Abstract
Peer support schemes, such as peer-led induction (PLI), aim to ease the challenges of imprisonment by harnessing prisoners lived experience to support other prisoners. These schemes are designed to help prisoners navigate disorienting transitions, especially in open prisons where increased autonomy coexists with institutional control. Despite the assumption that PLI promotes well-being, legitimacy, and adaptation, emerging critiques suggest it could potentially cause iatrogenic outcomes, exacerbating the suffering it aims to alleviate. This article draws on interviews with male ex-prisoners and staff involved in PLI across three English open prisons. The findings suggest that PLI reinforces institutional hierarchies, displaces responsibility for care onto prisoners, and leaves mentees unsupported. Framed through the concepts of liminality, responsibilisation, soft power, and iatrogenesis, the article illustrates how peer-led schemes risk becoming superficial ‘tick-box’ interventions. It offers new empirical evidence and theoretical insights into the co-optation of care and the governance of suffering, where institutional needs are prioritised over well-being. The article highlights that the value of studying PLI goes beyond critiquing the scheme to exposing the ways that carceral care can be stripped of substance, turning practices intended to be supportive into potential sites of harm.
Keywords
Introduction
Prison is a site of confinement but also a space of profound psychological strain. Although imprisonment is intended to provide a controlled and secure environment, it exposes individuals to structural, interpersonal, and symbolic harms that erode well-being and dignity (Schreeche-Powell, 2020, 2025a; Crewe, 2011a, 2011b; Goffman, 1961; Sykes, 1958). These harms are particularly acute during transitions such as transfer and adaptation to new custodial settings, which are emotionally turbulent and marked by uncertainty, disorientation, vulnerability, and heightened psychological harm (Durcan and Cees Zwemstra, 2014; Favril et al., 2020). These are liminal periods where individuals are neither fully integrated into the institution nor yet returned to freedom (Jewkes and Laws, 2020). In these phases, prisoners negotiate unfamiliar rules, routines, and social landscapes while grappling with the loss of their previous identities and support networks.
Open prisons are designed to prepare prisoners for release and exemplify the complexity of such transitions. They offer increased autonomy and reduced physical security yet remain embedded in systems of surveillance and institutional discipline. Transfer to an open prison can therefore produce conflicting emotions and harm (Schreeche-Powell, 2025a). Classic sociological analyses help to explain the depth of these harms. Sykes’ (1958) analysis of the pains of imprisonment remains foundational to understanding the penal experience. Goffman (1961) shows how mortification rituals in prisons strip individuals of their identity. These rituals are repeated with each transfer, reactivating prisoners’ distress and reinforcing their subordinate status. Haggerty and Bucerius (2020) identify how such pains have since proliferated. Shammas (2014) describes the ‘pains of freedom’ that accompany the relative autonomy of the open estate, showing how trust, choice, and responsibility can produce uncertainty and psychological strain. These insights underscore that freedom within penal settings can generate distinctive pressures of its own, illustrating how the promise of autonomy can coincide with heightened uncertainty and vulnerability during transitional phases. Transition-specific harms include entry shock (the acute stress of prison admission), fear of the unknown, and loss of social support through severed peer and staff ties (Jones, 2007). Thus, transfer and adaptation – even in the context of open prisons – are often deeply embodied experiences with potentially significant mental health consequences.
Peer support interventions are increasingly integral to institutional responses, with their use expanding significantly across criminal justice systems (Kjellstrand et al., 2021; Walton et al., 2025). In England and Wales, peer-led schemes such as the peer-led induction (PLI) initiative are embedded within the Safer Custody policy, which is the national framework for suicide and self-harm prevention. PLI workers are expected to provide prisoners with reassurance, information, and guidance to ease the transition process. Schemes such as the Samaritans’ Listener programme aim to reduce harm by leveraging prisoners’ experiential knowledge, enhancing legitimacy, and fostering adjustment. Their use, however, raises the possibility of iatrogenic outcomes, where interventions designed to help instead exacerbate harm (Illich, 1976; Scott, 2016).
Although they are framed as supportive, they may prioritise institutional needs over individual well-being (Schreeche-Powell, 2025a; Smith, 2025; Walton et al., 2025). Peer supporters occupy an ambiguous role as both prisoners and agents of institutional authority, potentially undermining trust and solidarity (Bagnall et al., 2015). Critics argue that such schemes risk becoming proceduralised or tokenistic, prioritising compliance over care (Stevens et al., 2025) and turning into superficial ‘tick-box’ measures (Schreeche-Powell, 2025a). They reflect a managerial culture of austerity and responsibilisation – a ‘doing more with less’ mentality (Ismail, 2022) that shifts responsibility for care onto individuals (Fletcher and Batty, 2012; Garland, 1996). In PLI, iatrogenic outcomes may occur when schemes reinforce hierarchies, heighten powerlessness, or leave mentees feeling isolated and distrustful while also absolving the institution of its duty of care (Author, 2025a; Scott, 2016).
