Frail in jail: how UK prisons are failing dying inmates
Inadequate conditions and insufficient care are forcing many into early illness and premature death.
Prison is a harrowing environment for any inmate, but the health challenges faced by older prisoners, here ‘prisoners’ refers to male prisoners in the prison estate, are especially immense. Mental and physical health conditions are endemic in the prison estate, with 90% of the prison population experiencing one or more moderate or severe health conditions.
The average life expectancy for prisoner’s in the UK is 56, a figure far lower than the UK’s average of 81. Given this, many older prisoners end up dying whilst completing their sentence. As revealed in a report published in 2019 by Age UK, older prisoners account for 50% of all prisoners that die in custody, this is despite prisoners aged 50 plus constituting 17% of the overall prison population.
Most prisoners are classified as ‘frail’ from the age of 50, with many presenting an array of health needs which are made worse by a tough living environment and unsatisfactory care provision.
In fact, between June 2002 and March 2020 the number of UK prisoners aged 65 or over rose by 67%, making people aged 50 and above the fastest growing age group in the prison estate. Overall, the number of incarcerated people aged over 60 has more than tripled in the past 20 years.
Katie Reade, Policy and Advocacy Manager at Hospice UK – a charity which published the Dying Behind Bars Report in 2021, told Social Care Today, ‘Prisons now rival care homes as providers of residential care for frail older men.’
In another report published in April, The Nuffield Trust laid out the specific health and care challenges faced by older prisoners. Dementia, depression, falls and incontinence were listed among the characteristics of older male prisoners who were identified as frail between 1st April 2018 and 31st March 2020.
Pointing to the prevalence of long-term health conditions among prisoners, the report added that of all men in prison aged 50 and above, over 40% had either intermediate or high-risk frailty. This contrasts with 8% of adults aged 50 and above who are seen to represent the same level of frailty in the UK as a whole.
Dignity at the end of life
Rachel Hutchings, Nuffield Trust Fellow and one of the authors of the report, told Social Care Today: ‘People in prison are potentially living with conditions which will require end of life and palliative care, and although there are pockets of good practice where prisons are working with local hospices and have various tailored services these are not widespread. The reality of an ageing prison population is that more prisoners will be suffering from these conditions and may require specific care.’
The number of prisoners receiving palliative care is rising. In fact, Hospice UK’s 2021 findings revealed that in the past decade, overall deaths in prison due to natural causes have increased by 77%.
Commenting on the palliative care needs of prisoners, Katie Reade explained that ‘There is an increasing need for end-of-life care, which is not being consistently met. People in prison have lost their right to liberty but they still have a right to equivalent health and care to what they would receive in the community.’
She added, ‘In prisons across the UK there are still cases of inappropriate use of restraints on people at the end of life, delayed or no consideration of compassionate release, and a lack of bereavement support. In some cases, older people in prison are not receiving equivalent end of life care to what people would receive in the community.’
Addressing the overall state of older adult health and care in prison, Katie Reade concluded that ‘Palliative care is often not prioritised by prison staff who often lack the appropriate specialist knowledge and skills.’
Better care is possible
Moving forward, prison staff require in-depth training to understand how to support someone at the end of life, especially given the security constraints of a prison setting. With some prison staff feeling like carers, informed and updated training of staff is desperately needed as the first vital step towards more widespread and radical prison reform.
The health challenges of prisoners must not be approached in isolation. As Louise Ridley, Senior Lecturer in Criminology at Northumbria University informed Social Care Today, ‘The health challenges faced by older prisoners relate to continuity of care, health journeys are pitted with poor provision of medications, lack of identification of new health problems and long delays in identifying these problems.’
She warned ‘Unless we have a national strategy that ensures good practice in all prisons and sets out benchmarks, then we will continue to see this huge disparity across the penal estate. It doesn’t take a huge amount for things to change, working with charities and organisations geared up to support older people can greatly influence the prison regime for older men.’
Both prisoners and staff are owed safe and secure environments in which to work and live. This does not mean overlooking healthcare support, but rather requires innovative and individualised care which has been proven to reduce the suffering experienced by those who face their final years in prison.
Images: Prisonimage.org and Andrew Aitchison via Getty Images
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