A new legal deadline for transferring severely mentally ill prisoners to hospital could fail without further reform, psychiatrists have warned.
The Mental Health Act 2025 sets a statutory limit of 28 days for transfers. It is due to come into force by the end of 2027. The law targets long-standing delays in transfers. A shortage of NHS beds often takes the blame.
A recent editorial in the British Medical Journal argues that the law may not achieve what it intends. On the limited evidence available, the authors say, only 15 per cent of transfers now happen within 28 days.
“Legislative change without parallel investment in pathways, provision, and staffing risks consequences such as reduced referrals, higher rejection rates, and disputes over when a referral formally begins,” they write.
The authors cite estimates that at least one in seven prisoners has a diagnosable psychiatric condition. These include depression, psychotic disorders, bipolar disorder and schizophrenia spectrum disorders.
According to the editorial, referral and assessment processes drive much of the inefficiency. Prison psychiatrists frequently face heavy demands for information to secure a referral. Many have no dedicated administrative support. Secure hospitals treat prison referrals with caution and often carry out their own assessments. The authors say this duplicates work and adds to delays in reaching suitable care.
“Referral delays typically arise over clinical thresholds, referral acceptance, and responsibility, allowing delays to be reclassified and obscuring accountability for prolonged waits,” they add.
The authors advise against adding secure hospital capacity as a way to speed up transfers. “Providing more beds offers only a temporary reprieve, rather than a long-term solution, because it fails to address the root causes of delays,” they write. Instead, they favour closer joint working between police custody, prisons, secure units and community services. They say this would improve access to care and reduce risk.
Four specialists wrote the editorial. Dr Anis Ahmed is Consultant Forensic Psychiatrist at Aston Medical School in Birmingham. Andrew Forrester is Professor of Forensic Psychiatry at Cardiff University. Dr Piyal Sen is Consultant Forensic Psychologist at Brunel University. Megan Georgiou is a postgraduate researcher at the University of Surrey.
