Abstract
Aims and MethodTo describe a group of prisoners who required transfer to mental health units from two London prisons. Data were collected from prison clinical records.ResultsOverall, 149 patient-prisoners were transferred over a 17-month period. Around a quarter were not previously known to services. the aggregate wait was 36.5 years (averaging between 93 and 102 days per prisoner) and the total saving to the National Health Service (NHS) has been estimated at £6.759 million.Clinical ImplicationsBoth prisons manage a large number of prisoners with untreated psychosis. While in prison, they save the NHS considerable sums of money, but transfer delays prevent timely treatment and could now be legally challenged.
Highlights
There were a total of 149 transfers from both prisons to National Health Service (NHS) mental health facilities during the 17 months under examination: 92 from Brixton and 57 from Belmarsh
Six of those transferred to hospital were remitted to prison under section 50 of the Mental Health Act
The way in which mental healthcare is provided for prisoners in England and Wales has changed substantially over the past decade, since serious problems with earlier provision were identified by HM Chief Inspector of Prisons in 1996.8 Before visiting psychiatrists received referrals from resident prison medical officers and service provision was patchily available
Summary
149 patient-prisoners were transferred over a 17-month period. Around a quarter were not previously known to services.The aggregate wait was 36.5 years (averaging between 93 and 102 days per prisoner) and the total saving to the National Health Service (NHS) has been estimated at »6.759 million. In a study of 16 prisons and institutions for young offenders in the UK, Brooke et al found that 5% of the remand population had a psychotic or affective disorder.[1] In a systematic review of 62 surveys based on interviews of unselected prison populations in Europe, Australia, New Zealand, Canada and the USA, Fazel & Danesh found consistent evidence that prisoners were several times more likely to have psychosis or major depression than the general population They found that comorbidity between mental illness, substance misuse and personality disorder was the norm, rather than the exception.[2]. The care pathway for prisoners requiring in-patient treatment is fraught with difficulties and most prison healthcare centres in London are used to accommodate prisoners at various stages of the transfer process They have become, for large numbers of prisonerpatients, waiting rooms for hospital admission. This invitation has since been taken up by a number of National Health Service (NHS) providers within the London area, and an outcome is awaited
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