Recent scholarship has examined the gendered dynamics of peer mentoring in women's prisons (e.g. Smith, 2025), while this article focuses on a distinct but equally under-examined space: the experience of PLI in male open prisons, where responsibilisation and institutional disengagement produce a different set of challenges and outcomes. The article draws on interviews with ex-prisoners who underwent induction during transfer to three open prisons in England, alongside interviews with staff involved in its delivery, to examine how PLI was experienced during this phase. Thematic analysis reveals that PLI implements a broader institutional logic of responsibilisation by shifting the burden of care onto prisoners. In doing so, PLI reinforces hierarchies between staff and prisoners and among prisoners themselves, as well as exacerbating the disorientation of liminality, producing iatrogenic outcomes rather than alleviating the pains of imprisonment.
Despite the expansion of peer support policies, with 7% of prisoners in England and Wales reported to be involved as peer supporters (Author, 2025a), large-scale or critical research is lacking (Buck et al., 2023; Lenkens et al., 2024). Previous studies have tended to take a narrow, functional approach, focusing on reoffending rather than examining the nuanced workings or implications of interventions (Buck, 2018). Peer support has largely been examined in closed institutions and at the time of first admission, while little is known about how peer support interventions operate in open prisons and during later-stage transitions. Despite the centrality of open prisons to penal trajectories, they remain under-theorised and under-examined. However, they offer a revealing context for exploring how institutional interventions can both alleviate and reproduce the pains of imprisonment.
By foregrounding prisoners’ perspectives on the harms and unrealised potential of PLI, this article develops the concept of the peer support paradox – showing how care-based interventions may deepen suffering through responsibilisation, managerialism, and neglect of actual need. The analysis is situated within scholarship that includes Illich's notion of iatrogenesis and Cohen's (1985) concept of paradoxical damage; Scott (2016) emphasises both concepts as enduringly relevant to prison life, where care and control are continuously in conflict. The article also extends Crewe's (2011b) account of soft power by demonstrating how ostensibly supportive practices can be hollowed out and instrumentalised within contemporary penal regimes. These insights contribute to critical criminological debates on the co-optation of care in carceral contexts, inviting us to rethink how care is imagined and enacted in prisons. The article's central contribution lies not in assessing PLI in isolation but in demonstrating how practices of carceral care, reconfigured through institutional logics, risk becoming iatrogenic-transforming initiatives that support prisoners into further sites of harm.
Transition, liminality, and the challenges of adaptation
Sykes’ (1958) pains of imprisonment remain central to understanding the experience of custody, yet they fail to fully account for prisoners’ heightened vulnerabilities during transitions. Goffman (1961: 23) describes how reception into a custodial institution involves ‘abasements, degradations, humiliations, and profanations’, which strip the individual of autonomy and identity. This mortification process does not occur only at first entry but recurs on each transfer, reactivating psychological stress. Entry into a new institution, even an open prison, can, therefore, reintroduce trauma, amplifying uncertainty and distress.
Jones (2007: 22) identifies entry shock as ‘the turmoil individuals face during their initial period of imprisonment when they enter the criminal justice system’. This shock also manifests during prison transfers, which are marked by abrupt shifts in regimes, social dynamics, and environments. During each transfer, prisoners repeatedly experience ‘abasements’ (Goffman, 1961), marked by renewed disorientation and stress. Fear of the unknown (Jones, 2007) emerges when prisoners face unfamiliar rules, peers, and expectations while having little information or control over their situation. As Jewkes and Laws (2020: 4) observe, such uncertainty produces a ‘period of instability or chaos, to one of tolerance or even transformation and reinvention’; a liminal stage.
A further pain, loss of social support, arises when transfers sever established relationships with peers and staff, leaving prisoners to renegotiate social networks under conditions of surveillance and mistrust. Research has documented that such losses are linked to suicidal behaviour and self-harm (Liebling, 1999; Pratt and Foster, 2020; Richie et al., 2021). In open prisons, where peer networks may be more fragmented due to their transient nature, these losses can undermine prisoners’ psychological well-being and institutional adaptation.
Thus, transfer and adaptation are key social and psychological events, marked by liminality and institutional intervention. The vulnerabilities felt by prisoners provide the rationale for peer-led interventions, which are emerging as a prominent institutional strategy aimed at mitigating psychological harm and supporting adjustment.
