National Preventive Mechanism Eighth Annual Report 2016–17 that may arise from them, as well as an inability to access them. These risks include: • delays in accessing appropriate treatment, which can lead to people becoming more ill, with potential long-term consequences; • being held in an unsuitable (including non‑therapeutic) environment; • excessive levels of security or excessively restrictive environments; • absent protections for detainees against restrictive practices or harm; • loss of continuity of care and a failure to transfer information about detainee’s needs; • decisions about accessing pathways being limited by availability and financial constraints rather than the detainee’s needs; • systems focused on the process or bureaucracy of the transfer rather than the outcome; • equality issues relating to the availability of facilities for men and women that affect pathways; • distance from home. Pathways from mental health to mental health settings75 Mental health services in the UK are organised nationally (Ashworth, Broadmoor and Rampton high secure hospitals in England and Wales, and the State Hospital in Scotland which is also the high secure facility for Northern Ireland), regionally (medium secure units organised across different health authorities) and locally (low secure hospital care which is provided in a range of units normally located within an individual health board or authority area). Pathways between these different types of services are common and arise for a number of reasons, which we will explore below. Legal and policy framework Each jurisdiction has specific legislation that governs detention and treatment in secure hospitals: • Mental Health Act 1983, amended in 2007 (for England and Wales); • Mental Health (Care and Treatment) (Scotland) Act 2003, amended by the Mental Health (Scotland) Act 2015; • Mental Health (Northern Ireland) Order 1986. The legislation in each jurisdiction provides a framework for both the transfer of detained patients from one part of the UK to another and the review of patients’ detention by mental health tribunals. There are clear pathways for professionals to follow when deciding on transfers, and there are regulations setting out protocols, timescales and the roles and responsibilities of governments in each jurisdiction.76 Final decisions on any proposed cross border transfers between secure care units will be authorised at ministerial level. 75. NPM members reviewed key policy documents and legislation to provide an overview of pathways between secure mental health settings, within and between jurisdictions. No specific fieldwork was undertaken for this project, but data from the Mental Welfare Commission for Scotland’s themed visit to all medium and low secure wards in Scotland between October and December 2016 informed this report. See Mental Welfare Commission for Scotland, 2017, Visit and monitoring report: Medium and low secure forensic wards, http://www.mwcscot.org.uk/media/385624/medium_and_ low_secure_forensic_wards.pdf [accessed 11/11/17]. 76. See: Mental Health Act 1983 Part VI –Removal And Return of Patients within the United Kingdom; Mental Health (Care and treatment) (Scotland) Act 2003, S290 and regulations – Scottish Statutory Instrument 2005 No. 467, as amended by Scottish Statutory Instrument 2017 No. 229. 30