Impact of Settings
There is a large body of research on the impact of certain settings on
persons living with dementia. An article by Davis et al. (2009) stresses how
institutional settings have negative effects on PLWD and there is a recent push for
a culture change towards more dementia friendly environments. It could be
argued that because incarcerated PLWD are in prison for the purpose of being
punished there is no reason for why the government should feel obligated to make
them more comfortable. However, this type of thinking may border on cruel and
unusual punishment when the incarcerated person may already be struggling to
function without even taking into consideration the setting they are placed in.
Some of the literature suggested making physical modifications to prison settings
to aid the older population and subsequently PLWD especially in regards to
navigating their environment (Dillon et al., 2019). This is not providing special
treatment but rather making the prison setting more equitable for those who need
it. Prisons are not designed for people with complex health care needs, so
modifications need to be made in order to create an equitable environment for
both older adults and especially persons living with dementia. In addition to this,
psychiatric hospitals are no better equipped to care for an older person living with
dementia and other potential comorbidities associated with advanced age.
Impact of Settings
In 2009 Peter Lee was moved into a care home specializing in memory
care where he later smothered another resident to death (Payne, 2018). Lee was
arrested and charged with second degree murder to which he was found unfit to
stand trial and subsequently sent to live at the Royal Ottawa Hospital to live in a
secure forensic unit (Payne, 2018). Comorbidities are common in older adults,
including Lee, and the hospital was not suited for complex needs as a nursing
home would have been and he eventually died there (Payne, 2018). Part of the
reason for Lee’s stay at the hospital was attributed to the fact that most long-term
care homes are reluctant to take in residents with violent tendencies or who are
involved with the legal system, referred to as a “double stigma” (Payne, 2018).
Parole and Probation
Although parole and probation are similar in the fact that both consist of
community supervision, there are marked differences. Parole always follows a
period of incarceration while probation can be imposed on its own or as part of a
sentence but only following an incarceration term of two years or less (Parole
Board of Canada, 2018). When a person is released on parole or receives
probation as a sentence they are given a list of conditions which they must abide
by or risk being re-incarcerated and incurring added breach charges (Parole Board
of Canada, 2018). The issue that arises in relation to persons living with dementia
on parole or probation is that they may forget or in some cases ignore their
conditions for lack of understanding the consequences.
Parole and probation officers are tasked with the job of ensuring that
individuals on parole and probation follow the terms of their release as well as
providing support and connecting them with available resources (Department of
Justice, n.d.). Just as with first responders, it is unlikely that parole or probation
officers would have any education or training on dementia. They, however, work
closely with social workers, mental health staff, psychologists and other partners
which would make it easier for them to access supports and resources for persons
living with dementia (Correctional Service Canada, 2015).
The challenge that exists for persons living with dementia being released on
parole or sentenced to probation stems from the symptoms of inhibition and
impulsivity. If a person is unable to discern the consequences of their actions, they
are more likely to violate the terms of their release. As a result of this, it can be
expected that persons living with dementia will be charged with breaching their
conditions and potentially being sent, or sent back, to prison.
There is a program available in Peterborough, Ontario that allows
prisoners living with dementia to be released on parole into the community.
Haley House addresses a significant gap in the justice system regarding
resources for persons living with dementia. Inmates can be referred to live at
Haley House and may be released on parole to reside there following a
screening process that assesses their risk to the community (Peterborough
Reintegration Services, 2017). The facility focuses on end of life care for
elderly inmates which is something that is severely lacking within prisons
(Peterborough Reintegration Services, 2017). Here, inmates are supervised
around the clock and have access to care workers that help them develop
reintegration plans that reflect the terms of their parole (Peterborough
Reintegration Services, 2017). If an individual breaches the terms of their parole
while living at Haley House they are promptly reported to their parole officer or
Corrections Canada’s monitoring system (Peterborough Reintegration Services,
2017). Unfortunately, this program is the only one of its kind in Canada and can
only house so many individuals at once making it a very limited, yet
intrinsically valuable, resource. There are no known resources for persons living
with dementia sentenced to probation.
Parole/Probation
In 2019 John Hardee was sentenced to 45 days of house arrest and
probation for obstruction of justice after he attempted to cover up a bribery scandal
in the government branch for which he worked (Lovegrove, 2019). Within mere
hours of his plea deal Hardee was arrested once again for violating his probation
by soliciting a prostitute and was remanded to prison while awaiting his next court
date (Lovegrove, 2019). Hardee was later sentenced to seven months in prison and
three on house arrest to be followed by three years of probation to condemn his
blatant disregard for the judges prior instruction (Lovegrove, 2019). A forensic
psychiatrist found that Hardee showed signs of mild dementia, depression, and
anxiety which could impair his judgement and influence impulsivity (Lovegrove,
2019). The judge announced that he could not recall anyone else ever violating
their probation so quickly (Lovegrove, 2019). As sexual offences are most
common with men who have dementia it would make sense that his disregard was
caused by a neurological condition. Additionally, the new sentence does nothing to
prevent Mr. Hardee from breaching his probation again in the future which is
likely to happen as his dementia progresses creating a cycle of recidivism.
Release
The criminal justice system typically concludes in an unconditional release.
The challenge faced here is figuring what happens now for persons living with
dementia who are released back into the community after spending time in prison.
Individuals with mild to moderate dementia may be able to live independently or
with the assistance of home care for a certain amount of time, but as the disease
progresses it is likely that they will require more care than is realistically available
outside of a care institution. As touched upon in Mr. Murphy’s case study, long
term care homes are reluctant to accept individuals with a history of violence or
criminal convictions and this poses an immense challenge when searching for
adequate care and housing (Motluk, 2019). This aspect of the criminal justice
system echoes the same concern that arises when examining parole and probation:
recidivism. Impulsivity and reduced capacity for understanding consequences of
actions could lead to repeat offending and returning to face the criminal justice
system all over again.
Before being released, prisoners make a release plan which outlines where
they will be living, what support they have available, plans for employment or
education, and leisure activities they wish to undertake (Correctional Service
Canada, 2016). There are a number of offender rehabilitation programs that focus
on corrections, education, socialization, employment and employability which are
intended to help inmates return successfully into the community (Correctional
Service Canada, 2019). Ethnocultural services are also available for inmates with
certain needs based on race, language, culture, and other beliefs (Correctional
Service Canada, 2019). The Canadian government published a report titled The
Social Reintegration of Offenders and Crime Prevention(Griffiths et al., 2007)
which details a framework for the social reintegration of prisoners. There are a
number of programs to assist in supporting the reintegration of prisoners into the
community including ones for mentally ill offenders, employment, housing and
finances, family support, substance abuse interventions, and recidivism prevention
(Griffiths et al., 2007). There are no programs specifically targeting individuals with
dementia, however, programs aimed at mental illnesses come close. Emphasizing
individuality, the report promotes continuity of care and a community based
treatment model alongside multidisciplinary case management for psychiatric
treatment and social service support (Griffiths et al., 2007).
Release
In 1988, Walter McMillan was arrested and charged with a murder he did
not commit, spending the next six years in prison on death row (Sederstrom,
2019). He was exonerated and set free in 1993 and developed early-onset
dementia shortly thereafter which was attributed to the trauma he experienced
(Sederstrom, 2019). For several years after his release he believed he was still on
death row and would beg people to help him up until his death in 2013
(Sederstrom, 2019). This case is depicted in the film “Just Mercy” released
December 25, 2019 and exemplifies the need for appropriate resources for
individuals with dementia post release.
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