Prisons full to brim with the mentally ill

THE health centre at a new London prison is full of mentally ill people who cannot be forcibly treated, and is a disaster waiting to happen, according to its former psychiatrist.

Psychotic prisoners, some suicidal and violent, are being kept in south London's Belmarsh Prison - and other such jails - because there are no beds for them in secure hospitals, where they could be treated, says Dr Humphrey Needham-Bennett, prison psychiatrist at Belmarsh until three months ago.

In a report in the British Medical Journal he says: "It is not unusual to wait three months for placement to a security unit even for an acute psychotic prisoner who is refusing treatment."

With his former Belmarsh colleague, Dr Ian Cumming, Dr Needham-Bennett gives a graphic account of conditions at Belmarsh, a new maximum security prison.

He says that when he was there the health centre held 40 prisoners, of whom about three-quarters were psychotic, half were awaiting suitable placement, and a quarter were refusing treatment.

He describes his daily reaction to conditions in the prison hospital as "disgust, despair and nausea".

"In the first cell there is a naked and contorted body lying on the floor next to a torn mattress, faeces are daubed on a wall and food lies underfoot,'' he writes. "From the next, a face appears at the hatch: `Hey Doc, when are you going to get me out of here?' I avoid eye contact, knowing that all our conversations end in threatened violence.

"In the next cell a man in strip conditions paces, mumbling to himself and occasionally shouting at his private demons. I hurry my pace and again ignore a question asked from a young, retarded man charged with rape, `When is my mum coming to see me?' I am simply waiting for a disaster to happen."

Dr Needham-Bennett said yesterday: "One of the problems is that you cannot forcibly treat a patient in a prison, only in a hospital or secure unit. Even when a diagnosis has been made and they are waiting for a bed, you cannot treat them if they refuse. The result is that you have people who are suicidal and violent.''

The underlying problem, say psychiatrists, is that there are too few beds in secure hospitals, such as Broadmoor. There are around 800 beds in 25 NHS medium secure units and a further 350 in privately-owned hospitals. The NHS is now estimated to be paying up to pounds 30 million to private hospitals for the use of medium secure beds.

According to leading specialists, there is a need for around 1,000 additional medium secure hospital beds across Britain.

A Home Office spokesman said: "Secure accommodation is provided by the Department of Health. Our position is that we have to do the best we can with those prisoners in our care. Part of this equation is there being enough secure accommodation for them to go to."

A Department of Health spokesman said: "As a consequence of the great expansion of assessment and diversion schemes, both court and prison-based, the number of patients admitted under Section 37 or Section 37/41 of the Mental Health Act has increased significantly. The number of patients transferring from prison to the NHS doubled between 1990 and 1993."

He said that the numbers awaiting admission to secure beds were now falling.

Judi Clements, national director of MIND, said: "It is an appalling situation. People working in that kind of environment must find it totally disheartening. We need more beds, particularly medium secure beds, but the problem is that it doesn't have a high political priority."