title: Referred to high secure care: determinants of a bed offer/admission and placement after one year.
abstract: BACKGROUND
  The admission process to high secure care ought to ensure that those admitted (a) receive mental health care that meets their needs and (b) that this is provided at an appropriate level of security.
  
  
  OBJECTIVE
  A study was undertaken to test the effectiveness of the gate keeping process according to these two criteria. METHOD All referrals for admission to Rampton high security hospital over one year were examined and, in addition, all women, all Anglo-Caribbeans and a random 50% sample of the Caucasian male majority were selected for interview. Each case was followed up for 12 months following the panel decision to determine his/her placement at that time.
  
  
  RESULTS
  Of 138 referred, 56 (41%) were initially offered a bed although nearly half (66) had been subsequently admitted by the end of the study period. Seriousness of mental disorder and offence were independently associated with admission. After one year, one third of those admitted were no longer in high secure care.
  
  
  CONCLUSIONS
  The variables predictive of admission (i.e. seriousness of both mental disorder and offence) suggest that the decision-making process was valid. Placement at 12 months tended to endorse the decision not to offer a bed, but it is more difficult to interpret the reverse as short admissions to high security for those who left within 12 months may have been appropriate. There was no apparent advantage in having a panel reviewing the decision of the assessing clinician.
authors.affiliation: Newton Lodge, Wakefield, Yorkshire.
authors.forename: Adrian
authors.initials: A
authors.lastname: Berry
authors.forename: Emmet
authors.initials: E
authors.lastname: Larkin
authors.forename: Pamela
authors.initials: P
authors.lastname: Taylor
authors.forename: Morven
authors.initials: M
authors.lastname: Leese
authors.forename: Neil
authors.initials: N
authors.lastname: Watson
authors.forename: Conor
authors.initials: C
authors.lastname: Duggan
mesh_terms: D000289:Admitting Department, Hospital; D000328:Adult; D000987:Antisocial Personality Disorder / Q000145:classification / Q000175:diagnosis; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D003657:Decision Making; D004739:England; D005260:Female; D006778:Hospitals, Psychiatric / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012637:Security Measures / Q000592:standards*; D016896:Treatment Outcome; D014754:Violence