Prisoners are People too – by Deanna Mezen, Churchill Fellow 2023

Categories: Care, Leadership, and People & Places.

According to Nelson Mandela “no one truly knows a nation until one has been inside its jails. A nation should not be judged by how it treats its higher citizens but its lowest ones.” (7)

The  following Executive Summary is taken from Clare’s report with kind permission. The full report can be found here or at the bottom of this article. 

Background

My Churchill Fellowship was born following a research study in 2018, (8) which involved the elderly and terminally ill and explored a prison-based service that used inmates as peer caregivers. This allowed the caregivers a sense of worth and established a role of trust and positive relationships within an end-of-life environment.

I do not propose to argue whether prisoners have or have not the right to choose where they will end their lives but rather to explore the concepts of practices from other custodial settings to ensure that dignity; both in elderly care and in dying can be advantageous to all.

To facilitate a human being to die with dignity is an integral part of humanity and it should be spread evenly. It should be afforded to the wealthy as well as those who dwell in the shadows of our prison world where they may die alone. Being a prison nurse gives you multiple opportunities to mature and share knowledge and gold standard care. Yes, it can be challenging but its rewards are often underestimated.

Imprisonment, and associated loss of liberty, is the punishment for crimes committed. Denying the same health and care services that any of us may need is not.

It is evident that health inequalities within the prison population present major challenges to hard-pressed health in justice services, both for discipline staff and healthcare teams. Dying well, wherever you are and whatever your background or circumstances, is a fundamental aspect of human dignity.

As part of a compassionate humane society, we need to do everything we can to make sure that people who are facing their last months, weeks and days of life receive the best possible palliative and end-of-life care.

Despite falling crime rates in England and Wales over the past 20 years, the number of prisoners has doubled. People over the age of 50 constitute the fastest growing section of the prison population and increasing numbers of older prisoners are dying in custody. Prisons are designed and built to accommodate young men and in large part that is what they do.

Older prisoners have always been something of a curiosity. Traditionally an older prisoner would be either a vagrant or a sex offender. The vagrants are still around now but are greatly outnumbered by sex offenders.

Some sex offenders are elderly because their failing physical abilities lead to behaviour which is deviant, or because they have always been deviant and they are growing older. However, an increasing number are convicted of historical crimes due to their victims finding it easier to disclose after the passage of years, and society is perhaps now more understanding and less likely to see the victim in an unfavourable light. In the UK the Prison Reform Trust produced a review in 2003, Growing Old in Prison. (9) The report states that older prisoners are not suited to the prison environment if they are suffering from any level of disability, so dying has always been an issue and this will only get worse with our growing elderly population.

Those considered “older” within the prison system are aged 55 and over. Inmates experience premature aging known accelerated aging during a prison sentence. Research has stated that one year in prison results in two years’ reduction in life expectancy for those who are incarcerated.

Elderly prisoners encounter several difficulties in their everyday life: limited socialisation, negative attitudes from the public and other inmates, restrictions on outside communications and threats to their safety due to their vulnerability.

They also have to deal with deafening noises, bright lights, demeaning strip searches, a never- ending loneliness, devastation of their home life, sickness and lack of control over trivial decisions – all common occurrences that happen within a prison setting.

When planning to handle an increasing elderly prison population, one of the most important issues that will be faced is creating an efficient social environment.

End-of-life treatment to the incarcerated is a difficult challenge. Peer-based care services could lower medical costs and improve quality of life for inmates who are dying. Using healthy prisoners to complement and adjust treatments can help inmates overcome previous documented barriers to end-of-life care. There are countries that enable healthier prisoners to deliver care to those who need it, but that care cannot be enforced by health providers or the correctional staff, as it is not mandatory by law. We need to explore whether terminally ill or elderly prisoners could process through the end-of-life journey with dignity while incarcerated. It may be that the only or first person who have shown humanity and care towards them in a long time could be a peer caregiver.

The need for prison palliative care is growing as the prison population ages. Dying in prison is not a new occurrence but dying with dignity for prisoners can at times appear to be an alien process. It is an urgent concern needing immediate attention due to chronic illnesses among an aging prison population. Proper implementation of end-of-life care is a significant issue for prison establishments as more and more individuals are facing the end-of-life journey while in prison.

It has been shown that if a facility offers organised programmes, along with compassionate medical and discipline professionals, dying with dignity is afforded. Officers assigned to medical units or wings that house the aging were more likely to assist medical staff in treating inmates than most officers who have not been exposed to this population.

7 https://www.amnesty.org/en/latest/news/2015/05/mandela-rules-on-prisoner-treatment-adopted-in-landmark-revision-of-un-standards- 2/
8 Depner,R.M., Grant, P.C, & Byrwa (2018) People don’t understand what goes on in here. Palliative medicine, 32 (5) 969-979 https://doi.org/10.1177/0269216318755624

9 Howse, K (2003) Growing Old in Prison, Prison Reform Trust, https://prisonreformtrust.org.uk/wp- content/uploads/old_files/Documents/Growing%20Old%20in%20Prison%20-%20a%20scoping%20study.pdf

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About the author

I have been a qualified nurse for 25 years and Advanced Clinical Nurse Practitioner and Non- Medical Prescriber who has worked in the Health in Justice setting for nearly two decades.

My first nursing post was in the Medical Assessment Unit at the Princess Royal Hospital in Telford. I was there for 8 years before pursuing my journey into Health and Justice. Starting out as a Primary Care Nurse at HMP Featherstone I soon found myself on the pathway to becoming an Advanced Clinical Nurse Practitioner at HMP Oakwood.

Now within my role I assess patients, prescribe treatments and educate and develop the primary care team. I am also the lead for our Transgender and veterans in custody communities but I also spend my time supporting some of the most complex men in society, with diagnoses of terminal illnesses, those who are often forgotten about, providing dignity and compassion in their final days.

I have worked to embed the Dying Well in Custody charter into HMP Oakwood whereby all of the men, who are at the end of life, are able to have some humanity during their last weeks and days.

Due to my dedication within this hidden world, I have been able to implement multiple ground-breaking interventions which I share on a local, national and international level to try to improve services within a custodial setting. Due to my work, I have had the honour too of being a finalist in the Nursing Times (2) and RCN Nursing awards (3) and have also been extremely proud to have been awarded the title of Care UK Nurse of the year, a Butler Trust Award (4,5) and most recently an international Human Rights Nursing award from “The Nursing Ethics Journal” (6) that is only given annually to two nurses globally.

2 Nurse shortlisted for top nursing award | Practice Plus Group
3 Prisoners are people too | RCN Bulletin | Royal College of Nursing
4 DEANNA MEZEN (HMP Oakwood) – Butler Trust
5 Nurse honoured by Princess Royal for end-of-life care in Staffordshire prison – insidetime & insideinformation
6 Home page news – Exemplary nurses receive Human Rights and Nursing Award at University of Exeter – University of Exeter

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