The Women’s Voice Review of a Pilot Study on Aromatherapy for Wellbeing

1. The Women’s Voice Review of a Pilot Study on Aromatherapy for Wellbeing in a closed women’s prison August 2012 MARY CHANCELLOR MIFPA, LDCA With acknowledgements to: Academic Supervisor: Dr Ruth Sewell PhD Autogenic Psychotherapist, UKCP (reg) Cert Ed, Lecturer in Integrated Palliative Care Clinical Supervisor: Liza Dagnall MIFPA

2. introducing Mary • Fully qualified and practising Clinical Aromatherapist for some years • Private practice based in the Cotswold town of Wotton-under-Edge • 4 years as an aromatherapist volunteer at our local hospice • Mobile service to support palliative care programmes in the community

3. Aromatherapy for Wellbeing “... My experience of prison was that, amongst the mixture of chaos and control, and the corrosive prison culture, there were indeed pockets of opportunity from which to gain a sense of positive engagement with others, inside and outside ...” Time Well Spent, Prison Reform Trust (James p3)

4. Her Majesty's Prison Service serves the public by keeping in custody those committed by the courts. Our duty is to look after them with humanity and help them lead law-abiding and useful lives in custodyand after release. At the gate you will be asked to show your ID and Visiting Order if visiting a convicted prisoner and asked who you are visiting. Only loose change for refreshments can be brought into the visit, so please leave any other items in your car or lockers provided in the gate. You will go through to a search area with a 'Pat down' search. Passive dogs are part of the search procedure and you will be asked to stand on a spot while they walk past. To ensure the safety and wellbeing at HMP you will then be brought through to the visits room where the person you are seeing will be waiting for you. Each prisoner is entitled to a maximum of 3 adults on the visit. Visitors wishing to hand in property for prisoners should do so before the start of their visit at the Visits Information Centre We regret we can only accept property for prisoners receiving a visit on the same day, and due to the high volume of property received, only up to 10 list-able items (underwear does not count to this entitlement) may be handed in per prisoner. Detailed guidance on property allowances is available in the Visits Information Centre. Please note all property handed in must be clean and appropriate On occasions, it may be possible to hand in medical items, but this will be subject to advanced written authority from a prison doctor and visits staff being made aware in advance Visitors can collect any property that prisoners are handing out at the end of the visits session from the Visitors Waiting Room, and will be asked to sign to say they are in receipt of items Prisoners wishing to hand out property may do so by application

5. HMP-X • Closed women‘s prison with an operational capacity of 362 • Original remit as a Remand Centre broadened to accept long term offenders • Usually 28 day stay pending determination of sentencing • Regime was already diverse, including a wide variety of employment, in-house community activities, a comprehensive Education programme and Basic Skills training • HMP-X welcomes 30+ voluntary and community organisations into the establishment offer support services to the women • New Mother & Baby wing/nursery accommodates up to 14 mums and their babies – who stay with them until they are 18 months and then Social Services places them either with family, foster care, or even adoption

6. Aromatherapy for Wellbeing “The purpose of the pilot study was to introduce the benefits of hand massage as a therapeutic intervention, using individually, blended aromatic essential oils for a select group from the female population at HMP-X and to report on the findings”

7. Measuring the outcomes • The outcomes were measured on psychological and physiological changes using a standard MYCAW process. • It was also hoped the involvement of the Health Care team would provide an opportunity to evaluate the financial implications of a potential reduction in medication and supervision

8. visit plans Each visit had a detailed visit plan which listed: • Date, time, number of participants, venue, core staff involved, other staff involved • Aims • Objectives • Resources to be provided by HMP-X • Resources to be provided by aromatherapist • Intended timings • Intended actions • Assessment post visit by Aromatherapist, Recoop Officer, Senior Prison Officer

9. ... massage begins with touch • M technique – gentle, non-invasive, soothing and calming • Hand massage as a simple tool to introduce therapeutic touch, protects the vulnerability of the receiver • Physiological benefits improvement in circulation, both of the blood & lymph, slows the pulse rate, lowers blood pressure and releases muscle tension • Psychological benefits relaxing an apprehensive mind, uplifting depression and despair, relieving pain and anger, the unquantifiable energy in a gift of touch

10. The Plan! • Participants to be identified and offered the opportunity to receive 4 half hour treatments of hand massage over a period of five weeks and to learn self hand massage • Mary meets with the individuals prior to treatment to ascertain medical histories and to ensure no contra-indications to massage or essential oils • Each participant has the opportunity to smell scented sniffers (oil impregnated blotting paper strips) to determine their preference for an aromatic handcream • Prior to each massage, the participants are invited to update any changes to their medical records and notes • Each participant will have an individual record of treatments and measured outcomes. The anonymised records and MYCAW forms will form the basis for evaluation

