The mental health service needs of all North London patients in medium (N =
97) and maximum security (N = 79) were assessed. Patients and key nurses w
ere interviewed using validated measures and, for patients in maximum secur
ity, the respective responsible medical officers (RMOs) also completed a st
andard enquiry form. Multi-disciplinary panels from the catchment areas the
n rated immediate and future needs for security and treatment. Unlike previ
ous studies, we found only 25% of patients ready for an immediate move to l
ower security and a greater disparity between those thought ready for disch
arge by their Special Hospital RMO and those thought ready for discharge by
the local panels. We identified a particular unmet need for long-term, 24-
hour, nurse-staffed accommodation, rather than long-term medium security.