What is it like to be disabled in prison or police custody? If something goes wrong, how do you access the structures, tools and treatment you need to survive? Around 36% of UK prisoners are disabled. Kai Charles investigates their experiences, finding a pattern of neglect, denial and delay within the confines of a crumbling carceral system.
Content warning: this story mentions suicide and self-harm.
When Alan Blake, who suffered from chronic obstructive pulmonary disease (COPD), arrived at Liverpool’s HMP Altcourse in July 2023 he had been sentenced to 27 months in prison.
In December he began to experience severe, chronic back pain. An MRI was requested by a GP on December 8. Despite this, the scan was not booked by prison staff nor were any additional forms of investigation.
Alan’s condition deteriorated. In March he reported that the pain medication prescribed was not sufficient. Again, nothing was done.
His transfer to an open prison was denied when he was later found to be self-medicating with stronger drugs, such as codeine, to manage the pain.
March brought another concerning sign, a screening for bowel cancer came back abnormal. Still nothing was done. Alan’s condition continued to deteriorate.
By the end of March he was struggling to eat or walk, relying on other prisoners to deliver food to his cell.
April and May came and went without investigation. It would be June by the time the MRI requested in December would be carried out.
On June 20, following a second abnormal blood test, the MRI was performed. The results suggested late-stage cancer. Alan was transferred to hospital on June 28. He died in hospital on July 14 2024, aged 56.
Alan Blake’s case is tragic but not uncommon. Disability and terminal illness in prison are characterised by suffering induced by a failing system, unprepared to provide necessary treatment.
In the publicly available coroners’ reports relating to deaths in prison over the past half decade delayed treatment is a repeated theme.
Deteriorating conditions
A prison is considered by many to be a place designed to strip its inhabitants of dignity, agency, and access to basic tools of psychological and physical survival. To shower, to read, to access sunlight – each is a battle and each is rationed.
But what happens when you add disability to this context? If something were to go wrong, would you have access to the structures, tools, and treatment that may be able to save you?
The 2010 Equality Act defines disability such that “A person is disabled if he or she has a physical or mental impairment and the impairment has a substantial and long term adverse effect on his or her ability to carry out normal day-to-day activities”. The definition is inclusive of a wide range of conditions including diabetes, paraplegia, schizophrenia, and heart disease.
It is estimated that 36% of UK prisoners are disabled.
So, how does this substantial proportion of prison inhabitants manage their conditions while being restricted from accessing the most fundamental resources? And how can disabled prisoners in the UK protect their health and their limited remaining self-determination within the confines of a crumbling carceral system?
“It’s awful,” Ruby Hammil, an activist and community worker who spent three months in New Hall Prison in West Yorkshire says. “One woman showed me a tumour on her breast as large as the breast itself, the guards kept refusing her access to a doctor because they found her annoying.”
In a report by academics from Manchester Metropolitan, Keele and York universities published in Health interdisciplinary journal in 2023, delayed access to healthcare is brought into sharp relief. The report, ‘Trying to battle a very slow version of the system that exists outside’: Experiences of waiting for healthcare in English prisons’, details both extreme wait times and difficulties in accessing treatment once the wait time has elapsed.
Not being informed of appointments, last minute cancellations, and cells not being unlocked on the day of an appointment all contributed to a situation in which even severe health conditions could be left untreated for days, weeks, or months.
“I had a broken finger, and it took them five weeks to send me to hospital to have an x-ray,” a woman prisoner reported as part of ‘No One Knows’ a report by the Prison Reform Trust. She continued, “I have a lump under my arm, and I am waiting to go and have an operation. It’s a bit worrying because my mum and nan had cancer. I’ve been waiting a year.”
The lack of agency for people in prison often extends to decisions concerning fundamental elements of survival for disabled people. Delays in assessments and treatments can result in prolonged suffering, permanent injury, and worse, can be a matter of life or death.
For Ruby, these delays could have cost her life. During her early days in prison a lack of food that met her vegan dietary requirements resulted in a period of starvation that triggered her eating disorder (which is a disability under the definition of the Equality Act 2010).
The disorder rapidly worsened and soon Ruby was not eating at all, passing food to cell mates and losing weight at a frightening speed. Despite a group of prisoners on her block advocating for her to receive medical attention, nothing was done.
She first collapsed whilst walking with a guard, but she was returned to her cell without medical attention. She continued to starve.
Her second collapse was also ignored. The third time she happened to be in front of nurses, in the health wing. This time she was taken to hospital by ambulance.
Ruby’s experience is not unique. “Whenever I tell people [who’ve been to prison] they reminisce about the people they knew who died from eating disorders in there because the prison just didn’t do anything,” she says.
Ruby survived due to a last-minute release on the basis that continued imprisonment endangered her life. She stresses this was only available due to her access to robust legal support through a pro bono lawyer, a resource unavailable to most incarcerated people.
