new prison inreach: dementia support provision · 2017. 3. 27. · alzheimer’s society healthcare...

Prison Inreach: Dementia support provision

Karen McCrudden Operations Manager

Natasha Sindano Project Supporting Officer

The Prison Population

Prison Inreach: Dementia Support

Provision

2

Alzheimer’s Society

Healthcare Statistics


Provision

3

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:


Provision

4

Prisoners aged 50+ years is the fastest growing group and accounted for 15% of the population in March 2016.


• 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


Current prison population


Provision

5

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


Provision

6


An overview of London’s prisons


Provision

7

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


An overview of London’s prisons


Provision

8

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


Provision

9


Examples of good practice


Provision

10

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.


Challenges to providing dementia support


Provision

11

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


Provision

12


Prison Inreach


Provision

13

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.

http://www.alliancemedical.co.uk/what-we-do/diagnostic-imaging/mobile-services











Addendum


Provision

14

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.


Thank you for

your time.


Provision

15

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.

new prison inreach: dementia support provision · 2017. 3. 27. · alzheimer’s society healthcare...

Documents