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With 6% of inmates now aged 60 or over, it’s not surprising that dementia is a growing concern for those working in offender healthcare



Alarmingly, those aged 60 and over are the fastest growing segment of the prison population in England and Wales; increasing by 125% between 2004 and 2014 and closely followed by those aged 50 to 59. It’s no wonder the Prisons and Probation Ombudsman, Nigel Newcomen CBE, is expressing his concerns over offender dementia care. 

In his latest Learning Lessons Bulletin, Mr Newcomen, explains whilst “things are beginning to move in the right direction” for dementia care “there is still a long way to go”. 

Predicted growth in older prisoners


The Ministry of Justice (MoJ) predict that the over 60 prison population will increase from 4,100 in 2015 to 5,500 in 2020. This is due to longer sentences as well as more later in life prosecutions for historic sex offences. 

Research by King’s College London and London School of Economics in 2014 estimated there would be 850,000 people in the UK with dementia by 2015. Of course, it’s impossible to put an exact figure on the number of offenders affected by the disease, but the Mental Health Foundation estimates around 5% of prisoners aged over 55 are affected. This means there could be several hundred prisoners currently living with dementia.
 

Implications of the Care Act


One of the fundamental changes over the past two years has been the introduction of the Care Act. This outlines the services prisons can expect for local authorities. Crucially, prisoners must now work with the local authority to develop care and support plans for each prisoner with eligible needs. 

There are still many challenges though. The prison estate, the Ombudsman’s report argues, has been designed for younger fitter people, but the accommodation is not always suitable for somebody with dementia needs. It is virtually impossible to “provide care that would be equivalent to that in the community” he says, which can be particularly challenging for those looking after the mental health needs of prisoners. 

Good practice


HMP Whatton has, however, introduced a special cell that can be allocated to prisoners with either mobility impairment or dementia. Originally housing four inmates, it has been re-designed for two. 

Some prisons, the report also notes, promote a Dementia Friends Scheme; an Alzheimer’s Society Initiative which aims to change people’s perception of the disease. 

In reviewing what’s worked in some areas and where there are failings in others, the key lessons observed by the Ombudsman are:

Lesson 1 Where a prisoner lacks capacity there should be appropriate assessments and documented decisions. Prisoners with dementia should have access to independent advocates where there are no other independent people, such as families or friends, to represent their interests.

 Lesson 2 There should be a local lead for adult social care at all prisons. This person should liaise with partners and coordinate care to avoid needs being overlooked. 

Lesson 3 Prisons should share best practice and consider innovative ways of coping with the dementia care needs of prisoners. 

Lesson 4 Prisoner carers play a vital role in helping those with dementia, but they must be trained and given information on the necessary safeguards. 

Lesson 5 When a prisoner is taken to hospital, any conditions affecting their mental capacity, such as dementia, must be taken into account and the decision to use restraints should be based on the risk the prisoner presents at the time. 

Lesson 6 Prisons should make reasonable adjustments to help prisoners with dementia and their families keep in touch with families involved in care discussions at the earliest opportunity. 

Next steps


It is hoped that the publication of the recommendations and findings will push the government into devising what Mr Newcomen describes as “ a properly resourced national strategy for its rapidly growing population of older prisoners, to guide its staff in their management of age-related conditions”. 

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