Can We Really End Dementia Behind Bars? Dementia behind bars (2012) noted the rising caseload of aging inmates in the United States and proposed three "avenues" to meet needs for mental health care. Because the "tough on crime" policies that increased inmate populations are not likely to be reviewed, this précis invites consideration of smaller but more tangible progress. Olivier Serrat 13/10/2017
1 Inferring from Data According to Human Rights Watch (2012), about 125,000 of the 1.5 million inmates in the United States in 2010 were 55 years of age and over, representing a 282% increase between 1995 and 2010 (compared with a 42% increase in the overall inmate population). Based on the data in Human Rights Watch (2012), Dementia behind bars (2012) warned that "… the prison system could soon find itself overwhelmed with chronic medical needs" (para. 2) and advised states to "pursue other avenues" (para. 6) to address the rising caseload of aging inmates in need of mental health care. To note, there is no official count of how many inmates suffer from dementia; notwithstanding, there may be more inmates with dementia than prison officials realized because corrections officers are not used to evaluating for Alzheimer's. Dementia behind bars (2012) proposed three "avenues" to tackle the problem: (a) partnerships between prisons and nursing homes to improve the quality of care; (b) compassionate release programs for frail inmates who no longer present a threat to public safety; and, (c) a revisiting of mandatory sentencing policies that did away with judicial discretion and drove up the number of inmates. Taken at face value, the recommendations of Dementia behind bars (2012) seemed sensible. But, the internal logic of Dementia behind bars (2012) was suspect: the editorial began with mention of rising costs and evidenced numbers later in the text—surely, an attention-grabbing device—but matters of finance were not actually mentioned in any of the three "avenues" the editorial identified. The partnerships between prisons and nursing homes would cost money, of course: so, did Dementia behind bars (2012) fear that mentioning these upfront would scupper its proposals? Or were things more complicated, if not complex? Three Grains of Salt Deeper consideration of Dementia behind bars (2012) raised difficult questions, sidestepped by the author(s), of which three came to mind (Serrat, 2017). First, Dementia behind bars (2012) focused on dementia but ignored other age-related infirmities. Why? Was that because dementia is of particular interest to the general public? Alzheimer's affected 5.5 million Americans at the time Dementia behind bars (2012) was published and that number was projected to soar because of the growing number of people aged 65 and more; notwithstanding, were all cognitively-impaired inmates serving life sentences? Second, while Dementia behind bars' (2012) proposed partnerships between prisons and nursing homes did sound feasible a priori, it was quite likely that the sometimes-violent crimes that the inmates had committed would make nursing homes reluctant to take them (and before that make states reluctant to parole them). Third, Dementia behind bars (2012) did not contemplate the possibility that a cure for dementia (or ways to slow its progress) might be developed and that a continuous improvement in the standards of dementia care might be achieved, in which case the recommendations that the editorial submitted might become less urgent (and perhaps even irrelevant). From Sweeping Statements to Small but Tangible Progress In the current and foreseeable political climate of the United States, neither the review of "tough on crime" policies that from the 1970s increased inmate populations (with long mandatory minimum sentences, more life sentences, and reduced opportunities for parole) nor comprehensive plans for appropriate housing and medical care in prisons can be expected. Albert Einstein is credited with saying that "The significant problems we face cannot be solved at the same level of thinking we were at when we created them." In the immediate, therefore, it
2 is not likely that much will change however much one might want it to. Some richer states could establish separate units for cognitively-impaired inmates and use professional caregivers; others might train prisoners to handle the demented inmates' daily needs, which might have the added benefits of both making these caregivers feel appreciated and polishing their prison records. On a case-by-case basis, there might also be scope for conditional release to home confinement under parole supervision. It is doubtless with such small improvements, not sweeping statements, that tangible progress might be made. References Human Rights Watch. (2012, January 26). Old behind bars: The aging prison population in the United States. Retrieved from https://www.hrw.org/report/2012/01/27/old-behindbars/aging-prison-population-united-states Dementia behind bars [Editorial]. (2012, March 25). The New York Times, A26. Retrieved from https://www.nytimes.com/2012/03/26/opinion/dementia-behind-bars.html Serrat, O. (2017). Inferring from data [PowerPoint slides]. Retrieved from https://www.researchgate.net/publication/321627709_Inferring_from_Data