Tuesday, 9 June 2009

Both prisoner and patient

© James Nachtwey/VII.

The government is to consider whether healthcare given to people in custody should be the responsibility of the NHS, not individual police forces. A recommendation to that effect was made by the Labour peer and former Home Office minister Lord Bradley in his review of how people with mental health problems or learning disabilities are treated in prisons and police stations. It seems any changes will be made quite quickly: a new programme board has been set up to consider the options and it will report within the next 12 months.

The recommendation reflects dissatisfaction with Forensic Medical Examiner services as a whole. Even though the Lord Bradley says some of those services are “excellent and invaluable”, he notes a widespread concern among professionals that medical care is not always available to police detainees when it is required. There is also a – perhaps understandable - desire to unify the provision of health services within the criminal justice system and thereby to ensure greater continuity of care and the smoother flow of information.

Lord Bradley’s recommendation is not new. It was made in Baroness Corston’s recent report on vulnerable women in the criminal justice system, and also in the Department of Health’s own consultation on a proposed strategy for offender care, published in 2007.

The new report also has something to say about Appropriate Adults, who it seems are utilised far less often than they should be. On a national level, there may be problems identifying the need for an Appropriate Adult in the first place, and then in locating someone who can perform the role effectively. The government has conceded that the role should be reviewed and has asked the programme board to consider the resource implications of such a course. Taking into account of the more general review of PACE, the board must also consider whether Appropriate Adults should be trained (and if so, how).

In response to Lord Bradley's report, the government also says:

* It might limit the time prisoners with mental health problems can be expected to wait to be transferred to hospital. (Lord Bradley said this wait might be pegged at 14 days.)

* There should be an evaluation of treatment options for prisoners with personality disorder and a review of the flagship programme for those with Dangerous and Severe Personality Disorder.

* The work of mental health prison in-reach teams should be reviewed.

* There should be better mental health primary care for prisoners, and a number of PCTs will therefore be nominated to take the lead in commissioning prison health care services.

* Consideration will also be given to making awareness about mental health and learning disability issues a key component of police training, and to giving all custody suites access to liaison and diversion services.