The security, clinical and social needs of patients in high security psychiatric hospitals in England

Abstract

Previous studies have indicated that between one and two thirds of patients in the high security psychiatric hospitals (HSPHs) could be transferred to lower security. The aim of this study was to measure the individual and placement needs of all patients in the three HSPHs in England. In total 1255 patients were assessed using staggered census dates. Five hundred (40%) patients were rated as suitable for transfer to lower security. Long-term medium and low security facilities constituted over half of the recommended alternative placements. Unmet needs for the total population were most frequently reported with daytime activities, substance misuse, sexual offending, safety to others, and psychotic symptoms. Most clinical and social needs were met. High secure Responsible Medical Officers (RMOs) reported that 500 patients could be transferred immediately to lesser levels of hospital security if such facilities existed. However 60% of patients were rated as continuing to require high secure care therefore special hospitals, or their equivalent, continue to be needed for the foreseeable future in England.

Keywords:

• high security psychiatric hospital
• individual needs
• placement needs
• security needs
• unmet needs

ACKNOWLEDGEMENTS

The following colleagues contributed to the High Security Needs Assessment study: Ashworth Hospital: Professor Louis Appleby, Julie Carlisle, Dr Mairead Dolan, Dr Jenny Shaw. Broadmoor Hospital: Martin Butwell. London: Lisa Davies, Dr Mari-Anne Harty, Dr Morven Leese, Mauricio Moreno, Stuart Thomas, Professor Graham Thornicroft. Rampton Hospital: Dr Liz Gethins, Dr Todd Hogue, Professor Peter Jones, Dr Hugh Middleton, Ann Priddey, Michelle Webster. We would particularly like to acknowledge the support of the following people: Dr Sian Rees, Dr Dilys Jones, Professor Nigel Eastman, Dr Sarah Bellamy, Dr Julie Hollyman, Lezli Boswell, Sheila Foley, Dr John Basson, Dr Gwyneth Sampson, Dr Diane James, Bob MacDonald, Professor Pamela Taylor, Ronnie Grant, Isabelle Park, and all members of the Expert Advisory Group and Wider Reference Group. We would also like to acknowledge the sustained and valuable assistance of the users, carers and the clinical staff of the services in the three High Security Psychiatric Hospitals. We are pleased to acknowledge the Department of Health who funded this study through the High Security Psychiatry Services Commissioning Board. Declarations of interest: none.