Memory Matters Inside – Cognitive Stimulation Therapy in Dartmoor Prison

Funded by Funded by National Lottery Awards for All Grant
Project Date: September 2019 – September 2020
Area: Dartmoor

Memory Matters have been providing Cognitive Stimulation Therapy (CST) to people living with dementia in the community for the last nine years with remarkable outcomes. CST in its nature builds relationships. It enables communities to better understand dementia, and people with dementia develop meaningful relationships.

CST sessions aim to actively stimulate and engage people with dementia, whilst providing an optimal learning environment and provide social benefits of a group. The sessions include a range of activities to stimulate thinking and memory.

In 2019 we met with the team at Dartmoor Prison to learn how they manage people living with a dementia. We learnt that many prisoners living with dementia face social isolation. We aim to take our model into the prison environment to help reduce this and better improve the relationships and skills of those that support.

The number of prisoners over 60 years old has tripled in the past 15 years. It is estimated that by 2020, 14 000 prisoners will be aged over 50, amounting to 17% of the UK prison population. Newcomen (2017) Elderly prisoners, according to the HMS Prisons Inspectorate (2004) can easily be dismissed as “old and quiet” and as a consequence may be overlooked given the ever-increasing demands on an already overstretched service.

There are few statistics regarding the prevalence of dementia among the elderly prison population but the Mental Health Foundation (2013) quoted an estimated 30% of older prisoners suffered from depression and in the same report it was suggested that 5% of prisoners over the age of 55 may be affected by dementia.

We have found that CST has been successfully delivered in Norwich Prison for a number of years and that the evaluations have been positive. There is a great deal of practical learning from the Norwich initiative that can be transferred into this project.

We aim to train prison staff and other suitable other prisoners who work with, and have contact with, those who show symptoms of dementia. The training will include Exploring Dementia and Behaviour that challenges workshops. We will offer CST training to ‘buddies’ to enable sustainability once the project is complete, to enable them to continue the sessions. This is also a great opportunity to up skill prisoners who support those living with dementia.

CST is important as a tool in helping to manage the symptoms of Dementia because as well as stimulating the mind, the group sessions offer an opportunity to share experiences and talk with other people with dementia in a relaxed and supportive environment. Being part of a group helps build self-esteem and can lead to being more confident to join in conversations and activities outside of the group.

For the prison staff and fellow inmates, CST gives the structure required to engage effectively with those living with the symptoms of dementia and may encourage empathy and understanding. Prison staff who work with elderly prisoners will develop their knowledge and understanding of CST and its benefits. We aim for them to feel more supported in working with prisoners with dementia. On a recent visit to the prison, we found that they identified a lack of skills to meet the needs of those with dementia and requested that they might learn how to be more effective.

Carers and relatives of those who have engaged in CST report an improvement in language and the willingness of people with dementia to participate in conversations. These findings can be transferred into the prison setting and evidence from the Norwich project demonstrates this to be so.

Norwich prison also found the groups led to more positive relationships between the staff and prisoners leading to a more harmonious environment. Norwich prisoners were felt to have improved self-esteem, evidenced by a marked improvement in their personal care, making an effort with their appearance when the group ran. It was noted that the participants were more willing to mix with others rather than isolating themselves.

The aim was to evaluate the outcomes for both the prisoners and the prison staff. We planned to carry out the initial session work over 35 weeks and will follow up with evaluation. The project should have taken 10 months to complete.

The outcome that we hoped would be achieved was a group of trained ‘Buddies’ who were able to provide research-based dementia therapy independently once the project had completed. A sustainable solution to a complicated issue.

A solution that is multi-faceted – Those with dementia in prison receiving therapy, buddies trained in skills for their role in prison and to take with them through life and prison teams knowing that good quality therapy is provided with minimum impact on staff and distress reduced.

The Original Project Plan:

The Memory Matters team engaged with Prison Staff, HMPS Libraries, Buddies Trainer, Nursing Team, and Good Prison Project Worker.

  • Ensure the prison has an area that can be used for the Group. Currently, the team at Dartmoor are developing a space that can be used as a day centre for older prisoners. The prisoners will be supported by their ‘Buddies’ – also prisoners. MM is supporting the team to build a weekly activity plan – this will encompass the Memory Matters Inside Project once a week.
  • Training in Exploring Dementia and Behaviours that Challenge us – both for staff and buddies.
  • Initial session to intro and do baselines – ACE Mini, QoL – AD, Loneliness Scale.
  • Two lots of 14 week sessions – initial group then open out to next group or run maintenance session depending on numbers.
  • CST Facilitators training for the buddies was to take place after the first 14 week session – this will enable the buddies to start to step in a run a session each with our facilitators – the aim is that they can continue after we have left proficiently.
  • Evaluation session after 14 weeks then another at the end.
  • Deliver evaluation to Governor of Dartmoor prison and working party.

Memory Matters Post COVID Plan:

Initial funding programme Sept 2019 to Sept 2020

The original plan could not be completed. Building on the original work, the team at Memory Matters feel that there is some mileage in providing the activities that would have taken place so that the buddies can continue to support those affected by memory loss in HMP Dartmoor. This enables us to keep supporting HMP Dartmoor for a little longer.

The aim of this project was always to upskill the Buddies to enable them to provide the support for those affected by memory loss in a sustainable way. By upskilling the buddies this means those living with dementia can have access to specific research based therapy during every interaction.

Before lockdown, the buddies had seen the facilitators run the sessions, they engaged well and understood the process. The Buddies also took part in training to understand the condition and its signs and symptoms better.

During this difficult time, the isolation both within, and outside of the prison for those living with dementia has been extremely difficult. The aim with the surplus left in the grant is to enable this work to continue by providing as much as we can to provide activity and occupation within the prison.

Reshaped Plan Due to COVID Restrictions:

1. Provide a dementia Activity Folder with 14 planned dementia friendly activities that can be completed as a group or individually. This will be delivered in a folder that will enable the activities to be used again and again.

2. Provide Dartmoor prison and buddies with Cognitive Stimulation Therapy Manuals to enable them to run CST on a one to one basis and in a group. Memory Matters will provide a mix of Making a Difference CST Manual, one, two and three. This will be available for the buddies who support those affected by dementia, staff and the prison itself as reference material. WE will purchase and get these delivered to the prison.

3. Provide two days training for prison staff either digitally or when safe to do so, in person. We will provide the most appropriate or requested training – either Exploring dementia (half day) or Behaviours that Challenge in Dementia (full day).

4. Provide two full days of her time to support the reopening of the Day Centre or to enable the development of an activity plan for the Two Bridges centre.

Further Reading

Meeting the challenges of dementia in prisons.pdf

The Prison Project: Raising awareness of dementia in prisons

Dementia in UK prisons: Failings and solutions?

This project was met with such enthusiasm from all involved and broaches a difficult subject. The team at Memory Matters are keen to explore this project in other prisons when the environment allows us to. We would be happy to hear from any prison who would like to discuss how this would work for them. If this is you – please get in touch.

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