Hospital transfers need proper assessment

Wilson et al ¹ highlight the delays in transferring prisoners to hospital, including a suggestion that a ‘postcode lottery’ operates. Although we agree with much of the article, we would contest the statement that ‘Given the extensive development of mental health in-reach services, and the fact that referrals are made by senior psychiatrists, it seems surprising that it has become routine for receiving units to undertake their own assessment, apparently duplicating work.’

Clearly, it is important that the transfer of mentally ill prisoners needing hospital treatment is expedited and this is no doubt a view shared by both prison psychiatrists and those in the receiving units. However, although this is the main concern of prison psychiatrists, receiving units also have to consider the appropriateness of the placement and issues of risk.

Furthermore, it is not always the case that referrals are made ‘by senior psychiatrists’. And regardless of the author of the referral, assessment by a receiving unit provides an opportunity for additional and often significant information to be collected. This enables the unit to carefully consider risk issues and prepare for a safe admission to an appropriately secure unit, an issue highlighted by the core Never Events relating to escape from medium or high secure units. ² Sometimes this more properly informed assessment clarifies that a prisoner does not need transfer for treatment. This was highlighted in the sensible guidance from the Department of Health, ³ which distinguished between routine and urgent referrals, allowing assessments to be appropriately prioritised.

Given that beds are usually at a premium in secure services, simply accepting every prison referral would lead to even further unacceptable pressure on beds and perversely exacerbate the very problem Wilson et al seek to address.