Striving for equal healthcare for prisoners

I admire the positive efforts of Davies & Dimond, ¹ but my views are more aligned with those expressed by Wilson. ² The Mental Health Act 1983 (as amended) does indeed apply in prisons. I have some further points to raise.

Clinicians working in prisons are likely to be aware of common debates between the healthcare workers and other staff. First, the status (prisoner v. patient) of a detained person; second, the related issue of health needs v. security needs - in practice, it is often the non-healthcare staff whose views prevail.

An important point to remember is that early active treatment of psychotic symptoms is not always desired. The initial concerns are often reported by prison officers with variable (often too little) training in mental health issues and can be unreliable. Even when observed correctly, symptoms do not necessarily indicate one specific diagnosis - psychiatric expertise is required for a careful evaluation. This is best carried out in hospital as prisons restrict movements (and behaviours) even on healthcare wings, making mental state examinations difficult.

The use of injectable medications requires monitoring and psychiatric reviews which, put mildly, are not easily carried out in prison settings. Davies & Dimond advocate depot medication to avoid repeat injections; this argument does not hold as medication in the format of short-acting injections may still need to be administered repeatedly while the depot takes time to have its desirable effects. Furthermore, the desirable effect may be a problem in itself. In the absence of adequate safeguards, I fear a slippery slope scenario. The use of depot psychotropic medication for non-psychiatric reasons may become commonplace in prisons.

Although there has been some progress, the services afforded to patients in prisons still fall short when we review issues such as length of time taken to transfer people from prison to hospital and the provision of psychological therapies in prisons.

In my view, the management plans, where indicated, should include an early transfer to a hospital setting under the available provisions of the Mental Health Act. This approach will help us to achieve the much discussed healthcare equivalence for prisoners that has been advocated for more than a decade. ³ This practice also upholds the principles endorsed by Lord Bradley. ⁴