Setting

This audit is relevant to general adult or forensic psychiatrists working in prison in-reach teams.

Background

Prisoners, as a group, present an excess of severe mental illness. In England and Wales, mental health in-reach teams were introduced to the prison estate to assist with high levels of need. However, prison-to-hospital transfer times have been a particular problem, which this audit sought to clarify.

Standards

No standard times for transferring acutely unwell prisoners to hospital were set until relatively recently. In 2006, the Department of Health produced agreed procedures for the transfer of prisoners to and from hospital under sections 47 and 48 of the Mental Health Act. These guidelines initially set a 7-day target for prisoner transfers, later amended to 14 days. The same 14-day target was affirmed in Lord Bradley's 2009 review of people with mental health problems and intellectual disabilities in the criminal justice system. The government later accepted that transfer delays should be reduced to a minimum, but did not confirm the application of the 14-day target. Section 47 of the Mental Health Act allows mentally disordered sentenced prisoners to be transferred to hospital from prison for treatment, while section 48 of the same Act allows the urgent transfer of mentally disordered remand prisoners. The transfer is ordered by the Secretary of State for Justice, if satisfied of the following:

ᐅ two doctors have provided written evidence (via a pro forma)

ᐅ the prisoner has a mental disorder (meaning any disorder or disability of the mind)

ᐅ the mental disorder is of a nature or degree that makes it appropriate for the individual to be detained in a hospital for medical treatment

ᐅ appropriate medical treatment is available.

Method

Data collection

The audit was designed for use by one or more prison in-reach teams. Before starting, the relevant prison was identified, along with the time period under examination.

The following information was collected from prison medical records:

ᐅ referral date

ᐅ assessment date

ᐅ acceptance date

ᐅ transfer date

ᐅ level of security of the accepting unit

ᐅ section of the Mental Health Act used.