Neurodisability and mental health
When Kayleigh Melhuish entered HMP Eastwood Park in Gloucestershire she was severely distressed. She had attempted to kill herself in the prison van and self-harmed throughout her time in custody.
During the three weeks preceding Kayleigh’s death she self-harmed regularly and told staff that due to her autism, prison conditions were highly distressing for her.
The ‘No One Knows’ report published by the Prison Reform Trust in 2008 shines a spotlight on the experiences of prisoners with Neurodisabilities. Respondents in the study reported being unable to access healthcare or food options as they were unable to fill in the forms required, unable to access prison rules, and were being abused by both officers and fellow prisoners.
For others, being unable to engage in courses required for their release was a major hurdle. Self-harm and suicidal thoughts were common in testimonies featured throughout the report.
The year 2024 saw a steep increase in deaths by suicide of incarcerated people, whilst rates of self-harm have been rising for the past two decades.
This lack of support proved fatal for Kayleigh. On 4 July 2022 Kayleigh was found hiding under a table, she told staff she couldn’t return to her cell as she was being bullied by her cellmate.
Staff proceeded to use extreme restraint, forcing her into a lying position, handcuffing her, and carrying her to the cell. Less than an hour later she was found hanging. She died three days later in hospital.
Kayleigh Melhuish’s case is particularly horrifying, bringing into stark relief the utter abandonment of people with mental health issues in the British prison system. Kayleigh faced restraint, abuse, and neglect when she was most in need of support.
Access to mental health care is a key point in the aforementioned ‘Waiting for Healthcare’ report. Respondents reported that unless you self-harmed or attempted suicide it was almost impossible to access care. In one prison there were only three mental health nurses available for a prison population of 1,500.
When asked about the situation for women in her prison, Ruby describes how people could often be seen “dripping in blood and covered in bruises”. The prison response was to put the inmates “on crazy levels of medication, really struggling in the hours that they were awake and then just zoned out, and then just locked in their cells.”
Ruby goes on to explain, “I mean, all these things are just punished”.
When, in extreme cases, people were taken to a healthcare wing, Ruby describes it as more dangerous than the common prison facilities: “just all the people that were really suffering put in an open plan room”.
The reports into self-inflicted deaths in prison demonstrate one point over and over and over: that the conditions that led to these deaths were known, that solutions were offered, and that they were ignored time and time again.
The cost of this apathy has been the deaths of too many people who entered a prison and left in a body bag.
Mobility aids, medication, and in-prison care
When Daniel Hall, who has Friedreich’s Ataxia (FRDA), a degenerative illness that requires 24/7 care, entered prison, the judge who sentenced him asked assurance that his complex needs could be met.
He would leave the prison to an intensive care ward a month later after repeated failures resulted in a rapid deterioration of his health. Daniel had been refused medication and appropriate care workers, and was allowed to repeatedly fall during his time in prison.
Whilst he was ultimately granted an emergency release after his time in hospital, his prison sentence very nearly killed him and caused a significant decline in health.
Access to care, medication, and mobility aids is a major issue for disabled prisoners.
G., a man supported by the Prisoners’ Advice Service, was given a broken wheelchair without footrests. His feet continually dragged along the ground ruining his shoes and causing pain in both feet.
Officers refused to push him, claiming they did not have the necessary training, leaving him regularly stranded. “Those unable to access a short-term loan of a mobility aid, including a wheelchair, may be unable to go back to work, may become socially isolated or be at risk of falling”, states the British Red Cross.
In prison the lack of a mobility aid can hamper access to other rights and resources, limiting access to food halls, libraries, outdoor spaces, showers, and rehabilitation or training courses.
Access to medication follows a similar pattern. Prisoners reported having to struggle constantly to receive medication. Once available from the prison, delays were common with people having to queue for extended periods to receive it, often going without other resources such as showers to do so.
Philip, an HIV positive man in his late 40s, describes in the ‘Waiting for Healthcare’ report the struggle he experienced in accessing HIV medication, saying “I had to fight tooth and nail”. Whilst Phillip managed to avoid missing a dose, others reported going weeks or months without vital medication.
At an event discussing the health implications of imprisonment, Alan Mitchell, a member of the British Medical Association (BMA) forensic and secure environments committee, stated that “prison, by its very nature, was often unconducive to health and wellbeing”.
In an environment designed to physically and mentally damage people, those already vulnerable are placed at a dizzying level of risk.
In their 2019 report on preventable prison deaths, Inquest, a charity that advocates for bereaved people in cases of state related deaths and investigations, highlighted lack of access to medication and appropriate healthcare as two of five major factors that contributed to prison deaths.
The cost of refusing access is suffering, permanent injury, isolation, and death.
Delays persist in emergency situations
Another factor highlighted in Inquest’s report was delays in emergency situations.
When Igor Vujkovic entered HMP Maidstone he informed officers of his epilepsy. Despite this he was placed in a single-person cell, against guidelines concerning epileptic prisoners.
