Benefits and risks of peer-supported social care in prisons in England and Wales

Overview

What was already known:

• Peer support schemes may have a range of benefits for prisons, staff and prisoners.
• Additionally, some risks of peer support in general have been identified (e.g. burden and risks of bullying).
• It was not known what the benefits and risks of peer-supported social care are.

What this chapter adds:

• The study has highlighted a range of benefits for the wider society, prison, staff, buddies and recipients.
• However, several risks were identified that need to be mitigated against, including risks to recipients, risks to buddies, and exploitation of the scheme by recipients and buddies.
• Findings highlight a need to put systems in place to prevent and monitor risks to buddies and recipients.

Introduction

Peer support schemes are being used for social care in prisons in England and Wales (see Chapters 3–61,42,43). Some knowledge on benefits (e.g. lower costs, increased prisoner confidence and saving staff time) and risks (e.g. burden for peers, issues of confidentiality, and risks of bullying and manipulation) of peer support schemes have been identified (see Chapter 36,40,41,129). However, there is limited knowledge on the perceived risks and benefits of peer-supported social care specifically.

This chapter answers the following questions:

1. What do stakeholders perceive to be the benefits and risks of implementing peer support schemes for social care in prisons in England and Wales?
2. Do perceived benefits and risks differ across different stakeholder groups?

Methods

This chapter draws on findings from the workshop, interviews with national leads, interviews with prison leads and interviews with staff, buddies and recipients (see Chapter 2).

Findings

Participant characteristics

We interviewed national leads (n = 7), prison leads across 18 prisons (n = 20), staff (n = 7), buddies (n = 18) and recipients (n = 19), and held a workshop with 13 national and local stakeholders (see Report Supplementary Material 6).

What are the perceived benefits of peer support schemes for social care in prisons in England and Wales?

Benefits of social care peer support schemes were identified (see Table 9).

Many potential benefits were identified across the data sources. These included benefits for the system/society, benefits for the prison, benefits for staff, benefits for buddies and benefits for recipients.

Benefits for system/society

Benefits for the system and the wider society were largely discussed in the workshop, with views that there are resourcing benefits (e.g. freeing up public resources) and potential benefits for reducing crime rates by reducing reoffending.

Benefits for prison

Benefits for the prison included safeguarding and safety (e.g. improving prison safety and highlighting safeguarding concerns), the prison atmosphere (e.g. improving the prison community ethos, building relationships and helping the prison run more efficiently), supporting care provision (e.g. taking pressure off the prison staff) and financial implications (e.g. reducing costs for prisons and local authorities). Cost savings were mostly discussed by case study participants (staff, buddies and recipients).

If we didn’t have the buddy scheme, I think you know a lot of prisoners would be, the outcomes would be a lot different, and I think people would really struggle, and their health would deteriorate, and we just haven’t got the time to focus entirely on doing that.

Well, it’s got to be saving them a few quid, isn’t it. They’re saving a hell a lot of money.

Benefits for staff

Benefits for staff included reducing workforce pressures (e.g. saving prison staff time and reducing the need for additional staff), providing staff with safeguarding information, and supporting care provision (by doing jobs that staff may not feel is part of their job description or that staff may not want to do, and supporting staff).

We take quite a lot of the pressure off of the staff. Because the clients can then ask us to get the washing up liquid [ … ] I think that’s what benefits the prison. Also, it takes a lot of pressure off of the not enough staffed social care that they haven’t got.

So we had a particular case recently that the gentleman used to be always out and about, and then he started just staying in his room and not really doing anything, [ … ] the peers sort of picked up on that. And then sort of highlighted it to myself, and then we went and reviewed him, and there was some physical health issues going on. So we managed to get him a GP appointment and try to address that.

Benefits for buddies

Benefits for buddies were identified, including personal development (e.g. giving back/feeling a sense of value and developing caring skills), benefits for mental health and well-being (e.g. satisfaction and pride), financial benefit (earning an honest wage), employability (e.g. skills development), building relationships, and benefits for their sentence trajectory (prison parole/records).

I get a great satisfaction you know, [ … ] it makes you feel better. When you go to your cell at night when you’re locked up, you think, you feel like you’ve had a worth, you’ve made someone’s life just a little bit better and that gives me a good feeling, it helps my well-being.

