Abstract
The high-security hospitals are undergoing a retraction process. In conjunction with this, regional services are being developed for those patients who require longer-term treatment at medium-security units.
Highlights
The Fender report (2000) analysed data from the high-security hospitals and regional plans to develop alternative secure services to produce a systems model of the change process
2000 and 2005, but an additional 140 beds will be commissioned as part of the dangerous and severe personality disorder (DSPD) initiative
Bed number projections took into account regional plans, including those that only existed in outline and for which funding was not yet identified
Summary
The new secure services being developed at regional level are staff intensive and expensive. There is a risk that resources may be diverted from other services to subsidise these expensive new developments This has happened already with some other aspects of the National Plan (Department of Health, 2001) such as the development of assertive community treatment teams. The national picture described by Fender (2000) is almost exclusively focused upon the development of secure beds These bedded-units need to be supported by robust community services (including 24-h nursed settings) if they are not to become rapidly bed blocked. It is essential that services are developed in such a way as to reflect the fact that they form a dynamic system rather than isolated secure in-patient units If this is not acknowledged there is a risk that services will be developed for the current high-security ‘reprovision’ population but that the system will not meet the needs of new cohorts of service users in the future
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