Secure mental health services

Secure mental health services provide accommodation, treatment and support for people with severe mental health problems who pose a risk to the public. Secure services work predominantly with people who have been imprisoned or admitted directly to hospital following a criminal offence.

The three levels of secure services (low, medium and high) have about 7,000-8,000 beds. 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.

Transfers from prison to secure services should ensure people with severe mental health problems have access to the right treatment and care. Such transfers, however, are often subject to excessively long delays even for very acutely unwell prisoners. People get stuck in the system – they can’t get in to secure care when they need it or get out when they don’t.

The Bradley Report called for a mandatory 14-day maximum transfer time for prisoners to be admitted to hospital and for a review of security at low and medium secure units.

The Five Year Forward View for Mental Health established new models of care in 2016 with the aim of supporting “‘step down’ and ongoing recovery in the community as soon as appropriate for the individual and as close to home as possible”.

Secure care pathways

In 2011, we examined the extent to which pathways into and through secure mental health services can be improved and ensure a better flow between prison and secure services.

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.

Achieving more consistent commissioning and provision of secure mental health care depends on a number of factors:

  • Changing how secure services are commissioned, i.e. a move from block purchasing (of mainly medium secure beds) to purchasing pathways and discrete packages of care that provide incentives to move patients to the lowest level of security they need and support community aftercare;
  • Developing effective community support and liaison to support reintegration and mainstream mental health services’ capacity to promote the recovery of former secure service patients;
  • Reviewing the balance of investment to ensure adequate step-down provision is developed;
  • Standardising treatment programmes so that treatment can be carried across tiers;
  • Developing a national secure service patient data-set that allows both individual progress monitoring and aggregated data to monitor performance and outcomes;
  • Developing shared learning networks to improve communication across tiers and in standardising treatment and care packages.

A summary paper of this report is free to download here.

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