11. Entry & Environmental Selection Criteria ... • 5 women pre-selected from the Rubies Group aged 49 and over, with a record of behaviour indicating their willingness to co-operate • The 5 women were required to understand and to give full and informed consent to take part in the Pilot Study, with permission to withdraw at any time without explanation • Full patient confidentiality and anonymity • From the initial assessment it as ascertained the women would not experience any allergic reaction to using essential oils. Thereafter the women would receive a regular supply of their individual handcreams, sufficient for 6 weeks use in total, based on a hand massage twice a day • The women were asked to complete a Daily Record Sheet to record their feelings before and after use. The participants were also requested by the Senior Prison Officer to record their thoughts in a daily journal

12. ... Entry & Environmental Selection Criteria • It was planned all 5 would be resident during the study period • Two inter-joining rooms would be made available in G Wing for each session: one room for each participant to receive aromatherapy with the aromatherapist, whilst the other participants remained under supervision • The Recoop Officer assisted at all sessions and was present with the participants before and after their treatment, although not with them during their individual treatments • It was proposed to involve the Health Care Team to evaluate the financial implications of a potential reduction in prisoner medication and supervision • It was proposed that the participants would accept the opportunity to learn hand massage techniques and to cascade that knowledge and skills among their peers, thereby creating a self-managing wellbeing programme

13. The plan and the reality! • No glass bottles, no containers, no lotions! • Carrying ... the recliner chair, towels, pillows, notes, handcreams etc to the other end of the prison, through 3 sets of gates requiring key holders to open and shut ... • Unpredictable shut downs where everyone is ‘frozen’ where they are located ... • Privacy and confidentiality when sharing a room with 6 people... • The unpredictability of their incredibly structured lives... • The emotional volatility and vulnerability of each and every one of them ...

14. The proposed treatment • Commencing with a blind sniffer test of essential oils soaked on blotting paper • Individuals identify symptoms that cause them concern and experience a natural treatment process • The instructions for use required the participants to engage with the therapy on a twice daily basis • To be mindful when they used their handcreams • To use their prescription responsibly The half hour massage sessions focused on relaxation; the association between a place of calm and self-worth with a unique personalised scent was repeated whenever the oils were used again – either by inhalation or by self hand massage

15. symptoms medications Loprazolam (benzodiazepine) Citalopram (SSRI) Sertraline (SSRI) nausea,indigestion, anxiety, insomnia, headaches, dizziness, suicidal thoughts, skin eruptions all 5 suffered with erratic sleep problems all 5 suffered with long term depression Metformin (antidiabetic) loss of appetite, nausea, vomiting Vit B injections Low self esteem, little self worth, despair and grief poor digestion (high carb diets), frequent stomach cramps, IBS, diabetes E45, steroidal creams thinning of skin Aspirin & Paracetamol (non-opioid analgesics) usually well tolerated Cocodamol (mild opioid analgesic) constipation Naproxen (NSAID) gastrointestinal disorders Anti-psychotic meds (details unknown) Becotide (corticosteriod inhalant) Salbutamol & Ventolin (sympathomimetic bronchodilator) thrush, lack of appetite Losarton (vasodilator) fatigue, dizziness Cerazette(contraceptive pill) Levothyroxine (synthetic hormone) well tolerated skin problems: rosacea acne, eczema, dry skin migraines, deep grief, mental health issues, chronic joint pain, arthritis, asthma, menopause Cancer, chronic depression, long term drug recovery Ensure (soft diet supplement)

16. The essential oils used • Boswellia carteri (frankincense) • Canaga odorata (ylang ylang) • Citrus aurantium var amara flos (petitgrain) • Citrus reticulata (mandarin) • Lavendula angustifolia (lavender) • Origanum marjorana (sweet marjoram) • Pelargonium graveolens (geranium) • Pogostemon cablin (patchouli) • Rosa damascena (rose otto) • Santalum album (sandalwood)

18. MYCAW template at first consultation ID Date of birth Date first completed: Please write down one or two concerns or problems which you would most like help with 1. 2. Now please circle a number to show how severe each concern or problem is now. CONCERN or PROBLEM 1 0 1 2 3 4 5 6 • Not bothering me at all  Bothers me greatly CONCERN or PROBLEM 2 0 1 2 3 4 5 6 • Not bothering me at all  Bothers me greatly WELLBEING – how would you rate your general feeling of wellbeing now? 0 1 2 3 4 5 6 • As good as it could be  As bad as it could be Thank you for completing this form

