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Abstract
Patterns of discharge/transfer and recall to a Special Hospital were examined in the 10-year period 1981-91. The introduction of the Mental Health Act 1983 led to a substantial increase in numbers receiving absolute and conditional discharges. Issues relating to public safety and the caution of the Home Secretary appeared to account for the observed shift away from direct discharge to greater use of regional secure units as a stepping-stone to discharge into the community.
Deficiencies in the assessment, treatment and supervision of restricted patients particularly with alcohol and sexual problems are highlighted. Some suggestions aimed at improving current practice include greater use of trial leave to regional secure units and better liaison between responsible medical officers, Special Hospital consultants and the Home Office so that failure rates are reduced and more appropriate use is made of the power of recall. The need for a system of reviewing these cases is apparent.