Reviewing: The Prison Doctor by Dr Amanda Brown

The Motive:

We’ve previously experienced a prison from the perspective of one of the officers, but a different view of life inside comes through the eyes of a healthcare professional. And how do people (GPs included) end up in prison anyway?

The Evidence:

Disenchantment with the 2004 GP contract took Dr Amanda Brown out of her comfort zone and into prison healthcare. That desire to more fully address the needs of patients landed her in some demanding situations. Her book covers three prison placements: in Huntercombe youth prison, in Wormwood Scrubs men’s prison, and finally in Bronzefield women’s Prison.

While Doctor Brown wanted to give more to her patients than the constraints of her NHS role allowed, prison presented new and formidable challenges. A past career spent mainly reassuring the worried well was perhaps not the ideal preparation for slit throats and punishment scaldings. And the security-first power structure implemented by the guards provided an unfamiliar hurdle to her medical decisions around emergency hospitalisation. If her plan had been to apply herself to the greater and more urgent need, she found the way to do it, but the price she paid was high.

What do we learn of the prisoners in the different establishments? Especially in the youth and women’s prison she commonly encountered a history of physical or psychological abuse, something that may culminate in criminality (and, where the abuse begins in childhood may even become a leg in the stool of psychopathy and violence). Such cases don’t always stem from poverty, as Doctor Brown found in the case of David West.

Another common factor she comments on is the role of substance abuse and drug addiction, and specifically the way addiction can often create a cycle of reoffending. An inmate with an 18 month sentence over which to plan a rehabilitation from heroin leads the Doctor to remark that this at least gave her “something to work with”.  Her thinking chimes directly with a suggestion from the prison officer Neil Samworth that sentencing of addicts should include an allowance for drug rehab. If many inmates are driven to crime to service an addiction then it seems obvious that addiction should be a primary point of intervention. In this, the role of prison healthcare is not just about prisoner wellbeing, but about societal wellbeing too. With proper planning, the prison doctor might save the rest of us from the reoffending that often follows discharging an addict with a prison record and potentially very limited employment prospects back into the wider community. Of course, the impact of drug-taking inside prison presents another very real problem, and Dr Brown’s exit from Wormwood Scrubs seemed precipitated by problems caused by the now very illegal “high” known as Spice.

Unsurprisingly, this can be an upsetting book to read. While it is easiest to think of the prison population as a homogenous them, distinct from the rest of us, such an attitude should not survive the female prisoner Andrea’s story of plummeting from a job in information technology to addiction and prison after being paralysed in a hammer attack and subjected to days of sexual assault. The idea of being attacked and left to die in a pile of bin bags should help us realise that some events would change the course of anyone’s life. The author asked the very valid question of whether prison is truly the appropriate answer for people like Andrea.

The Verdict:

This book is well worth reading, and credit is also due to the ghostwriter Ruth Kelly who worked alongside Brown on the project. It paints a vivid picture of life as a prison doctor, and interestingly raises some similar challenges to those raised by a prison officer we encountered previously. Both of these professionals flag substance dependency as a major driver of reoffending, and question the pointlessness of the cycle of imprisoning and releasing addicts without tackling the drug habit that will often lead directly to further crime.