In their paper, Kosky & Hoyle ^{Reference Kosky and Hoyle1} use a postal questionnaire to consider the provision of secondary mental healthcare in prisons. They conclude that ‘there is generally no correlation between input and prison capacity, although there was some evidence of correlation in the high secure… estate’.

Their introduction states: ‘The ONS [Office for National Statistics] data do try to quantify the range of morbidity across remand, convicted and female populations but do not consider security categorisation or age range.’ The high prevalence of mental disorder in prisons has been well documented, with higher levels of mental ill health established among particular groups such as women, older prisoners and juveniles. ^{Reference Fazel and Baillargeon2} Perhaps more important is the absence of discussion in this paper of the higher morbidity among remand as compared with sentenced prisoners, a difference highlighted by Singleton et al. ^{Reference Singleton, Meltzer, Gatwood, Coid and Deasy3} Indeed, the Royal College of Psychiatrists in their 2007 report ⁴ provided specific guidelines on psychiatric input to prisons. They acknowledged the method by which they came to the suggested norms was a guide, but crucially they differentiated between not only security categorisation, but also local remand v. dispersal prisons. ⁴ It is also worth noting that most prisons hold prisoners of a lower category, and the majority of prisoners in category A establishments are not actually category A prisoners.

Given known differences in levels of morbidity between remand and sentenced prisoners, it is surprising Kosky & Hoyle have chosen not to use this information in their results, particularly as these data were readily available (in terms of remand v. dispersal prisons). In our view, this information is essential when considering any future secondary mental healthcare planning. However, it would be even more useful if this included the proportion of remand v. convicted prisoners in establishments as well as the prison turnover. The paper perhaps only highlights what we already know anecdotally, that secondary healthcare in prisons varies and this variation may be arbitrary.