The use of beds in NHS medium secure units in England

Services for mentally abnormal offenders have recently been subject to a major review, with particular emphasis on expansion of the medium secure sector. This paper reports a case-note study of all 555 patients in the NHS medium secure unit system on 30 November 1991. Census data include demographic, clinical and offending characteristics, and anticipated outcome. As expected, patients were predominantly young, male and suffering from psychotic disorders. Most had previous contact with psychiatric services. Patients from ethnic minority groups were over-represented. The majority of admissions were from remand prisons, having committed serious offences: less than 30% of patients were Special Hospital or NHS transfers. There was little evidence of long-stay patients accumulating. Almost half the patients were expected to be directly to the community. Current bed numbers preclude an adequate service to the anticipated target populations, notably those inappropriately detained in Special Hospitals and 'difficult to place' NHS patients. The demand from the remand prison system severely restricts such admissions. Proposals significantly to increase the number of medium secure beds should be considered in the context of the very restricted service currently available.