Prison healthcare: community spirit and honour among thieves

Prisoners spoke of the close bond they formed with the people they cared for inside

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A study of prison healthcare has uncovered inmates giving routine care to others who are elderly, vulnerable or ill. It is time this was formally recognised.

When I began my research journey into prison healthcare in 2005, I had no idea what lay ahead. I only knew that my interest in the health of imprisoned patients had developed after a previous study for the Department of Health.

What followed was three years of conversations with imprisoned patients.

Unsure at first whether they would be willing to speak to me, I steadily began to receive letters. Everything I learned made me want to know more and I asked the prison community whether anyone would be willing to meet me and talk about their experience. Thanks to four very supportive prison governors who brought me together with people who wanted to talk, this was achieved.

The complete picture

The patients who participated in my study ranged from the very young to the very old. Some were lifers, others on shorter sentences or working towards their release date. Both men and women participated, from people who could not write to the highly educated. All shared a health experience and steadily the picture began to build.

By the end of my research a rich tapestry of experience had emerged and 22 distinct clusters of issues were identified. This article is my opportunity to share the first of these.

It was during a face-to-face meeting with male participants that I first encountered a community of imprisoned carers. During the discussions they spoke about the informal caring networks that exist in men's prisons. The topic surfaced when an elderly participant turned to another man in the group for assistance. The man said that the caring relationship had existed for some years and group members said this was quite common in men's prisons.

The ageing prison population and increasing number of people being jailed has led to high numbers of prisoners with complex medical issues. Group members said that one elderly man on their wing had recently had a heart valve fitted and he had required a lot of support following this. Although they added that it is not officially allowed for prisoners to administer medication to others they described it as common practice in men's prisons, particularly if the patient had a condition like Alzheimer's or other impaired cognitive function.

No support

Group members spoke of the close bond they formed with the people they cared for and the lack of support they felt was available in prisons for people taking on caring responsibilities. Sometimes, they said, caring for another person could happen over a number of years until the person being cared for was released, moved or died.

They felt vulnerable patients in prison were at risk of abuse, particularly where frail or cognitive impaired prisoners required assistance with social care tasks such as showering and toileting.

The group also spoke about the difficulties around recording accurate medical information. Previous medical notes are not readily available. Although these can be requested there is a charge and many prisons rely, they felt, on the medical history given to them by the prisoner when they arrive. This is widely acknowledged to present difficulties on a number of fronts, with some prisoners claiming to be taking a range of medication which they do not need, as it can be used as currency in prison.

Participants said some patients with sensitive medical issues would prefer not to disclose them to prison staff and it was common instead to give this information to other prisoners. One recalled being told by someone in this manner that he had tuberculosis.

Secret activity

As prisoners are not allowed to care for each other in any official sense the men I interviewed administer medication in secret and without medical backup. They are also showering and toileting very sick and frail people and believed their own health and well-being was being adversely affected.

They felt the situation should be openly acknowledged and recognised. The necessary support and backup, they argued, should be provided to those providing the care to others in prisons.

Women participants in the study also spoke at length about caring relationships in prison.

They believed the prison system is in crisis and had seen the women's prison population change in recent years, with increasing numbers of people with mental health and drug and alcohol issues placed in prison because of a lack of appropriate facilities in the community.

Addiciton issues

They described a population of mainly young women who have chronic addiction issues in a system doing nothing to help them. They felt these women would continue to return to prison throughout the decades to come, their state of health permanently in decline, draining prison healthcare resources.

In June the national strategy for carers was launched after a national consultation. A central challenge for the strategy will be to build on previous legislation and find ways of supporting carers that are appropriate to individual need.

It is not straightforward. In the community carers can remain isolated and invisible despite their right to recognition and services. This is greatly compounded if we think about reaching a community of carers hidden still further, behind prison walls.

Care givers

Many of the carers who participated in this study provide care, often for years, because they have a caring relationship with the person they look after. Others who participated spoke of the need to provide care when nobody else was prepared to do so. These are sentiments often expressed by carers in the external community too.

Participants spoke of their frustration trying to care for knowing it could mean they were disciplined if discovered by staff.

One male participant said he had to regularly shower an elderly inmate who had dementia and often soiled himself. To avoid finding himself on a charge the carer would leave his cell door open and stand fully clothed with his leg outside the shower in case the prison guards queried what was going on. He said it was ironic prison staff were prepared to turn a blind eye to the showering - possibly because of the smell if he did not - yet he had found himself on a charge for administering medication to the same person.

Other participants spoke of the anxiety of not knowing enough about the condition of the cared-for person.

Care in the community

Prison, it could be argued, is not the place for many people who find themselves there, in particular the very young and people with learning disabilities or mental health issues. In the absence of appropriate care in the community, however, these people all too often find themselves inside.

Carers behind bars find themselves taking on the role of caring for people with complex conditions and, in contradiction to the view of women participants in this study, most carers in prisons are men.

When asked what support they would like, participants wanted little. Information about the condition of the cared-for, training and recognition of their role as carer came top of the list. These modest demands would also feature close to the top of the list when carers in the external community are asked the same question.

I would like to express my gratitude to the carers who participated in the study and were willing to share their experience. It is hoped that the voice of this hidden carer community will be heard by the newly formed Standing Commission on Carers and they will become recognised as full members of the carer community.