Prison Inreach: Dementia support provision
Karen McCrudden Operations Manager
Natasha Sindano Project Supporting Officer
The Prison Population
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Alzheimer’s Society
Healthcare Statistics
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HIV 15 times higher in male prisoners than the rate of HIV among men in the
general population (0.3%). This is likely due to a higher concentration of drug
users and an increased likelihood of people sharing needles.
Hepatitis C 9% of male prisoners have Hepatitis C compared with 0.4% in the general
population
Mental
Health
Over 70% of the prison population has two or more mental health diagnoses.
For male prisoners, this is 14 times higher than the general population.
Alcohol 32% of men in prison were assessed as hazardous drinkers with an AUDIT
(alcohol use disorders identification test) score between 8 and 19. (Home
Office, 2004)
Substance
Misuse
44% of men in prison use heroin and crack cocaine.
The average age of chronic Class A drug users, especially heroin, is shifting
to an older demographic and this is an attributing factor to the rapid shift in
the age demographic of the prison population.
Smoking 80% of prisoners smoke (Public Health England, 2016)
An aging prison population
From the age of 50, prisoners have a physiological age 10 years advanced of their chronological age due to:
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Prisoners aged 50+ years is the fastest growing group and accounted for 15% of the population in March 2016.
Alzheimer’s Society
• Chronic poor health
• Chronic alcohol and substance misuse (poor lifestyle choices)
• Chronic mental health illness
• A life that has been filled with many highly stressful situations (often life in and out of prison)
• Low IQ
Alzheimer’s Society
Current prison population
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As of Friday 10th March 2017
there are 84,635 people in
prison, 80,696 of them are men
and 3,939 are women.
42% of the older prisoner
population are convicted sex
offenders longer sentences.
The Current Picture of Dementia Provision in
London’s prisons
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Alzheimer’s Society
An overview of London’s prisons
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Healthcare providers:
HMP Wandsworth
- St. George’s University Hospitals NHS
Foundation Trust
- South London & Maudsley NHS
Foundation Trust (SLAM)
HMP Wormwood Scrubs
- Care UK
- Barnet, Enfield & Haringey Mental
Health Trust (BEH)
HMP Pentonville
- Care UK
- BEH
We have been working with
HMP Wandsworth, HMP
Wormwood Scrubs and HMP
Pentonville.
- Category B
- Serve the local courts (very
transient population)
- Over-populated
- Severely under staffed
- Limited healthcare
resources/services
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An overview of London’s prisons
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Low awareness of dementia
among prison officers – not
acknowledged that they have
a duty of care to support
healthcare issues
- There is a disconnect
between “the prison side” and
healthcare
Regular changes of
healthcare providers –
inconsistent service.
Mental health teams are
trained in adult care, not older
adult care.
No baseline data is collected
following detox and no follow-
up is done to monitor if there
is ongoing cognitive
dysfunction.
Swift transfers and releases
give inadequate time for
support plans to be put in
place.
Dementia Support
Provision in Prisons outside
London
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Alzheimer’s Society
Examples of good practice
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Category C
Sex Offenders rehabilitation
Static population
Single occupancy in cells
Older prisoner population of
47% in July 2015
Longer healthcare
appointments
HMP Whatton, Nottinghamshire,
has been successful at detecting
dementia symptoms by raising
the awareness of dementia
among the prisoners and staff
using the Dementia Friends
initiative.
Through delivering basic
education about how dementia
presents and the more common
symptoms, the referral rate to
healthcare increased
significantly, which resulted in a
considerable increase diagnoses
of dementia.
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Challenges to providing dementia support
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Low levels of awareness of
dementia among prison
officers
Reliance upon prison officers
to secure health
appointments
Secondary care generally
provided by adult services
and not older adult services
Low ratio of prison officers to
prisoners – logistics in
arranging external health
appointments
Increasing dementia
diagnosis in London’s prisons
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Alzheimer’s Society
Prison Inreach
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Adequate assessment time is
needed if a proper diagnosis
is to be given.
- Links with local memory services
need to be established to support
this
Introduce a layered screening
system to suit the time restraints
in reception, on the wings and in
the mental suits.
There is a strong willingness
from the healthcare teams to
develop diagnosis pathways.
Mobile scanning units can be
used to screen a large
number of prisoners in one
day
- The cost of a mobile MRI & CT
machine for 12 hours is £3,350, 2
radiographers included
http://www.alliancemedical.co.uk/what-
we-do/diagnostic-imaging/mobile-
services
Given the stark lack of staff resources, the attendance to external appointments adds increasing pressure on a struggling workforce. Where possible, healthcare services need to go into the prisons to aid the dementia diagnosis pathway.
Alzheimer’s Society
Addendum
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The information contained in this presentation represents examples of practice
we have seen being adopted in an attempt to meet the challenge of diagnosing
and supporting people in prison with a dementia. It is not a recommendation of
best practice, or a suggestion to adopt these practices, although some examples
have been a catalyst for discussion, e.g. the adoption of the MoCA.
The mental healthcare team at HMP Whatton have a good relationship with the
local Memory Service and with their support, continue to use the MoCA at the
initial stages of assessment with what they believe to be good results. However,
we acknowledge that other memory services may prefer to use alternative tools.
Taking appropriate equipment to prisons remains the most expedient and cost
effective way of finalising support. Having checked with local memory services /
mapped dementia pathways, brain scans and ECGs are required prior to
delivering full diagnosis and access to appropriate medication.
If you are aware of any practice supporting prisoners with dementia and you
would like to share this with a wider audience, please let us know and we will
highlight this.
Thank you.
Alzheimer’s Society
Thank you for
your time.
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Karen McCrudden [email protected]
07590 417366
Natasha Sindano [email protected]
07718 322384
We don’t have all the answers but we have identified that collaboration is crucial from all sectors to ensure that prisoners who have dementia are getting diagnosed and receive the right support.