Medium secure provision in NHS and private units

The use of private sector medium-secure units is a practice now firmly entrenched in forensic psychiatry. An assessment of patients in both NHS and private sector medium-secure provision was undertaken, looking at all medium-secure patients funded by three adjacent North East Thames health authorities. Case-notes and clinical measures were studied for each patient and comparisons made between the patients in the NHS and private sector units. The major differences between the two groups were not in clinical measures but in the types of acts or offences the patients had committed to get them into medium security, and in the length of stay in hospital. The patients in the NHS units were more likely to have committed violent offences, more often against strangers, and to have spent more time in hospital in their lives than the patients in the private sector units. Some of these differences may be explained by differing admission policies in the two types of units. We look at this phenomenon and some of the issues needing to be addressed as a result of the parallel development of the private sector units alongside the NHS service.