The medium-secure project and criminal justice mental health

Abstract

Simon Wilson and colleagues (July 9, p 110)1Wilson S James D Forrester A The medium-secure project and criminal justice mental health.Lancet. 2011; 378: 110-111Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar make cogent arguments for improved community-based services for offenders with mental disorders in the UK. However, although the principles of quality community-based services are laudable, Wilson and colleagues put the cart before the horse. What we need upstream of community services is a more effective use of medium-secure services and their full integration with community-based treatment programmes.Commissioners need to stop restricting prisoners' access to medium-secure hospital beds and include the National Health Service and independent sector in calculating the total number of available beds. Men and women in prison identified as needing treatment in medium security should be transferred out of prison to hospital within 14 days—this is what Bradley recommended2Bradley K The Bradley Report: Lord Bradley's review of people with mental health problems or learning disabilities in the criminal justice system.http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_098698.pdfGoogle Scholar and there is capacity to achieve this. In London there are 60 medium-secure beds in the independent sector immediately available, but the average time taken to effect a transfer from prison to hospital is measured in months, not days.Commissioners should get smarter. Admission to hospital should be for short periods for symptom stabilisation and establishment of treatment. Patients returning to prison should be supported by the care programme approach (CPA) and their needs met by prison in-reach teams. Proper and effective CPA can follow the prisoner at release, reducing the likelihood of relapse and recidivism.The current UK Government is committed to saving money, controlling costs, and reducing offending. In Waiting on the wings,3Renshaw J Waiting on the wings: a review of the costs and benefits of secure psychiatric hospital care for people in the criminal justice system with severe mental health problems.http://www.laingbuisson.co.uk/portals/1/media_packs/Fact_Sheets/Waiting_on_the_Wings_2010.pdfGoogle Scholar Judy Renshaw suggests that effective treatment in hospital for mentally ill offenders can save society up to £600 000 over an offender's lifetime—a compelling argument for better, not less, use of our medium-secure estate.I declare that I have no conflicts of interest. Simon Wilson and colleagues (July 9, p 110)1Wilson S James D Forrester A The medium-secure project and criminal justice mental health.Lancet. 2011; 378: 110-111Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar make cogent arguments for improved community-based services for offenders with mental disorders in the UK. However, although the principles of quality community-based services are laudable, Wilson and colleagues put the cart before the horse. What we need upstream of community services is a more effective use of medium-secure services and their full integration with community-based treatment programmes. Commissioners need to stop restricting prisoners' access to medium-secure hospital beds and include the National Health Service and independent sector in calculating the total number of available beds. Men and women in prison identified as needing treatment in medium security should be transferred out of prison to hospital within 14 days—this is what Bradley recommended2Bradley K The Bradley Report: Lord Bradley's review of people with mental health problems or learning disabilities in the criminal justice system.http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_098698.pdfGoogle Scholar and there is capacity to achieve this. In London there are 60 medium-secure beds in the independent sector immediately available, but the average time taken to effect a transfer from prison to hospital is measured in months, not days. Commissioners should get smarter. Admission to hospital should be for short periods for symptom stabilisation and establishment of treatment. Patients returning to prison should be supported by the care programme approach (CPA) and their needs met by prison in-reach teams. Proper and effective CPA can follow the prisoner at release, reducing the likelihood of relapse and recidivism. The current UK Government is committed to saving money, controlling costs, and reducing offending. In Waiting on the wings,3Renshaw J Waiting on the wings: a review of the costs and benefits of secure psychiatric hospital care for people in the criminal justice system with severe mental health problems.http://www.laingbuisson.co.uk/portals/1/media_packs/Fact_Sheets/Waiting_on_the_Wings_2010.pdfGoogle Scholar Judy Renshaw suggests that effective treatment in hospital for mentally ill offenders can save society up to £600 000 over an offender's lifetime—a compelling argument for better, not less, use of our medium-secure estate. I declare that I have no conflicts of interest. The medium-secure project and criminal justice mental health – Authors' replyJohn Taylor's plea for more effective use of medium-secure services makes sense. However, our message is broader than the secure psychiatric estate. It concerns the whole offender population. The medium-secure programme in the UK was established with the best of intentions. Sadly, it has become focused on removing a small number of individuals with psychosis from the criminal justice system into specialist units, neglecting the problems of the majority. The bigger picture is being missed. Full-Text PDF