Ep31 Play and Criminal Justice an Interview with Joe Franks.

In this episode of 'Pondering Play and Therapy,' host Philippa welcomes Joseph Franks, a veteran in the field of mental health nursing since 2004. Joseph discusses his varied career, which spans working in mental health services, teaching at the University of West London, and his pivotal role as the mental health lead at Reading Prison. His experiences highlight the vulnerabilities faced by individuals in the justice system, particularly those with brain injuries, autism, care-experienced individuals and other neurodevelopmental conditions. Joseph also elaborates on the importance of diversion services and his ongoing work with Health and Justice Consultancy Limited, where he conducts clinical reviews into deaths in custody. He emphasises the need for societal change in responding to complex needs and introduces the concept of EMDR therapy as a potential tool within the justice system.

Joe's Linkedin Profile: https://www.linkedin.com/in/joseph-franks-5bb0a878/

Paper discussed in the episode: https://www.cdc.gov/violenceprevention/aces/about.html

Nadine Burke-Harris; Ted Talk: https://www.ted.com/speakers/nadine_burke_harris_1

Pondering Play and Therapy | Instagram, Facebook, | Linktree

Transcript

Philippa: 0:00

Welcome to this week's episode of Pondering Play and Therapy with me Philippa. And this week my guest is Joseph Franks Joe, who began his career in mental health nursing in 2004, working across inpatient mental health and learning disability services. Frustrated by the limitations of the medical model, he pursued further training in bio psychosocial interventions in psychosis. His early research explored the complexities of working with individuals on the autism spectrum. Joe later taught at the University of West London where he led modules on psychosocial and family interventions and co-authored nursing and mental health care, an introduction for all fields of practice. He then returned to Frontline Care as the mental health lead at Reading Prison, which sparked his long-term focus on offender health. He went on to lead, liaison and diversion services across Hampshire, the Isle of White and the Thames Valley before founding Health and Justice Consultancy Limited. Joe now works with NHS England and the Probation and Prison Ombudsman conducting clinical reviews into deaths in custody. His work continues to highlight the deep vulnerabilities in the justice system where many individuals or care leavers have brain injuries and live with neuro di, new route developmental conditions, raising critical questions about how society responds to complex needs. That's a whopping career, Joe, going on there. Thank you so much for coming on the podcast. I, you miss, so there's loads there. Yeah, thanks for coming on the podcast. So you've ended up working with deaths in custody, which is quite a specific and hard hitting role. I imagine

Joe: 2:04

It is, but it's not so different really from the job I'd moved from so when I left the NHSI was running services called liaison and diversion. And to put it plainly, we were the interface, if you like, between health and criminal justice. So we worked in the police custody suites, crown courts, magistrates community. And our role was to screen and assess individuals to pick up a wide range of vulnerabilities and either steer them away from criminal justice or what they used to say is divert them into criminal justice, which means you are sharing that pertinent health information and risk information along the pathway so all the decision makers have it to hand and they can keep that person safe. It's surprising to say that it's a fairly new service, fairly new endeavor. Hasn't been around for long because there is a wide recognition of the prisons especially and criminal justice generally are just full of people with a variety of challenges such as brain injury, autism, A DHD, their care leavers. There's mental health problems. Really is that the best society has to offer is to incarcerate all these people? Yes, they've committed crimes, but they've all come from horrendous backgrounds. And. Generally have some sort of vulnerability in tow as well. So yeah, from there ended up looking at the Destin custody'cause that's NHS England and NHS England funded us. And I built up some relationships and ended up on that cherry subject.

Philippa: 3:49

Oh gosh. So I'm guessing when you started your career back in 2004, that wasn't the thought that you had was actually, I'm gonna work my way and end up doing these reviews. No,

Joe: 4:00

not at all. I came into nursing fairly late. Really qualified in my thirties and I wanted to get into psychology and CBT, but for whatever reasons you just, you end up in places, don't you? You go with the flow sometimes and at other times you say, I. I need to take some control'cause I'm not happy where I am. Yeah, and to be honest, offender health and criminal justice was not an interest at all. And likewise, like the most general public I probably thought you good, all your bad. If you committed a crime, you go to prison'cause you're being bad. I didn't realize the depth of vulnerability in the prison population.

Philippa: 4:46

Okay. So how did you,'cause then you went and taught at at the University of West London after you'd done some nursing.

Joe: 4:55

Yes. Yeah. So that was, so I just finished my degree in psychosocial interventions and which

Philippa: 5:03

is what? Tell us what that is. Actually I don't know what that is.

Joe: 5:06

So it's it says it's serious mental illness, but you can apply it across the range really across the range of mental health difficulties that people are often up against or live with and it's a structured approach to a assessment b formulation with the client. And you're looking at things like relapse prevention. So you look at the previous relapses, you can map out that relapse, look at the trigger events. Those relapse signatures we call them generally remain the same the next time round people relapse. So then you've got an early warning plan. So we'd build in a plan. What are your earliest warnings? It might be I don't sleep all night. Okay, what do we need to do there? Who do you need to talk to? And then other practical steps to manage symptoms which are very much based on CBT approaches. And you incorporate the whole unit that lived around the individual. And that's where the family interventions comes from. And that's based on psychoeducation. The stress vulnerability model is central to all of this. I dunno if you about that. If people are listed and

Philippa: 6:16

they don't know Yeah. They dunno what a stress vulnerability model is. What is that? What does that mean?