Peer support as an institutional response
In response to the vulnerabilities inherent in institutional transitions, peer support interventions have become a central component of the Safer Custody policy in England and Wales. This national suicide and self-harm prevention framework encompasses institutional practices, assessments, and interventions designed to protect prisoners during vulnerable periods by identifying risk, offering support, and maintaining safety. Peer support schemes such as PLI aim to ease prisoners’ disorientation and facilitate adaptation by drawing on their experiential knowledge. Every prisoner has to participate in an induction programme on entering prison, although some may choose to refuse or resist. PLI adapts the induction process to include peers alongside staff in a power-sharing initiative that symbolises reconfigured penal power (Crewe and Liebling, 2017). This strategy is operationalised by training and empowering prisoners to collaborate in the reception and induction process. Introducing prisoners to the policy, procedures, and daily routine of the penal establishment has become a significant component of peer support. The programme is flexible and implemented in various ways in different prisons, but its roots lie in the induction insiders scheme, which explicitly aims to ‘improve the quality of life for prisoners by promoting community responsibility, supportive relationships, and a caring environment’ (HMP Safer Custody Group, 2005). Peers provide practical advice and support during the high-risk period when prisoners are new arrivals. These peers tend to be more advice and practicality-oriented than listening and emotion-focused, helping prisoners to navigate the institutional environment and its challenges (Perrin, 2024). They are responsible for supporting prisoners; assisting with basic needs (e.g. form-filling and writing letters); identifying gaps in information; alerting staff to risks of self-harm, suicide, or bullying; recording initial contacts and referrals; and following up with vulnerable prisoners as needed. They also participate in classroom-based components of induction alongside staff, covering topics such as offender management, family support, chaplaincy, resettlement, education, working-out schemes, and drug and alcohol support (Schreeche-Powell, 2025a).
The selection of peer workers is typically managed by frontline staff and depends on peer workers passing security clearance and meeting certain criteria, including no recent drug test failures; no history of bullying; and suitable personal qualities such as trustworthiness, literacy, care skills, and interpersonal skills. Peers are supervised by staff involved in induction and reception, who are expected to advise and support them. Some roles are paid, while others remain voluntary. Regardless of the specifics, the defining principle remains that peers lead induction delivery, complementing the staff role rather than replacing it.
Peer support draws on several interrelated theoretical frameworks that aim to explain its benefits within custodial environments. Social Learning Theory suggests that prisoners may adopt prosocial behaviours by observing credible mentors who model adaptive coping and adjustment (Bandura, 1986; Catherine-Gray and Denkers, 2024). Similarly, Social Inoculation Theory suggests that persuasive counter-narratives from experienced peers help mentees resist harmful attitudes and behaviours (Devilly et al., 2005). The Buffering Hypothesis (Cohen and Wills, 1985) proposes that social support moderates the psychological effects of stress, enhancing resilience during the high-stress periods of induction and transfer. Research also indicates that peer schemes foster trust, demystify institutional routines, and build social capital, thus providing both emotional and practical support (Walton et al., 2025). Together, these theories frame peer support as a hybrid intervention that is both social and institutional, benefiting not only the recipients but also the wider organisation.
Previous studies have documented that peer support provides a broad array of benefits for both recipients and institutions. For mentees, peer support can offer emotional comfort, reduce anxiety, mitigate self-harm and suicidal behaviour, and accelerate adjustment (Walton et al., 2025). At the institutional level, peer schemes reduce staff workload, enhance legitimacy, and improve day-to-day operations (Fletcher and Batty, 2012; Woodall et al., 2015). Peers often enjoy greater credibility than staff due to their lived experiences, thereby fostering trust and openness among mentees (Buck et al., 2023; Fletcher and Batty, 2012).
However, despite these benefits, scholarship has also highlighted the risks and unintended consequences of peer support. PLI is embedded within a coercive institutional framework where care and control are intertwined (Crewe, 2011a). The ambiguous position of peer workers can undermine trust and solidarity among prisoners (Bagnall et al., 2015), and schemes can become superficial exercises aimed more at institutional legitimacy than prisoner well-being. By embedding care within a bureaucratic, surveillant context, peer support risks intensifying feelings of mistrust, alienation, and disempowerment (Scott, 2016). Such harms are particularly pronounced during liminal, transitional phases when prisoners are already disoriented and vulnerable (Deacon, 2023; Jewkes and Laws, 2020).
These tensions reflect the ambivalence of peer-led interventions: while they can mitigate some of the pains of imprisonment, they can also cause iatrogenic outcomes, defined as ‘injury, hurt, or damage generated by an institutional practice that is justified on the basis of helping, assisting, or healing individuals with problems requiring remedy’ (Scott, 2016: 107–108). In clinical contexts, Illich (1976) defines medical iatrogenesis as harm inflicted by medical professionals through overtreatment, side effects, or unnecessary procedures. Cohen (1985) and later Scott (2016) extended this critique to the penal sphere, identifying how criminal justice agents inflict misery, stigma, and deviance under the guise of rehabilitation – what Cohen (1985) termed paradoxical damage.
