Prison

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.

Songs of Hope

Guilt, loneliness and fear are but a few of the many emotions attached to a prison sentence. These feelings are often long-lasting and can make returning to society very challenging. The current prison system offers little hope of effective rehabilitation with overall reoffending rates of 26% between July and September 2019.  

The Liberty Choir, set up in 2014, has a vision to reduce reoffending rates by providing high quality singing programmes within prisons. They currently have four community choirs who visit prisons on a regular basis to sing alongside prisoners. This inspirational initiative provides a sense of purpose, access to a supportive social network and long term support once prisoners are released, with many ex-offenders joining their local choir upon release. 

 A quick glance at the testimonials on The Liberty Choir’s website show the choir has been a lifeline to many and so much more than just singing. It has been the helping hand to lift them from the vicious cycle of repeat offending. 

 The choir is looking to expand their work and hope to benefit as many people as possible. They are currently looking for musicians with a passion for social justice to join their team. For more information or to consider whether you could be the next person to join this life-changing venture visit their website at libertychoir.org or find them on social media @libertychoiruk 

The Ms Maxwell Series: How small is too small?

Last week: what is torture?

Last week we started to revisit the topic of torture as it had made the British news once again when Ghislaine Maxwell’s brother, Ian, spoke out against the apparently torturous conditions in her New York jail. Mr Maxwell reported his sister is being held unnecessarily under constant surveillance, in a 6x9ft (1.8x2.7m) cell with no natural light, and with terrible food & water rations.

However, as we discussed, deciding whether Ghislaine is being tortured is complex. The United Nations (UN) Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT) contains a complex definition of torture, which can be difficult to interpret. And, although the United States of America (USA) has signed the CAT, it has not signed the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT). So the UN’s Subcommittee for the Prevention of Torture and Cruel, Inhuman or Degrading Treatment or Punishment (SPT) cannot inspect her cell within one of the USA’s many prisons and other places of detention.

Even if the USA was signed up to OPCAT, the SPT does not have published standards by which to judge whether - as Ian Maxwell claims - Ghislaine’s living space is indeed too cramped, too short on natural light & too lacking in privacy or if her food is really all that bad.

However, if Ghislaine was incarcerated in Europe, she would be held by a member state of the Council of Europe (CoE). All such states are automatically signed up to both its European Convention on Human Rights (ECHR) and its more detailed Convention on the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, which, through inspections by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), tries to ensure that the ECHR’s prohibition of torture is respected.

How small is too small?

So then, if for some reason Ghislaine was extradited to Europe, she and her cell may just be lucky enough to be inspected by a delegation from the CPT, which does have well-known standards. Let’s consider purely its standard on living space, which is the most objectively assessable of the complaints raised by Ian Maxwell on her behalf…

According to the CPT, each detainee should have ‘6m² for a single-occupancy cell + sanitary facility’ or ‘4m² of living space per prisoner in a multiple-occupancy cell + fully-partitioned sanitary facility’. By this definition then, Ghislaine’s single-occupancy 6x9ft (1.8x2.7m) cell - at ~4.9m² - is too small. Whether or not it could be considered ill-treatment amounting to torture - as per either the UN’s definition or the deliberation of judges sitting at the European Court of Human Rights (ECtHR) - is a far more complex, thorny question.

How does nelson mandela come into this issue?

Within International Humanitarian Law, prisoners’ basic needs must be met and their human dignity maintained. And so, in 2015, the United Nations revised its 1955 Standard Minimum Rules for the Treatment of Prisoners, now known as the Nelson Mandela Rules - as the late President of South Africa was, in his earlier years, very famously ill-treated whilst behind bars.

These 122 rules provide guidance on all aspects of a prisoner’s journey from admission right through to release. Regarding solitary confinement, rules 44 and 45 state:-

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.

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, and only pursuant to the authorization by a competent authority. It shall not be imposed by virtue of a prisoner’s sentence.

What about her lack of privacy?

