Defining the needs of patients with intellectual disabilities in the high security psychiatric hospitals in England.
BACKGROUND
Previous studies have suggested that a substantial proportion of the patients with intellectual disabilities (ID) in the high security psychiatric hospitals (HSPHs) should be transferred to more appropriate services to cater for their specific needs in the longer term.


METHODS
The individual and placement needs of high secure psychiatric patients detained under the legal category of mental impairment or severe mental impairment were assessed in a cross-sectional survey.


RESULTS
Patients had a large number of needs (on average 10.8), about a third of which were rated as unmet and therefore represented significant continuing problems. Approximately one-third of the sample could be moved out of HSPHs if appropriate alternatives were available. Factors associated with the continued need for high security included higher treatment and security needs, younger age, recent violent conduct and their index offence profile.


CONCLUSIONS
High security services are still required for a number of patients with ID. New and existing services need to be configured to meet specific profiles of need and provide long-term rehabilitation and specialist care.


BACKGROUND
This was part of a larger project funded by grants from the High Security Psychiatric Services Commissioning Board and Department of Health.
Thomas
S D
SD
PO29, Health Services Research Department, Institute of Psychiatry, London SE5 8AF, UK. s.thomas@iop.kcl.ac.uk
Dolan
M
M
Johnston
S
S
Middleton
H
H
Harty
M A
MA
Carlisle
J
J
Thornicroft
G
G
Appleby
L
L
Jones
P
P
D000328:Adult; D003072:Cognition Disorders / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D003710:Demography; D004739:England / Q000453:epidemiology; D005260:Female; D005555:Forensic Psychiatry / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006760:Hospitalization; D006778:Hospitals, Psychiatric / Q000145:classification*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D011321:Primary Nursing / Q000458:organization & administration