Building on theories of liminality, responsibilisation, soft power, and iatrogenesis, the study addresses gaps in the existing scholarship by examining how ex-prisoners experienced the PLI scheme during their transfer and adaptation to three open prisons in England. The analysis examines how peer-led interventions can simultaneously mitigate and exacerbate the harms of imprisonment during transitional moments, providing new empirical insights and theoretical interpretations of the unintended consequences of institutional care during later-stage penal trajectories.
Methods
This article draws on findings from a qualitative study of PLI in the open prison estate, which presented the accounts of both formerly imprisoned individuals who participated in PLI and prison officers involved in its delivery (Schreeche-Powell, 2025a). The study's core focus was on how males imprisoned during the ‘critical time’ of the transfer process – the early days of custody in open prisons after their transfer – experienced and navigated the mental health risks associated with this period. It also examined how these risks manifested in PLI schemes and the impact of current PLI initiatives on the mental health and well-being of these males. The study was motivated by a lack of research and theory regarding open imprisonment, especially on how power is applied and experienced during transitional and liminal phases in prison settings.
The research included 34 participants: 27 ex-prisoners (mentees) who had experienced transfer to one of three different open prisons in the south of England and engaged in PLI schemes, and seven prison officers (staff) directly involved in facilitating and delivering PLI at those sites. The ex-prisoner samples were all men in their twenties and sixties; 16 identified as White, nine as Black, and two as Asian. Just under two-thirds (16) had served previous custodial sentences, while 11 were serving their first sentence. Seven participants had prior experience of open prisons, whereas 20 were entering such settings for the first time. Most of the participants had experiences of prison transfer: nine participants had experienced more than 10 inter-prison transfers, seven participants between five and nine, and 11 participants between one and four. The participants’ length of stay in open prisons varied, with six participants remaining for over 2 years and 21 participants spending between 13 and 24 months in this setting.
The staff sample comprised seven White officers: five males and two females. They had different levels of service: three participants had over 10 years’ experience as officers, while four participants had < 4 years. They also had varied experience as induction officers, with three participants reporting 5 or more years in the role and four participants reporting around 2 years’ experience.
Data were collected between 2020 and 2024 through semi-structured interviews, which were chosen for their flexibility in enabling participants to reflect meaningfully on their experiences while producing ‘thick description’ (Geertz, 1973). This method allowed participants to express the significance of their transfer, induction, and adaptation experiences in their own words while also facilitating exploration of both prisoners’ and staff's perspectives. The interviews followed an iterative process consistent with grounded theory methodology (Charmaz, 2014), whereby insights from early interviews shaped subsequent questioning. They lasted for ∼45–90 minutes and were conducted through online media platforms such as Zoom and Teams according to the participants’ preferences. An interview guide was used, including topics such as experiences of induction in open prisons; the psychological and emotional impact of transfer; perceptions of support received (or lack thereof); power relations between staff, peers, and prisoners; and attitudes towards the legitimacy of the custodial regime. The interviews were audio-recorded, transcribed verbatim, anonymised, and checked against the recordings for accuracy.
It is important to recognise that both ex-prisoners and current serving staff, with the specific characteristics and experience required for the study, can be described as hard-to-reach populations. They are often socially invisible, which poses major barriers for their recruitment. Hard-to-reach populations may try to suppress their identities and perspectives due to fear of confrontation with legal authorities or because of social pressure from the broader community (Shaghaghi et al., 2011). This is especially relevant to prisoners or ex-prisoners because of the inmate code (Liebling and Maruna, 2005) and also applies to prison officer cultures (Crawley and Crawley, 2007). Given these considerations, the ex-prisoner sample was recruited using purposive sampling to ensure the inclusion of participants with specific and meaningful experience of PLI in the open estate. Ex-prisoners were recruited through a combination of social media advertising, targeted emails to members of prison reform organisations, and my informal networks developed during my prior prison research. This informal approach facilitated trust-building with a traditionally hard-to-reach group. The staff sample was also recruited purposively, incorporating additional elements of convenience and snowball sampling.
The original study employed a constructivist grounded theory approach (Charmaz, 2014), which combines inductive theory development with interpretive reflexivity. This choice was appropriate given the lack of specific theory about PLI in the open estate, aligning with grounded theory's aim to generate theory ‘grounded in data’ (Glaser and Strauss, 1967). The analysis was conducted using the systematic approach outlined by Huberman and Miles (1994) and involved three main stages: open coding, axial coding, and selective coding. For instance, one formerly imprisoned participant's account that induction ‘felt like being handed over to another prisoner without anyone really caring what I needed’ was initially coded during open coding as lack of staff support. Through axial coding, this was linked to the broader category of institutional withdrawal. In selective coding, it contributed to the overarching theme of iatrogenic outcomes, highlighting how the absence of meaningful care left prisoners feeling abandoned rather than supported.
