Prisons as a site of care – the health and welfare of older prisoners in UK prisons

Dr Warren Stewart (Senior Lecturer in Mental Health Nursing)

The proportion of older prisoners has increased dramatically meaning there are currently 14000 prisoners over the age of 50 in UK prisons. As many as 90 per cent of older prisoners have a moderate or severe health condition, and 50 per cent have more than three (Criminal Justice Alliance, 2020). Prisoners age more rapidly owing to a range of complex factors, these include, lifestyle choices, socio-economic status and increased institutional stress (Wahidin and Aday, 2010). Increased frailty and disability expose issues in relation to supporting older prisoners with their activities of living, treatment and access to formal health and social care services, (HM Inspectorate of Prisons, 2018).

The design and operation of prisons is based on the age crime-curve’ which assumes that prisoners are young and abled bodied (Mann, 2012);  this means that accommodation and activities are undifferentiated by age. There are socio-material issues in terms of the fabric and design of prisons, particularly the Victorian prisons, and the quality of equipment and furniture (e.g., inadequate beds) which impact of health, social activity and accessibility issues (Stewart, 2018). The effects of covid have resulted in longer periods in cell increasing isolation.

There are justice issues in terms of longer sentences in later life, leading to increased numbers dying in prisons (Shaw et al. 2020) effectively meaning de-facto life sentences, (Turner and Peacock, 2018). There are reports of older prisoners living with dementia, raising legal and moral questions on the value of punishing people with dementia. These issues present problems in terms of worries about their future, and for prison officers and health care professionals, in caring for the dying in an environment which is simply not configured for this role. The issues are set to the backdrop of increased disorder, violence, self-harm, overcrowding and increased drug use which have been exacerbated by years of austerity, resulting in reduced spending and staffing.

The above issues increase the existential precarity of older prisoner in prisons and on release, making it a public health concern. I recognize that prison officers, governors and health and social professionals are doing their level best with the resources available and this is without adequate training and staffing. As such, prisons fall short of the target of parity with community services, as set out in the Care Act (2014), (Tucker et al. 2018). However, the issues combine to place prison officers, prison and community health care and social care professionals in a difficult position, and pose a public health problem. It is high time to recognize and fund prisons not only as a site of punishment but as a place of care.

 

References

 

Care Act, (2014). Accessed at: www.legislation.gov.uk/ukpga/2014/23/contents/enacted

 

Criminal Justice Alliance, (2020). Accessed on 20.08.20 at http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/justice-committee/ageing-prison-population/written/105966.html

 

Her Majesty’s Inspectorate of Prisons, (2018). Social Care in Prisons in England and Wales: A Thematic Review. October 2018. London. Accessed at: https://www.justiceinspectorates.gov.uk/hmprisons/inspections/?s+older+prisoners

 

House of Commons Justice Select Committee, Ageing Prison Population, 5th Report 2019-21

 

Shaw, J. et al. (2020). Avoidable Natural Deaths in Prison Custody: Putting Things Right, (Independent Advisory Panel on Unnatural Deaths and The Royal College of Nursing).

 

Stewart, W. (2018). What does the implementation of peer care training in a U.K. prison reveal about prisoner engagement in peer caregiving? Journal of Forensic Nursing. Vol. 14. No.1. 18-26.

 

Tucker, S., Hargreaves, C., Roberts, A., Anderson, I., Shaw, J., and Challis, D. (2018). Social Care in Prisons: Emerging Practice arrangements Consequent upon the Introduction of the 2014 Care Act. British Journal of Social Work, 48, 1627-1644.

 

Turner and Peacock, (2017). Palliative Care in UK Prisons: Practical and Emotional Challenges for Staff and Fellow Prisoners.

 

Wahidin, A., and Aday, R.H. (2010). Later Life an Imprisonment. In (Eds) Dannefer, D. and Phillipson, C. The Sage Handbook of Social Gerontology. Thousand Oaks, California. PP 587-596.