19. symptoms Low self esteem, little self worth, despair and grief all 5 suffered with erratic sleep problems all 5 suffered with long term depression poor digestion (high carb diets), frequent stomach cramps, IBS, diabetes skin problems: rosacea acne, eczema, dry skin migraines, low mental state, deep, grief, mental health issues, chronic joint pain, arthritis, asthma, menopause Cancer, chronic depression, long term drug recovery

20. MYCAW follow up template ID Today’s date: Look at the concerns you wrote down before. Please circle a number to show how severe each of these is now CONCERN or PROBLEM 1 0 1 2 3 4 5 6 • Not bothering me at all  Bothers me greatly CONCERN or PROBLEM 2 0 1 2 3 4 5 6 • Not bothering me at all  Bothers me greatly WELLBEING – how would you rate your general feeling of wellbeing now? 0 1 2 3 4 5 6 • As good as it could be  As bad as it could be Other things affecting your health: The treatment you have received here may not be the only thing affecting your concern or problem. If there is anything else which you think is important, such as changes which you have made yourself, or other things happening in your life, please write it here. What has been most important for you? Reflecting on your time with Mary, what were the most important aspects for you? Thank you for completing this form

21. MYCAW Evaluation • The pilot study numbers were small – 3/5 participants completing the programme. One participant was moved to another prison before the last treatment, and one participant chose not to partake in her final treatment for personal reasons • The participants were pre-selected rather than self-selecting from within the whole community • Findings should be cautiously interpreted; however read in conjunction with their written and verbal feedback, 5 out of 5 experienced significant improvement, and some beyond the identified areas of concern (eg a reduction in medication for headaches, improvement in general skin tone, improvement in digestive disorders, improvement in the management of respiratory disorders) • There was no control group against which to draw comparison

23. The Findings • Overall an improvement in the quality of sleep, leading to an improved quality of mood and a less reactive and disturbed response to authority (eg lock up, legal visits) • Overall a measurable and significant increase in their sense of wellbeing leading to higher levels of tolerance of their environment and peer groups • Both written and verbal reflections indicate an improved sense of coping and a deeper appreciation of self worth • On a personal level, those who took part in the training and subsequently gave hand massage to others, reported experiencing a sense of purpose and pleasure in helping others

24. Feedback from the Recoop Officer • Directly after the hand massages ”...All 5 women seemed noticeably more relaxed and most of the time they were happy to just sit quietly. And if they did talk it seemed invariably on a deeper level and not as gossip. One of them started talking about the death of two of her children ..” • Over a period of time “... they ALL mentioned that they were sleeping much better. Two said they suffered fewer headaches, less dark depression and worry ... All told me that it helped with their self appreciation and self esteem. Altogether they feel less stressed and more able to cope with difficult situations on the Wings and/or in their personal lives...” • Passing on their skills and massaging others “... as part of the pilot group and as a care orderly she has been giving gentle massage to a 70 year old .. who found this helpful. Three new women have received hand massage and declared ‘it’s a lovely experience’...”

25. Voice of the Women “...I only had to open the jar and the most beautiful smell wafted out .. the knots in my stomach were untying themselves and my mind started to calm. Rational thoughts started to push my worries out. That feeling stayed with me most of the after-noon .. things don’t get on top of me so much. Problems which still happen, can be solved ... Aromatherapy has made me realise that I am a person. I can be cherished and that, even though I’ve made a huge mistake in my past, I can look forward to a future...” “...serene.. peaceful .. sleepy .. reflective ..tranquil .. energized .. balanced .. calm .. relaxed.. rested .. content .. passive ...” The best way out is always through Robert Frost

26. ‘Though no-one can go back and make a new start, anyone can start from now and make a brand new end’ Carl Bard “... The relaxation of the massage was incredible ... To actually experience it was unimaginable, my body relaxed of its own accord and I could actually feel my stomach muscles unclench .. Felt deeply relaxed for the first time in over a year and a half .. Slept well but woke with headache. Less headaches this week so far. Headache gone after massage and half an hour of inhaling the oils.. Lifted me to start another day. Calmed mind after another sleepless night ...” “... Had a good night’s sleep smelling my hands with the cream. I feel nice and calm to start the day. I also done a friend’s hands who was feeling very stressed out and she said she felt very relaxed afterwards and that she had a good night’s sleep .. So it worked on her as well.. I still wake often in the night but the sleep I am getting is better quality... Have not used cream for 3 days and found not sleeping well.. Yep slept well last night again so will use cream every night. Ready for bed ...” “... A GOOD NIGHT AGAIN - LOVE THIS CREAM” The Scream Edvard Munch That was exactly how I felt! Totally helpless and my head about to burst