We do not know the exact amount of time per day that Ghislaine is confined to her cell. We also do not know whether she is allowed day-to-day interaction with other detainees. However, in his interview Ian Maxwell stated the following:-

Ghislaine has been in prison now for nearly 250 days and counting… she is under 24 hour round-the-clock surveillance with ten cameras, including one that moves and tracks her movements. And on top of that there are four guards that are looking at her, and presumably there is another guard looking at the camera feeds. She is not allowed to move into the corners of her cell and she’s not allowed to be within two and a half feet of the cell door. That is her existence every day.

As we mentioned last week, Ian Maxwell intimated that - subsequent to Mr Epstein’s high profile suicide last year whilst in prison - Ghislaine is under constant surveillance due to the authorities’ fear that she too may try to end her life whilst in custody. However, he does not believe that she is a suicide risk, making this level of monitoring a ‘grotesque over-reaction’.

What should be done to prevent suicide in custody?

The World Health Organisation (WHO) has written guidance on suicide prevention in jails and prisons. This document explains that a thorough risk assessment process should be completed for every prisoner when they are admitted to the prison and advises on appropriate management techniques as and when necessary.

Adequate monitoring of truly suicidal prisoners is necessary, given that hanging can cause serious brain damage within three minutes and death within five to seven minutes.

The use of camera technology has become increasingly popular as an alternative to prison guard watches. Even so it still requires surveillance of camera footage and prompt action. The guidance say:-

Moreover, most inmates dislike constant observation if it occurs without emotional support and respect. Therefore, camera surveillance should never be utilized as a substitute for the officer’s observation of the suicidal inmate and, if used, should only supplement the direct observation of staff.

If Ghislaine’s New York jailors have conducted risk assessments that clearly identify her being high risk of suicide, then constant surveillance may be a necessity for her own safety. However, if Ian Maxwell’s claims are true and her jailors are acting purely out of an excessive fear for their own reputation, then her level of monitoring is truly excessive and could even be counter productive.

But what’s in a name?

However, let’s for a moment leave aside the varying degrees of both lack of privacy and cramped cells endured by Ghislaine and very many others of the world’s ~11 million prisoners. Instead, let’s consider the undeniable psychological and physical health consequences to keeping prisoners in any sort of secure environment where perpetual confinement and frequent observation are the orders of the day…

The COVID-19 pandemic lockdown has imposed on a massive percentage of the world’s free citizens has given us a tiny taste of the psychological sequelae of imprisonment. It is therefore unsurprising that detainees, especially those who have been kept in confined conditions, suffer from anxiety, panic, insomnia, paranoia, aggression and depression. These psychological symptoms in turn can increase the risk of self-harm and suicide.

Detainees kept under such conditions are also at higher risk of a range of physical effects such as joint and back pain, deterioration of eyesight, lethargy and cachexia.

Are such conditions ill-treatment? And could they be said to amount to torture, as defined by the UN’s CAT or as interpreted by the ECtHR’s judges? You try to decide. But either way, it’s neither necessary nor proportionate punishment for offending human beings in general to be kept in such conditions.

So what about her diet and exposure to sunlight?

Although the above symptoms may be caused purely by psychological stress, they cannot often be separated from the physical consequences of poor diet and lack of sunlight. And so next week we will focus on Ian’s claims that Ghislaine receives practically inedible food and is not given enough exposure to natural light.

How may such allegations be assessed?

What are the potential health consequences of such ill-treatments?

And are they ill-treatments that could be said to amount to torture?

Until next time…

Dr Esme MacKrill with Dr Rachael Pickering

The Ms Maxwell Series: What is torture?

Torture made the British news once again last week when Ghislaine Maxwell’s brother, Ian, spoke out against the allegedly torturous conditions in her New York jail. She stands accused of helping the late sex offender Jeffrey Epstein - the former friend & associate of British Prince Andrew - to groom young girls for sexual exploitation.

Currently on remand whilst awaiting a trial scheduled for July, she has been persistently denied bail. Ian Maxwell intimated that, subsequent to Mr Epstein’s high profile suicide last year whilst in prison, she is under constant surveillance due to the authorities’ fear that she too may try to end her life whilst in custody. Apparently she is being continually observed in a 6x9ft (1.8x2.7m) cell with no natural light and terrible food & water rations...

