We have an ageing prison population. There are currently just over 85,000 people in prison in England and Wales, of which just over 2400 are aged over 60, and about 500 are aged over 70. All but a handful of the older population in prison are male. Between 1996 and 2006 the number of sentenced prisoners aged 60 and over increased by 149%, making them the fastest growing sector of the prison population (Prison Reform Trust, 2010).

Despite what these figures may suggest there is no elderly crime wave. Part of the reason is that here are more older people in society generally. Also more older people are being sent to prison, and for longer. Thus there is an accumulation of people who have grown old while in prison, and those who enter prison – often for the first time – late in life (HMCIP 2004).

Most older prisoners are detained for a narrow range of serious crimes. 40% have been convicted of sex offences; more than one in four a crime of violence, and one in ten are in jail for drug offences (Prison Reform Trust, op cit). One in four is serving a life sentence; half are serving more than four years. Many have grown old in prison, but increasingly older men are being jailed late in life for serious sexual offences committed many years, even decades, previously. The phenomenon of a man detained for the first time in old age, sometimes late old age, with no criminal record is becoming increasingly common.

In spite of appearances, prison walls are permeable. Prisoners bring the problems of society into them, and they take the problems of prison back into society. Some of the older men in prison have histories of alcohol abuse (less often drugs) and homelessness is not uncommon: but there are many older prisoners for whom such experiences do not apply. Most have led ordinary lives, had jobs, businesses or professions, been fathers, grandfathers, held positions of one kind or another in society. When sentenced they enter an environment that is strange indeed. When released they are often completely ill-prepared for a life that will be nothing like the one they knew before they were jailed.

Few prisons are adapted to meet all the requirements of prisoners who are old and frail. The physical infrastructure is often old, sometimes centuries old. HMP Dartmoor, for example, was once a high security prison and one of the most notorious. Built in the early 1800s to house French prisoners of war, the external structure is largely original. It is five stories high. The environment is noisy, crowded, and older men, here and elsewhere stand out as a vulnerable minority in what is essentially a young man’s world– the average age of prisoners in England is 27, around a quarter are aged under 21 (PRT 2009 op cit).

People who are sentenced in England and Wales are detained in one of various categories of prison, depending on the nature of their offence and the risk they are considered to pose. Prisons are overcrowded and many are detained far from home; as a condition of their sentence some are forbidden all contact with their former environments, many are rejected outright by their families.They can be moved from one prison to another at very short notice, and equipment such as wheelchairs or walking sticks provided in one prison is not always transferred to another. The regime itself is dedicated primarily to security. Routines are rigidly enforced and prisoners have little choice over what they do.

Weekends and holidays especially are characterised by long period of inactivity and for those who retire from work or education days are uneventful. Indeed, the most striking characteristics of prison life for many is the boredom and the worry. Prisoners worry about themselves, their health, and frequently about others, usually family and friends outside, whom they feel powerless to help. A number of the men I interviewed had been carers to elderly parents or family members.

Every prison in the UK has its own team of health practitioners. In prisons managed by the state staff are employed by the National Health Service and consist of general and usually mental health nurses and GP cover. Only in 2006 was healthcare in prisons brought under the management of the NHS and standards of access and quality of care in the general community applied. Prisons run by private companies – about 10% of the whole estate, continue to contract their own health care. Contact with social services, occupational therapy and physiotherapy is patchy, at best. Prisoners have the same rights of care in hospital as anyone else, but access is complicated by the need to provide escort staff. Every day healthcare managers have to decide which prisoners can keep elective appointments and which can’t. Specialist in-reach services operate within prisons, but hospital wings are rarely adapted for intensive nursing or post-operative care, nor can they provide end of life care

In spite of long sentences, most older prisoners will be released, and it is this aspect of their sentence that many older prisoners fear the most. Some prisoners may be released early on licence, but can be recalled very quickly for the slightest breach of conditions. A life sentence means that if a prisoner is released they remain on licence for life. In most cases release is made to a hostel, often with little more than a day or two’s notice given of where they are going. Some prisoners are forbidden to return home or have contact with their families or neighbourhood. The Prison Service has no formal responsibility for people once they leave the prison gate. That belongs to the Probation Service, whose prime responsibility is public safety, not prisoner welfare. The phenomenon of an elderly man released from prison after a long sentence in which he has had to make few decisions about what he will eat, where he will go and when, what he will wear, how to look after himself is all too common. Such men may have no idea how to get themselves to the place where they are required to report other than brief instructions. Social services rarely have contact with prisoners prior to release. Clearly, providing support to elderly men who are frail and in need of care but who have been convicted of serious offences and may be considered still a risk makes caring for them in the community all the more difficult, and some services are unwilling to take them on.

I will always remember the words of one old man, who had been in prison for many years. “Prison is in your head,” he said, meaning attitude is everything. Typically an older prisoner will experience entry to prison as highly stressful, especially if they have no experience of it. The environment is like nothing else. It is noisy, crowded, they are aware that there are a thousand rules, most unwritten, that they must learn. Gradually they get to learn their way around the system and their place in it. If they are on a VPU they will be protected from most of the more aggressive younger prisoners, but not all. A prisoner can be deemed ‘vulnerable’ if he is at risk. Some on VPUs are in danger of retribution over drug deals or other issues on the main wings. They typically rise from bottom of the pecking order there to top on the VPU where most of the prisoners are elderly or frail. The older prisoner here are also assumed by everybody to be child sex offenders whether they are or not, and being seen as a child sex offender is dangerous for the person involved. Prisoners have their own sense of morality, in which certain types of crime are considered repulsive, while others confer a certain status. Some will take justice into their own hands given the chance. Prisoners quickly learn who is to be avoided, who trusted – though perhaps trusted is too strong a term. Prison officers do take risk of bullying seriously, but this means that everyone is watched at all times.

