The significant frustration felt by those routinely working in the difficult and challenging environment of prison has rightly had the spotlight shone upon it. ^{Reference Hassan, Senior, Edge and Shaw1} In my experience, general practitioners (GPs) working in these settings are reluctant to prescribe psychotropic medications, often to the point of obstinacy.

The reasons put forward are mostly that: (a) the GPs themselves have no experience or confidence in prescribing these medications, and (b) there is a perception that this is solely the remit of in-reach mental health services. The second explanation has taken on absurd dimensions where prison GPs have refused to continue a prescription of a commonly used antidepressant, started by a GP in the community, without it being authorised by a psychiatrist!

I would like to see a similar study done comparing the continuity of prescribing of other chronic medications (i.e. antihypertensives or antihyperglycaemic agents) for newly received prisoners. I suspect that there would be significantly less discontinuity with these agents, as a GP would be rightly criticised for claiming that he or she would not continue with a patient’s angiotensin-converting enzyme (ACE) inhibitor unless it was prescribed by a cardiologist! Indeed, a recent audit from the Offender Health Research Network ² hinted that psychotropic medications were more likely to be omitted following reception than other medications. In my view, this issue highlights the ongoing fault lines of professional disdain and mistrust towards psychiatry among our other medical colleagues. ^{Reference Craddock, Antebi, Attenburrow, Bailey, Carson and Cowen3-Reference Storer5} Solving this problem will have to go beyond the platitude of the ‘additional training required’ and will necessitate a significant drive to improve the image of psychiatry as a credible medical discipline.