Joe: 6:21

So it's, I still, it's sad. I still remember the author Soen and Spring came up with it in the seventies and it's just a very easy way to visually understand. What mental health is what's good mental health and what's poor mental health. And the theory is we're all prone to it. You put anybody under enough stress or pressure, they'll develop mental health problems. Some people are more vulnerable. Might be something that's happened in utero, might be something that's happened in childhood. Such of all the all the vulnerabilities we've mentioned earlier will make you more prone to mental health. And that's the theory. Put people under enough pressure, they'll flip over the line into poor mental health. And that's what the interventions work with in psychosocial interventions is with that theory in mind.

Philippa: 7:12

Okay. So you went on to teach this then at the University of West London?

Joe: 7:20

Yes. So I think the previous people who were delivering it had moved on in their careers and all of a sudden they had this course, this accredited course, and they didn't have any, anyone to run it. So they had one or two people. So they knew that I'd just finished my degree and my name was mentioned somewhere. And they just made contact, said are you interested? And me and another colleague ended up, never thought we would just thought, oh yeah, let's give that a go. We ended up lecturing at this university. I was never been so frightened in all my life. And yeah, it was really quite good. It was a steep learning curve. And it was academia. I did learn that I'm not in that I. I can do academia. I don't particularly like all the writing. But yeah, from there I ended up teaching the pre-registration nurses, post reregistration nurses, and you do turn into a bit of a jack of all trades. And that's it. I did about two years, 18 months, two years there, and then went back to clinical practice.

Philippa: 8:26

I was noticing that you've had some big swings. So you were in nursing, then you taught and then you ended up in reading prison. It's not natural trajectories, are they? So No,

Joe: 8:37

that's ended up in

Philippa: 8:38

reading prison. How did you end up there?

Joe: 8:40

There's a story there. So when the university employed me, it was to work on their campus in Redding, and I live in Redding. And then before the academic year started, they went, we can't open the campus because it's full of asbestos, so you're gonna have to teach at sla. So I was, I didn't drive at the time, so I was getting the train to lau teaching there. And then after six months they said, oh, we're gonna close Lau and move everything to West London. And I said, I can't afford to do that. And they weren't very sympathetic. So I carried on traveling up there for a little while and then after a bit I just thought I can't, I had two small children. I was leaving really early in the morning. I never had any money'cause I was spending it all on trains. Then I'd come home, the kids would be in bed. So I think the reading prison was, I just saw a job. And I thought I can do that. And it was one of those decisions that was turned out quite good in the end. I think initially I thought, oh my God, what have I done my first week or so in the prison? You think I've, I'm not sure I like this. But then you start to get your head around it, you start to understand how it works. You start to talk to some of the lads, some of the prisoners start to understand where they've come from and it becomes a really interesting place. So what

Philippa: 10:08

was your role in the prison then? What did you do? I

Joe: 10:10

was so it wasn't very fancy team lead. Sounds fancy, but there was me and another guy, Peter Horne, if you ever listened to this, Pete and we were the mental health team. Okay. For the prison. There was two of us. And then And how

Philippa: 10:25

many inmates? Prisoners. Oh, bloody

Joe: 10:28

hell.

Philippa: 10:30

In a ballpark. You don't have to name it now.

Joe: 10:33

I think it was, I think it could. They could have up to 400 prisoners, I think.

Philippa: 10:37

And that's a lot for two people to cover then.

Joe: 10:40

It's a lot. Yeah. Yeah. And we were meant to be your typical inReach team in the prison is secondary mental health and they only deal with serious mental health. But we did the whole lot, the primary issues all the way through to the serious mental health problems. But we quickly found there that the most of these guys had a trauma profile and yet we couldn't access any trauma therapy for them despite there being this notion of equivalence in, in care. I dunno if you've heard of that before. No. But they should have the same access to care and treatment as you and me, whether you're in prison or not. So we were just about to embark on a really interesting project to bring in some of that therapy. We had a part-time psychologist who, couldn't possibly, manage these complexities. And then they announced the prism closure.

Philippa: 11:36

Oh, gosh.

Joe: 11:36

Yeah. Yeah. So

Philippa: 11:38

when you say a trauma background, you mean during their childhood or, yeah. Things that have not, they haven't had the typically, parenting experience or typical Exactly. Family life that you would Yeah.

