I am pleased that my editorial has encouraged some discussion about how best to care for the mentally ill in prisons. Mr Gannon is right to point out that it is commissioning rather than providing that has moved to the primary care trusts. The reason for commissioning twice is perhaps to do with geography – people do not necessarily remain in the borough that is responsible for commissioning their health care. Prisoners are not as free to move around as other citizens and one can hardly expect a Leeds general practitioner to attend to her patient in Brixton prison, or vice versa. Otherwise, Mr Gannon and I appear to be in broad agreement – the status quo is unacceptable, and that is why I argued against any expansion of medical treatment under common law (contra Mr Gannon's assertion, and contra an earlier paper of mine (Reference Wilson and ForresterWilson & Forrester, 2002)). I advocated an extension of the Mental Health Act 1983 to prisons precisely because that would include openness, accountability and scrutiny in a way that more use of the common law would not. I think that it is the current system that is collusive and dishonest: the championing of equivalence (a noble idea) enables us to feel better about the reality of a failing system of hospital transfers for mentally ill prisoners. I do not, however, share Mr Gannon's optimism that more secure beds (at whatever level of security) are the solution, and it seems to me that history is on my side. At the moment we cannot even make provision within the National Health Service for the most severely mentally ill prisoners, let alone Mr Gannon's suggestion that there should be no mentally ill citizens in prison at all. I wonder whether that includes adjustment disorders, mild depression, treated schizophrenia, substance dependence and personality disorder? Peter Scott, a predecessor of mine at HMP Brixton, suggested that the nature of the walls (prison or hospital) were an irrelevant distraction as the people inside were the same in both types of institution and the treatment needed was broadly similar (Reference ScottScott, 1970). I have a great deal of sympathy with this view.