Are Special Hospitals needed?

Abstract

It has been recommended that the Special Hospitals should be replaced by high-security services at a regional level. This study examines the implications of such a change in policy and demonstrates that local facilities would have to contain a significant proportion of patients whose violent and criminal behaviour cannot be managed in medium security and where in some cases all previous therapeutic interventions have failed to prevent a progression through successively higher levels of hospital security over time. Admissions to Special Hospitals followed more serious behavioural disturbance in other psychiatric services and more serious offences; the patients had more extensive previous criminal histories and were more likely to have primary and comorbid diagnoses of personality disorder and paraphilias. Almost a quarter of all admissions to the Special Hospitals in 1988–94 were transfers from medium security. This study provides little evidence that medium-security services reduced the demand for beds in Special Hospitals over the study period. The transfer of high-security beds to local services would have to take into account the threefold difference in levels of demand across regional catchment areas.