Reconfiguration of the high-security hospitals: some lessons from the mental hospital retraction and reprovision programme in the United Kingdom, 1960-2000

Abstract

The high-security hospitals of England and Wales are entering a phase of major retraction, with local security services embarking upon the reprovision of services for patients with longer-term needs who do not require high security. The large area mental hospitals underwent similar changes and the lessons that may be learnt from this process are relevant to proposed changes in forensic services. These lessons include: (1) the risk of over-optimistic predictions concerning the time-scale and resources required for major bed reduction; (2) the problems associated with 'creaming off', with the risk of increasing acuity in the residual inpatient population accompanied by deterioration in the quality of the retracting services; (3) the risk of 'silting up' in the reprovided services in the absence of an appropriate community infrastructure; and (4) the importance of quality of life for longer-stay secure inpatients. This paper urges caution in view of the potentially serious clinical and organizational risks associated with these major changes in forensic services.