England and Wales: walling up madness

How does England and Wales handle mentally disordered offenders?

Many individuals who have committed offences and suffer from mental health illness are held under the ordinary prison regime. Others are detained in psychiatric facilities, sometimes for indeterminate lengths of time. These persons have different legal statuses, may be placed in several different settings, and receive various levels of care. What is the fate of mentally disordered offenders in England and Wales?

Prison Insider and the French National Union for Family and Friends of People Suffering Mental Illness and/or Psychological Disability (Unafam) examined the experience of offenders with mental health problems in eight European countries. Here is an overview of the situation in England and Wales.

— The information contained in this study only relates to two of the four nations of the United Kingdom.


ACCT (or, Assessment, Care in Custody and Teamwork): care planning process for prisoners identified as being at risk of suicide or self-harm.

CCG (or, Clinical commissioning groups): organisations in charge of local health services and responsible for the healthcare of released prisoners.

Hospital order: full-time psychiatric hospitalisation for someone who is declared not criminally responsible by a judge. The person is removed from the prison system and placed under a healthcare order which entails a remand to hospital. If the person is deemed to pose a “serious danger”, the measure is accompanied by a restriction order.

Inpatient healthcare unit: specific units in prisons dedicated to prisoners with severe mental health issues.

Mental health measure: a psychiatric assessment of persons released from Welsh prisons which allows them to access mental health services after their release.

MHA (or, Mental Health Act): the regulatory act which provides for the hospitalisation of people who have committed an offence and who present with “severely irresponsible behaviour or are abnormally aggressive”.

NHS England / NHS Wales (or, National Health Service England / National Health Service Wales): publicly funded healthcare systems in English and Welsh prisons respectively.

PIP (or, Positive Intervention Programme): the team that is usually called upon to administer treatment to recalcitrant patients without their consent, or to contain them in case of crisis.

PIPEs (or, Psychologically Informed Planned Environments): dedicated units in prisons for persons who present with severe personality disorders. The prisoners do not receive any treatment.

SystmOne: an IT system used to collect the medical history of prisoners.