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Chief inspector calls for assessments in police custody to prevent seriously mentally ill people ending up in prison

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Seriously mentally ill people are being sent to prison when they require urgent psychiatric assessment and treatment, creating unacceptable risks for the individuals concerned, staff and other prisoners, according to the Chief Inspector of Prisons.

Charlie Taylor’s warning follows concerns raised by inspectors at HMP Birmingham, where men with acute and untreated mental illness, including psychosis, were arriving from court without having received a mental health assessment in police or court custody.

While this practice is not typical elsewhere in England and Wales, inspectors found it had become an established pattern in the West Midlands. Police custody staff in the region were no longer requesting completion of a Mental Health Act assessment for detainees with clear signs of mental illness, before sending them to court. On average, nine prisoners a month were arriving at Birmingham without this assessment, that would normally determine whether they should be diverted for appropriate mental health care.

The consequences were severe. Inspectors found cases of men exhibiting disinhibited behaviour, including walking naked around wings and smearing faeces, causing significant distress to other prisoners and staff. Limited space on health care wings meant that some of the most seriously unwell men had to be managed on ordinary prison wings while awaiting specialist care.

What my inspectors found at Birmingham was particularly concerning. Men with severe and acute mental illness were being sent to prison when they should first have been assessed to determine the most appropriate setting for their care.

These were often extremely vulnerable individuals whose conditions could deteriorate further in jail. At the same time, their behaviour was having a profound impact on the staff and prisoners around them.

Prison officers are not mental health professionals. They work incredibly hard to care for some very unwell people, but prisons are simply not designed or equipped to provide the level of psychiatric treatment that many of these individuals need.
Charlie Taylor, Chief Inspector of Prisons

HM Inspectorate of Prisons has repeatedly highlighted the difficulties faced by prisons caring for people with serious mental illness. Once identified as requiring transfer to a secure mental health hospital, many prisoners continue to experience excessive delays before a bed becomes available.

At Birmingham, inspectors found that 31 prisoners had been assessed as requiring transfer since the prison was last inspected in October 2025. The longest wait in recent months had been 311 days. Similar delays have been identified elsewhere in the prison estate, with some prisoners waiting many months, and in some cases years, for appropriate treatment.

Unlike secure hospitals, prisons cannot compel treatment under the Mental Health Act. This means that prisoners suffering from severe mental illness may be unable or unwilling to take medication while waiting for transfer, increasing the risk of further deterioration and delaying recovery.

It is not acceptable for people with severe mental illness who need urgent treatment to be remanded to prison or left waiting excessive periods for hospital places.

The individuals concerned are at risk of suffering serious and potentially irreversible harm. Meanwhile, prison staff and other prisoners are left coping with the consequences of a system that is failing to provide timely access to specialist care.

Last month I wrote to ministers to call for immediate action. Prisons should not become the default destination for individuals whose primary need is urgent mental health treatment.
Charlie Taylor, Chief Inspector of Prisons

Notes to editors

  1. Chief Inspector of Prisons Charlie Taylor wrote to the Secretary of State for Home Affairs, the Secretary of State for Health and Social Care and the Secretary of State for Justice on 14 July 2026, before the appointment of Prime Minster Andy Burnham and his new cabinet. A copy of the letter is available at: https://hmiprisons.justiceinspectorates.gov.uk/?post_type=hmipris_reports&p=8637
  2. The letter followed an independent review of progress (IRP) at HMP Birmingham which took place between 22 and 24 June 2026. The report was published on 3 August: https://hmiprisons.justiceinspectorates.gov.uk/hmipris_reports/hmp-birmingham-4/
  3. The IRP found acutely mentally unwell men continued to be sent to court and remanded into prison without having had a mental health assessment while in police custody. Inspectors first identified this situation during an unannounced inspection of Birmingham prison in October 2025: https://hmiprisons.justiceinspectorates.gov.uk/hmipris_reports/hmp-birmingham-3/. They were advised that this was due to a change in practice associated with local implementation of The Right Care, Right Person national partnership agreement between the Home Office, Department of Health and Social Care, the National Police Chiefs’ Council, Association of Police and Crime Commissioners, and NHS England.
  4. An IRP at Foston Hall also noted that women with acute mental health problems continued to be sent to the West Midlands prison instead of being diverted to a hospital: https://hmiprisons.justiceinspectorates.gov.uk/hmipris_reports/hmp-yoi-foston-hall-3/   
  5. HM Inspectorate of Prisons is an independent inspectorate, inspecting places of detention to report on conditions and treatment and promote positive outcomes for those detained and the public.
  6. Please email media@hmiprisons.gov.uk if you would like more information.