In his recent editorial on mental health in prisons Dr Reed (Reference Reed2003) urges, understandably and in most cases correctly, that the quicker that patients with psychosis are transferred to specialist psychiatric care, the better.

However, there are prisoners with schizophrenia, willing to take medication, who survive reasonably comfortably in the prison milieu. Their great fear is that they will be transferred to a special psychiatric hospital; ‘nutted off’ in prisonspeak. They have reason to fear a transfer, for it effectively exchanges a finite sentence for an indefinite one. In the case of those serving a life sentence, it means their fate is in the hands of a mental health review tribunal rather than the Parole Board, the latter, they believe, being less cautious in recommending discharge. As an ex-member of both organisations, I would agree with them.

So, while prison is obviously bad for people with mental illness, hospital is sometimes worse.