Joe: 11:54

Often multiple traumas, small t traumas, big traumas, domestic violence, or they were just in the care system, so had no parental figures. Yeah. And some of the stories you heard from these lads. Could really get to you'cause you'd think if that was me, I'd be in prison as well. Yeah. And some read and some lads that were in there just bad luck. Yeah. But we were just about to embark on careers and you just saw what we had no option but to send them to prison. Now he can't join the Navy. Yeah. He was just about to join the Navy. And and you just think where is the thinking behind locking up young lads, 18 year olds.

Philippa: 12:40

Yeah. Yeah. And so then there you went on to liaison and diversion. So that is where you are trying to stop them ending up there. Is that right?

Joe: 12:54

That Yeah. In simple terms it is. So the service. Had a focus on first time entrance because you could have a bigger impact at that point. And that was generally youngsters or children. So we had a youth specific element to the service. And it was a lot better for kids to be honest. There is a, and there's a lot of work going on now within criminal justice to divert children away. And there's links being made with local football clubs and they're popping up all over the place. If you go on LinkedIn, there's a guy who does fishing and he'll take all these kid fishing and believe it or not, hardly any of them have been fishing. Hardly any of them have a hobby. So they're already from a background where a play is restricted or minimal or risky'cause of where they live. And it's having these real benefits, these diversionary efforts are having real benefits to kids and move them away from crime.

Philippa: 14:01

So the idea is that you identify that they've committed a first offense or a first criminal act that could possibly end, take the root of being in a custodial. Yes. But you say, actually, let's try this, or let's take them this way. And is there some that, because I guess people listening to this what they've committed something that is gonna give them six months in prison, but now you're sending them fishing. Yeah. I'm guessing it's more than that though. It's

Joe: 14:31

much more than that. So children, before they end up in criminal justice have being on the fringes of crime for a long time and they're known to the police. They really try not to bring kids into custody suites. There, there is evidence out there to suggest that by merit of bringing kids into the custody suite environment, all you are doing is criminalizing them, but you're entrenching it further. They just go out and commit more crimes. So there is a drive to stop children coming into to custody suites. The police have the

Philippa: 15:06

I'm gonna ask you a question there. Go on.'cause I am imagining lots of parents saying, yeah, but surely it just frightens them so they don't do it again. Because that would be the thought was let's get the police involved, get them there, and it's going to scare the jeebies out of them and they not wanting to go back again. Whereas you are saying actually bringing them into a custody suite. It does. There's evidence that actually it does the opposite of that.

Joe: 15:33

Yeah, exactly. You gotta think why if we think about the typical child that may be involved with criminal justice, we know that they're not always but nine times outta 10, they come from a diff dysfunctional background. They're well known to services already. So by that point, they've probably built up a distrust of services that can happen. And they're already running in those circles. So there's a lot of county lines that our listeners would've heard of, that they're involved in. There's a lot of coercion by adults as well to encourage them to commit crime or run drugs as you see in the county line cases. It can be a bit of a badge of honor, right? Being brought into the custody suite. Dependent on the circles you mix in, there are kids that it would frighten and they go I'm not doing that ever again. But there's some kids that are so desensitized to authority and the state and the system that it's just par of the court.

Philippa: 16:37

Yeah. And I wonder another bit is that it's more frightening the unknown than the known, so actually the worry of ending up in custody or, in the police station or whatever for some children. But then once they're there and the police officers are nice to them and they've, they've had a bed for the night and they've had some decent food and they've then actually. It doesn't, it's not really scary anymore. And like you say, they've seen so many other professionals, it just becomes another place. Yeah. That they just end up where people are nice to them.

Joe: 17:11

Exactly. Yeah. Exactly. And if they've had a lifetime of just being as a child you don't have the same rights as an adult being shipped from Pillar to post as a care leave and I'm not saying every Care leaver's experience is like that, but we know often it is. It comes as no surprise that just being in the custody suite is another one of those places. And the people become entrenched so that child will get into adulthood and they become entrenched in this cycle and they know they don't see custody as a threat in place. Some people wanna come back into prison to get a roof over their heads and three square males.

Philippa: 17:50

Yeah. Yeah, absolutely. So the diversionary stuff was to, so they did intend up in there and there's, and so what was your role in that? Was yours to identify these are the young people that actually we think we can make a difference to. Yeah,

Joe: 18:07

so our role was so the police would share data with us. We would have practitioners embedded in the custody suites, but also in the community because we know that all the children don't come through custody. They're dealt with by something called voluntary interview, which is a criminal justice process that sits out of the custody environment. It's extremely difficult to. Pick those kids up currently that are dealt with by that voluntary interview route. So we would have to now

Philippa: 18:39

what does that mean for what, what does a voluntary interview route mean? So

Joe: 18:43

rather it can apply to adults too. So let's say you, you've been naughty Philippa and the police has stopped you smoking a joint on the high street. They're not gonna arrest you and bring you into custody. They'll say, let's deal with this through a voluntary interview. And it might be they'll interview you at home, they've got a body-worn camera on, and you just say, yeah, I've been naughty. And you'll get some sort of postal requisition in terms of a fine.

