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Trends in special (high-security) hospitals

1: Referrals and admissions

Declaration of interest None.

Authors' details, references and dates of manuscript receipt and acceptance are presented at the end of Paper 2.

See Paper 2, pp. 260–265, this issue.

Background Special hospitals in England provide psychiatric care and treatment in high security. Their future is often questioned.

Aims To test for variation in demand for high-security psychiatric services over one 10-year period.

Method This study was from the special hospitals' case registers and hospital records. The main measures were numbers and annual rates for referrals and beds offered; the Mental Health Act 1983 (MHA) classification of mental disorder; adjusted population rates by health region; admission episodes; legal category of detention; admission source and type of offence.

Results Referrals to special hospitals showed no decrease during the 10 years; an apparent increase may reflect under-recording before 1992. Admissions fell by about 16% over the 10 years, but with regional variation. Women, civil cases, admissions under the MHA classifications of psychopathic disorder or mental impairment and directly from a court on a hospital order were most affected. There was an increase in admissions of pre-trial and sentenced male prisoners, and of transferred hospital order patients from other hospitals.

Conclusions There is continuing demand from all parts of the country for high-security hospital beds. The smaller numbers admitted appear to include more demanding cases.

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