Prison health-care wings operate front-line mental illness triaging and recognition functions and also provide care for complex individuals who display behavioural disturbance. Services are not equivalent to those in hospitals, nor the community, but instead reflect the needs of the prison in which they are situated. There is a recognised failure to divert at earlier points in the criminal justice pathway, which may be a consequence of national failure to fund services properly. Hospital treatment is often delayed.

To examine whether severity of violence was associated with specific types of psychotic symptoms a retrospective file review of men found of unsound mind by the Queensland Mental Health Tribunal was conducted. The association between symptoms and three levels of violence were examined. Capgras delusions and command hallucinations were associated with homicide; acute danger; and threat/control-override symptoms with serious violence, and grandiose delusions with assault occasioning bodily harm. When previous violence and substance use were controlled, the symptom variables remained significant predictors. Victims were more likely to be known when violence was more serious. The study provides support for the role of psychotic symptoms as one factor that may account for the relationship between mental illness and increased violence risk.

Aims and methodTo consider the link between responsible commissioner and delayed prison transfers. All hospital transfers from one London prison in 2006 were audited and reviewed by the prisoner's borough of origin.ResultsOverall, 80 prisoners were transferred from the audited prison to a National Health Service (NHS) facility in 2006: 26% had to wait for more than 1 month for assessment by the receiving hospital unit and 24% had to wait longer than 3 months to be transferred. These 80 individuals were the responsibility of 16 different primary care trusts. Of the delayed transfer cases (n=19), the services commissioned by three primary care trusts were responsible for the delays.Clinical implicationsThere are significant differences in performance between different primary care trusts related to hospital transfers of prisoners, with most hospitals able to admit urgent cases within 3 months. This suggests that a postcode lottery operates for prisoners requiring hospital transfer. Data from prison services may be useful in monitoring and improving the performance of local NHS services.