Philippa: 19:12

Okay. So you were or some other engineer to the police officer? Not at the police station, you're saying? Yeah, that was me. Yes. And. Then you get the whatever it is, the Yeah. Punishment that they deem to That's right. And the word naughty. Do you know, like when you said the word naughty there, I just want to say to you, no, children definitely are not naughty. I was just like, oh my gosh, we just don't use the word naughty.

Joe: 19:41

Oh, okay. And

Philippa: 19:42

that is just a different language, isn't it? I guess it's is that system that punishes people? Yeah.

Joe: 19:49

Yeah. And I think that was my choice of word naughty. Yeah.

Philippa: 19:52

Yeah. It really pled me there about, I was like, yeah, it

Joe: 19:55

didn't it?

Philippa: 19:55

Yeah. Naughty. Can't

Joe: 19:57

say that

Philippa: 19:57

you aren't naughty.

Joe: 20:00

So with children, it works slightly different because that contact then generates in should generate involvement of what used to be called youth offending teams. They remove the offending word because obviously we're dealing with children here, so youth justice teams and they, those guys are really good as well. And they'll do, they'll look at things like speech and language needs. They'll have a mental health worker embedded. They'll have psychological input as well, often provided by the local health trust. So we would work alongside them. And there'd be a degree of work that we could undertake. So we might say, okay, we'll do the speech and language assessment and we'll feed that through into criminal justice because that would aid with communication. So simple things like that. But we would also help those individuals navigate the system in the community. To access benefits, education, that kind of stuff.'cause a lot of people just don't have the wherewithal or the knowledge to access the system, particularly when you are a child. And you might not have that parental support or those parental figures or guardians. And if you do, they're not guaranteed to understand how to you and me, we, I'd give up sometimes trying to access the local system because you're just sitting there for ages, aren't you? And you're on the phone. You can't get hold of anybody. So that was it. By, providing this structure in the community, people are less likely to go off and offend again.

Philippa: 21:35

And was that for adults as well as children? So it was for anybody who was doing that first contact?

Joe: 21:42

Yeah, it was for everyone. Yeah. And it didn't just have to be first time entrance that was just something we focused on with children. We would've liked to have done that with adults, but the volume of people coming through the custody suites with some sort of need is just immense. And you can't possibly get round to them all. So we used to deal with the most serious, so it wasn't offense related, but if someone had committed a serious offense, we were there to undertake an assessment and inform the police if there was any need for mental Health Act detention or is there a learning disability there? That kind of stuff. And that informs, this informs the police and their decision making and their process and then laterally the courts and then if it's prison, that information will follow them to the prison. So yeah, we weren't just about getting people off the hook. As some might see, it was very much let's try and put in place what you and me Philippa have and what many people have in their lives and we know the evidence is there. Once you've got someone in stable accommodation, then the rest follows. You can't just kick people out homeless and say, don't offend again.

Philippa: 22:55

What you just said there about there being a high turnover of people that's surprising in itself that, because I guess you just think that actually people really don't commit crimes very often and there's just one or two people now. And again, and actually it starts from quite a young age. So you are criminally responsible from the age of 11.

Joe: 23:16

That's right. Yeah.

Philippa: 23:17

Which is so young. When I think about my kid at 11, the thought that, he had the ability to make choices like that would be mad

Joe: 23:31

it, yeah. Entirely. Entirely. And I think any mother who has had a child at that age would have the same thinking. But when you look at where it, where that lowering of the responsibility came from. It's a difficult argument to have, isn't it? Absolutely. Yeah. Yeah.'cause I do disagree with it, but then you have to be careful.

Philippa: 23:54

Yeah. Because as a parent you can see why at times you want people to be held responsible Yeah. For things. A, absolutely. Yeah. I agree. It's a balance. But children are very young, but the thought that you've got lots of people coming through a custody suite is quite surprising really. And that there's too many to, for you to be able to support.

Joe: 24:17

Yeah. Yeah. So in a custody suite, typically you would have what they call, the healthcare practitioner who is often commissioned by the police to provide healthcare to individuals coming in. And then you've got liaison diversion practitioners on the other side that were traditionally seen as mental health but we're not, we're all vulnerability. And an assessment, if you're doing a quick one, can take half an hour and then you've got to write up all the notes and make the referrals and provide a rapport. Or it can take an hour or more. If you're dealing with a someone who needs detained onto the mental health act, you've got a foot full, the cell probably typically where we were, cell capacity of up to 30 in some of the suites. And they could be fed up and they're in and out. As well. So you couldn't possibly get around to see everybody. You have to deal with the high priority in triage, which is It's stark.

Philippa: 25:27

Yeah. Yeah. And then you've got those being fed into prisons or other systems.

Joe: 25:35

Yeah. So you then it can get a bit complicated. So yes, so you're either released from custody or they remand you and if you're remanded onto the magistrates that's an overnight stay and then you'll be transported over to the magistrates and we're liaison and diversion are in the magistrates as well. And then you're either, you might be released from the magistrates or the magistrates might say no, I remands new to prison. And you'll come back here. For a trial, depending on plea or this is too severe, it is going to the Crown. You could be reminded up to 12 months waiting for a Crown Court case to come up. And we sit in all those elements. So we cover the whole system apart from the prison. But we've got something called reconnect that picks people up coming outta prison. So there's a 360 pathway. We wrap around it all now. Everyone wants us 24 7, but we're not, we're seven days a week, 12 hours a day.

