title: Influencing the care pathway for prisoners with acute mental illness.
abstract: BACKGROUND
  Despite improved mental health services in prisons in England and Wales, there are often delays in transferring acutely mentally ill prisoners to hospital, particularly in the London area.
  
  
  OBJECTIVE
  To establish whether clinical pathway interventions can reduce such transfer delays.
  
  
  METHODS
  Two clinical pathway interventions - one based in a medium secure forensic hospital and the other in a remand prison (pre-trial/sentence) - were independently introduced to manage referrals of prisoners with acute mental illness in London, UK. Time taken to transfer to hospital was measured for each and compared with the best available estimates for time to transfer prior to the new pathways.
  
  
  RESULTS
  Both interventions produced significant reductions in prison to hospital transfer times.
  The nature of the projects precluded ideal research design, but despite small sample sizes, provision of modestly funded small but dedicated elements of service to target the specified problem of transfer to hospital delays showed a significant advantage for such provision, whether hospital or prison based, psychiatrist or nurse led. Further research is now required to examine the whole pathway. More secure psychiatric beds may be required, at least in the short term, to support diversion policies and enable compliance with national policy directive, and to establish whether redesigned pathways can enhance treatment and behavioural outcomes for acutely mentally ill prisoners on a larger scale.
authors.affiliation: South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, UK. andrew.a.forrester@kcl.ac.uk
authors.forename: Andrew
authors.initials: A
authors.lastname: Forrester
authors.forename: Tim
authors.initials: T
authors.lastname: Exworthy
authors.forename: Oriana
authors.initials: O
authors.lastname: Chao
authors.forename: Karen
authors.initials: K
authors.lastname: Slade
authors.forename: Janet
authors.initials: J
authors.lastname: Parrott
mesh_terms: D000328:Adult; D004739:England; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008605:Mental Health Services; D011329:Prisoners / Q000523:psychology*; D011330:Prisons