Audit of transfers under the Mental Health Act from prison – the impact of organisational change

Abstract

AIMS AND METHODTo describe the change in the number of referrals of prisoners and the delay in transfer to hospital under the Mental Health Act following a change in the prison health care provision. The transfer time (time from referral to transfer to psychiatric hospital) of prisoners has been audited previously over 1996 and 1997.RESULTSThere has been an increase in the number of prisoners transferred. Both transfers under Section 48 of the Mental Health Act and the proportion of transfers to high security have increased. The average delay in transfer remains lengthy and there is a trend of increasing delay with increasing level of placement security.CLINICAL IMPLICATIONSDespite Government policies to facilitate the transfer of mentally disordered offenders, we found an increase in the delay to hospital compared with previous audits.

New procedures to cut delays in transfer of mentally ill prisoners to hospital

“…Acutely unwell prisoners may be moved to healthcare centres in prisons, where they receive care from general practitioners (GPs) and mental health inreach teams, but under the current Mental Health Act 1983 they cannot be treated in prison without consent. Previous studies have found unacceptable delays in transferring mentally ill patients to hospital (Isherwood & Parrott, 2002). For those refusing treatment while waiting for transfer the only option is to consider treatment without consent under common law (Earthrowl et al, 2003).…”

Postcode lottery? Hospital transfers from one London prison and responsible catchment area

“…[8][9][10][11] A greater proportion of the transferred prisoners in this study were considered appropriate for forensic settings (medium security) than general adult units. We would argue that prison psychiatry is neither forensic nor general, but has unique skills of its own, covering the entire range of mental health need, from primary care to high security.…”

“…7 The delays in transferring prisoners to hospital are well known. [8][9][10][11] We have looked in more detail at a potential cause of the delay, comparing the performance of the responsible primary care trusts.…”

Mental disorder and prisons

“…The prisoners were more likely to have had a chaotic lifestyle, characterised by frequent changes of accommodation, homelessness, and drug and alcohol use; in addition, many of them had never been in contact with mental health services. An audit of transfers to hospital from the same prison (Isherwood & Parrott, 2002) found lengthy delays in the transfer process, most often due to lack of available hospital beds.…”