In time, an older prisoner will learn to cope. Those who do so best are the ones who learn to accept the fact they are in prison and to avoid fighting the system. Some never do this. One man told me he hardly left his cell but spent his time glancing at the door expecting someone to come in and announce his innocence. Others get angry and threaten others or themselves. Those with determinate sentences have something to measure their sentence against – the half way point is significant. Those with indeterminate sentences don’t.

There are a lot of ex-service men in prison, and many of the guys I interviewed were ex-forces. Some described events in combat they had witnessed and the effects it had on them. Post Traumatic Stress Disorder is recognised as a cause of changed behaviour that can be threatening or dangerous to the person and to others. But that doesn’t mean it is treated in prison. There is very little individual therapy or treatment available except medication. Nor can transfer to secure psychiatric care be expected for any condition, except in the most extreme cases; though I did hear of cases in which prisoners had been sectioned on the day of release, when they had been suffering from acute mental illness in prison for months or years. Some prisoners recognised that transfer to secure hospital could mean they might never get out, and preferred to stay in jail for that reason.

In general, the extent to which the prison environment directly affects a person’s mood and mental health is hard to assess. Most of the people I interviewed spoke of the day-to-day experience in prison as boring and frustrating, with little of interest to occupy them. Long term exposure to incarceration is likely to be detrimental for some people, though others may benefit from an environment in which the stresses of living independently in the community are replaced by a regular routine and (to coin an American phrase) “Three hots and a cot.”

Clearly, prisoners who are frail, mentally or physically, require dedicated support if they are to avoid further ill health.The prison service is not well prepared to cope with increasing numbers of elderly frail people, some of whom will have demntia and other chronic conditions, and who may need end-of-life care behind bars.

Whatever we as a society may think about the way prisoners should be treated, it is the case that almost all will be released; and all have rights to care and treatment, in or out of prison. Though most prisoners can describe how prisons vary in character and regime, while they are inside life is at least relatively stable. Arguably it is sometimes easier to get medical attention in prison than in the community. Most prison healthcare staff, and many prison officers are genuinely dedicated to the welfare of the men and work hard to provide them with humane conditions, safety and as much dignity as the regime will allow.  Some prisons have older men’s clinics and improved access to psychological therapies. Some have dedicated gym facilities and staff to make assessments and graded exercise programmes. Many older men take part in education opportunities, and some become teaching assistants. Older prisoners may also occupy positions of trust, such as listeners who support people going through mental health crisis.

Age UK provides some good services to older people in prison and I am currently writing a Good Practice Guide to Working with Older Offenders. Such services include ‘buddy’ schemes in which prisoners are trained to provide care to other prisoners who need help with some simple everyday tasks. Visiting services, advice services, and day care are provided by a number of Age UK groups, and are generally popular and recognised to provide help that otherwise is not available. A new service in the South of England, RECOOP aims to provide tailored support t older prisoners in jain and on release. Older Prisoners’ Forums are slowly growing in number, too, and help to give older prisoners a formal voice and a role in the governance of the prison.

The greatest problem facing the older prison population is release.What good do we do if we take away a person’s autonomy but do nothing to prepare them for return to society?There is still a lot to learn about what currently happens to older prisoners on release, how they cope, how and when they fail. Do they just disappear, or end up as a statistic on somebody’s grim list? Or do they see re-offending as a better option than living alone in a world that cares less about older people in general than it should andolder ex-offenders least of all.  We have only just begun to understand this small  but growing group of vulnerable people.

References & Bibliography

Copeland, J.R.M., Dewey, M.E., Wood, N., Searle, R., Davidson, I.A., McWilliam, C., (1987) Range of mental illness among the elderly in the community: prevalence in Liverpool using the GMSE_AGECAT package, British Journal of Psychiatry, 150, 815-823.
Cooney, F, Braggins, J., (2) Doing Time: Good Practice with Older People in Prison, the Views of Prison Staff,London, Prison Reform Trust
Crawley, E., (2005) Surviving the prison experience? Imprisonment and elderly men, From Prison Service Journal,No 160
Crawley, E., Sparks, R (2005) Hidden Injuries? Researching the experiences of older men in English prisons, The Howard Journal, Vol 44, No 4, 345-356
Crawley, E., Sparks, R. (forthcoming 2011) Imprisonment: Work, Life and Death Among Older Men in British Prisons, Willan Publishing.
Fazel., S., Hope, T, O’Donnell, I., Jacoby, R. (2001) Hidden psychiatric morbidity in elderly prisoners, British Journal of Psychiatry¸179, 535 – 539
Frazer, L., (2003) Ageing Inside: School for Policy Studies Working Paper Number 1, Bristol, University of Bristol, School for Policy Studies.
First, M., Gibbon, M., Spitzer, R., et all (1997) Structured Clinical Interview for DSM IV Axis II Personality Disorders, Washington DC, American Psychiatric Press
Frazer, L., (2003) Ageing Inside: School for Policy Studies Working Paper Number 1,
Her Majesty’s Chief Inspector of Prisons (2004) ‘No Problems- Old and Quiet’: Older Prisoners in England and Wales: a thematic review, London, Home Office
NACRO, (2009) A Resource Pack for Working With Older Prisoners, London, NACRO
Prison Reform Trust (2010), Bromley Briefings, Prison Factfile, July 2010 
Ministry of Justice (2009) Prison population and Accommodation Briefing for 29 May 2009http://www.hmprisonservice.gov.uk/resourcecentre/publicationsdocuments/index.asp?cat=85
Walmsley, R., (2003) World Prison Population List. 4th Edition, London, Home Office Publications.