At 6:50am on 11 May an officer noticed that Mr Vujkovic collapsed on the floor of his cell. She called a second guard who observed that he was breathing. Despite one officer knowing he had epilepsy, they did not take any action.
At 8:49am a different officer again observed that Igor Vujkovic had collapsed and did not respond when his name was called. This time a medical emergency code was called.
It was too late; he had been dead for hours. When guards don’t respond rapidly to an emergency, or when there are significant delays in release to emergency care due to staff shortages, restraint plans, or systemic failings, the results can be fatal.
Igor Vujkovic’s death is the result of a combination of failures.
HMP Maidstone failed to recognise national guidelines regarding epileptic prisoner’s when they placed him in a single occupancy cell. They failed to communicate between one another regarding his epilepsy, leaving inconsistencies in which staff were and were not aware. They failed to respond when he collapsed, a choice that likely cost his life.
Igor Vujkovic’s case reflects another death featured in Inquest’s report, that of Annabella Landsburg, who had type 2 diabetes. Annabella lay unresponsive on the floor of her cell for 21 hours before dying of organ failure and severe dehydration.
When a prison nurse was called to her cell during this period, instead of providing her with medical aid, they poured a cup of water over Annabella, believing her to be faking illness.
Annabelle’s case is a brutal reflection of the extremity of suffering that can result from ignorance, bias, and neglect within the carceral system.
A particularly disturbing element in both these cases is that, as with those of self-inflicted deaths, they happened despite repeated warnings and recommendations during previous investigations. Both are part of a pattern in which disabled people’s lives are continuously jeopardized by a system that does not view them as worthy of the standard of care that they would receive outside the carceral system.
Abuse on every level
There are a number of factors that can contribute to dangerously poor standards of healthcare in prisons. Overcrowding, staff shortages, a floundering bureaucratic system, and communication failures between staff can all inhibit care. In some cases, it comes down to the decisions of individual officers and staff bodies.
In the ‘Waiting for Healthcare’ report multiple prisoners expressed that access to healthcare was impacted by prison staff’s opinion of the prisoner in question – or of the prison population as whole. If prison staff had a negative opinion of a prisoner, or prison population of which the prisoner was a member, it was reported that the prisoner in question would experience delay in care, poor quality of care, or refusal of care.
At times, however, why one person received care, and another was denied, seemed to have no obvious explanation at all.
The report matches what Ruby witnessed during her time in jail. She says: “All the steps are just completely disconnected, and I suppose really depending on who the prisoner is and who the guards are.”
A systemic issue within the British prison system is the opportunities it allows for abuse. In a 2020 report by a delegation from human rights watchdog the European Committee for the Prevention of Torture (CPT), three British prisons were found to be engaging in the practice of ‘preventative strikes’, that is punching compliant prisoners in the belief it would make them less likely to misbehave in the future.
Corroborating this, the ‘No One Knows’ report featured multiple testimonies of violence against prisoners with learning disabilities, with one in ten reporting physical abuse, including one case where a person reported being beaten for being ill and unable to work.
Charlotte, a 48-year-old prisoner described a disturbing situation she witnessed: “There was somebody else on my wing who had a very painful problem with her gallbladder, but she was just left to deal with her pain. They make these kind of almost playing God decisions… what do you put that down to? I don’t know, I actually don’t know.”
A particularly concerning detail in testimonies relating to neglect is that whilst persistence was reported as the only strategy available to prisoners to receive medical care it could also be construed as annoying or time-wasting, risking them losing access to care altogether.
Incarcerated people interviewed for the ‘Waiting for Healthcare’ report described how they worried repeated requests for aid could result in further delays. Max, a 29-year-old prisoner, decried the situation “the punishment’s being there, isn’t it? Not what they can do to you while you’re there”.
Abuse doesn’t stop at overt physical violence, it bleeds into neglect, denial and delay, which for disabled people can cause as much harm as violence would to an able-bodied prisoner.
A system that allows disabled people to die
The repeated failings of the British prison system come at the cost of disabled people’s lives. Those who do survive are marked by the deterioration of their health caused by their time inside. Inquest’s report identified five key forces behind prison deaths: mental health, failings in healthcare, failures in communication, failures in emergency response, and drugs, both prescribed and not.
The issue is not that the prison system is ignorant of the risk to disabled people, it is that it refuses to acknowledge or act to mitigate these risks. Neglect is not a bug of the prison system, rather it is a fundamental element of its design.
For disabled prisoners the already dire state of prison healthcare presents a constant threat to basic survival. The situation only worsens the longer a person is incarcerated with the lack of access to healthcare, and deleterious conditions of prison itself, worsening their health and increasing risk of permanent injury or crisis situations.
Organisations such as Inquest and the Prisoner’s Advice Service have called for action repeatedly over the past decades. Until their demands are met, disabled people will continue to suffer, disabled people will continue to experience permanent damage to their health, disabled people will continue to die.
All illustrations by Jiraporn Puengprayotekij
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