Inpatient care of mentally ill people in prison: results of a year's programme of semistructured inspections

Objective To investigate the facilities for inpatient care of mentally diso rdered people in prison. Design Semistructured inspections conducted by doctor and nurse. Expected s tandards were based on healthcare quality standards published by the Prison Service or the NHS. Setting 13 prisons with inpatient beds in England and Wales subject to the prison inspectorate's routine inspection programme during 1997-8. Main outcomes measures Appraisals of quality of care against published stan dards. Results The 13 prisons had 348 beds, 20% of all beds in prisons. Inpatient units had between 3 and 75 beds. No doctor in charge of inpatients had comp leted specialist psychiatric training. 24% of nursing staff had mental heal th training; 32% were non-nursing trained healthcare officers. Only one pri son had occupational therapy input; two had input from a clinical psycholog ist Most patients were unlocked for about 3.5 hours a day and none for more than nine hours a day. Four prisons provided statistics on the use of secl usion. The average length of an episode of seclusion was 50 hours. Conclusion The quality of services for mentally ill prisoners fell far belo w the standards in the NHS. Patients' lives were unacceptably restricted an d therapy limited. The present policy dividing inpatient care of mentally d isordered prisoners between the prison service and the NHS needs reconsider ation.