New directions: British and American models of mental health care in secure hospitals and jails'

Mental Health Nursing,  Jan 2003  by Godin, Paul

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The Northwest forensic academic network's second annual conference, University of Manchester

Forensic mental health care is rapidly developing in Britain, symptomatic of which are the growing number of books, journal articles and conferences, such as this one, on the subject. In a multiplex auditorium in Manchester, Louis Appleby, national director of mental health kicked off proceedings to an audience of mental health workers, academics, prison governors and others. He first outlined government policy objectives for the progressive transfer of patients in special hospitals to medium secure provision and for the application of the seven NSF standards to the prison population. The latter, he suggested, could be brought about by such measures as 'inreach' ACT type schemes, involving CPNs working into prisons.

He finished by offering a few reassuring words about the mental health bill. Despite its omission from the Queen's speech, he told us that the bill would be introduced 'soon' and that there was no dark government agenda to increase compulsory treatment. With this said, he emphasised positive aspects about the bill, namely, that all section patients would be entitled to advocacy and an automatic tribunal.

Graham Thornicroft, the next speaker, reported the findings of a survey of all patients in England's special hospitals. Though doctors and nurses were of the view that around a third of patients could be safely transferred to lower levels of secure provision there was less than total inter-subjective agreement between professionals as to who these patients were.

By 2004, however, an extra 400 MSU beds will be created to take patients from the special hospitals. As a Londoner I was quite intrigued to be told that a disproportionately large number (about half) of the patients in the special hospitals are from London and the south east.

Jeremy Coid then delivered a paper about a study of people discharged from an MSU. Six years after discharge 35 per cent had been re-convicted and as many as seven per cent were dead!

After this, Henry Steadman reported on diversion schemes in the USA, where the conviction rate is about seven times higher than in England. Steadman stated that we should stop thinking in terms of treatment resistant clients and instead consider the client resistant nature of services.

The afternoon was very much about changing services. Pam Robbins talked about her study of a screening tool used by 'correctional officers' (prison officers) on the prisoners received into jail in the USA, whilst Don Grubbin talked about a similar screening tool piloted in England. Both projects were aimed at finding a quick simple way to identify at an early stage, suicidal and mental ill prisoners.

During the conference I sat next to a prison governor who asked me: 'don't you think it is good that prisoners' mental health needs are finally being taken seriously by government policy?' 'Yes' was definitely my answer.

Copyright Community Psychiatric Nurses Association Jan 2003
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