… cliff edges and frailty …

Suddenly it seems the cliff edge isn’t a reality that only ex-offenders face.

COVID-19 is causing organisations like Citizens Advice openly to verbalise that financial problems are linked closely to vulnerability to illness and changes at work. Earlier in the pandemic CAB suggested that those with health risks, young people, and people in insecure work are vulnerable and are “near the cliff edge” – and that they need to be financially supported.

The CAB was quite right to highlight this cohort, and we hope the Chancellor has been able to provide the assistance required over and above the various COVID-19 support packages that he has already sanctioned.

But let us not lose the moment to bang the drum that ex-offenders transitioning into the community often also have health issues, are also frequently young and also do not have secure work lined up. One can reasonably argue that they also need proper financial support and should not simply be left to their own devices on release, after years of institutionalisation and with precious little preparation for what they will face outside the secure prison environment.

Borrowing from current affairs, if a stitch in time saves nine, then what is good for the goose ought also to be good for the gander.

In 2013 the medical journal The Lancet published a paper (*) asserting that frailty – defined as a vulnerability to adverse outcomes – increases susceptibility to “stressor events” such as minor infections, adverse reactions to medicines, surgical procedures etc. The paper went on to discuss that as susceptibility to stressor events increases and as the number of stressor events increase, this in turn leads to disproportionate changes in an individual’s health status, potentially resulting in falls, delirium, fluctuating disability, a loss of independence, hospitalisation or even death.

Meanwhile it is interesting to note, in relation to frailty, these days the NHS is encouraged to stop thinking about “frail elderly” people but to think about “older people living with frailty”, a way of looking at frailty that the NHS has impressively translated into a raft of diagnostic measures and treatments which include holistic assessments of individuals, identifying personal goals, protecting individuals from stressor events and developing personalised plans etc.

For the NHS there is a singular aim – to be able to return patients back into the community and reduce bed-blocking and in-patient populations ……………

If this approach works for the NHS, then, surely there is no reason why it should not also work for transitioning institutionalised offenders, lest anyone should forget that transitioning offenders are no less vulnerable than many older people needing to live with frailty, or the the at-risk cohort that the CAB entreated government to support earlier this year.

For anyone interested, in our self-employment training programme we cover this very ground and help course participants to become alert to relevant indicators of frailty.

(*) Frailty in Older People. Lancet, 2013 Mar 2: 381(9868); 752-762

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