Transfers from prisons to mental health units
Francesca Cooney, Advice and Information Manager at the Prison Reform Trust, considers that prisoners with severe mental health illness should be diverted away from the criminal justice system before arriving into prison
The recent Bradley Review was set up by the government to look at mental health, learning disability and criminal justice. It recommended that the Department of Health set a new minimum target for 14 days to transfer prisoners with acute, severe mental health illness to health care units. The Department of Health are currently looking at this and reviewing how it could work in practice. The Prison Reform Trust welcomes this move, but would also like the process to change so that people in need of such care are diverted away from criminal justice before arriving into prison and those needing treatment have the same access to a hospital place and standard of care as people in the community. We would also like to see information about transfers recorded and monitored more accurately.
Transfers do have targets at the moment but we are concerned about how the information is recorded. Currently, transfer time is measured from the time the NHS accepts the transfer request. This means that in some cases, if there are no available beds, there is a possibility that a prisoner will not be assessed for a while.
We are not sure how many people in prison should really be in hospital instead. This is because there are currently no records of how many people are remanded in custody waiting for a psychiatric report, how many are assessed as having mental health problems and how many are so unwell that they need to be transferred out of custody for treatment. Every year there are around 950 transfers from prison to hospital under the Mental Health Act.
In England, an average of 42 people per quarter have been waiting for 3 months or more to go to a hospital. They had all been assessed as needing to be in a mental health unit for treatment. The Chief Inspector of Prisons has estimated that four out of ten of people held in health care units in local prisons should be in secure NHS accommodation rather than in custody.
Last year we interviewed IMBs to find out about mental health services in prisons. Forty-nine boards provided information about transfers to mental health units. Just over half reported serious delays in arranging transfers. Only one in four felt that transfers were done in a timely and therapeutic way. Some of the problems we were told about were that after the consultant psychiatrist has assessed the prisoner, there often has to be further visits from the mental health unit taking them. This can take time to arrange. In addition, clinical directors in prisons cannot refer directly to services as a GP would in the community.
Funding can be complicated and some PCTs don’t want to pay for treatment. Identifying which PCT is responsible for an individual prisoner can lead to lengthy discussions, even though there are guidelines that say disagreements about funding should not affect care. There is a process for working out which PCT should be responsible. Firstly, if the patient was registered with a GP before entering prison, then the PCT in whose area the GP is located should pay. Otherwise it will be where the patient was living before prison. If this information is unknown or unavailable, the responsibility is deferred to the PCT where the offence(s) took place.
Delays in arranging transfers can also result in segregation being misused or overused. Prisons are not able to deal with acutely ill people and some may end up in segregation because they need to be restrained. Another barrier is that patients who were assessed and found to require a transfer, but were then moved to a different prison, had to be assessed all over again.
Once a transfer has been agreed, the prison has to get a ‘transfer direction’ from the Ministry of Justice. These can only be issued once a bed is found. If a place becomes available at short notice, the place might be taken up again before the movement order gets processed. In reality, a prison mental health in-reach team could work for weeks to find a suitable place. Then, the prisoner is assessed and accepted by the PCT, a bed will become vacant and the prison asks the Ministry of Justice for a transfer direction. However, the bed could be filled by another patient from the community before the transfer direction is received by the prison. Another problem is that transfer paperwork is valid for only 14 days. If a transfer does not happen in this time, another one has to be issued.
PRT’s main concern is that delays moving people into hospital can mean they are not properly treated, which can lead to a further deterioration in their mental health. There is a big difference between what happens to a severely mentally ill person in prison and one in the community. Prison health care staff have to go through an additional series of time consuming procedures to get assessments. This needs to be simplified and streamlined so that prisoners needing care in hospital can be assessed, transferred and treated quickly.
If you have any questions about our work, or if you want to receive any of our publications, please contact us. Our free-phone: 0808 802 0060 is open Mondays 3.30-7.30pm and Tuesdays and Thursdays 3.30-5.30pm.
We also have a freepost address: Prison Reform Trust Freepost ND6125 London EC1B 1PN. Keep up to date with PRT news, campaigns and reports www.prisonreformtrust.org.uk/newsletter
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