Benefits for recipients

The main identified benefits to recipients were better meeting their social care needs and enabling them to receive support they may need but may not receive otherwise, and allowing them to participate in the prison regime and integrate with the prison community. Other benefits included promoting independence, improving mental health (e.g. improving confidence and receiving emotional support), building relationships and preparation for release.

I’ve actually found it being a big help [ … ] Because I mean, there’s a lot of stuff that even I wouldn’t have been able to[ … ] I couldn’t sort of scrub the shower out, sort of thing.

What are the perceived risks and challenges of peer support schemes for social care in prisons in England and Wales?

While many benefits for the prison, staff, recipients and buddies were identified, workshop participants and interviewees also highlighted some risks and challenges of peer-supported social care that need to be considered (Table 10).

Some of the risks were more frequently reported than others. Below, we discuss the most frequently reported risk categories in detail, and then briefly discuss the less frequently reported risks.

Most frequently reported risks

Risks to recipients

Risks to recipients identified across all data sources including safeguarding concerns or issues (e.g. potential risks of recipients being abused by buddies), risks of buddies bullying peers, risks of unhealthy relationships developing, accusations of stealing, buddies stepping over boundaries and risks of dishonest prisoners. For example, some prison leads reported that buddies have been sacked from the role in the past for general misdemeanours (not to do with their buddy role), for bullying recipients, or doing something they should not be doing. Some prison leads also highlighted that they have had issues with some peers stepping outside of their boundaries, or recruitment of buddies who may not be allowed to act in caring roles in the community due to their offence type (due to not having enough information when recruiting buddies in the first instance, and therefore the need for close supervision and monitoring of individuals in these roles). Additionally, some recipients felt apprehensive when they initially started receiving peer support as they had previously had bad experiences of buddies taking advantage in the past (e.g. going through their belongings).

Some prison leads highlighted that there have not been any issues as of yet but that ‘it could be an accident waiting to happen’, thus emphasising the need to put mitigations in place to minimise the risk. Buddies, staff and recipients all emphasised the need of making sure that buddies have the right motivations and are selected carefully and security checked. Additionally having a lack of security checks or vetting processes was felt to enhance risks to recipients. However, some prisons spoke about having controls in place to mitigate against this when selecting peers [e.g. involving security during the application process to ensure that the right people are in these roles (based on offence type, etc. and prisoner motivations), notifications by security of any concerns, conversations with peers and recipients to identify issues, and resolving issues should they arise (e.g. suspending buddies if any misdemeanours are identified during role)]. However, monitoring and regulation of peer support services were not frequently reported by prison leads (see Chapters 5 and 8–10).

If there’s any suggestion of someone being dodgy they can’t be because I’m not having them bully older or disabled prisoners [ … ] I don’t know if it’s happened in the past because like I said we’re trying to get it back up there but I’ll be making it clear if anyone’s caught getting bribes then they will be off the process, they won’t be welcome as a buddy and they will get punished within the normal prison rules so they’re not immune to that so they know, the rules are crystal clear.

Yes, there can be conflicts in the role. Where somebody accuses somebody else of stealing or whatever, or there could be safeguarding issues as well, where you’ve got somebody helping someone write their canteen out and you’ve just got to be really mindful of all those things.

One of the frequently reported benefits was that buddies play a large role in safeguarding prisoners (e.g. from bullying or exploitation from other prisoners). Therefore, with appropriate monitoring of buddies, the risk from buddies may perhaps be easier to mitigate than those risks from the general prison population and may help to reduce safeguarding issues arising more generally.

Some recipients also raised concerns regarding the peer support service taking independence away from them by doing tasks that they could be encouraged to do themselves (e.g. cleaning their cell). In Chapters 5 and 6, this was reported as a key difference in different peer support schemes, with some schemes aiming to help recipients maintain and develop independence, and other peer support schemes much more task-focused on peers doing the jobs for the recipients and thus limiting their ability to develop independence themselves.