27. Aromatherapy for wellbeing – the Women’s Voice “...I was slightly nervous, someone else pampering me but within seconds all I could feel was the intense serenity of the massage, the oils rose up to greet me and immediately started to calm my mind, the relaxation of the massage was incredible...” “... I was feeling really low ..the hurt I’ve caused my family and the loss of my past life is also what makes me sad... Funnily the properties of the scents I’ve chosen help with loss.. The massage was wonderful. Truly relaxing,.. I took this feeling of utter calm back to the Wing. I could feel myself smiling and felt so comforted...” Been over to see Mary and we are learning .. how to massage so we can share it with others, which I think will be good as I feel very calm again and love the feeling of being relaxed and if this can be passed on to others it is a good thing all round...” Before use, felt very anxious, didn’t know what to expect... After use, felt really calm and relaxed.. I could sleep for a week ...” “...I feel fed up today, been and got weighed and I’ve put on 3lbs. I am sat here now looking at my pot of cream thinking is it because of all that cream that I have put on weight!!! No cos it’s only a little pot. ..”

28. AROMATHERAPY FOR WELLBEING This is to certify that (name) has successfully completed full attendance on the HMP Eastwood Park Pilot Study ‘Aromatherapy for Wellbeing’ August 2012 Mary Chancellor LDCA MIFPA

29. Extending the pilot study – Aromatherapy for stress management Based on the findings, it was proposed to focus the extended pilot study on the management of stress for women offenders and to explore therapeutic intervention in dealing with the most common symptoms: - • Lack of quality sleep • Irritability and short temper • Racing thoughts without let up • Frustration (personal, environmental, relationships) • Lack of self-worth

30. number crunching .... • 23 week period • 36 participants • including the 3 who had completed the initial pilot study • elderly, disabled, self-harm communities • participants are grouped in fours for ease of supervision and movement; training and review • Day Clinic Service (one day a week) would accommodate 7-8 sessions of half hour • Personalised handcreams provided at the first treatment and thereafter in sufficient quantity for the duration of the study • The Recoop Officer or nominated prison officer accompanies each group of four providing supervision and security

31. Review and evaluation • Regular review and evaluation of outcomes with nominated governors/officers • Ongoing review with all participants throughout their individual programmes and thereafter one session to evaluate and report on the ongoing benefits of therapeutic intervention. • In order to focus on the most suitable measurement and evaluation of aspects of managing stress, I was exploring more effective paper tests for use with the study, rather than continue with MYCAW which was found to be limiting in feedback. The tests are crucial to the real understanding of how to support offenders in managing stress. • The Extended Pilot Study would support the original research paper intended for publication in clinical aromatherapy and complementary health journals

32. The outcome • Senior Prison Officer presented the proposal to the Governor and it was well received • Supported by feedback from the Recoop Officer • Political environment puts a hold on all extra curricular activities at HMP-X • Staffing shortages and lack of resources significantly impact on what is possible • No funding available to take it forward • Sits on the back-burner. I’m still in touch and hopeful...

