Forensic psychiatry assessments and admissions from East London, 1987 – 94

Abstract

There is a shortage of information on the relationships between resources available to Regional Medium Secure services, demand from catchment area populations, and clinical factors which determine whether patients assessed are actually admitted. During a 7 year study period, the East London Service had few resources and the assessment process was entirely reactive in that all referrals were generated by external agencies. Patients selected for admission were primarily serious offenders with schizophrenia specifically referred for admission to medium security. The inpatient service was heavily reliant on admissions to the private sector. Needs of the catchment area population could not be met and it was necessary to prioritise a limited subgroup of mentally disordered prisoners at the expense of supporting local services and patients inappropriately remaining in maximum security. These findings are of contemporary relevance to the continuing lack of capacity in other medium secure services in the UK. Future service planning based on the ‘rates-under-treatment’ approach in the absence of adequate epidemiological data is discredited by these findings.

Keywords:

• Medium Secure Services
• psychiatric assessments
• service planning
• socioeconomic deprivation

ACKNOWLEDGEMENT

We would like to thank Laverne Harris who provided information on more recent assessments by the service.