Access to medium secure psychiatric care in England and Wales. 3: The clinical needs of assessed patients

The needs of patients in medium secure psychiatric units arc well documented, but little is known of the range of clinical and security needs of those assessed but put on waiting lists or not admitted. The aim of the study was to quantify needs for treatment and care of a nationally representative sample of patients assessed for admission to medium secure care. 34 units containing 98% of medium secure beds in England and Wales in 1999 participated. All assessments were logged. A random sub-sample was selected for detailed inter-views with assessing clinicians. Higher sampling fractions were used in smaller units. Unit monthly waiting lists averaged 5 patients for each available bed. Common reasons for referral were aggressive behaviour, deteriorating mental state, need for diagnostic assessment, and non-compliance with treatment. 42 per cent of assessed patients needed medium secure care, one-third on a long-term basis. The assessing units refused some patients who needed medium secure care, and accepted some psychotic patients who did not require security. 4 weeks after assessment, 65% of waiting list patients had still not been admitted. The conclusion was that a substantial shortage in medium secure beds existed, especially for long-term placements. A third of those needing medium secure care required it on a long-term basis, but assessing units did not admit many of these patients. Further work is needed on the low levels of assessed need for interventions relating to substance abuse.