Inadequacies in the Mental Health Act, 1983 in relation to mentally disordered remand prisoners

What psychiatrists think about Part III of the Mental Health Act 1983

Aims and method

The government has proposed a ‘root and branch’ review of the Mental Health Act 1983 to be conducted by the end of 1999. The aim of the study was to establish the views of general and forensic psychiatrists as to the adequacy of present legislative provision for England and Wales. The study was carried out by postal survey.

Results

The response rates were 82%, for forensic psychiatrists and 67%, for general psychiatrists. Most respondents considered most of present provision satisfactory. Areas considered in need of amendment were: the term ‘psychopathic disorder’; the requirement for an offence punishable by imprisonment before a hospital order can be made, provision for remands to hospital and the loss of clinical independence consequent upon the making of a restriction order.

Clinical implications

Forensic psychiatrists seem more willing than general psychiatrists to see their clinical discretion limited by the courts. Most of the suggestions were for changes to individual aspects of the present legislation rather than radical reform.

The Bentham Unit: a pilot remand and assessment service for male mentally disordered remand prisoners. I: Clinical activity in the first year, and related ethical, practical and funding issues

BACKGROUND

Because of continuing concern regarding the inadequacy of existing NHS provision for mentally disordered remand prisoners, the Bentham Unit was commissioned as a pilot project to provide rapid assessment and, where appropriate, hospital admission for such prisoners from the former North West Thames catchment area.

METHOD

Information is presented on the 150 referrals and 62 admissions in the first year of the service's operation.

RESULTS

The service met the Reed Report targets for assessment time. Most of those referred were previously known to psychiatric services. The alleged offences were more serious than anticipated. Those admitted were transferred to appropriate services at the conclusion of their court cases, and remained in contact with services three months later. Waiting for the conclusion of court proceedings significantly prolonged the length of stay. Substantial cost transfers from the criminal justice system to the health system were evident.

CONCLUSIONS

Adequate services for mentally disordered remand prisoners are entirely achievable; provision of such services is a resource issue, not a clinical problem.