The individual needs of patients in high secure psychiatric hospitals in England

Abstract

A comprehensive assessment of the needs of all high security psychiatric hospital (HSPH) patients in England has not previously been conducted. All inpatients in the three HSPHs in England (Ashworth, Broadmoor and Rampton, n = 1256) were assessed. Factors associated with placement need were modelled using logistic regression, then cluster analysis was used to identify patient subgroups on the basis of their individual needs. Forty percent of the patients could be transferred out of high security, according to the RMOs. While it was possible to identify factors associated with the continued need for high security the false negative rate was high. Patients had very diverse needs that did not fit neatly into clustered sub-groups. Due to the heterogeneity of the individual patients currently in the HSPHs, future service planning will need to focus on individualized treatment packages that are based on individual assessments of need. Such assessments should be considered in the wider framework of risk and accountability.