National Preventive Mechanism Eighth Annual Report 2016–17 Account from a forensic psychiatrist A forensic psychiatrist interviewed by HMI Prisons related the story of a patient who had been under her care in prison. The man had been seen by the liaison and diversion worker at court who recommended admission to a mental health hospital, but the judge remanded the man to prison. After three days at the receiving prison the man was relocated to the ‘inpatient’ unit. The forensic psychiatrist made a referral for a possible low secure hospital placement and established that the Psychiatric Intensive Care Unit was unwilling to take him. Low secure staff assessed the patient six days after referral and accepted him for transfer 20 days after referral but indicated that a bed was unlikely to be available for another month. While in the inpatient unit the patient was regularly on three-officer unlocks. Forty days after first referral the man appeared in court once again, but this was a different court with no liaison and diversion service. The man was given unconditional bail and allowed to leave the court. The attempt to transfer the man for mental health assessment and treatment had failed. Because of the safety precautions indicated for this detainee while in prison, the prison mental health team were concerned for his safety and the safety of others in the community due to his untreated behaviours. Conclusion It is of particular concern to the NPM that the failure to effect transfers efficiently can cause deterioration in prisoners’ well-being. The evidence gathered by NPM members makes clear that the problems with transfers between prisons and secure hospitals identified over the last decade, not least in the Bradley Report, have not gone away. In fact, analysis by HMI Prisons of its inspection recommendations shows a year-on-year increase in the proportion of inspections in which recommendations are made about Mental Health Act transfers. Though this data should be treated with caution because HMI Prisons inspects different prisons every year, it is notable that in 2016–17, HMI Prisons made a recommendation to improve the timeliness of transfers in more than half (56%) of its published inspection reports. The lack of public and comparable data, particularly from Scotland, Northern Ireland and Wales, makes it difficult to analyse the extent of the problem across the UK. The NPM welcomes recent scrutiny of these issues by the National Audit Office (NAO), the Joint Committee on Human Rights ( JCHR) and the Committee for the Prevention of Torture (CPT). All agree that the current recommended 14-day target is not being met and that this requires review. They made the following specific suggestions: • that a legal maximum time between the diagnosis and transfer of detainees requiring care in a secure hospital should be introduced ( JCHR); • that the MoJ and NHS England should routinely report how many prisoners are waiting to be transferred (NAO); • that all patients transferred from prison should automatically trigger a review by the Mental Health Tribunal of the transfer measure.126 126. Council of Europe, 2017, Report to the Government of the UK on the visit to the UK carried out by the European CPT from 30 March 10 to 12 April 2016, paragraph 176, https://rm.coe.int/168070a773 [accessed 13/11/17]. 46