Trends in special (high-security) hospitals

BackgroundSpecial hospitals in England provide psychiatric care and treatment in high security. Their future is often questioned.AimsTo test for variation in demand for high-security psychiatric services over one 10-year period.MethodThis 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.ResultsReferrals 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.ConclusionsThere 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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Trends in special (high-security) hospitals

The British Journal of Psychiatry ◽

10.1192/bjp.176.3.260 ◽

2000 ◽

Vol 176 (3) ◽

pp. 260-265 ◽

Cited By ~ 38

Author(s):

Martin Butwell ◽

Elizabeth Jamieson ◽

Morven Leese ◽

Pamela Taylor

Keyword(s):

Mental Illness ◽

Service Use ◽

Learning Difficulties ◽

Annual Number ◽

Hospital Discharges ◽

Mental Impairment ◽

Admission Source ◽

New Treatments ◽

Special Hospital

BackgroundIt has been argued that many patients in special hospital beds do not need to be there. In the 1990s there were initiatives to discharge women and people with learning difficulties.AimsTo test for trends in special hospital discharges and to examine annual resident cohorts.MethodThis study was from 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 region; admission episodes; legal category of detention; admission source and type of offence.ResultsThe median annual number of residents was 1859 (range 1697–1910), with an 8% fall for the period. This particularly affected people in mental impairment categories. Numbers were sustained in the male mental illness groups. Discharges, mainly to other institutions, increased. There was no overall change over the 10 years in length of stay for treatment, but successive admission cohorts from 1986 did show some reduction, even with solely remand order cases excluded.ConclusionsService planners need a longitudinal perspective on service use. Trends over 10 years to both fewer admissions and more discharges have reduced the special hospital population, but despite new treatments for schizophrenia, men under mental illness classification, as well as transfer from other secure settings, have gone against this trend.

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Male Afro-Caribbean Patients Admitted to Rampton Hospital between 1977 and 1986 — A Control Study

Medicine Science and the Law ◽

10.1177/002580249503500412 ◽

1995 ◽

Vol 35 (4) ◽

pp. 336-346 ◽

Cited By ~ 11

Author(s):

A P W Shubsachs ◽

R W Huws ◽

A A Close ◽

E P Larkin ◽

J Falvey

Keyword(s):

Mentally Ill ◽

Institutional Care ◽

Medication History ◽

Psychiatric Admission ◽

Admission Source ◽

One Year ◽

Special Hospital ◽

Special Hospitals ◽

Higher Doses

All Afro-Caribbean patients admitted to the Mental Illness Division of Rampton Hospital (a Special Hospital) between 1977 and 1986 and a randomly selected control cohort of Non Afro-Caribbean patients admitted in the same period, were compared on a variety of sociodemographic, psychiatric, criminological, treatment and outcome variables. Significantly, fewer of the Afro-Caribbean patients attracted the legal classification of Psychopathic Disorder. Detailed analysis was thus restricted to mentally ill patients in the two ethnic groupings. Similarities outweighed differences. There was no difference between the groups in terms of index offence, previous custodial sentence, in-patient psychiatric admission (including previous Special Hospital admission), admission source, Mental Health Act section, length of admission (including readmission) to Special Hospitals, likelihood of discharge or place to which discharged. Medication history in Special Hospitals was similar at one year and three years after admission. Afro-Caribbean patients had a lower incidence of childhood institutional care, a decreased likelihood of a previous supervision order, an increased likelihood of a previous Court appearance and received higher doses of antipsychotic medication four weeks after admission to Special Hospital.

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Unfit to Plead in England and Wales, 1976–88

The British Journal of Psychiatry ◽

10.1192/bjp.158.4.540 ◽

1991 ◽

Vol 158 (4) ◽

pp. 540-548 ◽

Cited By ~ 26

Author(s):

D. H. Grubin

Keyword(s):

Social Services ◽

Psychiatric Care ◽

Home Office ◽

England And Wales ◽

Criminal Convictions ◽

Mentally Impaired ◽

Special Hospitals

The Home Office files of all 295 cases of defendants being found unfit to plead between 1976 and 1988 were evaluated. The majority were male and either schizophrenic or mentally impaired. Median age was 32 years. Two-thirds had past criminal convictions, and nearly 90% had past contact with psychiatric or social services, but only 28% were receiving psychiatric care at the time of their alleged offence; 14% were hospital in-patients. Offences of theft and violence predominated, but in most cases they were not of a serious nature: 34% were rated as mild or nuisance, 40% moderate, and 26% severe. In more than 80% of cases, evidence linking the accused with the offence seemed good. Less than one-third were admitted to special hospitals. Forty-six per cent of the population (135 patients) eventually regained their capacity to plead (within a median of four months), with 76 (26%) returning for trial. Of the remainder, 68 (23%) are still in hospital, 39 of whom have been there for more than five years. Time to discharge without trial reflected the severity of the alleged offence.

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