Hospital ward used as remand prison: Lynn Eaton reveals how a plan to reduce suicides in jails is being thwarted by long court delays

'Excruciating' delays in Crown Court hearings are jeopardising a pioneering project aimed at keeping mentally ill offenders out of prison.

The pounds 1.2m Bentham unit, funded by the Department of Health and North West Thames regional health authority, is based at Ealing hospital, west London, in a locked ward on the St Bernard's wing, a former Victorian mental aslum.

Set up in February, it aims to relocate suicidal or mentally-ill prisoners into hospital, for more appropriate care. After initial assessment the unit expects to refer them to longer stay facilities within a month.

But beds are being blocked by patients forced to stay on the ward for up to six months waiting to come to court. 'It puts a major strain on our unit,' said Kevin Murray, consultant forensic psychiatrist. 'People remain in a state of anxiety until their court cases are finalised, and the possiblity of doing therapeutic work with them is compromised.'

Beds are being used inefficiently as patients have to wait months for a hearing before being sent on to longer term facilities, says Dr Murray in a report on the first four months of the unit. Long term treatment can only be given after a court finds them guilty.

'Put simply, if a case is clinically sorted out, with a clear diagnosis and an agreement to admit to another unit, but no Crown Court date is available for three months, why should the health service meet costs created by the courts?' said Dr Murray.

People held on remand in London jails can expect to wait an average of three months or more before their case comes to court, according to a recent report by the National Audit Office.

Of the 40 patients who have been on the ward since it opened, three men have stayed for at least five months; one who came there on 18 April will not have his case heard until mid-October; another who came on to the ward on 11 May has his case listed for this week.

The unit opened following criticism of the prison service from Judge Stephen Tumim, Chief Inspector of Prisons, for the high level of suicides. He highlighted the appalling standards many prisoners face, particularly on remand. They are often obliged to share a cell, locked up for 12 hours at a stretch and slopping out - even though they are technically innocent.

The conditions are bad enough for anyone who is mentally stable, let alone someone seriously depressed or suffering a psychotic illness.

The new unit has received accolades from solicitors and the Mental Health Act Commission, whose members visited in June.

The unit can hold up to 14 men. Most of its current occupants come from Wormwood Scrubs, though a handful are from Brixton and Pentonville. They are accused of anything from violent rape to attempted murder and at least a quarter attempted suicide before arrival.

With an average of 45 prisoners committing suicide each year and many more attempts, prison officers are all too happy to refer prisoners to somewhere that can offer treatment.

According to David Griffiths, a Middlesex probation officer on secondment to the unit, mentally-ill prisoners may be abused or maltreated by other prisoners. 'That just adds to the negative way they feel about themselves. When the prisoners are transferred here and given appropriate treatment they improve remarkably.'

One man transferred to the unit had tried - almost successfully - to hang himself in Wormwood Scrubs while awaiting trial on charges of attempting to kill his wife with an axe. The man had no previous record of mental illness, no criminal record and had always held down a good steady job.

What is more, he had no recollection of his suicide attempt and was severely depressed at the string of events that were happening around him. He had suddenly lost his job, his wife wanted to divorce him and she was denying him access to his child.

'I think had he stayed in prison he would have succeeded in killing himself - if someone is that determined they will,' said Mr Griffiths.

Eventually staff at the unit found him a bed in a mental hospital near his home. He has even begun to resume telephone contact with his wife.

Prisoners transferred to the unit have to be sectioned under the Mental Health Act - 'nuttered out' as it is known in the prison system. But they are likely to receive treatment rather than just a stretch in jail as a result.

Of the 40 men dealt with, three have gone to regional secure units, 15 have moved to hospital wards in their home area and two have been released into the community. This latter option is usually linked with a probationary requirement to attend an outpatient clinic for regular check-ups.

Only five of the patients at the unit have been returned to the prison system, usually because after assessment they were not considered mentally ill and could not be detained.

(Photograph omitted)