A court-focused model of forensic psychiatry provision to central London: Abolishing remands to prison?

The Reed Report recommended the abolition or amendment of the magistrates' power to remand into custody for psychiatric reports. This study examines the practicability of such moves, in an area of nearly half a million people, in the first year of a new local court-based forensic service characterized by the combination of assertive court psychiatric assessment and ready local access to beds in a range of levels of security. Records of all admissions from the criminal justice system in central London were gathered prospectively at court and retrospectively from hospitals, prisons and purchasers for a 1-year period. The rate of compulsory admission to hospital of non-serving prisoners in this population was 24.5 per 100,000 inhabitants. The majority of admissions were to locked or secure placements; 85% were admitted after assessment at court and this paper examines the reasons why 15% of cases were not captured by the new system. It is concluded that assessment at court could replace assessment at the remand prison in the majority of cases. A power to remand in custody for psychiatric examination at court would still be necessary, given the structure of most services. It would be practicable to place new legal limits on the length of time for which such remands might be made.