Mental Health Act transfers from prison to psychiatric hospital over a six-year period in a region of England

2020 ◽  
Vol 10 (3) ◽  
pp. 219-231
Author(s):  
Laura Woods ◽  
Laura Craster ◽  
Andrew Forrester
Keyword(s):  
Mental Health ◽  
Intensive Care ◽  
Psychiatric Hospital ◽  
Psychiatric Morbidity ◽  
England And Wales ◽  
Content Type ◽  
Mental Health Act ◽  
Medium Security ◽  
Hospital Transfer ◽  
Transfer Times

Purpose There are high levels of psychiatric morbidity amongst people in prisons. In England and Wales, prisoners who present with the most acute mental health needs can be transferred to hospital urgently under part III of the Mental Health Act 1983. This project reviewed all such transfers within one region of England, with an emphasis on differences across levels of security. Design/methodology/approach Over a six-year period (2010–2016) within one region of England, 930 psychiatric referrals were received from seven male prisons. From these referrals, 173 (18.5%) secure hospital transfers were required. Diagnostic and basic demographic information were analysed, along with hospital security categorisation (high secure, medium secure, low secure, psychiatric intensive care unit and other) and total time to transfer in days. Findings There were substantial delays to urgent hospital transfer across all levels of hospital security. Prisoners were transferred to the following units: medium security (n = 98, 56.9%); psychiatric intensive care units (PICUs) (n = 34, 19.7%); low secure conditions (n = 20, 11.6%); high secure conditions (n = 12, 6.9%); other (n = 9, 5.2%). Mean transfer times were as follows: high secure = 159.6 days; other = 68.8 days; medium secure = 58.6 days; low secure = 54.8 days; and psychiatric intensive care = 16.1 days. Research limitations/implications In keeping with the wider literature in this area, transfers of prisoners to hospital were very delayed across all levels of secure psychiatric hospital care. Mean transfer times were in breach of the national 14-day timescale, although transfers to PICUs were quicker than to other units. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. Originality/value This paper extends the available literature on the topic of transferring prisoners with mental illness who require compulsory treatment. There is a small but developing literature in this area, and this paper largely confirms that delays to hospital transfer remain a serious problem in England and Wales. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. This could include different referral and transfer models as a component of service-based and pathways research or combining referral pathways across units to improve their efficacy.

scholarly journals Rise in the use of section 136 of the Mental Health Act 1983 in England and Wales: A viewpoint on Loughran (2018)

2019 ◽  
Vol 60 (2) ◽  
pp. 140-146 ◽  
Author(s):  
Mark Cresswell
Keyword(s):  
Mental Health ◽  
Recent Work ◽  
Theoretical Perspective ◽  
Causal Analysis ◽  
England And Wales ◽  
Mental Health Act ◽  
The Law

This article provides a critical viewpoint on Loughran’s recent work in Medicine, Science and the Law on the causes of the rise in the police’s use of section 136 (s136) of the Mental Health Act 1983 (Loughran M. Detention under section 136: why is it increasing? Med Sci Law 2018; 58: 268–274). The rate of this rise seems significant: by 2014, it was five times more likely that a person in England would be detained in a hospital under s136 than it was in 2000, and the trend has continued to the present day. This viewpoint considers the significance of the s136 rise from the theoretical perspective of causal analysis.

R v Westwood (Thomas): diminished responsibility and disposals under the Mental Health Act 1983

2021 ◽  
Vol 72 (2) ◽  
Author(s):  
Sean Mennim
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
England And Wales ◽  
Mental Health Act ◽  
Court Of Appeal ◽  
Diminished Responsibility

This is a commentary on R v Westwood (Thomas), where the Court of Appeal of England and Wales held that the judge had erred in assessing Westwood’s ‘retained responsibility’ as medium to high under the Sentencing Council Guideline for manslaughter by reason of diminished responsibility. Although the sentencing judge concluded that the offending was caused by Westwood’s anger, the Court of Appeal found the psychiatric evidence clearly indicated that the most significant factor was Westwood’s mental illness and that his anger at the time of the offence was a manifestation of his mental illness. Westwood’s responsibility was low, and it was appropriate to impose both a hospital and restriction order.  

scholarly journals Repeated Police Mental Health Act Detentions in England and Wales: Trauma and Recurrent Suicidality

2019 ◽  
Vol 16 (23) ◽  
pp. 4786
Author(s):  
Claire Warrington
Keyword(s):  
Mental Health ◽  
Lived Experience ◽  
Mental Health Problems ◽  
Police Intervention ◽  
England And Wales ◽  
Mental Health Act ◽  
Self Harm ◽  
South East England ◽  
National Police

