Table 3 Challenges to Assessment

There are difficulties in accessing specialists to undertake dementia assessments in the prison setting (Moore & Burtonwood, 2019). Challenges included a lack of: procedure regarding further assessment for people of concern (Brooke & Jackson, 2019; Gaston & Axford, 2018; Sindano & Swapp, 2019; Tilsed, 2019; Treacy et al., 2019; Turner, 2018); limited staff knowledge (Forsyth, Heathcote and Senior et al. 2020); staff confidence in diagnosing dementia (Sindano & Swapp, 2019; Treacy et al., 2019), including prison healthcare staff delaying diagnosis (Sindano & Swapp, 2019; Treacy et al., 2019); lack of training and, particularly in local prisons (Forsyth, Heathcote and Senior et al. 2020); regular health-checks for long-stay prisoners (Brooke & Jackson, 2019; Brown, 2016); time and resources (Turner, 2018; Correctional Investigator Canada, 2019; Inspector of Custodial Services, 2015; Goulding, 2013); the high turnover of prisoners (Forsyth, Heathcote and Senior et al. 2020) and; prison-specific screening or assessment tool(s) (Brooke & Jackson, 2019; Patterson et al., 2016; Turner, 2018; Correctional Investigator Canada, 2019; Feczko, 2014; National Institute for Health and Care Excellence, 2017). Problematically, prisoners tend to underreport any cognitive or physical symptoms either for fear of repercussions (Pandey et al., 2021) or because of poor insight into their cognitive impairment and deteriorating health (du Toit et al., 2019) and it was reported that some people did not attend assessments for fear of bullying from other prisoners (Murray, 2004). Further to this, ensuring that consent is given freely by an incarcerated individual (who may also have dementia) is challenging. Low literacy levels and high rates of learning disabilities would mean that provision of information and checking of understanding would have to be scrupulous to ensure informed consent had been obtained (Moore & Burtonwood, 2019)