To our mind, an obvious question lurking behind this storyline is…

What is torture and who gets to decide when it’s been committed?

Let’s find out…

What exactly is torture?

In 1988 The United States of America (USA) signed the United Nations (UN) Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT). This convention was adopted by the United Nations General Assembly as a way of upholding both Article 5 of the Universal Declaration of Human Rights (UNDHR) and Article 7 of the International Covenant on Civil and Political Rights (ICCPR):-

No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. (Article 5 of UNDHR)

No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. (Article 7 of ICCPR)

Article 5 of CAT defines torture in a very specific way:-

For the purposes of this Convention, the term "torture" means any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.

This sounds most comprehensive, doesn’t it? Is it in fact too comprehensive and, at the same time, too lenient? Because now we’re wondering…

  • How do we decide if someone else’s pain or suffering is severe?

  • Why is a torturous action suddenly non-torturous if it’s been done by people other than agents of the state acting in official capacities?

  • And why are certain undeniably painful and (some might say) barbaric actions - such as flogging, finger or hand amputation, and death by stoning - non-torturous if they are the outpourings of a particular country’s laws?

Alongside CAT, there is the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT). This was produced subsequent to CAT, to ensure that State Parties - that is, countries signed up to CAT - could be held accountable to it:-

The objective of the present Protocol [OPCAT] is to establish a system of regular visits undertaken by independent international and national bodies to places where people are deprived of their liberty, in order to prevent torture and other cruel, inhuman or degrading treatment or punishment.

Though as its name suggests, OPCAT is optional. So a country signing up to CAT but not OPCAT will not have the UN’s Subcommittee for the Prevention of Torture and Cruel, Inhuman or Degrading Treatment or Punishment (SPT) inspecting its prisons and other places of detention. The USA is yet to sign OPCAT. But even if it did qualify for SPT inspections, this monitoring body does not have published standards by which to judge knotty problems like how small is too small a prison cell.

What happens if we throw geopolitics into the mix?

As well as being an American citizen incarcerated in her own country, Ghislaine also holds two European citizenships - English and French. So it would be interesting to consider how this situation might be judged if she’d been arrested whilst in Europe…

In comparison to worldwide countries signed up to CAT, all European countries (except for Belarus, which - in common with the USA - still performs executions and so is ineligible for membership) are members of the Council of Europe (CoE), which means that they are signed up to both its European Convention on Human Rights (ECHR) and its more detailed Convention on the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, which details a mechanism for ensuring that the ECHR’s prohibition of torture is respected:-

No one shall be subjected to torture or to inhuman or degrading treatment or punishment. (Article 3 of ECHR)

There shall be established a European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (hereinafter referred to as “the Committee” [the CPT]). The Committee shall, by means of visits, examine the treatment of persons deprived of their liberty with a view to strengthening, if necessary, the protection of such persons from torture and from inhuman or degrading treatment or punishment. (Article 1 of the Convention on the Prevention of Torture)

Therefore, unlike the UN’s optional buy-in to CAT and OPCAT, all CoE member states are obliged to comply with Article 3 of the ECHR and the Convention on the Prevention of Torture. In other words, every European prison outside of Belarus is fair game for a mandatory inspection by the CPT, which is to the Convention on the Prevention of Torture as the SPT is to OPCAT.

Moreover, the ECHR does not actually define the torture that it bans. Instead, judges at the European Court of Human Rights (ECtHR) play the ECHR as a living legal instrument when deciding if an alleged case of ill-treatment could be said to amount to torture.

So then, what does this mean for Ghislaine?

Next week we will start to explore issues relating to Ghislaine’s brother’s claims about her cramped cell, inedible food, constant surveillance, and lack of natural light.

How may such allegations be assessed?

What are the potential health consequences of such ill-treatments?

And are they ill-treatments that could be said to amount to torture?

Until next week…

Dr Esme MacKrill with Dr Rachael Pickering