Philippa: 26:38

Once we've got then children or teenagers, young adults being sent into remand and those sorts of things, what is life like there? Are they able to access those things, that you'd want children and young people, you want adults to be experiencing Yes. But particularly children and young people you want them to experience Yes. Those everyday things, don't you?

Joe: 27:06

Yeah. Yeah. I think the, when children are a sense of secure environments in criminal justice, it is generally really serious offenses. Because they, there's a real effort to try, we don't want kids in prison. Yeah. It's not a good place for'em to be, but by myriad of, you've got a criminal justice system that's was created for men and adults primarily. So it's not a good fit for females and it's an even worse fit for kids. And by myriad of its structure, the opportunities to, for play. Limited, and it's very much dependent on the secure environment you sadly end up in. So that in itself, we know has an impact on. So

Philippa: 27:50

how is it different when it's created for men? What, make, what, yeah, what, is there or isn't there that you would want to be there for kind of women and children?

Joe: 28:01

So the whole system is not geared towards kids. So police custody suites, let's say that's the starting point. You've committed some sort of crime and you need to come into police custody. Yeah. You would be held in the same cells that adults would be held in. And you've gotta consider, these are kids from the age of 11. It's only fairly recently that they've started to. Bring things into custody suites to make them more child friendly. So there'd be a sale that's de designated for children that's specifically designed in an age appropriate way provision of fidget toys and balls and things to do. So that, that's one aspect of it being designed for adults and males.

Philippa: 28:45

And I'm assuming it's designed for adults and males who are neurotypical and not neurodivergent either.

Joe: 28:54

Exactly, yes. Yeah. And that's something that's gaining some traction within criminal justice is this work around people who have a neuro background. They're trying to make things a bit more neuro friendly. And again, it's really difficult when you are working within a structure that's, that, that's been there for so many years and has operated fundamentally in the same way for so many years to bring it in'cause you are, you're actually having to change the physical environment. But there is some recognition, it all sounds really bleak, but in the background there's some great work going on. There's lots of really important research going on. And you've got a lot of people who are leading figures within criminal justice who are now researchers. Because they knew when they worked in policing that they just couldn't arrest themselves. Out of these difficulties, they're arresting people and then 10 years later they're arresting their, those individual's children.

Philippa: 29:52

Yeah. So you've

Joe: 29:52

got a generational thing there as well.

Philippa: 29:55

Yeah.

Joe: 29:55

Sorry, I go on a bit sometimes, don't I?

Philippa: 29:57

No it's interesting. It's very interesting. And then, so once you've got a child or somebody, in custody, or, I mean in prison, whether it's on remand or whether they're saving a sentence or whatever it is. What opportunities then is there for play or for connection that is a'cause I imagine it is a very frightening place to be, especially if you are a 13, 14-year-old, even if you are a streetwise. Kiddos come from, it's noisy. It's smelly, it's, there's massive levels of power imbalances isn't, they're both between the adults and the children, but I imagine between, between the peer groups as well and that's just surviving. That must be really hard.

Joe: 30:50

Yeah, it does depend on which secure institution a child would end up. And I can only really comment on that from my time working at reading young Offenders Institution. And they did have time for football. There was a football pitch, then they used to go out and play. There was structured gym opportunities. And then on the wings they generally had pool tables, but the regime came first. So if there was an incident, everything locked down, you don't have those opportunities. You're just stuck behind your door. And that can happen with some frequency. As you can imagine in a prison that could be potentially volatile or there's violence there things are gonna get locked down quite a lot whilst wing staff deal with the incident or the situations. So that's all I can really comment on in terms of the availability of play. But, not the same as you would expect outside.

Philippa: 31:50

And so you said you do the 360 and help people when they come back out. How are they helped to reconnect to their families? To their relationships? Because those are gonna be surely the most important thing.

