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

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.