sticky affair….

Platinum bear

I grew up mainly in England and one of my favourite childhood TV programmes was a cartoon series of sticky stories about Britain’s hairiest ever smuggler of breakfast condiments! And I wasn’t the only one to love them. Yes, Paddington Bear is dear even to the heart of Queen Elizabeth II. Recently she even invited him to Buckingham Palace for tea and marmalade….

Criminal intent

Of course the Queen should not be associating with risky people. So in deciding to issue Paddington’s invitation to afternoon tea, the safety-conscious Palace officials must have decided to overlook his criminal record:-

• illegal asylum seeker: he was smuggled in on a boat from Peru,

• breaker of quarantine regulations: he should have been caged for a few months until we were sure he wouldn’t re-introduce rabies to Britain,

• smuggler: all that expensive marmalade!

Peru. Palace. Kigali?

So Paddington’s made it all the way from Peru to the Palace. Where’s next?

Well, he could be about to receive a second offer that he can’t refuse - a Home Office-funded trip to Rwanda to dialogue with local officials about Peru’s persecution of hairy citizens. One thing’s for sure: he’ll need to pack a very good razor because it’s a one-way ticket and the local climate necessitates daily body shaves!

But that’s okay folks. After all, regardless of whether or not he was persecuted back in Peru, Paddington is an illegal asylum seeker who has also committed crimes on our soil.

Seriously though

Quite rightly, the British government wants to act effectively to stop the ongoing horror of aggressive people smugglers herding vulnerable people to their deaths in the icy waters that surround our island nation.

And so now they have come up with a cunning plan. Under new rules due to go live this coming week, Paddington-esque figures who survive the Channel crossing may be re-routed - to Rwanda of all places. The first flight is due to leave today.

It remains to be seen just how un-British the Rwandan welcome will be. But whatever it is, it will be a far cry even from Paddington’s everyday life with the Brown Family at 32 Windsor Gardens. Concerningly, the European Union’s foray into Rwandan outsourcing has not had a good write-up, and Amnesty International is still finding much to criticise in Rwanda’s treatment of its own people.

Moreover, this is not an off-shore scheme. There will be no application to the British asylum system. No, there will just be the option of claiming Rwandan asylum.

Tortured souls

No, I do not condone breaking the law by not claiming asylum in the legally-prescribed manner.

Yes, something needs to be done to stop trafficked people drowning in the English Channel.

And yes, some of those attempting to cross the Channel are merely economic migrants waving false claims of torture & ill-treatment.

But no, let’s not forget that many others really have been tortured & ill-treated in detention settings within their countries of origin. So whichever country considers their claims needs to have detailed knowledge of torture & ill-treatment, appropriate attitude towards and facilities for both suspected & proven survivors, and cultural acceptance of the immigrants who go on to be granted refugee status.

And no, the Refugee Convention should not be quietly set adrift amongst the useless life jackets and other floating props of this packed-out comic tragedy.

British justice?

This is an important issue for me, and not just because I spend significant parts of my working life assessing complainants of torture & ill-treatment. It’s also important because I am a British citizen. Some of you readers are British citizens. And the British Government represents us, so this Rwandan scheme is being done in our name. Moreover though, the British government is accountable to us. So we should tell them what we think about this Rwandan scheme.

I’ll go first: I think it’s just incredible…

• incredibly unkind,

• incredibly immoral,

• incredibly un-British.

So I’ve got to sign off now and email my MP.

Your turn…

Dr Rachael Pickering is our voluntary Chief Medical Officer. Her personal opinions are not necessarily the same as those of Integritas Healthcare. We are always grateful for support.

Staying safe

A piece of reflective testimony from our Rachael, our Chief Medical Officer whose childhood in the port city of Hull gave her taste for fresh fish and tales of the sea…

Safe harbour

In Spring 2020 I was happily at my usual work in the Western Pacific. Then COVID-19 barrelled up into a worldwide tsunami and, like most missionary-minded healthcare professionals, I was returned to the proverbial safe harbour of home. I don’t mind telling you that I was relieved.

Then I had a safe but relatively steady two years. Sure, I encountered some risk in English prisons working with COVID-positive prisoners. But in general it was easy. I even managed to get lucky: COVID resurged across Europe just as I was delivering a young family member to live in France for a year; so I got to spend Lockdown Two marooned in a beautiful French city with an amazing library. And thanks to the French seeming to regard pâtissiers as essential workers, I had endless supplies of tasty pastries! Life at that point in my pandemic could have been far, far worse!

So overall, my pandemic has been largely spent in comfort with my feet up by the proverbial fireside. But one can have too much of a good thing…

Back out to sea

This spring I was excited to learn that foreigners were once again allowed to travel to Olongapo, the Philippine port city where I spent a lot of time pre-pandemic. I booked a flight and headed off for what I thought would be a great time. After all, I’d been there dozens of times before. But instead I found myself unexpectedly terrified and unwell. Two years by my fireside had made me forget just how hard overseas medical work can be. A boat that’s been idling in a harbour for ages shouldn’t be simply returned to the sea. It needs to be prepared. Or else it flounders.