Joe: 32:05

Yes. Yeah. So that part of the service came last and that's very new. I think that's about four years old now. That idea of reconnect. So we would work, traditionally work with people up to the prison gate once, then in the prison, that's not for us. Then they're released, they come and you'd see the same person, oh, you are back again, are you? And what's happening is people are being released from prison. They have no support networks. They might not have secure accommodation. And we read about this in the media all the time, plus they might have substance misuse needs. So they then need to be sure that they're gonna get their methadone script if that's being done properly. All of these things that they need to, oh, they need to go and see probation as well. As soon as they're released, they gotta get there. So there was a recognition that people are set up to, to fail because what you do, you've got nothing. And the only thing you know is I'll commit a bit of crime. So at least got some money in my pocket and people would end up back in prison. So reconnect was put in place and it was a lady called Kate Morrisey's idea who worked in health and Justice NHS England and and quite simply, when people were coming up to release, we would ask them to be referred into reconnect if they had some sort of vulnerability because we, they couldn't refer everybody. But we also know most people have some sort of vulnerability in Prism. And we'd go in and we'd do an assessment. We would start building up some sort of rapport. We had people with lived experience who worked within the service. So they had been imprisoned themselves and they had a period of desistance and recovery. And they come from work for us, and we deploy these individuals and say, go and talk to old Johnny. He keeps telling us to, do one because he doesn't trust us. He's so entrenched. And the difference was quite remarkable because you'd have someone sitting opposite that person who could say, I know where you're coming from, mate. And I've made the, I've made the journey. And I'm sitting here now, that kind of stuff. Hook them in. We'd settle'em down in the community, make sure everything's in place, link them in with community, mental health teams, all of that kind of stuff. And we could do that up to six months maybe a little bit longer and we do that alongside our probation colleagues as well.'cause nine times outta 10, these guys are under probation too. So that's the idea. But with these things, you're only as good as the services out there. Yeah. Including the liaison and diversion side. So if you are trying to refer someone in to a service because you think they've had a brain injury, there isn't anything really apart from some charities too. So what do you do? And that was what we were up against a lot of the time. Services. Massive waiting times. Yeah. Yeah. And if you've got the background that you might have from a prison. You live a transient life, you're gonna lose your phone or it's gonna get stolen, you're gonna have a different address. People just get lost in the system.

Philippa: 35:23

Yeah. And that was what was, what I read out was that you are quite passionate about kind of care leave, brain injury, neurodevelopmental, and there was, you saw a lot, a high representation of people like that in the criminal justice system. Yes. Is that right?

Joe: 35:42

Yeah. Yeah, that's right. I think one of the first prisoners I worked with was an 18-year-old with a diagnosis of schizophrenia and he was a care leave. And he hadn't committed anything serious. And then he was care leaver and his story was, I turned 18, they put me into A B and I didn't even know how to cook. Yeah. And then you think what? Yeah what? The trajectory was only ever gonna be Prism. And he had no parental figures. And I found that really sad. You have to say to him that you gotta think about yourself. I won't say his name. And no one had ever said that to him before. He'd come back and go no, you're right. No one's ever said that to me before.'cause he would follow the pack. And and genuinely nice lads. Rogues, there was some rogues there and there's one or two yeah. And one or two that you didn't wanna be around? I.

Philippa: 36:41

I work with children at the young age, really, who have had early life trauma for what, for whatever reason. Often there's neglect and some kind of abuse wi within that, and we can see that they've got big, unresolved feelings and lots of things going on and I work with them within a family. Often where they've got consistent, predictable caregivers Yes. Who are really working with them, really hard to be able to work through their trauma and then be able to develop some level of regulation. Yes. But there's still a level, sometimes of violence, aggression of stealing within that lying, those sorts of things. Those are all part of a trauma presentation. Really. It doesn't, it's just that they've needed all these things to survive in a house. Yeah. Or a place that wasn't gonna meet their needs. They had to meet their own needs and they found ways to do that.

Joe: 37:37

Yes.

Philippa: 37:38

And I think, I suppose I wonder if that when they're little, when they're young, there's a lot of empathy and understanding for that. There's a lot of, okay. Yeah. We can see they've got this background by the time they're getting to 15, 16, 17 people, I. Or the system can almost run out of empathy it feels like. And there's this change from, oh my gosh, you've had trauma to that language of they're naughty, they're bad, they're choosing to do this. They can choose to do something different. And I often think that. People are just trying to survive. I'm sure that 90% of people don't really want to get into the conflict that they get into. They're doing it in because that is the only way that they know how to not die sometimes. Whether that's because if they're not part of the gang they're outside the gang and that's a risk. They're not gonna be fed. If they don't steal, they're not gonna be included.'cause we need connection, don't we? We all need connection in any way, shape or form. And some ways, these are the ways that I always remember there was a lad when I was at school who was in and out of a youth offending. A place up here. And I remember him saying why wouldn't I get three meals a day and I get to go to sleep all night. Yeah. Because he lived in a house where his dad used alcohol and was very violent when he was in a YOI, youth Defending Institute. He was safe. Yeah. And he would say, why wouldn't I be there?

Joe: 39:08

Yeah.

Philippa: 39:08

And there isn't a system either to advocate for them. Is there either, if

Joe: 39:13

no,

Philippa: 39:13

maybe our kids got into trouble you would take responsibility for that, but you would be able to argue some way about, yeah, we'll do this, we'll do that. And systems seem to be more empathetic to kids who've got adults around them and actually really, they probably should be more empathetic to the kids that don't have adults around them.

