Prison Inreach

Dementia Support Provision: HMP Wandsworth, HMP Wormwood

Scrubs, HMP Pentonville & HMP Isle

of Wight

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alzheimers.org.uk

Karen McCrudden Operations Manager (West London)

Natasha Sindano Project Supporting Officer

An ageing prison population • Current prisoner population (as of 4th November 2016) - 85,124 prisoners - 81,229 male prisoners - 3,895 female prisoners - Prisoners aged 50+ years account for 15% of the population (as of March ‘16)

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alzheimers.org.uk

From the age of 50, prisoners have a physiological age 10 years advanced of their chronological age due to: • 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

As of 4th November 2016

Prisoner healthcare statistics • Give statistics of healthcare inequalities

• Lifestyle choices

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alzheimers.org.uk

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)

Dementia awareness: prison officers • We are unable to determine what the prevalence of dementia may be among the

prison population due to such low diagnosis rates.

• We suspect this is the result of: - low awareness of dementia not identifying the symptoms

- dismissing symptoms as drug related or mental health related

- High ratio of prisoners to prison officers makes it difficult for prison officers to monitor effectively

- not having the capacity within their role to support external healthcare visits due to staff shortages

- Limited information from the healthcare teams

• Despite staff shortages, prison officers on the wings are in a key position to monitor the behaviour of the prisoners and seek healthcare support for the prisoners.

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alzheimers.org.uk

Dementia awareness: healthcare staff • Low awareness among some of the mental health teams (relative to the prison

environment)

• Disjointed services in healthcare, mental health services and primary health sometimes work in isolation.

• No follow-up/further investigation post detox, even when there are symptoms of other illnesses

• Care UK at HMP Wormwood Scrubs want their HCAs trained to use basic dementia screening tools.

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alzheimers.org.uk

Increasing dementia diagnosis (1) • Dementia diagnoses are under-represented among the prisoner population

• Our key aim for the second year has been to raise the awareness of dementia among staff and prisoners, through doing this we expect the diagnosis rate to increase

- Prisoners: Dementia Friends sessions

- Healthcare: Dementia Friends sessions and workshops around ‘Darkness in The Afternoon’

- Prison Officers: exploring options for e-learning (most efficient way to reach a large number)

• Working with the CCGs local to the prisons to implement appropriate dementia screening tools for use in reception and follow-up assessments.

- screening tools do not require a healthcare practitioner to administer but would require the support of healthcare team

• Mobile imaging units, which can be used for assessing a large cohort in one go (can be used for various healthcare investigations, not just dementia diagnosis)

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alzheimers.org.uk

Increasing dementia diagnosis (2) • Adequate assessment time is needed if a proper diagnosis is to be given

- Links with the local memory clinics need to be established to support this

• Prisoners need to be educated to report when they are noticing changes in peers’ behaviour as they could be signs of the development of dementia

• Through a general increase in awareness we hope prisoners will feel safe to come forward about their difficulties

• There need to be adequate support plans in place, which are used to find appropriate resettlement placements so that support is continued when leaving the prison.

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alzheimers.org.uk

Summary of key points

• The prevalence of dementia is vastly under-represented due to dementia symptoms not being identified.

• Dementia awareness among the prisoners, prison officers and healthcare teams is key to raising the diagnosis rate.

• The prisons often don’t have the resources to escort prisoners to external appointments – diagnosis needs to be facilitated by in-reach services.

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alzheimers.org.uk

Thank you for your time

• Natasha Sindano

• natasha.sindano@alzheimers.org.uk

• 07718 322384

• Karen McCrudden

• karen.mccrudden@alzheimers.org.uk

• 020 8687 0922

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alzheimers.org.uk

Creating Dementia Friends

within an open prison

Dementia Friendly Prisons:

People with dementia are supported to live

independently (supported where needed to cope

with the prison regime) for as long as possible.

People should be supported to have as much

choice and control as exercised by their peers.

• Challenges People with dementia may have:

memory, decision making, concentration,

problem solving, communication and motor

skills

• Role of Dementia Friendly Communities and

Dementia Action Alliance

• Challenge the stigma and discrimination

attached to a lack of understanding of the

condition

HMP Wakefield

Delivering Dementia Friends in a prison setting:

• Wellbeing Days

• Capture entire staff team

• Roll this out to inmates and families

• Understand unique circumstances

Information Stand HMP Wakefield

•A lot of interest from prisoners who had family

members with dementia.

•Prisoners see people irregularly don’t know what

to do or say.

•Prisoners were very open about discussing their

depression and anxiety when hiding memory

problems and their coping strategies.

Dementia Friendly Environments in prisons

• Layout of cells

• Improved Signage

• Fitting in-cell adaptations

• Lack of light and stimulation

• Steps

• Access to Activities

Why should we promote Dementia Friendly

prison services?

• Wellbeing of an ageing prison population

• There is scope for greater information

sharing between prisons.

• Dementia Friends is free and can be tailored

to the prison environment.

• Dementia Champions training is free and

inmates could attend from open prison

settings

Thank you for your time

Wendy Porter

Services Manager Wakefield and Five Towns

wendy.porter@alzheimers.org.uk

01924 373264

Memory

Assessment in a

high security prison

Richard Clibbens

Nurse Consultant

Wakefield Memory

Service

In-reach assessment of suspected dementia

from a local Memory Service

• Number of referrals relatively small (less than one

a month)

• Reduced with new mental health liaison team and

period of joint working

• Broad age range

• Broad range of assessed cognitive difficulty (from

mild cognitive impairment to severe cognitive

impairment)

• Routing blood screening/ brief cognitive

assessment & CT head scan completion variable

initially

Mixture of referral sources from within the

prison system

• Primary Care Department

• Hospital team

• Liaison Mental Health Team

• Often prompted by the person themselves

Differential Diagnosis

• Prevalence of depression & anxiety

• Impact of substance misuse

• Impact of physical health medication

• Lifestyle factors (exercise, smoking, diet)

• Opportunity to provide intervention & re-

assess reduced

Challenges in maintaining a high quality service

• Usual consent to assessment process unclear

• Person being assessed does not know what to

expect

• Usual post-diagnostic pathway challenging to

provide

• Reviewing prescribed anti-dementia

medication relies on a third party

Challenges for in-reach staff

• Arranging appointments

• Time-consuming (security etc.)

• Unfamiliar environment

• Reliant on what is arranged and available on

the spot

• Can be excellent or limited additional

information

Obtaining corroborative/ carer information

• Sources; liaison team, other prisoners, prison

officers

• Written notes

• Access to health records (variable

information)

• Other prisoners as carers

Improvements

• Increased awareness/ confidence in memory

assessment

• Access to specialist assessment

(Neuropsychology, PET/ DaT scans etc.)

• Monitoring of Mild Cognitive Impairment

• In-house expertise, a justifiable resource?

• Memory assessment specialists

Thank you for listening

Richard.Clibbens&swyt.nhs.uk

www.england.nhs.uk

Thank you for joining us.

A link to an online evaluation and copies of speaker slides

will be sent to all registered attendees.

A recording of the webinar will be available in due course.

Dementia Care in the Prison

Setting