Helping prisoners with dementia

Globally, and within the England and Wales Prison Service, prisoners are aging, which is a risk factor for developing dementia. Other factors of dementia are also high in the prison population, including mental health problems, poor levels of education, lack of involvement in healthcare, repeated head injuries and poor lifestyle choices, such as poor diet or addiction to tobacco, alcohol and illegal drugs.

Prisoners with dementia are a vulnerable population, at risk of becoming victims of crime and bullying by fellow prisoners. These prisoners may also face difficulty in following the prison regime and cause disruption, due to misunderstanding of the regime rather than defiance. If prison officers are unaware that a prisoner has dementia, the prisoner may be reprimanded for behaviours that are beyond their control.

However, there is very little information on the prevalence and care of prisoners with dementia. In 2018 I was awarded a Winston Churchill Fellowship to explore initiatives that might support older people in prison, including those with dementia. I travelled to New Zealand and visited Auckland South Corrections Facility and Rimutaka Prison, just outside of Wellington.

The Auckland South Corrections Facility contains a vulnerable prisoners wing. The classification of vulnerable prisoners includes any prisoner with learning disabilities or dementia, and prisoners who self-harm or those who harm others. This wing contains a number of different individual cells, some with minimum furniture and the possibility of 24-hour camera observation, some more traditionally furnished cells. All prisoners are assessed on admission to this wing, to enable the staff to identify triggers that may suggest an onset of a psychotic episode or the need to self-harm. Staff support individual prisoners through classes, but prisoners spend most of the time in the wing with no formal activities.

This approach supports the safety of vulnerable prisoners, such as those with dementia, from fellow prisoners who may take advantage of them. In addition, prison staff on this wing assess a prisoner’s behaviours with the support of healthcare professionals, and therefore prisoners are not reprimanded when a disruption to the regime occurs.

Rimutaka Prison contains a High Dependency Unit (HDU), which is a 30-bed unit for prisoners who require physical support. A number of the prisoners also have a diagnosis of dementia. The HDU is staffed 24 hours a day, by a registered nurse, three healthcare assistants and two prison officers. Interestingly, when prisoners are admitted to the HDU, they become recognised as patients. I feel that the set-up is very similar to that of a nursing home.

The prisoners/patients on the HDU were unlocked from their cells all day and had continued access to an outside space, which is unusual for prisoners. No formal activities were completed with the patients, either inside or outside in the allocated space, although the healthcare assistants discussed drawing or playing cards when time allowed. However, on my visit no activities were being completed and it was unclear how often engagement of this kind occurred with prisoners.

Nurses working on the HDU do not carry security keys, which identifies them as being healthcare professionals and allows them to develop therapeutic relationships with their patients. This approach allows a clear distinction between healthcare staff and prison officers, which the prisoners appear to recognise: they interact with the nurses as nurses and not guards.

On returning to the UK, I had a clearer understanding of the possibilities of supporting people with dementia in the prison setting. However, there remains a need to develop specialist units, to support vulnerable prisoners, such as those with dementia, with prison officers and healthcare professionals working together. These units would require dedicated staff, and a higher prisoner-to-staff ratio, which may be difficult in the current climate. Furthermore, specialist units are required that provide 24-hour social care for aging prisoners with complex health issues, including dementia. In the UK there are a number of specialist palliative care units, but not social care units such as the development of modern nursing homes within the prison setting.

The value of my visit lies in understanding the need for appropriate and tailored dementia education for prison officers and healthcare professionals working in prison settings. I am hopeful that the implementation of education and cost-effective interventions will improve the support of prisoners with dementia.