Criminal Behaviour and Mental Health

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Volume 6 Issue 3 (September 1996), Pages 199-296

Long‐term medium‐security hospital units: a service gap of the 1990s? (pages 213-229)


The majority of psychiatric patients, even those who also offend against the law, are likely to be served best by good community services but a few of them will need treatment in a secure hospital. Treatment in high security for patients from England and Wales is provided by three special hospitals. In the 1980s provision of medium‐secure hospital units began, but there is still a considerable shortfall of such beds. Data from a variety of settings suggest that the continuing gap in medium‐secure provision may be qualitative as well as quantitative. This paper considers the case for long‐term medium security, and the likely size and nature of demand. It would be misleading to assume that those with long‐term medium‐security needs constitute a homogeneous group. Some new facilities, probably built on to existing medium secure hospital units, are likely to be needed; if estimates of real need for high‐security places are correct, then some places already exist and are being used by default in the special hospitals. For some patients, notwithstanding the old image of special hospitals, these may be ideal placements if redesignated, even redesigned. A variety of provision and effective cooperation between purchasers and providers will be essential to satisfy real need and ensure that the number of patients needing secure accommodation remains more or less within present estimates. Copyright © 1996 Whurr Publishers Ltd.

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