Risks to buddies

Findings identified a risk of burden and emotional risks for buddies. For example, the burden of working with challenging or demanding clients, buddies getting burned out due to the demands of the role, risks to buddies’ mental health if they are paired with someone who has experience of something which is triggering to the buddy, or becoming overly attached to recipients.

You have to be very careful who you are linking individuals with because some [buddies] may not have declared any historical offence which has occurred in their life which affected them badly, and we may be pairing them with somebody who also is going through something which triggers memories of what they went through, and this could be a detriment to our [buddies’] mental health and well-being.

Additionally, findings from staff, buddies and recipients highlighted that buddies have experienced some risks undertaking their role as social care buddies, for example recipients threatening buddies to give them some of their pay or other threats, recipients being antisocial or aggressive towards buddies, buddies being blamed by recipients if they do not get what they need (e.g. medicines that buddies have helped to order), and recipients taking up too much of the buddies’ time.

How safe? I feel very safe. Well I’ve had a couple of clients in the past that have been more a danger but then you know your boundaries and you step back. [ … ] You don’t get yourself in a dangerous situation.

Some risks to buddies were identified by one group of participants only. For example, recipients also highlighted a potential risk of buddies getting into trouble if recipients tell them something (e.g. relating to suicide) and they do not escalate it. National stakeholders identified a potential risk to buddies if they whistle-blow safeguarding issues relating to staff, and that buddies may still have to remain in that prison in coming years. Additionally, prison leads highlighted that buddies may experience risk of overstepping boundaries, due to a sense of responsibility if they are not allowed to provide certain types of care, but that person’s needs are not being met by others.

Sometimes when you’ve got a woman who’s really helpful and just wants to help that person it’s hard to pull them back a little bit and make them rein it in, you know, just, it’s like, it’s not what you’re there for, you’ve got other people to do that job and you know, you’re putting yourself and that other person at risk by doing that.

Exploitation of role

All groups of participants identified potential for the role to be exploited by staff, buddies and/or recipients. For example, buddies and/or recipients have been found to use the role to facilitate trafficking contraband or obtain goods.

So from previous experience, we have people in roles that were then going to different wings and kind of escorting and things around the wings that they shouldn’t have been.

If you’re that way inclined and you’re manipulative, you can take advantage of quite a few of the old boys.

On the other hand, recipients have been found to exploit the role by claiming they need more support than they actually need.

She didn’t need it, that was the thing, she didn’t need it, she was just trying to pull on people’s heartstrings a little bit.

Secondly, peer support roles for social care may be exploited by staff asking them to carry out duties which are not part of their role, for example staff asking them to support prisoners who are not their clients (and buddies not feeling able to say no to staff). This includes being asked to perform roles that are not in their job description such as helping non-clients move, or cleaning non-client cells that are dirty or are inappropriate for the role (e.g. taking blood sugars). Additionally, one lead identified a reliance on buddies to provide specialised care when the prison does not have trained staff available. Workshop participants also raised risks relating to social care buddies being seen as a cheap solution instead of investing in prison officers.

Because occasionally we have had in past where somebody might have, they might not be able to get in the shower, so staff will say to them, mate, you’re his buddy, go and take him in the shower type of thing. So they’ll obviously often explain to staff, oh no that’s not my role gov you know what I mean because my role is that, that, and the other.

You know it’s a case of if they need somebody moved we’re kind of like Pickford’s now, because we’re buddies […] they just think that’s our position, that’s our job to move, to help the OAP move. You know if they’re not really on the books we don’t have a duty to do that but we do because we don’t mind doing it and I think sometimes they come across in a way that they expect it.

Less frequently reported risks

Buddies raising care expectations

Some participants (prison leads, national stakeholders and staff) highlighted potential difficulties associated with different people requiring different levels of care, and therefore a need to manage expectations and the risk of peers not sticking to boundaries relating to their role and inadvertently raising expectations of what care recipients should be receiving.

Buddy expectations on release

Some national leads highlighted risks around perceptions of transferability of the role. For example, some buddies may believe that they could be employed in care roles following prison, but national leads emphasised that the law is clear on this and that this would not be possible. Some issues were raised around prisons wanting to introduce care qualifications, but that this may raise the expectation of a care job following release. Participants highlighted that they should not be seen to be equipping prisoners with care roles for these reasons but that this may not always be considered. This risk was not, however, raised by peers or recipients.

