title: Medium secure forensic psychiatry services: comparison of seven English health regions.
abstract: BACKGROUND
  Regional medium secure developments have proceeded unevenly, with wide variations in resources to deliver services.
  
  
  OBJECTIVE
  To compare patients admitted to seven (pre-reorganisation) regional services and styles of service delivery.
  
  
  METHODS
  A record survey of a complete sample of 2608 patients admitted on 3403 occasions between 1 January 1988 and 31 December 1994.
  
  
  RESULTS
  Services differed according to location of patients before admission, their legal basis for detention, criminal and antisocial behaviour, diagnosis, security needs and length of stay. Regions with more resources and lower demand provided a wider range of services. Thames services were relatively under-provided during the study period, with North East Thames substantially reliant on admissions to private hospitals.
  
  
  CONCLUSIONS
  Uncoordinated development led to under-provision despite high demand. Certain regions prioritised offender patients and did not support local psychiatric services. New standards are required for service specification and resource allocation to redress inequality. Traditional performance measures were of limited usefulness in comparing services.
authors.affiliation: Forensic Psychiatry Research Unit, St Bartholomew's Hospital, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Coid
authors.forename: N
authors.initials: N
authors.lastname: Kahtan
authors.forename: S
authors.initials: S
authors.lastname: Gault
authors.forename: A
authors.initials: A
authors.lastname: Cook
authors.forename: B
authors.initials: B
authors.lastname: Jarman
mesh_terms: D000328:Adult; D003415:Crime / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D005555:Forensic Psychiatry / Q000458:organization & administration*; D006292:Health Priorities; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D012637:Security Measures; D012926:Social Control, Formal; D014852:Wales / Q000453:epidemiology