Section two Focus on detention issues Case study – HMP Bristol: a mixed picture During its 2017 inspection of HMP Bristol (Category B men’s prison), HMI Prisons identified very good links between the prison’s mental health service provider and the local NHS medium secure unit (MSU). The prison psychiatrist also practiced at the MSU and a forensic psychiatrist from the MSU attended the weekly prison health multidisciplinary meeting, which kept the prison on the MSU’s agenda. As a result, transfer times to the unit were reasonably good. This was not the case for transfers to high secure units or MSUs that were further away. The transfer time was being counted from when a bed became available, which is not compatible with the 14-day guideline. HMI Prisons noted that most prisoners were admitted to a hospital within two to four weeks, but between April 2016 and February 2017, six out of 14 transfers had taken longer than five weeks to complete. Capacity in secure mental health services Across the UK, capacity constraints in secure mental health services hinder the pathway from prisons and lead to prisoners being transferred across jurisdictions. In Northern Ireland, the lack of a local high secure hospital means that some prisoners are sent to Carstairs (in Scotland) or Ashworth, Broadmoor or Rampton (in England).124 Similarly in Wales there are no high secure hospital beds. Successive inspections by HMIPS have identified delays in transfers from prisons for women and men due to the insufficient provision of medium secure hospital beds in Scotland. The absence of high secure mental health beds for female prisoners has been identified as an area of concern in Scotland by the MWCS. The matter is under consideration by the Scottish Government, although the way forward has not been agreed. In England, there are insufficient secure mental health beds to meet demand.125 Lack of access to secure hospital beds is the most frequently cited reason for delayed transfers from prison to secure mental health services. The NPM is aware that there are aspirations to increase capacity but this will not be achieved for several years. Transfers at the end of prison sentences The failure to effect transfers before a prisoner has completed his or her sentence means that opportunities to prevent mental deterioration through appropriate treatment may have been missed and/or the public placed at risk. One NPM member identified three cases where prisoners had been released before the prison had completed the process for transfer to a secure hospital. This was of concern because the prisoners in question had suspected mental disorders which may have responded to treatment and/or a mental disorder which may have been a factor in the offence/alleged offence. 124. Criminal Justice Inspectorate Northern Ireland, 2010, Not a Marginal Issue: Mental Health and the Criminal Justice System in Northern Ireland, http://www.cjini.org/getattachment/24d6cd45-20bb-4f81-9e34-81ea59594650/Mental-Health-andthe-criminal-justice-in-Northern.aspx [accessed 13/11/17]. 125. Department of Health, 2000, The NHS Plan, A plan for investment, A plan for reform, page 118. 45