1. Mental health in prisons

Over 7,000 prisoners in England received support from custodial mental health services between July and September 2021, according to research published by independent mental health charity the Centre for Mental Health in April 2023. Commissioned by NHS England, the research collected data from 7,704 people receiving support from a mental health service whilst in custody. This represented 14% of the prison and youth offender institution population in England (58,889) that completed the survey. However, the report noted that this was unlikely to represent all of those in custody with mental health vulnerabilities. A diagnosis of personality disorder was the most common presenting problem in England after anxiety and/or depression and psychosis, according to the study findings.

Psychologically informed planned environments (PIPEs) were one of several types of custodial mental health services the report referred to. PIPEs were first established in 2011 as part of the offender personality disorder (OPD) pathway programme. Jointly commissioned by His Majesty’s Prison and Probation Service (HMPPS) and NHS England, the pathway’s purpose was to provide psychologically informed services for high-risk offenders with personality disorders. NHS England guidance states that someone with a personality disorder would think, feel, behave or relate to others differently from the average person. Examples of disorders include borderline personality disorders and antisocial personality disorders.

PIPEs and their impact on prisoner wellbeing are also widely unknown. As such, an HMPPS-commissioned study carried out in 2016 and 2017 aimed to determine if the PIPE model had been effective. HMPPS published the findings from this study in October 2022.

2. How PIPEs work

PIPEs are specifically designed residential units that support the rehabilitation of offenders with personality difficulties, according to HMPPS and NHS England practitioner guidance. PIPEs have been established in certain prisons and approved premises in England to support individuals through the criminal justice system and into the community. ‘Approved premises’ are housing within the community that provide intensive supervision of high-risk individuals who have left prison and are on licence in the community. Approved premises were previously called ‘probation hostels’.

Staff working in PIPEs receive additional training and support to develop an increased psychological understanding of their work. This enables them to create an enhanced safe and supportive environment that can help the development of individuals who live there.

PIPEs aim to maximise ordinary situations and approach them in psychologically informed ways. Support services in PIPEs focus on the importance of relationships and interactions between staff and residents. Examples of services include keywork sessions with staff, structured group discussions, socially creative sessions and enrichment activities.

PIPEs are not considered a type of treatment, unlike offending behaviour programmes, which aim to change an offender’s thinking, attitude and behaviour. Instead, PIPEs aim to provide supportive environments where additional psychological considerations are recognised.

3. Types of PIPEs

According to HMPPS and NHS England practitioner guidance, there are three types of PIPEs in prisons:

  • Preparation PIPEs: These residential units are designed to motivate and engage prisoners in preparation for the next step of their OPD pathway (which is usually treatment). Services will focus on the prisoner’s readiness for treatment, motivation and engagement, as well as exploring barriers to treatment.
  • Provision PIPEs: These residential units are designed to provide a supportive environment for prisoners undertaking treatment programmes. They aim to increase engagement with treatment activity and support residents to apply the skills they have learnt during treatment.
  • Progression PIPEs: These residential units focus on supporting prisoners after they have completed a treatment programme. They are designed to help prisoners practise and develop skills and behaviours learnt during a treatment programme.

For those released from prison into approved premises, a community-based PIPE is also available:

  • Approved premises PIPEs: These are used to support residents to reintegrate and resettle in the community.

According to HMPPS, there were 27 PIPEs established across 25 sites in England as of January 2021. Of these, 18 were in prisons and nine in approved premises. An additional two sites were also in development at the time (one in prison and one in approved premises).

4. HMPPS-commissioned research on the effectiveness of PIPEs

Queen Mary University in London carried out an HMPPS-commissioned evaluation of PIPEs in 2016 and 2017. This assessed staff and residents’ experiences of PIPEs to analyse whether the PIPE model had been effective. The evaluation focused on the first five years of PIPEs’ operation (2011 to 2016) specifically.

HMPPS published the evaluation findings in October 2022. It said preliminary indicative evidence suggested that prison PIPEs led to an improvement in social and relational functioning within prisons. Residents were shown to have better problem-solving skills and more positive relationship styles when compared to residents in other prison wings. Additionally, prison PIPEs staff reported that the PIPE model supported stronger relationships with residents and led staff to feel an increased sense of “mattering” in their roles. Overall, the evaluation suggested that both staff and residents in prison PIPEs understood the positive impact that PIPEs had on their wellbeing and development.

However, the picture for approved premises PIPEs was less clear. The report said researchers were unable to provide a “robust” conclusion on the effectiveness of approved premises PIPEs. Researchers referred to implementation difficulties of the PIPE model in approved premises caused by violence, drugs and staff restructuring. Whilst some residents said they had received support to make positive progression, the report said residents had not attributed this success to approved premises PIPEs specifically. In conclusion, the report said future research was needed to identify whether the PIPE model could be applied effectively in community settings.

The report noted that the evaluation’s methodology had several limitations, including limited scope and small sample sizes. These limitations meant that some findings should be viewed with a degree of caution.

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