title: The treatment and security needs of patients in special hospitals: views of referring and accepting teams.
abstract: BACKGROUND
  Various studies suggest that 20-30% of patients in England and Wales in high security could be safely managed in medium security but there are no objective criteria and little attention has been paid to differences of opinion.
  
  
  METHODS
  The authors compare the views of the referring and receiving team on the security needs of all special hospital patients from two London health authorities.
  
  
  RESULTS
  Disagreements were found in only 8% of cases, and they were more likely to occur in patients detained under the legal category of psychopathic disorder. Between 21% and 33% of patients were rated as misplaced by one or other team but these figures include patients who were either already on trial leave in another hospital or on the waiting list for an identified placement. Patients for whom there was agreement on misplacement, with no identified route out of high security, account for 9% of the total. Most patients with treatment-resistant schizophrenia were not receiving atypical anti-psychotic medication.
  
  
  CONCLUSIONS
  It may be more realistic to plan future services on the basis that only 9% of patients are misplaced, rather than the previous estimates that appear to have guided current policy. Patients detained under the legal category of psychopathic disorder present particular problems and there is a need to develop appropriate facilities at medium secure level. In the meantime, no patients should be admitted to high security without consultation with the catchment area service and a jointly agreed plan for future rehabilitation.
authors.affiliation: Department of Child Psychiatry, Institute of Psychiatry, London, UK. k.sayal@iop.kcl.ac.uk
authors.forename: Kapil
authors.initials: K
authors.lastname: Sayal
authors.forename: Anthony
authors.initials: A
authors.lastname: Maden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000987:Antisocial Personality Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D001291:Attitude of Health Personnel; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006301:Health Services Needs and Demand / Q000639:trends; D006778:Hospitals, Psychiatric / Q000458:organization & administration* / Q000706:statistics & numerical data; D006782:Hospitals, Special / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007298:Insanity Defense; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000706:statistics & numerical data; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000453:epidemiology / Q000628:therapy; D012637:Security Measures / Q000458:organization & administration* / Q000706:statistics & numerical data