Impact of a dedicated service for male mentally disordered remand prisoners in north west London: retrospective studyBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7089.1244 (Published 26 April 1997) Cite this as: BMJ 1997;314:1244
- Tim Weaver, research fellowa,
- Fiona Taylor, research associatea,
- Barbara Cunningham, research associatea,
- Shane Kavanagh, research fellowb,
- Anthony Maden, senior lecturer in forensic psychiatryc,
- Sian Rees, consultant in public health medicined,
- Adrian Renton, senior lecturer in public health medicinea
- a Department of Epidemiology and Public Health, Imperial College School of Medicine at St Mary's, London W2 IPG
- b Personal Social Services Research Unit, University of Kent at Canterbury, Canterbury CT2 7NF
- c Department of Forensic Psychiatry, Institute of Psychiatry, London SE5 8AF
- d Department of Public Health, Ealing, Hammersmith, and Hounslow Health Agency, Southall, Middlesex UB2 4SA
- Correspondence to: Mr Weaver
- Accepted 6 December 1996
Government policy has encouraged speedy transfer of mentally ill prisoners to NHS care,1 2 but arrangements have often proved slow and ineffective.3 4 The Bentham Unit was set up in February 1994 to provide rapid assessment and (where appropriate) transfer for male mentally disordered remand prisoners in the former North West Thames Regional Health Authority. The unit provides regular outreach assessment sessions at Wormwood Scrubs and other prisons and is based in a 14 bed locked ward to which patients may be admitted before court disposal and determination of final placement.
Subjects, methods, and results
We retrospectively identified all prisoners referred for NHS psychiatric assessment who had been remanded to prisons within the area covered by North West Thames Regional Health Authority (Wormwood Scrubs, Brixton, Pentonville, Wandsworth, and Feltham) between 1 April and 31 August 1994 and determined those who were assessed and admitted by the Bentham Unit. We measured the intervals between remand, assessment, and transfer and compared these measures between subgroups subject to different placements. Similar comparisons were made with those referred from Wormwood Scrubs during the same months in 1993 (before the unit opened).
During the 1994 study period, 158 remand prisoners in North West Thames region were referred. The Bentham Unit assessed 62 (39%) of these. For 71 patients subsequently admitted to NHS inpatient care, the median interval between remand and final transfer to NHS hospital was 36 days (table 1). Admission to a remand bed at the Bentham Unit or the similar local Riverside Forensic Service5 was associated with a shorter length of stay in prison but a significantly longer total interval between remand and final transfer (median 85 days v 55 days, P=0.015).
Of the 158 referrals, 58 were prisoners remanded to Wormwood Scrubs. Comparison with referrals from Wormwood Scrubs during the same months in 1993 showed a significant increase in the proportion of the remand population referred (4% v 8%) and a doubling in the proportion finally admitted to NHS hospital (14 (2%) in 1993 v 29 (4%) in 1994). During the 1994 period 21 of 29 patients were temporarily admitted to the Bentham Unit.
For all Wormwood Scrubs patients subsequently transferred to NHS inpatient care, there were large and significant reductions between the 1993 and 1994 study periods in the median intervals between remand and first assessment by a NHS psychiatrist (median 27 days v 11 days, P<0.05), and between remand and transfer from prison (median 122 days v 46 days, P<0.05). Although the median interval between remand and final placement increased marginally between 1993 and 1994, patients were transferred from prison more quickly, and those who were admitted to the Bentham Unit also had a median 69 days of NHS psychiatric care before final placement.
Combining outreach services with a 14 bed secure ward, the Bentham Unit transfers mentally ill remand prisoners faster than do catchment services. Although the comparison of transfers from Wormwoods Scrubs does not allow differences between the periods before and after the unit operated to be reliably attributed to the service, intervention by the unit has coincided with a significant decrease in the time that male mentally disordered remand prisoners spend in prison and a doubling of the number of patients referred for assessment and the number transferred to NHS care. This suggests that a previously unmet need has been identified.
As a regional service, the Bentham Unit seems to reverse the principle of local care promoted by Reed.2 However, given the failure of local arrangements,3 4 the role of similar units with special skills in forensic psychiatry should be further assessed. Early transfer out of prison will deliver more timely treatment and enable local providers to engage with patients before they are finally relocated. Research must assess the full clinical, social, and economic impacts of specialist units to generate an evidence base for the development of future forensic services.
Funding: Former North West Thames Regional Health Authority.
Conflict of interest: None.