Consent and treatment in prisons

I. Qurashi

Gulid Lodge, Whittingham Lane, Preston PR3 2AZ, UK

I read the article by Earthrowl et al (2003) with interest. The issue of providing treatment to prisoners, who are frequently incapable of consenting, will not be unfamiliar to psychiatrists providing mental health care in these establishments. Although the authors correctly state that there is no legislative framework for providing treatment for mental disorders in prisons, this may be slightly disingenuous. The current legislative framework that provides for the treatment of mental disorders, namely the Mental Health Act 1983, is clear that prison health-care wings are not hospitals. It follows that any treatment that is administered forcibly must be consistent with common law. Separate legislation is therefore unnecessary.

They also appear to have overlooked recent guidance on this matter. The Department of Health (2002) in collaboration with the Prison Service has set out, in detail, good practice guidelines for providing care to both competent and incapacitated adult prisoners. These outline circumstances in which prisoners who lack capacity can receive treatment. We have found this very helpful in developing protocols for treatment in the prisons we visit.

The development of policies and protocols will assist in establishing who, when and in which circumstances incapacitated prisoners may be treated and allow us to be more confident when making these difficult decisions.

EDITED BY STANLEY ZAMMIT

REFERENCES

Department of Health (2002) Seeking Consent: Working with People in Prison. London: Department of Health.

Earthrowl, M., O'Grady, J. & Birmingham, L. (2003) Providing treatment to prisoners with mental disorders: development of a policy. Selective literature review and expert consultation exercise. British Journal of Psychiatry, 182, 299–302.[Abstract/Free Full Text]


 

Authors' reply

L. Birmingham and J. O'Grady

University of Southampton School of Medicine, Community Clinical Sciences Research Division, Ravenswood House, Medium Secure Unit, Knowle, Fareham, Hampshire PO17 5NA, UK

EDITED BY STANLEY ZAMMIT

Declaration of interest

J.O. is a member of the Department of Health Prison Expert Group.

We fail to understand Dr Qurashi's comment that ‘separate legislation is therefore unnecessary’. Our paper sets out a policy for providing treatment to people with mental disorder based on common law (Earthrowl et al, 2003). We are not proposing separate legislation.

Dr Qurashi also mentions that we appear to have overlooked recent guidance from the Department of Health (2002). The Department of Health guidelines were produced in July 2002, after our paper was accepted for publication.

These guidelines provide guidance on establishing capacity but, in our opinion, they do not tackle the practical issues relating to the management of prisoners with mental disorder in any great detail, they do not deal with the ethical issues surrounding the provision of an equivalent service in prisons adequately and detailed guidance on making a concerted effort to obtain treatment under the Mental Health Act in hospital before proceeding with treatment under common law is lacking. In our view, these are serious omissions.

REFERENCES

Department of Health (2002) Seeking Consent: Working with Peoplein Prison. London: Department of Health.

Earthrowl, M., O'Grady, J. & Birmingham, L. (2003) Providing treatment to prisoners with mental disorders: development of a policy. Selective literature review and expert consultation exercise. British Journal of Psychiatry, 182, 299–302.[Abstract/Free Full Text]





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