Although the original study produced an inductively grounded theory of PLI, the present article revisits the data. The thematic reframing of the data for this article reflects an interpretive choice to foreground the theoretical constructs of iatrogenesis, responsibilisation, and carceral governance and organise the findings thematically to engage explicitly with critical theoretical debates about them while seeking to preserve the integrity of the original data.
Ethical issues were central to the study's design, given the vulnerability of the participant groups and the history of unethical research within prisons (Charles et al., 2014). Although the ex-prisoner samples in the present study were no longer imprisoned, they remained metaphorically ‘captive’ due to lingering disempowerment and marginalisation (Nickel, 2006). Therefore, the study adhered to the four ethical principles outlined by Diener and Crandall (1978): avoiding harm, ensuring informed consent, protecting privacy, and avoiding deception. Ethical approval was obtained from the author's academic institution. Participants were provided with detailed information sheets before giving written or verbal consent. Confidentiality and anonymity were guaranteed, and pseudonyms were assigned for the purpose of this article. Participation in the study was voluntary, with the right to withdraw at any time without any consequences.
I was highly conscious of the inherent power imbalances between myself and the participants and aimed to reduce these imbalances by utilising the reflective framework proposed by Dickson-Swift et al. (2007). This framework includes themes such as self-disclosure, rapport, reciprocity, feelings of guilt, and the interview process, all of which help to enhance transparency, encourage reflection, and prioritise participant voice. As with all qualitative inquiries, my own interpretive lens shaped how I approached the field and engaged with participants; maintaining reflexivity was central to ensuring analytical balance. A fuller account of my positionality in relation to this fieldwork is provided elsewhere (see Schreeche-Powell, 2025a, 2025b for a comprehensive account). In this article, I focus on the substantive themes emerging from the research.
Helping or harming? Perspectives on PLI
The original study explored the experiences of imprisoned men who participated in PLI after their transfer to three different open prisons, alongside the perspectives of prison staff involved in its delivery. Three interrelated themes illustrate the dynamics involved:
Liminality and fear of the unknown. Responsibilisation and managerialism: Shifting the burden of care. The peer support paradox: Between formal schemes and informal solidarity.
These themes are examined below, drawing on participants’ narratives and theoretical lenses to understand how a seemingly benevolent intervention can generate harm within a coercive institutional context. This can exacerbate stress, amplify institutional harms, and reinforce feelings of alienation, thus representing an iatrogenic dynamic.
Liminality and fear of the unknown
For many participants, transfer into an open prison was a profoundly disorienting and unsettling experience that intensified rather than alleviated their feelings of vulnerability and uncertainty. This transition, while ostensibly a long-anticipated and sought-after step towards freedom, left prisoners feeling unmoored – suspended between the punitive regimes of closed prisons and the promise of release. Such experiences reflect a condition of being ‘betwixt and between’, where established roles and structures have been stripped away but new ones remain unclear or unattainable (Turner, 1967).
Freddy (formerly imprisoned) captured this vividly: It's like being thrown into deep water without a life jacket … I didn't know what was coming next ... just not knowing ... waiting. … anxiety went sky high … I overthink at the best of times but new prison, new people, new rules, new things to learn – it kind of takes over your thoughts. I was obsessing over it, and it was stressing me out. I had people I could rely on in my old prison, but here, it's like starting from scratch. Nobody knows you, and you don’t know who you can trust.
In many cases, prisoners were left with not just a fear of the unknown but also a perception of being abandoned at a critical point in their sentence, reinforcing feelings of disposability. This aligns with Jewkes and Laws’ (2020) account of imprisonment as an emotionally turbulent process. However, what emerges here is that such turbulence does not necessarily diminish with progression through the penal system. Instead, the unique conditions of the open prison – combining autonomy and surveillance – exacerbate the uncertainty, intensifying the harms of liminality rather than resolving them.
Responsibilisation and managerialism: Shifting the burden of care
Alongside feeling disoriented, participants described how both the design and implementation of PLI reflected broader institutional logics of responsibilisation and managerialism. These dynamics shifted the burden of care and adjustment away from the institution and onto prisoners themselves. Mentees were expected to cope independently, while peer workers were tasked with providing support to other prisoners without adequate resources or authority.
Many mentees expressed frustration at the expectation that they would adapt to their new environment with minimal institutional support. One formerly imprisoned described it bluntly: It's like trying to stop the flow of blood from a gunshot wound with a plaster. They expect you to get on with it, but they don’t give you what you need.