Risk to quality of care

One national stakeholder who was interviewed raised a potential risk of peer support potentially preventing prisoners from receiving more appropriate support in some situations. Further challenges in the workshop were highlighted in relation to risks associated with some care needs or clinical conditions not being picked up because of an over-reliance on buddies. Some participants also identified risks relating to recipients not receiving care due to there being a high turnover of trained buddies. Furthermore, prison leads reported that buddies can face access issues (being let out of their cell or access limited to wings) in which they are unable to provide care to their recipients on all occasions.

It is also possible that the cost savings associated with buddies providing social care may be a risk as it may hide the real ‘cost’ of providing social care to prisoners. Workshop findings indicated that there is a lack of understanding of what ‘good’ looks like, which therefore creates a risk as there is no evidence-based standard against which a service can be judged. This means that it is challenging to explore whether a service is adequate or where improvements could/should be made.

Conflicts between different peer support roles

Some participants highlighted risks associated with different peer support services having different confidentiality clauses which mean that peers may not be able to do both the peer-supported social care and listener role. For example, one of the peers is both a buddy and a listener and raised the issue of confidentiality conflicts between both roles. If a social care client talks of suicide, they can report it but if in a listener role, they cannot report it due to confidentiality.

Risks associated with the practicalities of having boundaries in place

Participants acknowledged the need for clear boundaries and drawing a line to ensure safety. Some staff, buddies and recipients raised issues associated with the boundaries for peer support social care that are in place and being unable to help when needed. For example, not being able to help people up when they fall, due to not being able to touch other prisoners. These perceptions may therefore lead to some buddies overstepping the line to provide support that they perceive to be necessary (e.g. catching recipients if they fall or helping to put someone’s jumper on).

They tell you, the officers tell you if they’re going to fall over, you’re not allowed to catch them. So what’s the point of shadowing them up there? You know and it’s a natural reaction. If someone’s going to fall, you’re going to try and catch them.

Risks of delays or gaps in care provision

Some participants highlighted risks associated with delays or gaps in care provision. For example, buddies raised issues of safety relating to delayed social care provision arising from lack of processes (e.g. lack of processes to get referral from officer to health care). Additionally, some delays in care were identified (e.g. one peer provided an example of prison cell bells being too far away from a person’s bed, meaning that they were unable to access care and support for hours).

Their referrals for the outside you know social care, they’re not getting. You know unless you’re really bad, that’s the only time that I’ve seen that they’ve got their social care.

Risks to continuity on transfer or release

National leads highlighted risks to continuity on transfer or release. When prisoners are released or transferred between prisons, there can be a lack of care plans and insufficient records identifying whether they were in receipt of peer support and why, particularly if their only support was informal. The consequent risk is that the same support is no longer available and specific needs become unmet.

Certain factors may exacerbate risks such as funding, type of prison (e.g. the turnover rates of trained prisoners) (see Chapter 5).

Discussion

Key findings

The study has highlighted a range of benefits for the wider society, prison, staff, buddies and recipients. However, several potential risks were identified that need to be mitigated against, including risks to recipients, risks to buddies and exploitation of the scheme by recipients and buddies.

How findings relate to previous research

Findings from this study are consistent with many of the benefits highlighted in the review (see Chapter 3), for example, benefits lowering costs for the prison service, improving prison atmosphere, reducing workload for staff, self-development for buddies, and relationship building and emotional support for recipients. Therefore, findings indicate that many of the benefits associated with peer-supported social care are consistent across peer support schemes more generally in prisons. However, some benefits were more prominent for social care than for other peer support schemes. For example, those relating to care provision and ensuring that prisons are providing and prisoners are receiving the social care support that they need, enabling recipients to develop independence and participate in regime, and feelings of satisfaction and value for buddies arising from supporting other prisoners with their social care needs.

Furthermore, we have found that buddies and recipients are aware of safeguarding policies and the need to support safeguarding practices (as outlined in HM Prison and Probation Service; Ministry of Justice45). An additional benefit of the peer support scheme for social care specifically was that buddies support safeguarding practices in the prison and report any issues to staff when they become aware of them. Therefore, buddies may play a role in identifying unmet social care needs and highlighting these to the prison.

