Psychotic offenders and prison

I recently assessed a man on behalf of a mental health review tribunal who had been diagnosed with schizophrenia some 14 years into a life sentence. He was then treated for the next 15 years in prison for this condition without the benefit of an assessment as an in-patient in a National Health Service (NHS) hospital. In prison his symptoms were not completely controlled and in a paranoid state he wrote abusive letters to the staff. He failed to get parole. His condition fluctuated and finally, in 2005, he was transferred under Section 47/49 of the Mental Health Act 1983 to an NHS regional secure unit. He was described on admission as actively psychotic. New treatment was started with excellent results. By the time I assessed him on behalf of the mental health review tribunal he had lost his symptoms of psychosis.

My colleague has told me of two men recently seen, both of whom had offended as a result of the psychotic state they were in at the time. Each was, quite properly, placed in psychiatric hospital while awaiting trial. Both had recovered by the time their separate trials were heard and no longer needed to stay in hospital. Instead of their treatment being continued in the community they were, astonishingly, sentenced to imprisonment.

I raised the subject with The Chief Inspector of Prisons. She replied that ‘ …prolonged treatment in prison is indeed an all too common way of managing psychotic prisoners.’ She also reported that although arrangements to transfer prisoners from prison to hospital are better than they once were, there are still delays of months - much too long a time for a psychotic patient.

A prison is not designed to provide the level of expert care of a psychiatric hospital nor is it a community appropriate for the care of a person with chronic psychosis. How can we as a profession tolerate the present state of affairs?