Pathways through the criminal justice system for prisoners with acute and serious mental illness.
OBJECTIVE
To evaluate pathways through the criminal justice system for 63 prisoners under the care of prison mental health services.


RESULTS
A small number (3%) were acutely mentally ill at prison reception, which may reflect the successful operation of liaison and diversion services at earlier stages in the pathway. However, a third (33%) went onto display acute symptoms at later stages. Cases displaying suicide risk at arrest, with a history of in-patient care, were at increased risk of acute deterioration in the first weeks of imprisonment, with a general absence of health assessments for these cases prior to their imprisonment. Inconsistencies in the transfer of mental health information to health files may result in at-risk cases being overlooked, and a lack of standardisation at the court stage results in difficulties determining onward service provision and outcomes.


CONCLUSIONS
Greater consistency in access to pre-prison health services in the criminal justice system is needed, especially for those with preexisting vulnerabilities, and it may have a role in preventing subsequent deterioration. A single system for health information flow across the whole pathway would be beneficial.
Division of Psychology, Nottingham Trent University, UK. Electronic address: Karen.slade@ntu.ac.uk.
Karen
K
Slade
Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
Chiara
C
Samele
Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
Lucia
L
Valmaggia
Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, UK. Electronic address: andrew.forrester1@nhs.net.
Andrew
A
Forrester
D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders; D006297:Health Services Accessibility; D006801:Humans; D008131:London / Q000453:epidemiology; D001523:Mental Disorders / Q000453:epidemiology*; D008605:Mental Health Services; D008875:Middle Aged; D011329:Prisoners; D055815:Young Adult
Court; Criminal justice; Mental illness; Pathway; Police; Prison