Improving the experience and care

As we approach the last week of the consultation on proposed guidance relating to individuals held within prisons and immigration removal centres who have been detained under the Mental Health Act for assessment and treatment, Alison Boreham reflects on her own experience of being imprisoned whilst mentally ill:

At around 2am on 19 October 2009 – on a motorway in the south of England – my life changed.

In a highly distressed state and not aware of where I was or what I was doing, I was hauled back from the edge of the carriageway by a police officer who undoubtedly saved my life that night.

I was taken to custody in Newbury and charged with causing a dangerous occurrence on a road. My local mental health trust had washed their hands of me, saying I was not mentally ill and needed to be prosecuted for my behaviour. So, faced with no real choice, the magistrates remanded me to prison for my own safety for psychiatric reports.

This is the back story to my involvement with forensic psychiatric services. Through a series of events I ended up in a low secure unit in Wales and then Northampton for six years under section 3 of the mental health act. So much for not being mentally ill.

My experience of being imprisoned and transferred to secure hospital is unusual. I eventually saw a psychiatrist in prison, after my records were lost for six weeks, and she recommended a transfer to hospital. However, as my own treating psychiatrist from my home area refused to agree to this, or even to write a report about me, this didn’t happen whilst I was in custody. I eventually made my way into the system through being detained in a local ward after assessment in the cells at Newbury magistrate court, and then transferred home to finally be assessed for secure care some three months later.

It is not difficult to see that this whole process was long, drawn out, distressing, complicated, uncoordinated and ultimately probably very expensive. Anything that can stop this happening to anyone else, has to be a step forward. We have already made progress towards diverting people away from the notion of using prison as a place of safety by the implementation of Liaison and Diversion teams in custody and courts. However, in my case this would not have helped as my own team were insistent that I was not suffering from any mental illness.

The proposed transfer and remission guidance for people detained within the prison system is hopefully another positive step. If my need had been identified immediately on arriving at the prison, dealt with by qualified mental health nurses and subsequently assessed by a secure service, the impact on me and my state of distress would have been greatly improved. Additionally, the distress caused to my family would have been reduced and their obvious concerns for me could have been heard.

The most important thing for me and for those people who I know have been through this process is the importance of clear, decisive communication. In my case, the lack of information from my home team, the loss of documents regarding the reasons why I was in custody, no clear decision making about why I was there massively affected me. Mostly, no one told me what was happening. It was a void of information for me and my family.

This matter is clearly addressed in the proposed guidelines and states the importance of involving family or carers in this process where appropriate, and to inform the service user or prisoner what is happening to them and why.

For me, prison probably saved my life. That having been said, the proposed guidelines will go a long way to making the experience of being mentally ill while in prison or an immigration removal centre a safer and better-informed process. If the proposed timescales can be met, this will also improve a person’s experience as they will access appropriate care in as short a time as possible.

However, I have some concerns as to implementation. Clinical assessments, from a service user perspective, can be wildly different – as in my case. The notion of a third clinical opinion is a good one but needs to be carefully managed so that any bias on the part of the prison or immigration removal centre team or accepting service is not introduced in selecting the third assessment.

Also, where prisoners or detainees are diagnosed with a personality disorder, it is vital that this does not become a barrier to hospital transfer; again as clinical views vary on this diagnosis as to whether it constitutes a mental illness and whether it is treatable. These people are often the most vulnerable in society, with multiple difficulties that lead them to offending behaviour. I am proof of this.

I would urge as many as possible to complete the consultation questionnaire so that the views and experiences of others can be considered in this vital process.

  • NHS England and NHS Improvement are currently holding a national consultation on guidance relating to individuals held within prisons and immigration removal centres who have been detained under the Mental Health Act for assessment and treatment within mental health in-patient services. To respond to the consultation, which closes on 19 July 2019, visit



Alison Boreham is an expert by experience working in the broader field of mental health service provision.

Her main interest is in secure services and mental health within the criminal justice arena.

She is currently volunteering as a peer support worker within Bristol and Taunton courts supporting people with mental illness through the court process.

Alison also works extensively with her local clinical commissioning group as an expert by experience and has also worked with NHS England at a national and local level by providing a lived experience perspective to meetings and consultations.