Poor services put older prisoners at greater risk of ill-health, says report

The number of older prisoners in England and Wales has risen
from 365 to 1,154 between 1990 and 2000 and looks set to rise still
further according to Growing Old in Prison, a report by
the Prison Reform Trust.

The report, released late last month, argues that older prisoners
are being neglected because the Prison Service is failing to meet
their specialist health, social and rehabilitation needs. It
predicts that numbers of older prisoners will continue to rise due
to measures within the criminal justice bill currently being put
before parliament.

Prison Reform Trust director Juliet Lyon says that for older
prisoners, and particularly those with a disability, prison is a
double punishment. “Jail is experienced by older people as a
harsher environment than it is by younger men.”

Stuart Ware, an ex-prisoner who is now director of Pacer 50plus, a
support network for older prisoners, says:”I know from my own
experience that prison life can be twice as difficult for older
prisoners. Prisons and their regimes are not designed for people
over 60 who have special health and social needs.”

The report calls for a national strategy for older prisoners to
address:

• Health care.
• Provision of disability services.
• Social care provision.
• The development of education and rehabilitation
  programmes.
• The specific resettlement needs of older prisoners.

But the government has dismissed the need for any such strategy.
In May, the then minister for prisons and probation Hilary Benn
told parliament: “There are no plans to put in place a separate
national strategy for elderly prisoners that specifies regime
requirements. The Prison Service aims to assess prisoner’s needs
through sentence planning. This takes account of the requirement
for appropriate accommodation, health care, regimes and
resettlement support for all prisoners.”

Growing Old in Prison says more than 80 per cent of older
prisoners have a long-standing chronic illness or disability. But
it expects their health care to improve because the NHS took
responsibility for it in April this year. The report also outlines
how prisons are aiming to improve disabled prisoners’ access to
facilities by 2004, although Ware doubts this target will be
met.

The government announced plans for HMP Norwich to build a new
health care wing for 15 older and infirm long-term prisoners
earlier this month but no building work has begun and there is no
date for completion.

The report also says that social care in prisons is failing many
older prisoners. Lyon says that social care received by older
prisoners is variable around the country but worse than that
received by older people in the community. She adds that prison
staff receive no specialist training in how to care for older
prisoners and that there is a failure to acknowledge that people
age faster in prison.

The report states that more than half of older prisoners suffer
from a mental disorder, with the most common being depression. Ware
says that this is partly caused by the prison regime’s failure to
cater for older people, leaving them to drift into inactivity. HMP
Kingston, in Portsmouth, which holds only life sentence prisoners,
is the only prison in England and Wales to have a specialist unit
for older prisoners. It has received mixed reports over the past
few years.

Crispin Truman, chief executive of Revolving Doors, a charity that
works with ex-offenders with mental health problems, says that many
older people leave prison with unidentified mental health problems
because psychiatric services in prison are too specialised and only
focus on those with the highest level of need. Truman explains that
this makes them highly vulnerable. “If they are not diagnosed, they
are denied a whole range of health, social care and housing
services.” He adds that those who do not receive services can
return to crime and end up back in prison.

Ware says that unless certain health problems such as Parkinson’s
disease and Alzheimer’s are identified in prison, it is unlikely
they will be diagnosed on the outside after release because the
Probation Service is so overstretched.

Truman says that the Probation Service no longer provides a
befriending role, when often this is what many older people
require.

The trust’s report also highlights the need for improvements in
rehabilitation services for older prisoners released back into the
community. “The major problem is when they come out,” says Ware.
Although he was only in prison for just over a year, he estimates
that it took him between four and six years to get over it. He adds
that he came out with mental health problems and that for those
serving long stretches this problem is even more severe.

Lyon says the links between older peoples’ charities, councils and
prisons need to be strengthened in order to help older prisoners
back into the community. Mervyn Eastman, a trustee of the charity
Action on Elder Abuse and author of the report Discovering the
Older Prisoner, released in 2000, says that many older
prisoners receive social care services in prison but after release
these do not continue.

He argues that, in order to ensure services carry on, social care
provision in prisons should be made the responsibility of the local
authority where each prison is located, following in the steps of
health services. “If prisons are to be seen as part of the wider
community then it makes sense for social care to be social
services’ responsibility in partnership with the prison service,”
he says.

Ware says that many older people do not have families to provide
them with support, exacerbating their isolation. He says prison
overcrowding is adding to this, with older people being sent to
stay in prisons far away from where they live. This can make it
harder when people are released, he adds, as the social services
department whose care they are released into may never have heard
of them.

Ware believes that if an older person is coming out of prison it
increases the likelihood that they are going to have much greater
caring costs and that the government does not take this into
account when it imprisons them. “The cost implications for health
and social services are not recognised,” he says.

He argues that, in order to address this, once an older prisoner
has left prison a sum of money needs to be transferred to the
receiving social services department to cover the cost of their
social care.

With more older people being imprisoned and a lack of specific
services for them in jail and when they are released, some are
querying whether they should be there in the first place.

Geoff Dobson, deputy director of the Prison Reform Trust, says that
there needs to be more research into what types of community
service could act as an alternative to imprisonment. He asks
whether the current lack of options could be causing some older
people to be imprisoned inappropriately.

Ware says he knows of older prisoners who become involved in
helping in community care services on a voluntary basis while they
are in prison or once they have left and that this should be looked
at as an alternative to jail.

He highlights alcohol services as one area where older prisoners
could help out, explaining that despite many older people having a
history of alcohol abuse, services are becoming ever more focused
on the young. “Peer support programmes are often used but not in
terms of older people for older people,” he explains.

As the levels of older prisoners rise it will become even more
pressing for the government to address this problem. The trust
raises questions around the extent to which ministers should favour
developing age- or disability-specific services, and says that it
may have to consider building “nursing home prisons” similar to
those in the US.

Regardless of how older people are imprisoned, Lyon questions
whether putting them in jail is the answer. “Is locking up more and
more prisoners into their old age of any real benefit to society?”
she asks.

– Ken Howse, Growing Old in Prison from the Prison Reform
Trust, 020 7251 5070.