Joe: 39:36

Yeah. Yeah. I think you're right. But the sad reality is a lot of these kids they're not heard or seen, are they? Yeah. I can't remember where I read it, Philippa, but there was lots of local authorities were asked how many children are missing or out of education, employment, and they didn't hold a register. We know there's lots of kids out there that are asylum or hidden from the system. And I and I agree with you, it's, those are the ones that we ought to be worried about'cause they're the ones who are the next generation, if you like, of unfortunately people who are gonna use criminal justice. Just wanted to go back to adverse childhood experiences. And just wanted to mention a research study that was done. And I wondered if you have read it, Philip? It's a very famous study that was done in America looking at ACEs. And the study looked at a whole range of what we call advert chances, experiences. So it could be, was there a drug user in the house, was there an alcoholic in the house? So we're not talking, extreme stream trauma. But these wide range of things and the findings were quite stark, so they were able to track. These individuals over years. And it wasn't just mental health problems that people went on to develop or more contact with. Criminal justice, there's a whole range of physical symptoms as well. Obesity drug and alcohols there, diabetes, a whole range, which makes you wonder and when you read the study, it makes you wonder we've got things the wrong way round here. If kids weren't exposed to so many of these ACEs then we wouldn't have an overflowing prison population or probation service that's on its knees or youth justice services that are on, on, on their knees. And it's within all of that play would sit too. I'll try and find that study.

Philippa: 41:45

Yeah. Oh yeah, I've read it. There's a woman I think is amazing, called Nadine Berg Harris. Yes. And she talks about it quite a lot, and there's quite a bit on YouTube. She does some really accessible, brilliant videos.

Joe: 41:58

Good.

Philippa: 41:59

Yeah. I will put a link to the study at the bottom of this because it's a really interesting one. Like you say, not just about the trajectory into criminal justice, but also about health and suicidality. I think something like a hundred, you are 112% more likely to attempt suicide if you've had four ACEs or more. Yes. I might be quoting that wrong, but they're quite high, aren't they? Quite They are. They are. Or only, yeah. Quite, they're not low level but for a few number of these adverse experiences. I will put a link

Joe: 42:34

I had it all written down. I was gonna sound all really academic then and give you dates and I really

Philippa: 42:39

did. You did sound all academic. You knew it all I think that's the other thing that they talk about, don't they? Is toxic stress it in that study. And I imagine, which is the stress that is too overwhelming for your body, isn't it? It's not the everyday kind of stress. Yes. I imagine you must get that in prison, that toxic stress on a daily basis.

Joe: 43:02

Yeah there's often debt. We know that the contraband is currency'cause there's no, no money. So cigarettes and drugs you get, get yourself into debt, then you're at risk. There's also issues with gangs or individuals that have beef with each other. So yeah, you are. You could be in fear. Yeah. They've got the, that's why they have vulnerable prisoner wings. They have to lock a certain proportion of the prisoners separately away to protect them from the rest of the population.

Philippa: 43:37

It's my biggest fear in life is being in prison. It is absolutely my biggest fear in life. That thought of losing your liberty, being with so many people and being scared all the time. Yeah, because that, I can't think of anything worse than that. It's just, yeah, it really is my biggest fear. So you've moved on from there now, and now you've got your own company. So tell me about that. So this is where we started was about deaths in custody. Yes. You've got this experience and now you've started your own company,

Joe: 44:14

so Yes I was I've never liked to take risks. I was in the NHS for 20 years and I reached a point where I just thought I need to do something else for my own kind of sanity really. And I took this risk. I knew that there was opportunities to write these clinical reviews for deaths in custody. But you weren't employed you'd be paid on a, invoice basis or on a contract, not on the contract type basis. So you would either be, need to set yourself up independently or as a limited company. And it just got me thinking I've also finished my EMDR training. I need to be paid through some sort of limited company. Let's set one up the name might change, it might not. And I'll then can do these clinical reviews and I can in invoice people and that, that was the real reason. It wasn't for any I haven't got any grand ideas, but who knows where it might end up. Despite my desire to go back into therapy, MDR R therapy, I still wanna keep a foot in the health and justice side of things.'cause I've still got a real passion for it. Yeah, I have. And it's a system that if it worked well, could do great things and there's great people in there trying to make those changes.

Philippa: 45:32

So e mdr r we have done a podcast I dunno, several episodes ago about some about E MDR R. But yes, somebody might not have listened to that. So tell us a little bit about, in the last few minutes, about EMDR and I guess in a prison system. EMDR is quite a might be quite a useful therapeutic tool, really. Yeah,

Joe: 45:53

I think so. EMDR,

Philippa: 45:55

what does it stand for?

