The Clerkenwell scheme: assessing efficacy and cost of a psychiatric liaison service to a magistrates' court.

OBJECTIVE To determine the efficacy of psychiatric liaison schemes to magistrates' courts in shortening the period that mentally ill accused people spend in custody between arrest, the provision of psychiatric reports, and admission to hospital under the Mental Health Act 1983 and to establish the direct costs of setting up such schemes. DESIGN A nine month prospective study of court referrals and concurrent analysis of prison records. SETTING An inner London magistrates' court (Clerkenwell) and a large remand prison (Brixton). PATIENTS Consecutive series of 80 remand prisoners receiving psychiatric assessment through a liaison scheme; 50 remand prisoners placed on hospital orders by magistrates' courts after being remanded to prison for reports; 364 psychiatric prisoners undergoing second opinion assessments at a remand prison; 520 offenders in a remand prison placed on hospital orders. MAIN OUTCOME MEASURES Comparison of lengths of time spent in custody for different stages of the assessment and disposal process. RESULTS For the 50 remand prisoners assessed in prison the mean time from arrest to appearance in court with a psychiatric report was 33.7 days and from arrest to admission to hospital 50.8 days. For those examined in court under the liaison scheme the equivalent figures were 5.4 days (t = 12.63, p less than 0.0001) and 8.7 days (t = 13.04, p less than 0.0001). The number of hospital orders made at the court increased fourfold after the liaison scheme began. The additional direct costs of the scheme were negligible. CONCLUSION Psychiatric liaison services to magistrates' courts can greatly reduce the length of time that offenders with mental disorders spend in custody. Such schemes may increase recognition of offenders suitable for admission to hospital. A scheme could be established in some areas within existing service provision.