Nick Le Mesurier

Older People in Prison

The article below is a shortened version of one that was published in Generations Review, the newsletter of the British Society for Gerontology in January 2008


Older People and the Penal System. 

Introduction
Until very recently there were no policies specifically directed at improving the welfare of older people in prison. Lately, a few reports and papers have emerged which draw attention to these needs and argue for their better recognition, and in October 2007 a toolkit for good practice in care for older offenders was published by the Department of Health. There is growing awareness within the academic and policy literature of the high levels of mental and physical health problems experienced by prisoners of all ages. Increasing numbers of older prisoners also bring to the prison service additional problems of disability and age-related illness. Prisons are poorly equipped to meet the health care needs of older prisoners, almost all of whom will be released, often with very little in the way of community support. This article draws upon current literature to give an overview of the population of older prisoners and their needs, and outlines some of the implications these have for the way they are served in prison and on release.  

The population of older prisoners
Much attention has been paid in the media recently to the growing number of people in prison in England and Wales and to the pressures this imposes on the prison service. While attention is rightly paid to the large number of young people in prison, much less attention has been paid to the growing number of older people who are in prison, often for very long sentences. 

There are currently almost 80,000 people in prison in England and Wales. Of these just over two thousand are aged over 60, and just over one thousand are aged over 65. All but a few of the older population in prison are male. Most are detained for a narrow range of serious crimes. Just over half have committed sex offences; one in five a crime of violence, and one in ten is in jail for drug offences. Increasingly, older men are being jailed for serious offences committed many years previously. 

 Sentence inflation
There is no ‘elderly crime wave’. Rather, there has been a general increase in length of sentence imposed by the courts, and an accumulation of older male prisoners. The Prison Reform Trust has identified a process of “sentence inflation” - rather than a deliberate targeting of older offenders. Harsher sentencing policies generally have also seen this group become - almost as collateral to mass incarceration - the fastest growing sector of the prison population. This has been described as a “’stacking effect’ caused by the accumulation of both ageing long term and life prisoners and ‘new entrants’ serving longer sentences” often for sexual offences. 

The health of older prisoners
Very little empirical research has been undertaken on the health needs of older prisoners in the UK. Seena Fazel and colleagues surveyed the health records and self-reported health status of 203 men in prison aged 60 and over in 2000. They found that 85% had at least one chronic illness recorded in the medical notes and 83% reported at least one long standing illness in interview. The most common complaints were psychiatric, cardiovascular, musculoskeletal and respiratory disorders. Three quarters were prescribed medication, but only 18% of those with psychiatric illnesses received any treatment.. 

Mental disorders are particularly common amongst prisoners of all ages, but are especially so amongst older prisoners. In Fazel's study 53% had at least one diagnosable psychiatric condition, and 30% had depression, including 17% who had experienced a major depressive episode. These figures are much higher than those found in comparable populations in the community. 

Though prisons have a public duty to protect the public and to rehabilitate offenders, in practice they often struggle with health needs they are not resourced to meet. For some offenders, the experience of prison itself is likely to exacerbate their health problems, so that their time in prison will serve only to increase the risks they pose to themselves and others on release.

Care in prison
Life in prison can be hard for anyone, but older prisoners are especially vulnerable. It has been suggested that prisoners may have a health status about ten years greater than their age peers in the community. Prisoners are often detained far from home and can be moved at short notice. Bullying and substance misuse are common, and many older prisoners are held in ‘vulnerable’ wings away from the predatory attentions of younger inmates. Even there, proper access to exercise, social contact or education is sometimes difficult if prisoners have mobility or other health problems, or if they feel intimidated.

Discharge and resettlement
Preparation for discharge that takes into account the needs of older prisoners is often limited, inadequate or absent, though there are a number of voluntary organisations, such as Age Concern that contribute positively at a local and a national level. Some Age Concern Organisations are developing tailored services inside prisons. But they face considerable challenges. Many older prisoners have led chaotic lives and have been in and out of prison a number of times. Some lack basic self-help skills. Some are not registered with a GP, and some need education in benefits awareness, and pension rights. All will have lived for some time within a total institution in which every minute of the day is governed by the regime. On discharge local authorities are often reluctant to offer needs assessments to ex-offenders on the grounds that they are not normally resident in the jail. Probation services are not equipped to serve the health and social welfare needs of older frail ex-offenders.

Options for care
The NHS is in the process of taking over responsibility for commissioning primary care services in public sector prisons. As such many primary care trusts are exploring ways in which the health needs of prisoners can be met and how equal standards of access and service can be applied. The recently published guide to the care of older offenders is an important landmark in the development of properly dedicated services and makes specific recommendations how prisons should address key principles within the National Service Framework for Older People. It is however, not mandatory and depends crucially on good joint working between the health services, local authority and prison services. 

In the USA a number of dedicated older persons’ prisons have been built that function as a form of secure nursing home provision for prisoners who have additional social, medical or nursing needs. Inmates in these establishments are relatively free from the persecution of younger, fitter, prisoners, and are able to access facilities dedicated to their needs and increasing frailty. However, there are as yet few prisons in the UK adapted to the needs of older or disabled prisoners and there is limited recognition of their needs as a distinct group, though some prisons hold significant numbers of prisoners who are old or frail, or who, on retirement, are locked in their cells for most of the day.

Conclusion
Individuals who have been through the prison system may draw little sympathy from society, and older prisoners, especially those who have committed sex offences, are likely to draw less. Yet older prisoners have rights to equal access to treatment and to access to services under the National Service Frameworks for Older People and for Mental Health, and the Disability Discrimination Act. Moreover, almost every prisoner will be released at some time, and many will present with health and social care needs that have been exacerbated by their experience in prison. Recognition of the problem is improving, but without a dedicated national strategy for care to older prisoners and ex-offenders progress will continue to be piecemeal.  


© Nick Le Mesurier 2008