I have been asked the question on several occasions, 'Do I miss working in prisons'? The answer does not take much thought; of course I do! I worked in a prison environment for 15 years in various roles before a recent and difficult decision to leave.
There are positives and negatives in all jobs. We work to live but spend many of our waking hours at work, therefore we need a job that delivers rewards, that we feel is of intrinsic and extrinsic value. In the caring profession, we want to make a difference. I worked in prison mental health for 15 years both as a nurse and manager and in all that time I fully believed we were making a difference and improving the mental health outcomes for people. Clinical work can take its toll, particularly in a prison, as we work with people with extremely complex needs. The move to a managerial role gave some respite from daily challenges faced by clinical staff and enabled me to feel increasing control in the ability to improve the service for both staff and service users.
In 2014, following on from the role of service manager for mental health, I was fortunate to obtain the position as Head of Healthcare within the prison, broadening my responsibility to the whole of the health care provision. I like to think I successfully managed this for four and a half years and developed the service and relationships for the benefit of all, but this was not without cost to my well-being.
In a senior managerial position, it can be difficult to get a work life balance. There is always work to do, deadlines and targets to reach, not to mention the need to be constantly available to the other staff. As the 'CQC Registered Manager' I really felt the responsibility for the service, feeling that the proverbial 'buck' stopped with me. Maintaining relationships was a key part of this role. Though health care staff generally had good relationships with prison staff, there were always tensions between the need for health care and the need to maintain security and the essential running of the prison. Trying to balance budget, staffing, security risks and the well-being of the patients was a daily consideration. As Head of Healthcare it felt like I had 'three masters'; my employer, NHS England as commissioners of the service, and the Prison Governing Governor who had overall responsibility for the prison.
So, what kept me at the prison for 15 years? Two answers spring to mind. Firstly, I could make a difference in improving health outcomes for people in prison. Secondly, there was a comradery and relationship with other staff from different disciplines that I don't think you see anywhere else. Prison is one of the last of the traditional institutions. In my opinion the relationship between staff themselves and their relationship with the prisoners is of paramount importance. In conjunction with multi-disciplinary working, shared role understanding and boundaries, these are the key to successful outcomes for people in prison, both in terms of health improvement and rehabilitation.
Working in a prison environment does not suit everyone but I would not change my experience and never rule out returning to it one day. It is a unique environment with unique opportunities for enabling change. You just need to ensure you look after yourself and each other!