Secure Units: Why They are Needed

Abstract

The Beauchamp ISU based at Central Hospital, Warwick, has admitted 105 patients over a six-year period, 14 of these on more than one occasion, which has accounted for 121 admissions with 109 discharges. The opening of a pre-discharge unit in 1985 resulted in a 50 per cent increase in the number of patients admitted to the ISU. The majority of patients were male and had a diagnosis of schizophrenia, and 30 per cent of patients were of non-European origin. The mean length of stay was six months. The future role of secure units is discussed. There will be a need for the forensic psychiatric service to adapt to the changes resulting from the present government policy of community psychiatric care. The group of patients at present identified as requiring secure accommodation need a range of facilities and the number of patients requiring those facilities is likely to increase as psychiatric hospitals close. The special funding of the secure units must be maintained and any attempt to erode or to accept a lower level of funding must be resisted.

Four years' experience of a regional secure unit

“…This last fear was echoed by the Glancy Report (Department of Health and Social Security, 1974) and shared by Gostin (1986) who also believed that the units would become isolated and the patients they dealt with stigmatized. The experience of the interim secure units (ISUs), set up prior to the RSUs, was encouraging (Higgins, 1977;Faulk and Taylor, 1986;Gudjonsson and MacKeith, 1983;Bullard and Bond, 1988 …”

Prison transfers to Special Hospitals since the introduction of the Mental Health Act 1983

“…The expansion in the RSU programme (Snowden, 1985) does not appear to have impacted greatly on the numbers of sentenced prisoners being transferred after the Mental Health Act 1983. Although national figures are hard to come by, in one region for a 4-year period only 14 sentenced prisoners were transferred to the RSU (Bullard and Bond, 1988). The increase in numbers of sentenced prisoners being transferred to other hospitals (including RSUs) from 1990 onwards may be accounted for by a heightened awareness of the problem and an increasing willingness of prison medical officers to refer mentally disordered prisoners to hospital (Home Office, 1990).…”

Specialist forensic mental health services

“…Between 10% and 20% have a primary diagnosis of personality disorder (Faulk and Taylor, 1986;Bullard and Bond, 1988;Coid et al, 2001). The average age is usually in the early thirties with a considerable range from 18 to old age.…”

“…RSUs that service inner-city areas have an over-representation of ethnic minority patients, mainly of African Caribbean Specialist forensic mental health services S21 origin (Coid et al, 2000). Most patients are admitted from prison and the courts with some coming from general psychiatric wards and about a tenth from the high secure hospitals (Faulk and Taylor, 1986;Bullard and Bond, 1988;Coid et al, 1991).…”