Medium secure forensic psychiatry services - Comparison of seven English health regions

Background Regional medium secure developments have proceeded unevenly, wit h wide variations in resources to deliver services. Aims To compare patients admitted to seven (pre-reorganisation) regional se rvices and styles of service delivery. Method A record survey of a complete sample of 2608 patients admitted on 34 03 occasions between 1 January 1988 and 31 December 1994. Results Services differed according to location of patients before admissio n, their legal basis for detention, criminal and antisocial behaviour, diag nosis, security needs and length of stay. Regions with more resources and l ower demand provided a wider range of services. Thames services were relati vely under-provided during the study period, with North East Thames substan tially reliant on admissions to private hospitals. Conclusions Uncoordinated development led to under-provision despite high d emand. Certain regions prioritised offender patients and did not support lo cal psychiatric services. New standards are required for service specificat ion and resource allocation to redress inequality Traditional performance m easures were of limited usefulness in comparing services. Declaration of interest None. Funding from the Department of Health.