Joe: 45:56

It's eye movement desensitization regulation, I believe. Yeah. Yeah. Someone will ring up and say, I've got it wrong. And it's based on a theory called adaptive information processing. And so I might ring up'cause that's wrong as well. I think it's a IP and the theory is that as it suggests is that the information in the minds can be adapted. Yeah. Now the main thrust of the MDR is to work with traumas and they could be small traumas, large traumas, and the theory behind, let's say trauma is that, when we're faced with something that's so frightening it's terrifying or it's scary. The reptilian part of the brain takes over because that's your fight or flight response and then the experience somehow gets. Stuck in your rational brain, and that's why later down the line, you can relive the incident or you can suffer with other mental health difficulties. And that, that's what we see a lot of depression, a lot of anxiety. But actually when you scrape the surface right at the middle of it, there's some sort of trauma or some sort of poor childhood upbringing and the theory is that we access those memory networks and eye movement is known to play a part. And if you think about REM in sleep, rapid eye movement, is it is thought to be the brain kind of filing, if you like cleaning itself out processing those memories from the day before. So we're processing that traumatic experience through the memory. Yeah, we are helping that process along and then you become free from those symptoms or those dis the things that are distressing you. So it might be you're not sleeping very well or it might be flashbacks, that whole range of symptoms that you might get from post-traumatic stress. The core model, if you like, of EMDR can be complemented with other protocols if you like to treat things like grief to treat things like depression, OCD, it's being looked at for addictions as well. There's a lot of work and a lot of theory around all of these disorders, and if you think about people who are labeled by mental health services as, let's say. Used to be per borderline personality disorder. It's called e Emotionally Unstable Personality Disorder. Now they've often got three or four labels, but actually at the core of it is some sort of trauma profile. And we're just treating the low mood well that's start treating the trauma. So I'm going on a little bit about it, but that is the main thrust of EMDR is the IE. Movement. The therapist facilitates. It very much stays out the way and the brain works through it itself. And there's other techniques that come into play to, to help individuals manage dissociation and intense distress because you're asking people to bring up these images in their minds. And you need that distress to be lowered Yeah. To enable you to access it and work through. So there's lots of other techniques that come into play. That was delivered by quite a well-known EMDR consultant called Simon ProLock who travels around the world teaching and delivering treatment. He was training a load of people in Jordan because of all the trauma that's happening in Gaza and all the refugees. So yeah it's an expanding area and it's really fascinating.

Philippa: 49:50

EMDR, this is the way I think about it is that it's like we've had this experience that, gives us big feelings for whatever reason. And it's stuck. So it's like you've got your river of life going along and every now and again you kinda get this thunder cloud. Yes. That kind of crashes all across it and brings up all this fear, makes that river all unsafe really. And then we respond to it and however we respond. And it might disappear for a bit, but it's just following behind and eventually it will crash into us again and EMDR is really a way of just soothing out that cloud, isn't it? So the experience is still there. Yeah. It doesn't take away your memory of it. No. You still know that happened. You still can recall it, but what it stops is that. Great big thunder kind of crashing into our Yeah. Our lives. Every, every day or That's right. Once a month or whenever it is triggered.

Joe: 50:49

Yeah that's right. The disturbance associated with the memory

Philippa: 50:53

Yeah.

Joe: 50:54

Is reduced or eliminated.

Philippa: 50:57

And it's, they don't really know, do the, how it works other than it's some bilateral movement and lots of people do it through eye movement with kids it's often done through tapping or that's throwing a ball or something like that. But it needs to be bilateral. That's right. By understanding

Joe: 51:15

bilateral stimulation. Yeah. Eyes is probably the most familiar and the most used, but people can tap doesn't have to be your shoulders, it can be your legs. And there's lights. You can get as well. And if it's online, you follow a can, follow a dot with your I. Yeah. So that

Philippa: 51:34

you can be done online and in person contact

Joe: 51:37

it. It can be, yeah. Yeah. And it works very well. Online it works very well therapists generally have a, some sort of platform that's designed specifically for that type of therapy and it's really quite effective. And the beauty of EMDR is it's quick.

Philippa: 51:54

Yes.

Joe: 51:54

'Cause let's not take away anything from CBT and the other therapies out there. But it has a quicker response. Yeah. And that's what people are after at the end of the day is quick relief from their symptoms.

Philippa: 52:06

And I guess it's one therapy that may suit some people. It's not for everybody, is it? And it might be in combination with talking therapies or, creative therapies or whatever it is, but it's just adds to that therapeutic tool bag. For some people it's going to be useful and really helpful, like you say, it's got quite a good ethical research base to it, hasn't it? Yeah. Of of outcomes really.

Joe: 52:33

Yeah. It has really good outcomes. And there's that, I think they're looking at it for suicide at the moment.

Philippa: 52:38

Be adding that into your company and gonna be up in there at some point. Yeah,

Joe: 52:44

that'll be part of my repertoire. What I'm particularly interested in is providing EMDR within criminal justice. Yeah. And that's why I want to keep that side of things going. But if not, as I've always done, I'll see where things take me.

Philippa: 52:59

That's good. We've been talking for an hour now, Joe, so thank you so much. And it will be interesting to hear if you get EMDR in criminal justice and how that goes at some point.

Joe: 53:10

Yeah. In

Philippa: 53:11

the future. So thank you so much for being on our podcast, and I will add links, to your website and to the paper that we talked about ACEs.

Joe: 53:21

Yeah. Add link to my LinkedIn page.

Philippa: 53:24

Your LinkedIn page. We'll put it on there then. Thank you. Absolutely will. Thanks Joe.

Joe: 53:29

Thank you.