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Objective: To define the prevalence of mental disorder and need for psychiatric treatment in new remand prisoners and to determine to what extent these are recognised and addressed in prison. Design: Study of consecutive male remand prisoners at reception using a semistructured psychiatric interview. Setting: Large remand prison for men (HMP Durham). Subjects: 569 men aged 21 years and over on remand, awaiting trial. Main outcome measures—Prevalence of mental disorder at reception, prisoners need for psychiatric treatment, identification of mental disorder by prison reception screening, and numbers placed appropriately in the prison hospital. Results: 148 (26%) men had one or more current mental disorders (excluding substance misuse) including 24 who were acutely psychotic. The prison reception screening identified 34 of the men with mental disorder and six of those with acute psychosis. 168 men required psychiatric treatment, 50 of whom required urgent intervention; 16 required immediate transfer to psychiatric hospital. Of these 50, 17 were placed on the hospital wing because of mental disorder recognised at prison screening. Conclusion: Not only is the prevalence of mental disorder, in particular severe mental illness, high in this population, but the numbers identified at reception are low and subsequent management in prison is poor. Key messages In this study in Durham prison 26% had a serious mental disorder Only about a quarter of the mentally disordered patients were recognised by the prison doctor and hospital officer Only two fifths of patients who required urgent psychiatric treatment were put into the prison hospital Improved diagnosis of psychiatric illness in prison will greatly increase the pressure on psychiatric beds

Editor—Lincoln et al report the US experience of smoke-free prisons.1 We report experience in Ashfield Young Offenders Institute, a prison in South Gloucestershire which accepts remand and sentenced young people between the ages of 15 and 18. Ashfield introduced a smoke-free policy on 1 February 2005. Smoking is not permitted in the prison by young offenders …

Editor—In their case study of substance misuse by remand prisoners Mason et al found that “present prison procedures fail to identify the extent to which substances are used and misused in people newly remanded to prison.”1 In a recent (unpublished) study of the health needs presented by prisoners remanded into La Moye prison, Jersey, I examined the …

EDITOR—Prisons in England and Wales are known to house a considerable number of mentally ill people.1–3 Many of these people probably pass through health screening undetected when they are received into prison and remain on ordinary location (on prison wings) without ever coming to the attention of a doctor.4 5 During two visits to large local male remand prisons as a guest medical inspector with …

Most regional health authorities have or plan to have secure units for treating mentally abnormal offenders. A retrospective study was carried out to compare the effectiveness of the health care services for men remanded to Winchester prison from Oxford and Wessex regions over the five years 1979-83. Thirty seven (30%) of 124 prisoners from Oxford region were rejected for treatment compared with 36 (16%) of the 220 men from Wessex region. Men from Oxford region were significantly more likely to be recommended for admission to a special hospital than those from Wessex (13/124 (10%) v 9/220 (4%), respectively) and significantly less likely to be recommended for admission to a hospital in the catchment area (35/124 (28%) v 94/220 (43%)). Men on remand from Oxford region were significantly more often perceived as being disruptive or aggressive by hospital staff and more likely to be labelled as having psychopathic or personality disorders. These differences may have reflected different attitudes towards mentally abnormal offenders and the allowances in the services available in the two regions; in particular, Oxford region did not have a secure unit or a forensic psychiatrist. If mentally ill prisoners do not receive the treatment that they need they run the risk of being criminalised. Most such men are best treated in general psychiatric units; only a few require secure conditions and staff with specialised psychiatric skills.