Trends in special (high-security) hospitals I: Referrals and admissions

Background Special hospitals in England provide psychiatric care and treatm ent in high security. Their future is often questioned. Aims To test for variation in demand for high-security psychiatric services over one IO-year period. Method This study was from the special hospitals' case registers and hospit al records. The main measures were numbers and annual rates for referrals a nd beds offered; the Mental Health Act 1983 (MHA) classification of mental disorder; adjusted population rates by health region; admission episodes; l egal category of detention; admission source and type of offence. Results Referrals to special hospitals showed no decrease during the 10 yea rs; an apparent increase may reflect under-recording before 1992. Admission s fell by about 16% over the 10 years, but with regional variation. Women, civil cases, admissions under the MHA classifications of psychopathic disor der 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 senten ced male prisoners, and of transferred hospital order patients from other h ospitals. Conclusions There is continuing demand from all parts of the country for hi gh-security hospital beds. The smaller numbers admitted appear to include m ore demanding cases.