Personal Views

Waiting for a disaster to happen

BMJ 1995; 311 doi: (Published 19 August 1995) Cite this as: BMJ 1995;311:516
  1. H Needham-Bennett,
  2. I Cumming

    This is not a feel good story.

    I unlock the door to the ward each morning and experience the same mixture of emotions and feelings as I did on the first day—disgust, despair, and nausea. I try to walk about 20 metres which will take me to the relative sanctuary of my office. In doing so I pass several cells. Out of some the prisoners watch me and into some I peer. The stench of the slop out and unwashed humanity hangs in the air. In the first cell there is a naked and contorted body lying on the floor next to a torn mattress; faeces are daubed on the wall and food lies underfoot. From the next, a face appears at the hatch: “Hey Doc, when are you going to get me out of here?” I avoid his eye contact, knowing that all our conversations end in threatened violence. In the next a man in strip conditions paces, mumbling to himself and occasionally shouting at his private demons. I hurry my pace and again ignore a question asked from a young, intellectually retarded man charged with rape. “When's my mum coming to see me?”

    This somewhat melodramatic account is not taken from some historical archive but represents my own experience of working as a psychiatrist in a prison hospital. Actually, that is not entirely true and therein lies the problem—it is not a hospital, it is a prison health care centre.

    Prisoners cannot be treated against their will in the prison system, except urgent treatment given under common law. That crucial difference denies insightless psychotic men the opportunity of treatment, even when they have been found guilty of an offence, even when the diagnosis is not in doubt, and even when they are awaiting transfer to hospital on a section of the Mental Health Act made …

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