Prison Medical Service

Just as most mental disorder in the community as a whole is managed in primary care, so most mental disorder among prisoners has been managed by the Prison Medical Service. There are moves to make health care in prisons part of the general NHS, and, increasingly, NHS purchasers (currently known as Primary

Care Trusts, although changes in nomenclature and organization are frequent) are being given responsibility for health care in prisons.

From the point of view of mental health care, this is highly desirable. If a patient with mental health problems enters prison, it is desirable that knowledge about his diagnosis and treatment should follow him in; conversely, a patient with mental health problems being managed in prison should be able to have this management continued when he is released. Integrating prison medical services within the general NHS will be likely to help to reduce the discontinuities in mental health care on reception into or discharge from prison, which have been frequent under the arrangement of having a separate prison medical service.

Because of the high rates of mental disorder in prisons, most prisons also have regular input from general adult and/or forensic psychiatric services. They will advise on diagnosis and management, either in the general wings or the prison hospital. In some units, there are dedicated facilities, set up by mental health services, and staffed and managed by them.

Compulsory treatment under the Mental Health Act 1983 (see Chapter 27) is not, however, permitted in prisons. Sometimes it is necessary to transfer an inmate to psychiatric hospital, not necessarily under conditions of security, and the psychiatrist is able to assist in placement. There are appropriate sections of the Mental Health Act, regarding both sentenced (s47) and remanded (s48) prisoners.

As previously indicated, surveys of prisoners indicate that up to 50 per cent or more can be diagnosed as having some sort of mental abnormality. Sociopathy and substance misuse are the main diagnoses, but learning disability, functional psychosis, organic brain disease, and epilepsy are also found in excess. In some cases this disorder has not been recognized. Others are in prison because no psychiatric hospital place can be found for them. However, the presence of certain psychiatric disorders, such as personality disorder, substance misuse, or treated chronic mental illness, does not necessarily mean that prison is inappropriate.

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