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

Abstract

Aims and MethodWe sought to determine whether new procedures recommended by the UK Department of Health in partnership with the Home Office reduced delays in transferring mentally ill prisoners to hospital. Our main outcome measure was time taken from identification of a prisoner's need for transfer to actual transfer to hospital. Waiting times for transfers that took place during 6-month periods before and after introduction of the new procedures were assessed. We also assessed adherence to medication while awaiting transfer.ResultsThere was a reduction in mean waiting time from 77 days to 53 days (24 days; 95% CI –2 to 50). Approximately 50% of patients offered medication while awaiting transfer were non-adherent.Clinical ImplicationsDespite the new procedures, many individuals with acute mental illness remain untreated in prison for several months while awaiting transfer to hospital. We recommend that time limits should be specified for hospital transfers from prison comparable to norms under civil sections.

Transfers from prison to hospital under Sections 47 and 48 of the Mental Health Act between 2011 and 2014

“…This is in contrast to previous studies which found that transfers to medium secure settings took significantly longer than transfers to PICU and general psychiatric inpatient units (McKenzie & Sales, 2008;Bartlett et al, 2012). Our finding is likely to be limited by an under-representation of prisoners who were transferred to high security hospitals.…”

“…A number of factors have been found to have an impact on the transfer duration, including security level of the receiving unit, with transfer times increasing with the level of security (McKenzie & Sales, 2008;Bartlett et al, 2012), and seriousness of offending, with offenders with less serious offending being transferred more quickly (Bartlett et al, 2012). In addition, one study found considerable differences in transfer times between commissioners, suggesting that some commissioners are more efficient in transferring prisoners than others (Wilson et al, 2010).…”

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.…”

The Mental Capacity Act and mental healthcare in prison: opportunities and challenges

“…2 Transfer of prisoners who are unwell is frequently delayed and thus initiation of treatment can be delayed, with the result that prisoners receive care not in keeping with current best evidence or good practice guidelines. 3 Before the introduction of the Mental Capacity Act there were arguments for the development of policy in line with the view that case law allowed for more extensive treatment of mentally incapacitous prisoners than just that given in emergency situations. 4 It is acknowledged that there are potential risks in this approach, as good response to treatment in prison may mean that conditions for transfer to hospital are no longer met, depriving mentally ill prisoners of a more appropriate standard of care.…”