Additionally, findings are also consistent with the challenges associated with peer support programmes in prison identified in the review (see Chapter 3) and in the wider literature (e.g. Buck et al.130). For example, the risks for buddies that were identified such as burden, confidentiality, prisoner safety, potential for abuse, and dealing with problems beyond their role. However, this study identified the most frequently reported risks which should be given the most attention (e.g. risks to recipients, risks to buddies and risks of exploitation). This study also highlighted additional challenges such as risks associated with quality of care, unmet need, and gaps in provision of care.

The PSI on safeguarding46 highlights the need for prisoners to protect adult prisoners from abuse and neglect. However, we found that it may be challenging to do this without clear governance and monitoring processes in place. There are several potential risks that must be mitigated against when implementing peer support services for social care. Governance processes must include clear boundaries, appropriate recruitment and employment processes, training and support for buddies, and training for staff (as outlined in Chapters 5 and 6 and HM Prison and Probation Service; Ministry of Justice45).

While guidance recommends that prisons and local authorities must work together to put care plans in place and provide support to meet these needs,26 we found that there may be risks associated with unmet social care need and delays in provision of social care support in some cases. This together with findings on factors influencing social care provision (including the need for protected roles and understanding of social care, collaboration between local authorities and prisons, resources, and processes and procedures for social care) (reported in Chapter 5) demonstrates a need for clear governance processes to be put in place for social care in addition to clear processes for peer-supported social care, to ensure that personal and non-personal social care needs are being met. It appears that clear processes may be particularly important when prisoners are released or transferred between prisons.

Strengths and limitations

Findings on benefits and risks have been triangulated across different data sources, including national and local stakeholders (workshops and interviews), prison leads and staff, buddies and recipients. This demonstrates similarities and differences in perception of risks and benefits across different groups and demonstrates the most frequently reported benefits and risks.

While findings represent a wide range of individuals from different roles and experiences, they may not capture all benefits or risks relating to peer support services for social care.

This study qualitatively explored perceptions of benefit and risk derived from people’s own knowledge and experiences. However, the quantitative evidence-base is limited, and we are not able to give an indication as to the extent to which peer-supported social care achieves these benefits or generates these risks (e.g. how much aspects such as mental health or independence are improved).

Implications

Findings highlight a wide range of benefits of peer support services for social care, indicating that there are many positive elements to implementing peer support schemes for social care for all stakeholders.

Findings provide an insight into the key risks that must be overcome and mitigated against when implementing peer support services for social care. For example, prisons must be aware of and have sufficiently resourced and feasible systems in place to prevent against and monitor risks to recipients (e.g. bullying and safeguarding issues), risks to buddies (e.g. burden) and risks of exploitation by staff, buddies and recipients when planning the governance of services. Prisons need to ensure governance processes are in place to protect buddies and recipients [e.g. clear recruitment processes that involve security vetting and provision of job descriptions with clear boundaries, training for staff with regard to what the role is and what the role is not, and training and supervision for buddies (on a range of topics specific to providing peer support social care)]. Findings indicated that the most formal application, employment and training processes for buddies tended to be those led by local authority or external provider organisations (see Chapter 5), so resources and support need to be in place for other prisons to achieve this and ensure risks are mitigated.

Additionally, prisons must be aware of and monitor wider risks relating to social care provision, including risks relating to the quality of care received, risks relating to delays in care provision or prisoners not receiving formal social care support in addition to peer support, and risks of continuity of care on release. Recommendations as to how data could be used to monitor these risks are described in the next chapter.

Findings provide insight into the type of impacts and risks that may need to be formally measured when evaluating the effectiveness and cost of peer support schemes for social care in prisons in England and Wales.

Future research

Future research is needed to explore the effectiveness and cost-effectiveness of peer-supported social care, including whether there is evidence that peer support quantitatively improves outcomes for prisons, staff, buddies and recipients. Additionally, there is a need to quantify the frequency with which risks occur to mitigate against them.

Conclusions

Findings highlight the multilayered benefits of peer support schemes while transparently highlighting risks associated with implementing peer support schemes in prisons in England and Wales.