More detained in secure hospitals

The number of people in secure hospitals is rising

The number of people detained in secure psychiatric wards in England has reached a record high, figures show.

More than 3,500 were being detained in secure hospitals in July 2007, experts at the Sainsbury Centre for Mental Health said.

They said the figures raised important questions about whether people were being detained appropriately.

The government said the figures reflected their policy to make sure people were treated in the best place.

Are secure hospitals the best form of diversion from prison? Would community-based alternatives be better? With one prisoner in 10 experiencing severe mental illness, how many places are needed? Sean Duggan, Sainsbury Centre for Mental Health

The report on Forensic Mental Health Services - which provides care for people who have come into contact with the criminal justice system before being transferred to the NHS - found a large increase in people in high- and medium-secure units over the past decade.

High-security units are for people who pose a serious danger to the public.

Between 1996 and 2007, the population of high- and medium-secure units rose by 45%.

A more in-depth look at the figures showed the growth occurred overwhelmingly in medium-secure units.

Debate

The Sainsbury Centre also found that most people are admitted to secure hospitals from prison.

About 40 people each quarter have to wait in prison for more than three months before transferring to a secure hospital.

More than one-third of people detained in 2004 had committed violent offences.

And in 2005, 26 people died while being detained in a secure hospital.

Fewer than one patient in 10 re-offends within two years of being discharged from secure hospital.

The study's author, Max Rutherford, said he hoped the figures would inform national debate.

"Forensic mental health services form an important alternative to prison for people with severe mental health problems.

"Yet little is known about them outside the mental health system and they rarely figure in public debate."

Alternatives needed

Sainsbury Centre director of prisons and criminal justice Sean Duggan said: "With prisoner numbers reaching record levels, we need viable alternatives for people with the most severe mental health problems.

"Currently, medium-secure beds are the only option in many places.

"The number of people being detained in these units is growing year on year."

He added there were important questions for national policy. "Are secure hospitals the best form of diversion from prison? Would community-based alternatives be better? With one prisoner in 10 experiencing severe mental illness, how many places are needed in forensic care?"

A spokesperson for the Department of Health said: "More medium-secure services have been built over the last decade and the NHS have been working to transfer any patients out of high-secure accommodation if their needs would be better met in lower levels of security.

"We have been working closely with prisons and the NHS to speed up transfers from prisons for those that are so ill that they cannot be treated in prison and need to be detained in secure accommodation."

But Marjorie Wallace, chief executive of the mental health charity Sane said a lack of psychiatric services that offer inpatient care and rehabilitation has resulted in people becoming so disturbed that they end up in the criminal justice system.

"Despite all the monies put into building news medium-secure units, there are still far too many mentally ill people in prison."

Lucy Smith, Senior Mental Health Policy Officer for Nacro, the crime reduction charity, said: "Too many people with mental disorders are not receiving the treatment they need at the right level.

"The risk-averse nature of the system and the lack of resources for community mental health teams means that many people are ending up in much higher security than is needed.

"The majority of prisoners with a mental disorder are diagnosed with a personality disorder.

"We need to develop specialist forensic services in the community to ensure that these people get help before they get tangled up in the criminal justice system."