Mental Health Act transfers from prison to psychiatric hospital over a six-year period in a region of England

Abstract

Purpose There are high levels of psychiatric morbidity amongst people in prisons. In England and Wales, prisoners who present with the most acute mental health needs can be transferred to hospital urgently under part III of the Mental Health Act 1983. This project reviewed all such transfers within one region of England, with an emphasis on differences across levels of security. Design/methodology/approach Over a six-year period (2010–2016) within one region of England, 930 psychiatric referrals were received from seven male prisons. From these referrals, 173 (18.5%) secure hospital transfers were required. Diagnostic and basic demographic information were analysed, along with hospital security categorisation (high secure, medium secure, low secure, psychiatric intensive care unit and other) and total time to transfer in days. Findings There were substantial delays to urgent hospital transfer across all levels of hospital security. Prisoners were transferred to the following units: medium security (n = 98, 56.9%); psychiatric intensive care units (PICUs) (n = 34, 19.7%); low secure conditions (n = 20, 11.6%); high secure conditions (n = 12, 6.9%); other (n = 9, 5.2%). Mean transfer times were as follows: high secure = 159.6 days; other = 68.8 days; medium secure = 58.6 days; low secure = 54.8 days; and psychiatric intensive care = 16.1 days. Research limitations/implications In keeping with the wider literature in this area, transfers of prisoners to hospital were very delayed across all levels of secure psychiatric hospital care. Mean transfer times were in breach of the national 14-day timescale, although transfers to PICUs were quicker than to other units. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. Originality/value This paper extends the available literature on the topic of transferring prisoners with mental illness who require compulsory treatment. There is a small but developing literature in this area, and this paper largely confirms that delays to hospital transfer remain a serious problem in England and Wales. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. This could include different referral and transfer models as a component of service-based and pathways research or combining referral pathways across units to improve their efficacy.

The Referral and Admission of Prisoners to General Adult Psychiatric Intensive Care Units (PICU)

“…This guidance defines 'general community' as those who are not in a registered mental hospital or in the prison estate [5,6] 5 . 1 Chiswick, D (1992) https://doi.org/10.1136/bmj.305.6867.1448 2 2.12 The three levels of security offer the appropriate environmental, procedural and relational processes to manage the assessed risks, including escape, from hospital appropriate for transferred prisoners [10,11].…”

Highlighting “Risky Remands” Through Prisoner Death Investigations: People With Very Severe Mental Illness Transitioning From Police and Court Custody Into Prison on Remand

“…In contrast to the Coroner's findings, the PPO's report of January 2018 stated unambiguously: "we consider that staff at Exeter could not have predicted that Mr Francis intended to take his own life on 24 April and, therefore, could not have prevented his actions" [(50): p. iii]. There is, however, rigorous evidence that individuals with psychotic disorders and delusional-like experiences are at increased risk of suicide compared to the general population (52), and there are high levels of psychiatric morbidity amongst people in prisons (53). Whilst the PPO may have had very good reasons for their judgment, their underpinning evidence base and its application to this case is unfortunately not stated.…”

“…Practitioner training and increased mental health assessment and bed capacity are also likely required. Mr Basalat's case is particularly sad because Northamptonshire Magistrates Court refused his bail "for his own protection" [(54): p. 1], facilitating his remand to a prison environment that "is not a safe place to wait for a hospital bed" [( 26): p. 6; see also p. 20] and that records high levels of psychiatric morbidity (53).…”

“…The PPO appear to tacitly focus their investigation on practices within prison, but it would be useful to transparently state this and consider that failing to highlight the lack of diversion from police or court custody serves to perpetuate the remand of people to prison rather than hospital, and also risks (mis)assigning blame for deaths to prison staff who are not trained to manage people with serious mental illnesses. Moreover, the PPO's report stated unambiguously that, although Mr Basalat was remanded for his own protection with a known psychiatric diagnosis of schizophrenia whilst apparently having a relapse and active delusional-like experiences (52,53), "there was no evidence that he was at imminent risk of suicide or self-harm" [(56): p. iii]. Nevertheless, in the case of Keenan v. the United Kingdom (2001) (application 27229/ 95), the European Court of Human Rights dismissed a claim under Article 2 (right to life) of the European Convention on Human Rights/ Human Rights Act 1998 in the UK because Keenan's record contained no formal diagnosis of schizophrenia, a condition in which the risk of suicide was well known and high, hence the authorities could not have known that he was an immediate suicide risk.…”

Management of ADHD in Prisoners—Evidence Gaps and Reasons for Caution

“…There are high rates of self-harm (46) and suicide (47,48), which though linked to ADHD in general population (49), are strongly associated with personality disorders, depression, substance misuse, and psychosis (50)(51)(52)(53)(54)(55)(56), and of violence (57-59), which is especially associated with ASPD (56,(60)(61)(62)(63)(64)(65). Despite this, prison mental health services remain chronically underresourced (66), with substantial delays in transfer to hospital for treatment in most countries where data is reported (67)(68)(69)(70), and limited access to and study of psychosocial and follow-up interventions that may be effective (27).…”