Summary

In Ireland in 2018, over 70% of prisoners in solitary confinement, and 8% of the general prison population, suffered severe and disabling mental illnesses, a phenomenon heavily criticised by the United Nations. Dr Cox’s research shows that these failings are long-standing. To influence public debate on the mental health crisis in Irish prisons, Dr Cox co-devised a series of events that informed a wide range of people of the enduring neglect of prisoners’ mental health.

Through her research – and these innovative, award-winning arts projects – Dr Cox communicated challenging materials and histories, influencing public perceptions of prisoners’ right to psychiatric services in appropriate settings. Ultimately, this has contributed to the wellbeing of prisoners and ex-offenders.

Research description

New knowledge

From 2014, Dr Cox led a multifaceted research project looking at mental illness in Irish prisons from 1830 to today. The research drew on neglected historic prison and medical records and is the first in-depth study of the topic. Modern prison regimes developed during the nineteenth century. These included the ‘separate system of confinement’, which required prisoners to be isolated in cells for around 18 hours each day. Dr Cox’s research showed that these prison regimes have had a detrimental impact on prisoners’ minds, producing or exacerbating psychiatric conditions.

Her research highlighted a strong resistance to change in penal policy, despite widespread official recognition that the separate system led to significant and lasting damage to prisoners. Elements of that system remain today in the use of solitary confinement, segregation and ‘restricted regimes’. High levels of mental illness among prisoners, and poor medical care, have been integral to penal reform campaigns since the 1830s. Prisoners, as well as NGOs, have agitated for improved conditions.

Through oral interviews – with current prison staff, prisoners and ex-offenders – conducted as part of arts-related events, Dr Cox’s project showed that these patterns persist in Irish prisons today, and that prisoners’ and ex-offenders’ wellbeing can be improved through working with historical materials in participatory arts projects.

This is the first time I have ever been heard, that I have ever spoken about my experience; I got to tell my story, from the age of 12 upwards from the time of reform school, borstal and time in prison.

— The Trial participant, 2018

Arts projects

With art sector and academic collaborators, Dr Cox coproduced and co-devised several innovative arts projects:

• An award-winning play, The Examination (with Dublin theatre group, Brokentalkers)
• An arts installation, The Trial (with artist Dr Sinead McCann)
• A museum exhibition (at Kilmainham Gaol Museum, Dublin, with Dr Oisín Wall)
• And in partnership with Professor Hilary Marland (University of Warwick), a second play, Disorder Contained (with theatre group, Talking Birds)

The plays and art installation were toured in Ireland and the UK. Each event drew on original historical research by Dr Cox, Dr Oisín Wall, Dr Fiachra Byrne and Professor Hilary Marland. The events examined the history of mental illness, addiction, self-harm and psychiatric treatment in adult and juvenile prisons from the nineteenth century to the present day.

The Examination and The Trial blended historical enquiry with contemporary research and directly involved imprisoned people who, through their participation in a series of creative workshops and oral interviews, were cocreators of the final productions.

To expand the reach and impact of each event, Dr Cox and her team organised a series of supporting activities. These included post-show panel discussions following performances of the plays and at the launch of The Trial. The team contributed to various print and radio media, maintained and published original research blogposts on the Prison Project website, and contributed to a range of arts sector and NGO publications.

Research impact

Social and cultural impact

Between 2016 and 2019, Dr Cox brought knowledge to new audiences, changing perspectives on crime, mental illness and criminal justice. Around 83,000 people attended the original performances of the events. Subsequent tours expanded these large audiences. 85% of respondents to audience surveys reported the events led them to reflect on unfamiliar social justice issues and think differently about prisons and prisoners’ mental health:

“Created awareness of lack of choice & control around a person’s physical and mental health while in prison.” “I … did not appreciate the mental anguish prisoners experience.”
— The Examination audience members (2019)

“What an amazing way to explore multiple voices and perspectives on a complex and nuanced topic. Innovative … Fascinating to see how historical and contemporary themes align and how historical perspective can inform contemporary policy on healthcare in Irish prison.”
— The Trial audience member (2018)

Co-produced by Dr Cox with Brokentalkers, the play The Examination won ‘Best Production’ at the 23rd Irish Times Theatre Awards (2020) and the Dublin Fringe Festival Awards (2019). Willie White, who suffered psychiatric illness in prison, also won ‘Best Actor’ at the Dublin Fringe.

Health impact

Prisoners and ex-offenders experienced positive outcomes having interrogated research materials and participated in events led and co-devised by Dr Cox. And they said that history gave their experiences ‘more weight’ and helped them feel heard and believed:

"Helped me to release some of the anger I had within me about my prison experience.”
— The Trial participant (2018)

Policy impact

Between October 2015 and June 2017, Dr Cox co-convened two policy conferences. The first was held at the Shard, London (February 2016) and the second at the National Gallery of Ireland, Dublin (June 2017). These developed links with prison reform organisations in the UK and Ireland, including the Howard League for Penal Reform, Irish Penal Reform Trust, the Irish Prison Service, prison psychiatrists and medical staff, probation officers, and the authors of key reports on mental health in prison. Speakers at the conferences examined the work of penal reformers and the enduring nature of mental illness in prison, asking how history can inform current work on prison medicine.

Through Dr Cox’s collaborations, penal reform advocates recognised the importance of history and art for their work, praising the integrity and quality of Dr Cox’s projects:

“History is a way that we can benchmark progress. It tells us that positive change is fragile … It [the project] brought us face to face with society’s complicity in social inequalities, to profound effect. We couldn’t look away.”
— Fíona Ní Chinnéide, Irish Penal Reform Trust (2020)

Academic impact

Dr Cox and the team published original academic research articles. They contributed to podcasts and blog series and to the publications of her policy partners, like the Howard League for Penal Reform (see References below). She co-designed novel methodologies, blending historical research with contemporary experiences. This approach was integral to her works’ successes:

“Using interviews with prisoners and historical research, our prejudices and assumptions about prisons and prisoners are called out, switched up … the sum of those parts is an extraordinary thing, a piece of theatre unlike any other.”
— Review of The Examination, The Stage (2019)

“The presentation of historical cases alongside more recent ones encouraged reflection on changes and continuities in the health experiences of prisoners."
— The Trial, audience member (2018)

The topic “was handled with immense sensitivity, underpinned by in-depth high-quality research that was transformed into something powerful, meaningful and accessible through art.”
— Irish Penal Reform Trust (2020)