Section two Focus on detention issues In England and Wales and Northern Ireland funding cuts have led to the withdrawal or reduction of mental health professionals situated in police custody suites. This leaves the police (and the forensic mental health staff who provide general health care to detainees) vulnerable due to a lack of specialist support and advice. The pathway becomes more challenging to manage as there is a lack of early assessment by trained staff and a greater likelihood that detainees will need to be transferred to a mental health facility for assessment. This potentially increases the risks to the detainee, who will be kept in an inappropriate location for a longer period of time, and to the custody officer responsible for their safe detention and care. It may also mean the police have less time to source a health-based place of safety before the need to charge or release. Pathways from prisons to mental health settings100 The inappropriate detention of people with mental health problems in prisons and the prevalence of mental health problems among prisoners have been a matter of public concern over many years.101 The provision of health care in prisons more generally is a growing concern for NPM members, and will be prioritised over the next year by members of the NPM’s Scottish sub-group. In addition to the need to provide appropriate physical and mental health care to all prisoners, individual NPM members have identified concerns about the situation of prisoners with serious mental health issues requiring inpatient treatment, which requires a pathway from prisons to secure mental health care.102 The absence or inaccessibility of such a pathway can pose significant risks to the ability to offer appropriate and timely treatment and prevent further deterioration of mental health conditions. A turning point in the understanding of mental health issues in the criminal justice system came in 2009 with the publication of the Bradley Report. As a result of this, there has been greater focus on developing liaison and diversion schemes to ensure that people in need of treatment for mental disorders in hospital are identified by police and courts and are not sent to prison. However, despite the intention to introduce and implement such schemes, research shows that there has been a decline of more than 25% in the use of hospital orders (which allow defendants to be sent for medical care instead of receiving a prison sentence) since 2011.103 100. A literature search was undertaken to inform the development of this project. Input was provided by CJINI, HIW, HMIPS, IMB, IMBNI, MWCS and RQIA. 101. See Department of Health, 2009, The Bradley Report: Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system. 102. Criminal Justice Inspectorate Northern Ireland, HM Inspectorate of Prisons, Education and Training Inspectorate, Regulation and Quality Improvement Authority, 2016, Report on an unannounced inspection of Hydebank Wood Secure College 9–19 May 2016; Report on an unannounced inspection of Ash House Women’s Prison, Hydebank Wood 9–19 May 2016; Report on an unannounced inspection of Maghaberry Prison 11–22 May 2015 (and subsequent follow-up reports). HM Inspectorate of Prisons, 2017, HM Chief Inspector of Prisons for England and Wales Annual Report 2016–17. HM Inspectorate of Prisons for Scotland, 2008, Out of Sight: Severe and Enduring Mental Health Problems in Scotland’s Prisons. 103. Yeung, P, 2016, ‘Rise in prisoners moved to mental health hospitals’ in The Guardian, 14 September 2016. 39