Access to medium secure psychiatric care in England and Wales. 1: A national survey of admission assessments

Abstract

A shortage of medium secure psychiatric beds is widely recognized, but there is little data on patients referred for admission but not accepted. This paper examines the relationships between assessed need for and admission to medium security. The method used was interview survey with principal clinical assessors of patients assessed for admission to medium secure units in England and Wales in the first half of 1999. A stratified random sample totalling 418 patients from 34 medium secure units, including 98% of relevant beds nationally was used. Factors associated with being assessed as needing medium security (but not necessarily being admitted) included having features of acute schizophrenia, non-compliance with treatment, a history of sexually inappropriate behaviour, and being referred because of self-harm. A ‘grave’ current offence and a history of recent or many past custodial sentences were also important. For patients seen in prison, NHS or community services, just under a fifth of those assessed as needing medium security (especially long term) were not admitted, and just under a quarter of those admitted needed low or no security. It was concluded that the match between need for and admission to medium security is poor. Insufficient range of provision leads to inappropriate use of medium secure beds.

Keywords:

• medium secure unit
• mentally disordered
• offenders
• forensic
• need