Centre for Mental Health

Secure mental health services

The secure services population is rising, from 2,500 in 1995 to a record high of 3,937 in December 2008.

The most recent available figures from the Ministry of Justice show that 1,501 people were admitted to forensic services (high and medium secure hospitals) in England and Wales in 2008. More than half (926, or 62%) were transferred from prisons. In the same year, 1,255 people were discharged or died. Of these, 499 (40%) were to the community. Most others were discharged to other hospitals (186, 15%) or back to prison (167, 13%).

The cost of a year in a medium secure hospital is an average of £165,000. High security is in the region of £300,000. This compares with £39,000 for a year in prison (not including mental health care costs).

A transfer from a prison to a secure hospital is often a very slow process. The government instigated a pilot project to bring waiting times down to 14 days, but often it takes several months for a transfer to take place. We have received numerous reports that prison transfer times are rising but the available statistics do not provide sufficient information to give a clear picture of what is happening on the ground.

Pathways to unlocking
secure mental health care

Lord Bradley's review reported in April 2009, and the government published the offender health strategy (the Improving Health, Supporting Justice delivery plan) in November 2009. The Bradley Review contained little reference to forensic services meeting the needs of mentally disordered offenders. But it did highlight the need for prison and healthcare services to work together effectively and swiftly.

One gap in the review and therefore a major area for further work is 'pathways to unlocking forensic mental health services', in particular medium secure psychiatric services for offenders sent from court and transferred prisoners. Medium secure services are typified by slow patient throughput so there are concerns about the capacity of forensic services to meet the needs of offenders in prisons.

Our project

In partnership with the National Mental Health Development Unit (NMHDU), this Centre for Mental Health-led project provided new evidence on forensic mental health services. It addressed eight specific points:

1. What are the barriers and facilitators for transfers from prison and courts and how can we implement a 14-day transfer procedure?
2. Explore the availability of beds, bed occupancy and lengths of stay in medium secure units.
3. The cost-effectiveness of services and effective use of existing resources.
4. How to improve flow between prison and medium secure units through identifying good practice.
5. Redress the balance between medium secure units and inreach mental health prison services - is future investment in inreach more cost-effective?
6. Are hybrid institutions feasible?
7. Alternative provision - look at the recovery model, and the resource implications and possible benefits / outcomes.
8. What about an expansion of forensic aftercare services?

The findings

This report examines the extent to which pathways into and through secure mental health services can be improved through the different security levels and ensure a better flow between prison and secure services. It is based on a review of current secure service provision carried out by the Centre and commissioned by the National Mental Health Development Unit.

It finds that secure mental health services vary widely across the country in terms of who they admit and what support they provide. Most patients spend longer than a year in secure hospitals, with a lack of community support for those who could be discharged a common cause of bed blocking.

Pathways to Unlocking Secure Mental Health Care also finds that little evidence is available about the long-term outcomes secure services achieve for their patients.

The report makes 15 recommendations to make secure services more efficient and better value for money.

A summary paper of this report available to download below. The full report is available on the right.

Download the Pathways report summary (1.1 MB)