Most police Mental Health Act (Section 136) detentions in England and Wales relate to suicide prevention. Despite attempts to reduce detention rates, numbers have risen almost continually. Although Section 136 has been subject to much academic and public policy scrutiny, the topic of individuals being detained on multiple occasions remains under-researched and thus poorly understood. A mixed methods study combined six in-depth interviews with people who had experienced numerous suicidal crises and police intervention, with detailed police and mental health records. A national police survey provided wider context. Consultants with lived experience of complex mental health problems jointly analysed interviews. Repeated detention is a nationally recognised issue. In South East England, it almost exclusively relates to suicide or self-harm and accounts for a third of all detentions. Females are detained with the highest frequencies. The qualitative accounts revealed complex histories of unresolved trauma that had catastrophically damaged interviewee’s relational foundations, rendering them disenfranchised from services and consigned to relying on police intervention in repeated suicidal crises. A model is proposed that offers a way to conceptualise the phenomenon of repeated detention, highlighting that long-term solutions to sustain change are imperative, as reactive-only responses can perpetuate crisis cycles.

The use of section 135(1) of the Mental Health Act in a London borough

2015 ◽  
Vol 20 (3) ◽  
pp. 133-143
Author(s):  
James Watson ◽  
Stephanie Daley
Keyword(s):  
Mental Health ◽  
Hospital Admissions ◽  
Service Providers ◽  
Demographic Data ◽  
Small Scale ◽  
Hospital Data ◽  
Nominal Data ◽  
London Borough ◽  
Content Type ◽  
Mental Health Act

Purpose – The purpose of this paper is to determine the incidence of the use of section 135(1) of the Mental Health Act 1983 in a London borough and describe the main features of the population subject to that section. Design/methodology/approach – Uses of section 135(1), hospital stay, and demographic data were gathered from service and patient records over one year. Means, medians, modes and standard deviation were calculated for interval data. Nominal data were cross-tabulated and the chi square test applied where appropriate. Study data were compared to census and national hospital data; the significance of proportional population differences were calculated using the Z-test. Findings – In total, 63 uses of section 135(1) were recorded. It was primarily used with people with psychotic diagnoses (79 per cent), and was used predominantly in black populations, and among people aged 40-54. People admitted to hospital after section 135(1) use who had psychosis diagnoses had median spells in hospital that were double the corresponding national median. Research limitations/implications – Total uses of section 135(1) in the borough equated to 25 per cent of the national total for all section 135 admissions recorded in 2012/2013. Hospital statistics in England focusing on admissions alone may fail to reflect a more widespread use of this section. Further research is required to confirm and develop the findings of this small scale study. Practical implications – The repeated use of this section is suggested as a marker for reviewing practice and resource allocation to prevent or shorten hospital admissions for people with psychosis diagnoses. Originality/value – This paper highlights gaps in NHS data collection in England relevant to policy makers, mental health service providers, and the police service.

Mental capacity legislation and its impact on parents with learning difficulties involved in childcare and family law proceedings assessments in England and Wales

2018 ◽  
Vol 20 (1) ◽  
pp. 17-32
Author(s):  
Daniel T. Wilcox ◽  
Leam A. Craig ◽  
Marguerite L. Donathy ◽  
Peter MacDonald
Keyword(s):  
Mental Health ◽  
Family Law ◽  
Good Practice ◽  
Learning Difficulties ◽  
Mental Capacity ◽  
Mental Health Practitioners ◽  
England And Wales ◽  
Content Type ◽  
Health Practitioners ◽  
The Impact

Purpose The purpose of this paper is to consider the impact of mental capacity legislation when applied to parents with learning difficulties who lack capacity within childcare and family law proceedings in England and Wales. Design/methodology/approach The paper relies on a range of material including reports published by independent mental health foundations, official inquiries and other public bodies. It also refers to academic and practitioner material in journals and government guidance. Findings The paper critically reviews the application of the guidance when assessing mental capacity legislation as applied in England and Wales and offers by way of illustration several case examples where psychological assessments, and the enhancement of capacity, have assisted parents who were involved in childcare and family law proceedings. Research limitations/implications There has been little published research or governmental reports on the number of cases when parents involved in childcare and family law proceedings have been found to lack capacity. No published prevalence data are available on the times when enhancing capacity has resulted in a change of outcome in childcare and family law proceedings. Practical implications The duty is on the mental health practitioners assessing mental capacity that they do so in a structured and supportive role adhering to good practice guidance and follow the guiding principles of mental capacity legislation assuming that the individual has capacity unless it is established that they lack capacity. Guidance and training is needed to ensure that the interpretation of the Mental Capacity Act (MCA) and its application is applied consistently. Social implications For those who are considered to lack mental capacity to make specific decisions, particularly within childcare and family law proceedings, safeguards are in place to better support such individuals and enhance their capacity in order that they can participate more fully in proceedings. Originality/value While the MCA legislation has now been enacted for over ten years, there is very little analysis of the implications of capacity assessments on parents involved in childcare and family law proceedings. This paper presents an overview and, in places, a critical analysis of the new safeguarding duties of mental health practitioners when assessing for, and enhancing capacity in parents.

