Abstract

SummaryThe UK Mental Health Act 1983 does not apply in prison. The legal framework for the care and treatment of people with mental illness in prison is provided by the Mental Capacity Act 2005. We raise dilemmas about its use. We highlight how assessing best interests and defining harm involves making challenging judgements. How best interests and harm are interpreted has a potentially significant impact on clinical practice within a prison context.

Highlights

  • Prison Service Order 1600 outlines the use of force as justified and lawful only where it is reasonable in the circumstances, it is necessary, no more force than is necessary is used, and it is proportionate to the seriousness of the circumstances

  • Circumstances where mental health professionals may consider the use of force to be justified in the ‘best interests’ of a person’s health and social care may not be covered by Prison Service Order (PSO) 1600, leading to the potential conflicts between healthcare and prison staff

  • A person who is very unwell and extremely agitated and threatening will often be on a restricted regime, which may mean they come out of their cell for brief periods of time, often a maximum of 1 hour a day

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Summary

Prison Service Orders and the Mental Capacity Act

Prison Service Order (PSO) 1600 - Use of Force, is the framework under which ‘use of force’ by prison staff is considered ‘lawful’; it was issued in 1999, with amendments in 2003. Prison Service Order 1600 outlines the use of force as justified and lawful only where it is reasonable in the circumstances, it is necessary, no more force than is necessary is used, and it is proportionate to the seriousness of the circumstances. Circumstances where mental health professionals may consider the use of force to be justified in the ‘best interests’ of a person’s health and social care may not be covered by PSO 1600, leading to the potential conflicts between healthcare and prison staff. Examples in our experience include use of restraint, when all other interventions have not been successful, to transfer to healthcare a resisting prisoner who is very unwell with a psychotic illness; or to provide basic nursing care for a prisoner with a psychotic illness as a consequence of which they have refused to wash for many weeks

Best interests
Defining harm
Compulsory treatment in prison
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