Peer workers were perceived as compromised by conflicting incentives and institutional pressures. Several participants described how peer workers were more focused on advancing their own interests, such as gaining favour with staff, than genuinely supporting mentees. Ash (formerly imprisoned) observed: They’re feathering their own nest … They don’t care about you, just about looking good for the staff. They have power, which they apply for their own motivations … like another set of screws on us and getting busy but just not in uniform.
Institutional pressures for efficiency and procedural compliance also shaped the delivery of peer support. Participants repeatedly described PLI as overly bureaucratic and more concerned with documenting activity than delivering meaningful support. A prison officer criticised the emphasis on paperwork over outcomes: The system is obsessed with forms – whether we’ve filled them out, not whether we’ve actually made a difference. At present, there is too much emphasis on following guidelines and rules instead of actually helping the prisoners … in a more needs-focused manner.
The combination of responsibilisation and managerialism transformed what was intended as a supportive and empowering initiative into an alienating and superficial process. Rather than alleviating the pains of transition, these institutional logics intensified them by shifting the burden of care onto those least equipped to bear it – prisoners themselves. Participants highlighted how this dual burden left both mentors and mentees feeling manipulated, disillusioned, and unsupported. This dynamic echoes broader tensions identified within open conditions. As Shammas (2014) observes, the freedoms offered within open conditions can generate unease, as responsibility and trust become emotionally demanding and precarious expectations. In this context, apparently empowering interventions, such as peer-led support, can paradoxically reproduce constraint and harm. Yet, while Shammas locates pain in the existential ambiguities of conditional freedom, the concept of iatrogenesis developed here shifts attention toward the unintended consequences of care itself. The focus is not on freedom as burden, but on support as a site of harm-a process through which initiatives inadvertently sustain the very pains they are designed to alleviate.
The peer support paradox: Between formal schemes and informal solidarity
Although all participants acknowledged receiving some form of peer support during induction, they consistently critiqued its quality, authenticity, and usefulness. They often dismissed formal peer support as superficial, transactional, and lacking in genuine care, while informal networks emerged as vital sources of support and adaptation.
Ash, a mentee, articulated this: They’re called peer support, but they’re the last people you’d go to if you actually needed help. They were only interested in getting me out the door so they could get on with cooking their dinner and association … questions just went unanswered – they were invisible. You have to figure it out yourself or find someone you trust – the mentors just tick boxes and disappear. Luckily, I knew a few fellas from my last prison – they showed me the ropes … no one else did.
This preference for informal over formal support highlights what could be termed the ‘peer support paradox’: by formalising and systematising care, prison authorities undermine the authenticity of peer support, driving prisoners back towards the very unsanctioned networks the intervention was meant to replace (Schreeche-Powell, 2025a). This dynamic echoes Matthews’ (1988) critique of ‘informal justice’, where initiatives ostensibly grounded in empowerment and participation risk becoming repressive substitutes for, rather than progressive alternatives to, formal justice. In the case of PLI formal schemes, which are shaped by institutional logics of surveillance and self-interest, participants often perceived them as extensions of the prison's coercive apparatus. Although informal networks were fragile and precarious, they felt more authentic and better aligned with the actual needs of prisoners.
The context of PLI – shaped by managerialism, responsibilisation, and soft power – stripped peer support of its credibility. Rather than fostering solidarity, it often reinforced distrust and deepened prisoners’ feelings of abandonment. Informal networks, though inconsistent, filled the void left by institutionalised care, enabling some prisoners to mitigate their liminality and navigate transitions more effectively. These findings highlight the unintended consequences of formalised peer support: as care becomes instrumentalised and bureaucratic, it risks turning into another mechanism of control, driving prisoners to seek solidarity outside sanctioned channels. This tension underscores the fragile balance between institutional care and prisoners’ strategies of adaptation and resistance.
Strikingly, across both staff and prisoner interviews, no participant provided a consistently positive account of PLI. While many participants experienced PLI as a bureaucratic and superficial intervention that prioritised institutional convenience over prisoners’ well-being, some acknowledged that the underlying concept of peers supporting one other through transitions has considerable merit if properly implemented. Their criticisms were not of peer-led support itself but of its execution, which they perceived as hollowed out by managerial priorities (Schreeche-Powell, 2025a). One formerly imprisoned participant reflected: They need to sit down with us and ask us what would help us settle better … if they did that and gave us what we wanted to know, then I would have felt so much better. It's a great idea in principle, but they ain’t got it set up right here to do that, that's all.
Similarly, a further mentee remarked: If they did what we needed, then it would be really helpful.