EMERGENCY REPAIRS

I don’t mind admitting that I returned from that first pandemic-era trip in poor shape. I’ve needed emergency repairs - rest & relaxation, counselling, exercise, medical attention, and time - time to pray and (something I had let lapse a bit during the pandemic) to daily seek guidance from God’s Word, the Bible. And my reading reminded me that I had neglected to appoint a captain for my ill-fated trip:-

Then he [Jesus] told them what they could expect for themselves: “Anyone who intends to come with me has to let me lead. You’re not in the driver’s seat [captain’s cabin] — I am. Don’t run from suffering; embrace it. Follow me and I’ll show you how…”
(The Bible, Gospel of Luke 9:23-27, The Message version)

Not made for the harbour

I’m much better now and, thanks to two lovely friends, I’ve just managed to get away on a seaside mini-break! I really enjoyed watching boats of various sizes sail in and out of the local harbour. And then this morning I read this article and listened to this song, both of which were written by Andy Flannagan, a fellow medically-qualified, musical & left-listing Christian whose ministry I have always admired greatly…

Andy is quite right. We COVID-era Christians are at risk of mission paralysis from the ‘stay safe’ mantra. We’ve spent more than two years parting from each other with well-meaning reminders to ‘stay safe’. Absolutely, God doesn’t want us to die of COVID complacency. Yes, we should stay as safe from COVID as is practical. But no, He doesn’t want us to remain in safe harbours, drinking endless lattes in cosy cafes. He wants us back out in open waters, returning to our workplace ports, but guided by Him - the very best ship’s captain who knows have to navigate life’s dangerous waters.

Bon vogage

So now I’m preparing to set out from my home harbour once again. Yes it still feels a tad unsafe but this time I’m not frightened. Because I’ve remembered that workplace ports - in my case, overseas places of detention - were not, are not, and never will be completely ‘safe spaces’.

If you too have been in lockdown mentality, I wish you safe passage back to your own workplace. Remember that, whatever risks we face in our various work places, He is always right there beside us:-

Jesus, undeterred, went right ahead and gave his charge: “God authorized and commanded me to commission you: Go out and train everyone you meet, far and near, in this way of life, marking them by baptism in the threefold name: Father, Son, and Holy Spirit. Then instruct them in the practice of all I have commanded you. I’ll be with you as you do this, day after day after day, right up to the end of the age.”
(The Bible, Gospel of Matthew 28:18-20, The Message version)

Bon voyage!

Rachael

Dr Rachael Pickering is our voluntary Chief Medical Officer. She is in great need of prayer support and, thanks to COVID, financial assistance. If you’d like to receive her personal newsletter +/- help financially, please do get in touch.

ASD + Bars: Hi I'm Zoe

My name is Zoe. I am 20 years old and I live in England. As a teenager I was detained (sometimes called ‘sectioned’) twice under my country’s Mental Health Act (MHA). I even spent my 17th birthday in hospital. It was a very distressing time. I don’t remember all of it but what I do recall still upsets me. Thinking about it makes me cry. I’m crying now as I type. 

Thankfully I haven’t needed another admission since then, but I am still very affected by my disabilities. You might be looking at my photograph and asking yourself, ‘What disability?’ It’s called Asperger Syndrome, which is an Autistic Spectrum Disorder (ASD). I also have bipolar mood disorder, another life-long condition. Disabilities like mine, which are not obvious at first glance, are called ‘hidden disabilities’. If you met me, you wouldn’t notice anything was amiss - not at first anyway. Yet my conditions do affect just about every part of my life.

Me (and my mum) telling mental healthcare workers about my experiences in hospital

I am trying to find my way in the world and this includes having a zero-hours job as Integritas’ autism and disabilities advocate (ADA). It helps that my mum is the chief medical officer and my dad is on the board, so they are around to help me when I need their support with this work. I am so lucky in this regard. Most young people with autism are completely out of employment, yet alone those who have another mental health challenge like my bipolar mood disorder.

In addition to their Integritas roles, both my parents are jobbing English prison doctors, and my mum has a special interest in mental health. So I’m quite used to hearing talk about the problems of caring for detained patients who have mental health issues. But my own lived experience of having been detained in hospital has given me personal insight into what needs to change for autistic people held in hospitals, prisons and other types of secure environment around the world.

And so throughout 2022 I’m going to be exploring various aspects of detention that affect detainees with ASD who may also have additional mental health needs. My intention is to help raise awareness and advocate for positive change. I do hope that you read my series and tell other people about it.

Until later this month…

Miss Zoe Pickering

PS If you’d like to support my work on this series, please donate to our Winter Appeal.