All referrals to medical officers in Brixton Prison over a five-month period in 1989 were examined. This paper reports the progress through this remand prison of those men who were considered to be suffering from a major psychiatric disorder. Many men had been charged with relatively minor offences. The net effect of medical intervention was to delay release from custody. Because of the administrative delays inherent in the system of medical referral and hospital admission under section 37 of the Mental Health Act 1983, it was those prisoners who were most ill who tended to remain in prison for the longest periods. Judged in terms of its efficiency to ensure speedy treatment for mentally ill remanded offenders, the present system is regarded as cumbersome and extremely inefficient. It is suggested that greater use should be made of section 48 of the 1993 Act to divert mentally ill, remanded offenders from prison.

When the length of stay of restricted patients admitted to Broadmoor under the legal category of psychopathic disorder was examined, the factor found to be of primary importance was the gravity of the admission offence. If the men's offences did not cause personal injury, they had a good chance of early release. Patients convicted of violent or sexual offences, and particularly those who attacked strangers, made up the great majority of the long-term group. For the mentally ill there was no relationship between length of stay and admission offence: instead the data suggested that severity and chronicity of illness were the main relevant factors.

Non-psychotic remand prisoners who were referred by Holloway's doctors to outside psychiatrists, or who were the subject of court reports, or who were diagnosed as mentally handicapped, were followed up to the time of sentence. Most of the referred women were minor offenders with diagnoses of mental handicap or personality disorder. They were usually refused beds on treatability criteria and then released with non-custodial sentences. Some were highly disturbed, and it seemed that the police who charged them, the courts who remanded them and the prison psychiatrists who referred them, all found it hard to accept that psychiatry had so little to offer these people. Local health and social services need to address the problems raised by this small group of women. Arsonists more often obtained beds than minor offenders, and were likely to be imprisoned when hospital places were not forthcoming.

In 1976, 163 patients were approved by the Department of Health and Social Security for transfer from the Special Hospitals to the open wards of the National Health Service. By autumn 1978, a quarter were still waiting for admission. Patients meeting most difficulty were the severely handicapped non-offenders, who were usually refused unseen on the ground that local subnormality hospitals were full. The role of the DHSS and of the Regional and Area Authorities was in general restricted to bewailing problems they could not help to solve. Some two years after their transfer, enquiries were made in the NHS about the 105 transferred patients. Removal back to the Special Hospital had been requested for seven, and another three had been removed by the police and prosecuted.

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