These reflections reveal that prisoners perceive PLI to have potential, provided it undergoes a redesign that genuinely addresses their expressed needs and priorities. Rather than abandoning the scheme altogether, participants advocated for a more authentic, participatory approach that centres their voices and aligns the intervention with the original ethos of care. Such insights suggest that reforming the design and delivery of PLI by prioritising prisoners’ perspectives over institutional targets could help realise its potential as a meaningful support mechanism rather than a ‘tick-box’ exercise.
It should also be noted that some of the participants’ experiences coincided with the COVID-19 pandemic, a period in which many formal forms of support were suspended or reduced. It is therefore possible that some prisoners derived particular benefit from PLI during this time. Research on other peer schemes during COVID-19 underscores this potential. For example, studies of peer-based initiatives in UK prisons found that when professional services were withdrawn, peer recovery organisations not only continued their services but in some cases expanded their activities, maintaining continuity of care and support (see Best et al., 2022). Although this area was not a direct focus of the interviews with participants, these findings suggest that peer-led initiatives may at times provide meaningful benefits in conditions of crisis and scarcity, even while their iatrogenic risks remain salient. However, positive accounts regarding the PLI intervention were fragmented and overshadowed by the prevailing narrative of frustration, mistrust, and emptiness. This does not discount the possibility that some prisoners may have experienced more meaningful benefits from peer support in other contexts, but within the current dataset, such accounts were marginal. As currently implemented, the cumulative effects of carceral care being hollowed out rendered the PLI intervention iatrogenic (Illich, 1976): a source of harm despite its ostensible intent to support.
Iatrogenic outcomes of PLI
In June 2024, 87,726 people were imprisoned in England and Wales, representing a 2% year-on-year increase (Ministry of Justice [MOJ], 2024). In the preceding 12 months, 85 self-inflicted deaths occurred in custody – up from 63 in June 2009 – underscoring a long-term deterioration in prison mental health outcomes. The picture is even starker in relation to self-harm: in the 12 months ending March 2024, incidents rose by 24% to 73,804, equating to one act every 10 minutes (MOJ, 2024). Rates in male prisons were especially acute, with a 32% increase overall and 652 incidents per 1000 prisoners, alongside a 13% rise in the average number of self-harm events per individual. Compared to the general population, self-harm in prisons remains 10–20 times more prevalent (MOJ, 2019). Such troubling outcomes are often exacerbated during periods of institutional transition, intensifying psychological distress and the risk of self-harm (Schreeche-Powell, 2025a).
The stated purpose of peer support during induction is unequivocal. Effective peer support has long been positioned as a critical mechanism for reducing self-harm and suicide, fostering a secure, respectful, and healthy atmosphere within prisons (Bagnall et al., 2015; HMPS Safer Custody Group, 2005; Walton et al., 2025). As set out in policy, the objectives of PLI include providing prisoners with information and reassurance upon arrival, offering positive and immediate guidance, equipping new arrivals with essential knowledge for navigating the early days of custody, and conducting follow-ups with particularly vulnerable individuals (HMPS Safer Custody Group, 2005).
However, despite these objectives, the prevalence of physical and mental health problems in prisons has regrettably remained a persistent and widespread problem, highlighting the pains of imprisonment. In addition, the peer support model of induction, which is a mechanism that aims to address such mental health concerns, has not been rigorously evaluated or revised since a limited pilot study nearly two decades ago (HMPS Safer Custody Group, 2005). As one staff participant noted: No one really knows if it even works – they [management] just keep doing it the same way because it looks good.
The current findings suggest that PLI, as embedded within the wider institutional framework of the prison, can, in certain circumstances, generate harms that appear to undermine its stated aims. As a following formerly imprisoned participant explained: They say it's to help you settle in … but it just makes you feel watched, like you’re on show, and you don’t trust anyone. They say it's for your benefit, but really it's just another way to control you. It actually made me more stressed, more on edge. It just feels like another way to keep an eye on you – like you’re being monitored, not helped. (Joey, ex-mentee)
Crucially, the harms identified were experienced by mentees – those the intervention was purported to help – and manifested as heightened mistrust, stress, alienation, and a sense of being surveilled and manipulated. Participants described feeling they had to navigate an intervention that emphasised institutional convenience over their well-being. One mentee concluded: It felt like they cared more about ticking the boxes and looking good for the inspectors than about actually helping us settle in.
