Inpatient care of mentally ill people in prison: results of a year's programme of semistructured inspections
The care of mentally ill prisoners in prison healthcare centres falls well below that provided for mentally ill patients in the NHS, finds research in this week's BMJ. Most prison inpatients are mentally ill and the Prison Service has aimed to provide the same standard of health care as the NHS since 1991.
Reed and Lyne from HM Inspectorate of Prisons, conducted a semi-structured survey of 13 prisons with inpatient units in England and Wales as part of the routine prisons inspection programme during 1997-98. The 13 prisons had 348 beds, 20 per cent of all inpatient prison bed capacity.
The survey revealed that facilities were often poor, staff numbers were low, and many staff were not sufficiently trained. Only one in five of the nursing staff had received mental health training, and almost a third had not had nurse training. None of the doctors in charge of inpatients had completed specialist psychiatric training. Most prisons kept patients unlocked for around 3.5 hours a day rather than the 12 hours required by current prison service standards. Therapeutic activity was limited, and periods of exclusion were lengthy, averaging 50 hours.
The authors conclude that prison should provide an ideal opportunity to diagnose and treat mental disorders among people who don't often use NHS services, and to ensure they receive appropriate treatment. And this not only benefits those who are ill but also the community at large when they are released. But they found little evidence that this was being effectively carried out. They call for more NHS involvement in treating mentally ill prisoners.
Dr John Reed, through Jean Ward at the Home Office, London