Trends in special (high-security) hospitals 2: Residency and discharge episodes, 1986-1995

Background It has been argued-that many patients in special hospital beds d o not need to be there. in the 1990s there were initiatives to discharge wo men and people with learning difficulties. Aims To test for trends in special hospital discharges and to examine annua l resident cohorts. Method This study was from case registers and hospital records. The main me asures were numbers and annual rates for referrals and beds offered: the Me ntal Health Act 1983 (MHA) classification of mental disorder; adjusted popu lation rates by region; admission episodes; legal category of detention; ad mission source and type of offence. Results The median annual number of residents was 1859 (range 1697-1910), w ith an 8% fall for the period. This particularly affected people in mental impairment categories. Numbers were sustained in the male mental illness gr oups. Discharges, mainly to other institutions, increased. There was no ove rall change over the 10 years in length of stay for treatment, but successi ve admission cohorts from 1986 did show some reduction, even with solely re mand order cases excluded. Conclusions Service planners need a longitudinal perspective on service use . Trends over 10 years to both fewer admissions and more discharges have re duced the special hospital population, but despite new treatments for schiz ophrenia, men under mental illness classification, as well as transfer from other secure settings. have gone against this trend.