Sir: Birmingham's article (Psychiatric Bulletin, December 2001, 25, 462-464) succinctly captures the current difficulties in providing adequate mental health care for prisoners. The description of poor facilities, inadequate resources and the difficulty of providing care and therapy in a non-therapeutic environment will be instantly recognisable to practitioners working within prisons.

Having had the opportunity to work as a locum medical officer and a visiting psychiatrist at a women's prison, and viewing the same problems from different sides of the fence, it is evident that forensic psychiatrists have a prominent role in developing ‘coordinated, integrated services’ for mentally disordered offenders. Rigid, ineffective and inefficient procedures can be improved, resulting in an improvement in care and, more importantly, removal of the barriers preventing these individuals from accessing the services that they are entitled to.

In my experience this involves the training of non-medical staff in the recognition of mental disorders and reducing the stigma and discrimination attached to being ‘a psychiatric patient’. Additionally, evidence of ineffectiveness can be collected, using audits and surveys, and the results presented to those involved in the commissioning and purchasing of medical services. In our own case this involved completing an audit of the referral process, which revealed excessive waiting times, long waiting-lists and indiscriminate presentation and follow-up, as a result of which the system was altered after consultation with prison staff. As Birmingham correctly states, identifying and managing these individuals earlier has resulted in a noticeable improvement within the prison environment.

Finally, from our experience it is not the identification of these individuals that is the major difficulty, rather it is the management of complex, multiple health care needs in a setting that currently cannot meet those needs, with resources both inside and outside prisons already stretched. More optimistically, with the NHS now being involved in providing health care within prisons, there is now an opportunity to deliver effective, integrated services.