O'Neill Adam, Heathcote Leanne, Archer-Power Laura, Ware Stuart, Shaw Jenny, Senior Jane, Forsyth Katrina
University of Manchester, Manchester, United Kingdom.
Greater Manchester Police, Manchester, United Kingdom.
Health Justice. 2025 Jan 20;13(1):5. doi: 10.1186/s40352-024-00313-5.
The number of older adults entering the criminal justice system is growing. Approximately 8% of older prisoners in England and Wales have suspected dementia or mild cognitive impairment (MCI) and experience difficulties in everyday functioning, and disruption to their daily life. At present, no specific dementia/MCI care pathway has been implemented that is applicable and appropriate for use across different prisons in England and Wales. The aim of this paper is to explore the experiences of older adults with dementia/MCI in prison, and a range of key stakeholders, around the day-to-day issues faced by people with dementia/MCI and prison, healthcare, and third sector staff regarding the delivery of support for individuals with dementia/MCI.
Thirty-two semi structured interviews were conducted with prison, local authority, and healthcare staff; peer supporters; third sector care providers; and individuals with dementia/MCI themselves, across five establishments, to provide multidimensional perspectives of dementia/MCI in criminal justice settings. The data obtained during interviews were thematically analysed.
From the data, six key themes emerged: (I) ethical concerns around trial, sentencing and detainment for people with dementia/MCI; (II) An unforgiving prison system, providing physical and social environments incompatible with supporting individuals with dementia/MCI; (III) An unprepared workforce requiring training in dementia/MCI. (IV) A lack of collaboration leading to sub-optimum management of the support needs of people with dementia/MCI in prison; (V) Peer support 'plugging the gap'; and (VI) staff 'hands tied behind back'.
Results point towards a pressing need to develop more appropriate support systems for individuals with dementia/MCI throughout the criminal justice system. Ethical concerns around the judicial process for individuals with diminished cognitive capacity must be considered. Prison governors should examine ways to make the living environment more appropriate for these individuals, and a joined-up collaborative approach to health and social care should be adopted. Staff must be appropriately trained to support and identify individuals with dementia/MCI. Peer support schemes require formal evaluation, and training/oversight of these schemes should be comprehensive.
进入刑事司法系统的老年人数量正在增加。在英格兰和威尔士，约8%的老年囚犯疑似患有痴呆症或轻度认知障碍（MCI），他们在日常生活中存在困难，日常生活受到干扰。目前，尚未实施适用于英格兰和威尔士不同监狱的特定痴呆症/MCI护理路径。本文旨在探讨患有痴呆症/MCI的老年人以及一系列关键利益相关者在监狱中面临的日常问题，以及痴呆症/MCI患者、监狱、医疗保健和第三部门工作人员在为痴呆症/MCI患者提供支持方面的情况。
在五个机构对监狱、地方当局和医疗保健工作人员、同伴支持者、第三部门护理提供者以及患有痴呆症/MCI的个人进行了32次半结构化访谈，以提供刑事司法环境中痴呆症/MCI的多维度视角。对访谈中获得的数据进行了主题分析。
从数据中出现了六个关键主题：（I）对患有痴呆症/MCI的人的审判、量刑和拘留的伦理关注；（II）一个不宽容的监狱系统，提供与支持患有痴呆症/MCI的人不相容的物理和社会环境；（III）一支没有准备好的工作人员队伍，需要接受痴呆症/MCI方面的培训；（IV）缺乏合作导致监狱中患有痴呆症/MCI的人的支持需求管理欠佳；（V）同伴支持“填补空白”；（VI）工作人员“束手束脚”。
结果表明迫切需要在整个刑事司法系统中为患有痴呆症/MCI的人开发更合适的支持系统。必须考虑对认知能力下降的个人的司法程序的伦理关注。监狱管理人员应研究如何使生活环境更适合这些人，并应采用卫生和社会护理的联合协作方法。必须对工作人员进行适当培训，以支持和识别患有痴呆症/MCI的人。同伴支持计划需要进行正式评估，并且对这些计划的培训/监督应该是全面的。