scholarly journals Mentally disordered young offenders in transition from child and adolescent to adult mental health services across England and Wales

2017 ◽  
Vol 19 (4) ◽  
pp. 301-308 ◽  
Author(s):  
Maria I. Livanou ◽  
Vivek Furtado ◽  
Swaran P. Singh
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Young Offenders ◽  
England And Wales ◽  
Content Type ◽  
Health And Wellbeing ◽  
The Impact

Purpose This paper provides an overview of transitions across forensic child and adolescent mental health services in England and Wales. The purpose of this paper is to delineate the national secure services system for young people in contact with the youth justice system. Design/methodology/approach This paper reviews findings from the existing literature of transitions across forensic child and adolescent mental health services, drawing attention to present facilitators and barriers to optimal transition. The authors examine the infrastructure of current services and highlight gaps between child and adult service continuity and evaluate the impact of poor transitions on young offenders’ mental health and wellbeing. Findings Young offenders experience a broad range of difficulties, from the multiple interfaces with the legal system, untreated mental health problems, and poor transition to adult services. Barriers such as long waiting lists, lack of coordination between services and lack of transition preparation impede significantly smooth transitions. Research limitations/implications The authors need to develop, test and evaluate models of transitional care that improve mental health and wellbeing of this group. Practical implications Mapping young offenders’ care pathway will help to understand their needs and also to impact current policy and practice. Key workers in forensic services should facilitate the transition process by developing sustainable relationships with the young person and creating a safe clinical environment. Originality/value Transition of care from forensic child and adolescent mental health services is a neglected area. This paper attempts to highlight the nature and magnitude of the problems at the transition interface in a forensic context.

Assessment of Suicide Risk

1987 ◽  
Vol 150 (2) ◽  
pp. 145-153 ◽  
Author(s):  
K. Hawton
Keyword(s):  
Mental Health ◽  
Psychiatric Disorders ◽  
Psychiatric Hospital ◽  
Suicide Risk ◽  
Clinical Skills ◽  
Clinical Decisions ◽  
Suicide Attempters ◽  
Mental Health Act ◽  
Hospitalised Patients ◽  
The Many

Among the many clinical skills that psychiatrists must acquire, the ability to assess the risk of patients killing themselves is probably the most important and demanding. It is often a crucial factor when making clinical decisions, such as in the choice of treatments, when deciding whether admission to a psychiatric hospital is necessary and when implementing the Mental Health Act. This review first explores the problems in assessing suicide risk. Subsequently, the risks of suicide for patients with major psychiatric disorders and for particular clinical populations, including hospitalised patients and suicide attempters, are examined together with the findings from research investigations which can assist psychiatrists when making decisions about the risk of suicide.

scholarly journals Community Treatment Orders

2014 ◽  
Vol 1 (16) ◽  
pp. 149
Author(s):  
Kris Gledhill
Keyword(s):  
Mental Health ◽  
Revolving Door ◽  
Community Treatment ◽  
Patient Treatment ◽  
England And Wales ◽  
Mental Health Act ◽  
Heated Debate ◽  
Policy Objectives ◽  
Treatment Order ◽  
Community Treatment Order

<p>A community treatment order is now a well-established feature of various common law jurisdictions in North America and Australasia, and in other countries. Its introduction into England and Wales was a central part of the government’s drawn out reform of the Mental Health Act 1983, and it attracted heated debate as part of the Parliamentary process, both in the exchanges between Parliamentarians and the evidence and briefings filed by interested parties. A CTO provision was introduced with a speedier gestation period in Scotland. But there is no single form of “community treatment order”; and there may also be different policy objectives. What is usually central is the desire to provide a regime for patients who are assessed as being able to function in the community so long as they accept medication but who may disengage from treatment and relapse to the extent that they require in-patient treatment: the description “revolving door” is often attached to such patients and was during the course of the debates.</p><p>The first question to be explored is whether what emerged in the Mental Health Act 2007 is much different from what already exists in relation to such patients: if it is and it allows community treatment which was previously not available, the further question is whether that is a good thing in light of the experience of other jurisdictions that have CTO regimes. If it is not, there are two further questions: firstly, why has something called a CTO been introduced if it does not amount to a change of substance; and secondly, is it a missed opportunity in light of the information from other jurisdictions – in other words, would a substantive change provide benefits which England and Wales is now missing?</p>

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