This blog represents a summary of some of my experiences during a research development trip with researchers based at the University of Louisville (UL). It is based solely on my observations and experiences and is not the official views of the US Department of Corrections. The trip was generously funded by the University of Brighton, via the International Collaboration Fund. The purpose of the visit was to progress the analysis of data generated through a study on older adults in Kentucky prisons; to visit a selection of correctional facilities; the observation and limited engagement with (prisoner) Peer Care Givers (PCGs) in US prisons, and to identify future research funding streams. Both myself and my U.S. co-researchers have experience implementing and evaluating peer caregiver programmes in prisons. During the visit I shared my own research through the Medical Ethics Research online seminar series at UL with around 100 academics, students and community groups in attendance.
I visited four correctional institutions in Kentucky, each of them was extremely interesting on many levels. The institutions were Roederer Correctional Complex (RCC), Kentucky Correctional Institution for Women (KCIW), Louisville Metro Department of Corrections (LMDC), and Kentucky State Reformatory (KSR). The rationale for visiting these particular institutions, was to gain an overview of the pathway through the Kentucky state justice system. Reflecting on the differences and similarities between British and US systems made for some interesting comparisons. As a mental health nurse academic with experience managing health services in justice settings I was intensely interested in the health and social care facilities, however, there were numerous other areas of interest. A manager talked us through administration issues, such as, the assessment and allocation processes, the number of prison spaces available and associated costs per place, throughout the state of Kentucky. My immediate impression was US prisons are slightly better funded than UK prisons, this is on the basis of a number of observations, such as the number of MRI scanners and the thoroughness of medical screening. Prisoners in two institutions were given iPad style tablets and could make phone calls through them. Each new prisoner is assessed by an MDT including a psychologist as well as nursing and justice workers. A judge sits permanently at LMDC, and I was surprised to learn appearances were filmed and some of the material was televised!
My intention is not to sensationalise the differences but significantly at LMDC the officers carried handcuffs, pepper spray and tasers. I saw physical restraints of various kinds, such as an upright restraint chair, (said to be rarely used). At KSR we were shown around a disused segregation unit with accommodation for as many as 178 prisoners, inclusive of an autopsy room, prison morgue and evacuations tunnels. At times it felt like we were on a movie set. Yet there was a tangible rehabilitation ethic. We saw some very well-equipped prison industries’ centres and a large horticulture centre. Rescue dogs were being trained in several sites for the local community, unexpectedly the rescue dogs resided in the prisoner’s cells overnight.
The following section discusses some of the issues relating to peer caregiving in Kentucky prisons. In each facility we saw different approaches and methods of prisoners supporting other prisoners; peer support in prisons can mean a wide variety of tasks and involve many formal and informal roles and responsibilities. I spoke with several justice and healthcare professionals and engaged with teams of PCGs in two prisons. In KCIW, the PCGs were based on the mental health day unit, and at KSR where the PCGs were located in the dedicated dementia unit.
At KCIW, I visited the physical and mental health centres, interestingly they have a dentistry, chemotherapy and other allied health facilities. The facilities were well equipped, and the buildings appeared modern, indicating a good level of funding. I was able to engage with two PCGs of a team of eight; interestingly both had been employed as care assistants prior to being sentenced. Most of the residents on the unit appeared to be self-caring, so the role appeared to relate to supporting social activity, as opposed to traditional care work. The manager said the PCGs were paid $2.50 per day for their labour. She suggested there was a relatively high turnover of PCGs which was not ideal. The PCGs said they enjoyed their work, they felt training on dementia, communication, resilience, loss and safeguarding would support their roles.
At KSR, I was shown around a very large healthcare unit, which includes, a physical health unit, an acute mental health unit, and the segregation unit was upstairs in the complex. I observed the space where the inmates undertook residential courses on various forms of psychological skills training. The most significant part of the tour was the dedicated regional dementia unit. Prisoners experiencing neuro-cognitive disorder in neighbouring institutions could be transferred here for specialist support. Management of the centre was overseen by a generic manager, however, on a day-to-day basis the centre was managed by a clinical social worker, supervised by a psychologist.
Five PCGs were on duty during the visit, three PCGs worked on the centre during the night. This is a comparatively well-paid position at $2.70 per day. I observed the PCGs performing a number of activities including cleaning and helping older prisoners with arts-based activities. I was shown a de-escalation room and there were three blank documents that were completed by the PCGs, covering the nutritional intake, sleep, hygiene and behaviour of the older adults – these documents formed a basic daily care record. The guides mentioned that the PCGs could not perform their activities during the Covid-19 pandemic, and we heard how much their services were missed.
What lessons can be shared between UK and US prisons in relation to supporting and supervising PCGs? Given the increasing numbers of older, frail and nearing the end of life in UK prisons it would seem reasonable to review some aspects of the official guidance. Acknowledging the need for careful screening, training and supervision, a review could enable greater flexibility within the role, or something more similar to the American PCG model.
As yet, the UK does not have an equivalent to regional dementia care centres in UK prisons. This would seem like a need, and a cost-effective service and it has the potential to improve the quality of care. In the US, there appears to be an argument for greater discretion or a relaxing of official legislation in specific vulnerable prisoner units. In both the UK and US, there should be greater recognition for the role of the PCG, to retain their services and increase the quality of care. Specifically, more training and ongoing support and supervision are needed.
