Defining high, medium, and low security in forensic mental healthcare: the development of the Matrix of Security in Scotland

Abstract

As differing levels of security in forensic mental healthcare have evolved, there has been no clear or concise agreed definition of high, medium, or low secure care. This paper reviews the historical use and abuse of security as treatment. More recent attempts to define security level and purpose are reviewed, and the trinitarian model of relational procedural and physical security is described. In Scotland there has been a need to define security levels for the purpose of private sector registration, service development, and, most particularly, appeals against excessive security made under new mental health law. The Matrix of Security which has been developed in Scotland, and those aspects of physical and procedural security that differ between security settings, are described.