33. Bibliography ... • Advances in Psychiatric Treatment 2003 : The Mental Health of Prisoners Luke Birmingham 2003 [http://apt.rcpsych.org/content/9/3/191.full] 12/08/2012 • Aromatherapy and Essential Oils (PDQ (R)) National Cancer Institute at the National Institutes of Health, Health Professional Version Last Modified 08/10/2012 [http://www.cancer.gov.cancertopics/pdq/cam/aromatherapy/healthprofessional/page6/..] 16/08/2012 • Aromatherapy for Health Professionals 3rd Edition Price & Price 2007 Elsevier Ltd • Aromatherapy to soothe passage of time : Agencies The Guardian UK 31 May 2005 [http://www.guardian.co.uk/society/2005/may/31/prisonsandprobation] 16/08/2012 • Community solutions better than prison for women offenders (11/7/07) : Fawcett Society July 2007 [http://www.fawcettsociety.org.uk/index/asp?PageID=496] 16/8/2012 • Effects of aroma hand massage on pain, state anxiety and depression in hospice patients with terminal cancer: SY Chang Department of Nursing, Keimyung University, Korea August 2008 [http://www.ncbi.nlm.nih.gov/pubmed/18753801] 16/08/2012 • Grendon: a prison in danger : David Wilson InsideTime issue November 2010 [http://www.insidetime.org/articleview.asp?a+843&c=grendon_a_prison_in_danger&c..] 16/08/2012 • HMP Grendon: Therapy for dangerous prisoners Caroline McClathey BBC New UK 16 November 2011 [http://www.bbc.co.uk/news/uk-11947481] 16/08/2012 • HMP Grendon: Victim of its own success : Noel Smith The Guardian Thursday 5 August 2010 [http://www.guardian.co.uk/commentisfree/2010/aug/05/hmp-grendon-victim-of-its-own-success] 16/08/2012 • In Support of the WI Rebecca Deverell, Policy & Research Officer, highlights the ‘Care Not Custody’ policy of the Women’s Institute : Rebecca Devell InsideTimes Issue June 2011 • [http://www.insidertime.org/articleview.asp?a=975&c=in_support_of_wi&cat] 16/08/12 • Interview with a GP about self harm Dr Gemma Newman The Site.Org 20 July 2010 • [http://thesite.org/audioandvideo/video/healthandwellbeing/selfharmgpinterview] 16/09/2012 • Low Levels of assaults and drug use at Grendon: The only UK prison to have proven to reduce reoffending rates, HMP Grendon is a model for therapeutic care : Rowena Davis Community Care September 2009 [http://www.communitycare.co.uk/Articles/02/09/2008/109196] 16/08/2012 • Month By Month November 2011 ‘Rachel goes up north and is surprised and cheered by HMP Garth’s Therapeutic Community : Rachel Billington Inside Time Newspaper November 2011 [http://www.insidertime.org/articleview.asp?a=1077&c=month_by_month_november] 16/08/2012 • MYMOP [http://sites.pcmd.ac.uk/mymop/index.php?c=welcome] 18/09/2012 • MYCAW [http://sites.pcmd.ac.uk/mymop/index.php?c=sister&s=mycaw] 18/09/2012

34. ... Bibliography • New Guide to Medicines & Drugs 7th Edition The British Medical Association 2007 Dorling Kindersley UK • People who self harm : Harmless 19 April 2012 [http://www.harmless.org.uk/viewpage.php?page_id=2] 16/09/2012 • The Complete Guide to Aromatherapy S Battaglia 2007 The International Centre of Holistic Aromatherapy • The short term physical and psychological management and secondary prevention of self harm in primary and secondary care : NICE Clinical Guidelines CG16 Self Harm July 2004 [http://publications.nice.org.uk/self-harm-cg16] 16/09/2012 •  Row Over Acupuncture for Prisoners : Debbie Andalo Society Guardian UK Thursday 2 June 2005 [http://www.guardian.co.uk/society/2005/jun/02/crime.penal] 16/08/2012 • Stress and the Effects of Working in a High Security Prison Joseph Micielli 2006? [http://www.ncjrs.gov/pdffiles1/224105.pdf] 16/09/2012 • Self-harm – Causes : NHS Choices 8 November 2011 [http://www.nhs.uk/Conditions/Self-injury/Pages/Causes.aspx] 16/09/2012 • Self Harm Leaflet: Royal College of Psychiatrists January 2012 [http://www.rcpsych.ac.uk/mentalhealthinfoforall/problems/depression/self-harm.aspx] 16/09/2012 • Statistics about Women in Prison : Women in Prison reference Statistics on Women and the Criminal Justice System Ministry of Justice 14 March 2010 [http://www.justice.gov.uk/statistics/criminal-justice/women] 16/09/2012 • Time Well Spent : Kimmett Edgar, Jessica Jacobson & Kathy Biggar The Prison Reform Trust UK 2011 • What is Self Harm? Mental health worker Frances McCann explains what self-harm is and how services like 42nd Street, Manchester can help .. Frances McCann, Senior Mental Health Practitioner The Site.Org 20 July 2010 [http://thesite.org/audiovideo/video/healthandwellbeing/selfharmmentalhealthworker] 16/09/2012 • Women Prisoners: self-harm, suicide attempts and the struggle for survival Mark Townsend Guardian Saturday 11 February 2012 [http://www.guardian.co.uk/society/2012/feb/11/women-prisoners-suffering-mentalhealth] 16/09/2012

35. The Women’s Voice Review of a Pilot Study on Aromatherapy for Wellbeing in a closed women’s prison August 2012 MARY CHANCELLOR MIFPA, LDCA With acknowledgements to: Academic Supervisor: Dr Ruth Sewell PhD Autogenic Psychotherapist, UKCP (reg) Cert Ed, Lecturer in Integrated Palliative Care Clinical Supervisor: Liza Dagnall MIFPA THANK YOU FOR LISTENING!