Prison Service needs strategy for dealing with inmates with dementia, Ombudsman says

The Prison Service needs to develop a strategy to deal with the growing number of older prisoners so that staff can manage age-related conditions such as dementia better, the Prisons and Probation Ombudsman (PPO) has said. 

PPO Nigel Newcomen made this call as he published a bulletin on lessons that can be learned from investigations into deaths of prisoners with dementia. 

Those aged over 60 are the fastest-growing segment of the prison population, increasing 125% between 2004 and 2014. The Ministry of Justice projects the population in prison aged over 60 to increase from 4,100 in 2015 to 5,500 in 2020. Dementia is a condition often associated with the ageing population. 

There have been relatively few investigations into deaths in custody which have highlighted issues relating to dementia, but this will be a growing issue as the prison population continues to age. The number of prisoners affected is unknown, although the Mental Health Foundation has estimated it at approximately 5% of prisoners over 55 years old. If this is the case, there are likely to be several hundred prisoners with dementia. 

The report found that: 

• When someone has dementia, they may, over time, lose the capacity to make decisions about their care and treatment

• Lack of appropriate space or facilities can make it difficult for prisons to provide care that would be equivalent to that in the community

• Prisoners are likely to need support, such as with collecting their food and cleaning their cells and, when used effectively, prisoner carers can provide essential support to prisoners with dementia

• When elderly and infirm prisoners travel to and from hospitals for appointments and treatment, restraints are often used inappropriately.

The lessons from the bulletin are that: 

• Support should be given to those with dementia to help them make informed decisions about their care and, where they lack capacity, there should be appropriate assessments and documented decisions

• All prisons should have a local lead for adult social care to coordinate the care of individual prisoners with dementia

• Prisons should share best practice and consider innovative ways of coping with the increasing number of prisoners with dementia

• Prisoner carers must be given training and safeguards need to be put in place to ensure arrangements are appropriate

• When a prisoner is taken to hospital, a risk assessment should fully take into account their health, mobility and mental capacity and the use of restraints should be based on the actual risk they present

• Prisons should make reasonable adjustments to help prisoners with dementia and their families keep in touch. 

“Dementia is a potentially life-limiting condition affecting both physical and mental capacity, although most people with dementia die of other complications, such as pneumonia or a stroke,” Newcomen said. 

“In my investigations, I have frequently been struck by how ill-prepared prisons were to deal with this new challenge, essentially because they were designed to meet the needs of younger people and not chronic age-related conditions. Things are beginning to move in the right direction in some prisons, with examples of good practice, but there is still a long way to go. 

“The Prison Service badly needs a properly resourced national strategy for its rapidly growing population of older prisoners, to guide its staff in their management of age-related conditions such as dementia.”