Prisons ‘ill-equipped to deal with rising dementia population’

Prisons are ill-equipped to tackle a rising population of inmates with dementia and must invest in training, routine screening of older prisoners and support from external agencies to do so.

That was the conclusions of an international study into the challenges of supporting prisoners with dementia that highlighted good practice in doing so, published today by the Mental Health Foundation.

The number of sentenced prisoners aged over 50 in England and Wales has risen by 74% to almost 10,000 in the past decade, according to government figures, a trend driven by tougher sentencing policies. Also, prisoners tended to be physiologically “older” than their chronological age due to the psychological and physical impact of incarceration and prior issues such as substance misuse, meaning those suffering from dementia were affected earlier than the wider population.

However, dementia remained “a hidden problem” because most prisons did not screen for cognitive impairment on entry, prison officers mostly lacked the skills to identify possible dementia, sufferers did not tend to report symptoms and mental health services were often focused on other inmates whose behaviour was more challenging.

Good practice

Researchers surveyed 14 prisons from England (eight), the United States (four), Belgium (one) and Japan (one) to identify potential good practice in supporting inmates with dementia. Among initiatives identified, the study found that:

• Eight of the prisons were developing or had developed specific assessment tools for older prisoners, with seven using a dementia screening tool, such as the Mini Mental State Examination;
• One of the prisons, HMP Isle of Wight, had set up a “memory services prison pathway”, enabling staff to refer on inmates with suspected memory problems to the mental health team or over-50’s clinic for a memory assessment;
• Another jail, HMP Stafford, provided an assessment for care services in the community two months prior to release with the results forwarded to relevant agencies;
• Most prisons had appointed a lead on older offenders to co-ordinate services, with six of these leads having received training specific to the role;
• Prisons had also provided age-specific training for security officers and other staff;
• 10 prisons employed carer and buddy schemes in which younger inmates helped provide care for older prisoners with physical or cognitive impairments.

Prisons also reported what they needed to improve their support to inmates with dementia, including dementia awareness and signposting training for staff, greater nursing capacity and funding for adaptations.

Recommendations

The report made recommendations in five areas to help prisons better support people with dementia. They were:

• A basic cognitive screening test should be conducted on all new arrivals aged over 50 with individuals attaining low scores undergoing more comprehensive tests and reassessments conducted at least once a year;
• Basic training in dementia awareness should be provided to all officers, and an older person’s lead should be appointed within prison healthcare teams;
• Stronger working relationships should be forged with external agencies specialising in dementia care, including charities and healthcare providers, who could provide services to the prison;
• Prisons need clearer referral procedures when there are concerns about cognitive impairment to provide swifter diagnoses;
• Prisons should be adapted to better accommodate prisoners with dementia, for example through clear signposts with relevant pictures and easier access to exercise areas.

The report warned that many of these changes needed to be led by government, concluding: “In the absence of change at the highest levels, individual prisons will continue to face a reality not dissimilar from the older offenders in their care: quietly coping as best they can, while the capacity to do so continues to diminish.”

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