The research presented is a survey of all of the identified forensic psychi
atry Medium Secure Units (MSUs) within Great Britain. The study examined th
e numbers and nature of all escapes from these units over a 42-month period
. The research focused on the relationship between the building design of t
he units and the nature of patient escapes. The results showed that overall
numbers of patient escapes from the units was low. The average number of e
scapes was 3.14 per unit over the three-and-a-half-year time-span of the su
rvey. However, the recent: increases in bed numbers in medium secure units
had been paralleled by a larger percentage rise in escapes. Most escapes fr
om the units occurred from three main areas. These were the perimeter fence
, the roof, and internal and external windows. The implications of the meth
ods of escape and their relationship to the building design of MSUs were di
scussed and recommendations made for future building designs.