While the current research provides clarity about how institutional dynamics contribute to iatrogenic outcomes, it is necessary to reflect critically on the methodological and contextual limitations of the analysis. First, the sample was relatively small and purposively recruited from three open prison sites. While appropriate for qualitative inquiry (Patton, 2002), this limits the representativeness and generalisability of the findings. The reliance on self-selected participants recruited via charities, networks, and snowball sampling may have introduced a bias in favour of those more willing to share critical experiences of induction. While this enriched the depth of the narrative, it risked under-representing more neutral or positive perspectives. Also, the study relied on ex-prisoners’ and staff members’ retrospective accounts. Although these accounts are rich and authentic, they reflect subjective perceptions that cannot necessarily be corroborated by contemporaneous observation of the schemes in action. At the same time, their distance from the immediate constraints of imprisonment allowed for more reflective accounts of PLI while also highlighting how their experiences of such schemes over time. Debates about sample size in qualitative research are inevitable, especially regarding the strengths and limitations of using a small sample. Martel (2004: 170) suggests that such small samples generate (in)valuable insights about the particular, or “local”,’ supporting more in-depth analysis, and the article does not claim to be representative of all individuals within the criminal justice system who are experiencing or involved in the processes of transition, transfer, and PLI. Consequently, caution should be exercised in extrapolating these findings to different stages of the custodial experience, closed prisons, women's prisons, or other jurisdictions where the characteristics may differ significantly. Instead, it provides an in-depth insight into experiences within the criminal justice system.
While the study did not directly focus on the pandemic, it is important to acknowledge that COVID-19 reshaped the dynamics of peer-led support in prisons. The restrictions amplified conditions of scarcity, increasing prisoners’ reliance on informal peer support and potentially heightening both its benefits and its iatrogenic risks. Future research could usefully examine how peer schemes operated during and after lockdowns to illuminate how crises interact with institutional withdrawal, as well as the extent to which peer interventions serve as either a buffer or a further site of harm.
In totality, the methodological limitations of the original study do not negate the value of the findings but rather contextualise their scope. The article provides a nuanced understanding of the unintended consequences of PLI while suggesting the need for further empirical work – particularly longitudinal, multi-site, and observational studies – to substantiate and extend these insights.
Conclusion
The constant flux within prisons is intrinsic to the suffering that those imprisoned experience while confined within their walls. Regardless of the underlying philosophy of punishment imprisonment entails pain, an enduring theme in penal scholarship.
This article has shown how PLI, while presented as a supportive intervention, often exemplifies institutional disengagement where care is offered in name but not in substance. Participants experienced transfer as a profoundly liminal event: disorienting, uncertain, and emotionally destabilising. Yet PLI, rather than alleviating this vulnerability, was widely perceived as ineffectual, procedural, and detached from prisoners lived realities. In this way, the scheme risked deepening the very pains of imprisonment it claimed to mitigate – not through overt cruelty, but through the quiet violence of neglect, responsibilisation, and managerialism.
Participants’ accounts reveal not merely a critique of one particular intervention but a broader caution about how carceral institutions frame care: as something that can be delivered cheaply, bureaucratically, and without genuine engagement with those it purports to serve. The findings remind us that even well-intentioned reforms can reproduce harm when they fail to address the emotional and social needs of those imprisoned. For scholars, these dynamics underline the importance of theorising not only the presence of power but also its strategic absences – the ways that institutions retreat into procedural minimalism and call it care. For practitioners and policymakers, the accounts invite reflection on whether support aligns with prisoners lived realities of these liminal moments or merely serves institutional convenience.
Thus, the significance of this article lies less in its critique of PLI itself and more in its illumination of how carceral care, when hollowed out by managerial logics, becomes another site of harm. The analysis, therefore, advances a broader conceptual argument about the unintended consequences of care in penal governance. The concept of iatrogenesis is used here to theorise how practices of care within the penal field can themselves become mechanisms of suffering and control, capturing how interventions presented as supportive and participatory can reproduce the very forms of pain they aim to alleviate. By centring harm within the logics of care rather than coercion, this framework reframes how the pains of imprisonment are understood in late modern penal regimes. It highlights a neglected dimension of penal power: the capacity of caring practices, shaped by both responsibilising and institutional logics, to paradoxically perpetuate rather than mitigate the pains of imprisonment. To ignore these unintended consequences is to collude in them. However, recognising them opens up the possibility, however tentative, of imagining interventions that are grounded in trust, authenticity, and a willingness to listen to those at the sharp end of the penal experience.
Footnotes
Ethical considerations
This study received ethical approval from The University of Kent IRB (approval 16012020ESP) on 16 January 2020 at 16:40:30 GMT.
Consent to participate
Respondents gave written consent for review and signature before starting interviews. They were provided with PIS sheets that detailed the study, and these were also read orally. Participants gave informed consent to participate in writing.
Consent to publication
Informed consent for publication was provided in writing by all participants. Participants were assigned a unique identification code which correlates to their allocated pseudonym. All data is confidential and was anonymised utilising pseudonyms once transcribed.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
Declaration of conflicting interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data availability statement
The data supporting the findings of this study are not publicly available due to confidentiality requirements under the conditions of ethical approval. Disclosure of the data would breach participant privacy and the terms agreed upon by the ethics review board.