The prison population is ageing fast, due in part to longer sentences and increasing numbers of prosecutions for historic sexual offences. The over-60s are now the fastest growing age group in prisons – numbers increased by 146% between 2002 and 2014 – and their social care needs, no different to those of older people outside prison, may be exacerbated by their surroundings. In 2013, the House of Commons justice select committee reported that many older prisoners were being held in establishments that could not meet their needs.
With the Care Act 2014 requiring that local authorities and prison staff work together to respond to the social care requirements of prisoners, there are greater opportunities for occupational therapists (OTs) working with older people and those who are disabled.
But it is not just those groups who can benefit from occupational therapy while behind bars, explains Gaby Stewart, the College of Occupational Therapists’ policy officer in Scotland. There is currently only one dedicated OT post in the Scottish Prison Service, and Stewart’s responsibilities include working to raise awareness of her role and the benefits of occupational therapy in prisons.
For young offenders, who often have mental health problems, learning disability or difficulties, or have suffered head injuries, OTs can offer training in basic life skills that can make a significant difference and improve the chances of rehabilitation.
Research by the Office of the Children’s Commissioner for England suggested that 23% to 32% of young people in custody have a generalised learning disability, while a 1997 study from the Office for National Statistics found that 95% of people in young offender institutions aged between 16 and 20 years had a mental disorder. Some 60% of young people who offend have difficulties with speech, language and communication, and half of this group have poor or very poor communication skills.
The Roots and Shoots gardening project in HMP Grampian, where inmates grow produce for the prison kitchen, is one example. But schemes like this do more than just develop interests, Stewart says: working in a group helps participants develop communication skills that will help them hold down a job outside.
Giulia Grantham, a senior OT in social care at Essex county council, is developing a link with Chelmsford prison that will see OTs work with disabled and older prisoners.
“People who are in a prison environment obviously face restrictions, but we don’t want to further those restrictions and disadvantage them compared to anyone else there. If they’re not able to work in prison because the doors aren’t wide enough, or there’s no ramp, then we’re not promoting their wellbeing or supporting their rehabilitation.
“If somebody in the community couldn’t access a library because the doors were too narrow for their wheelchair, we’d bring that service to them. We need to be able to do that in prison too.
“You need a slightly different skill base working in prisons. Usually you can use the environment around the person you’re assessing to understand what may be a problem for them. If you’re restricted to assessing someone in a tiny visiting room, you have to have a lot of knowledge about their condition, and around what skills are needed for particular activities in prison, to make sure there’s a good fit.
“The only way I was able to carry out an assessment like that was by assessing a prisoner’s ability to move around the room and to listen to instructions, for instance to change direction – that allows you to see if someone has motor and processing problems.