The police generically refer to the different types of hospital unit in terms of ‘low’ or ‘medium’ or ‘high’ security. In reality there are many different types of mental health hospital and this terminology is not necessary correct or helpful, not least because some hospital sites have a mixture of security levels with ‘medium secure’ wards within larger ‘low secure’ facilities. All clear so far?!
Against this lack of clarity – for those who are not mental health professionals – I have been asked to do a post explaining the main types of unit and some differences between them. To do so, I am going to mention some units in my force area to explain their provision.
- High Secure or Special Hospitals:
- There are only four of these in the UK: Broadmoor (Berkshire), Ashworth (Merseyside), Rampton (Nottinghamshire) and Carstairs (Scotland).
- These hospitals take patients from all over the UK: predominantly, patients from Wales are in Ashworth and those from Northern Ireland and Scotland are in Carstairs.
- These institutions are occupied by patients who almost exclusively entered the mental health system via the criminal justice system and have been detained under Part III of the Mental Health Act.
- This includes some extremely high-profile individuals like Ian Brady, Peter Sutcliffe, Beverly Allitt and so on.
- The security in facilities such as these are consistent with a category B prison and in parts, Category A.
- Average stay in hospital for High Secure patients is measured in very many years: usually 6-8, but some patients will never be released.
- Medium Secure Units:
- There are many of these facilities across the country, three of them in my force area, which will become four later in the year.
- Reaside Clinic is a male medium secure unit (MSU) for adult men.
- Yardley Green Clinic will open later in the year and is also a male MSU. This is being built because of increased demand for medium secure services within the West Midlands region – there are a decent number of patients accommodated ‘out of area’ at any given time.
- Ardenleigh is an MSU for Women and Children. There are only 80 or so ‘forensic beds’ for children in the country. 20 of these are in Ardenleigh.
- Brooklands is an MSU for patients with learning disabilities.
- Again, these units are often populated by patients who have entered the mental health system via the criminal justice system, especially via Part III of the Mental Health Act 1983.
- They sometimes accept patients who are moving down from High Secure care with a view to ongoing rehabilitation and potentially, for release.
- Low secure and general adult psychiatric hospitals.
- There are many such units in any police force area; of all sizes but ‘low’ secure and ‘general adult’ are not the same thing.
- Some facilities include Psychiatric Intensive Care Units (PICUs) which provide enhanced levels of care and security at this level – lower staff / patient ratios, etc..
- Some are specific to client type: ie, men, women, older adults, children or learning disabilities.
- Some are mixed estates, including some with mixed (sex) wards and they prove controversial to some patients who find themselves detained with members of the opposite sex.
- I have heard strong representation from some adult female patients about being detained on mixed sex wards with male patients; raising concerns amongst other things about being rendered vulnerable to sexual advances or even sexual assault;
- Some ‘low secure’ facilities have a medium secure ward; with enhanced levels of security for a very small number of patients. For example, my force has a learning disabilities facility which is a low secure or general LD unit. However, it has one part for just eight patients, which is a medium-secure unit.
- Low secure and general psychiatric hospitals often deal with patients who were previously detained in MSUs, as patients move through rehabilitative programmes towards release.
- Step down facilities:
- Most areas have facilities which might be termed ‘hostels’ and which are often referred to as step-down facilities.
- These are places where patients may still be bound by legal frameworks under mental health law, but which are supervised semi-independent units where patients live with support.
- Again, a method of allowing patients to take move in stages from complete detention under the MHA to complete release without exposing patients to so much that it renders recovery impossible.
- Sometimes such facilities have a focus on supporting patients with particular issues like drug or alcohol addiction who do not need full inpatient care.
One thing that gets confusing about many of these facilities, is their ownership and coverage. All of the High Secure hospitals are National facilities, but are operated by local mental health units, like West London Mental Health Trust for Broadmoor. In the West Midlands, Reaside Clinic (MSU) is run by Birmingham and Solihull MH Trust but takes patients from all over the West Midlands region, not just from Birmingham and Solihull; Ardenleigh’s children’s unit is a national facility.
This has been a fairly simplistic run-through and I hope it struck the balance of being helpful without being over-complicated. Sometimes, a name alone is insufficient to know which type of facility a hospital will be, but in fairness to mental health units, the stigma associated with mental health means they may not wish to advertise such issues.
One example as to why: when I was a local inspector in an area of Birmingham, proposals were unveiled to build a new mental health unit in an area of the city which generated a high level of inpatient mental health demand. It was to be a ‘general’ facility built in that part of the city specifically for low risks patients from that part of the city. A series of public meetings were held by the mental health trust to brief the local community and allay any fears. I would say that no amount of persuasion by the trust was able to convince the community that the people detained there would not be extremely dangerous homicidal patients who represented a real risk to the safety of the community. The anger at the meeting ensured that the police present were not just explaining how partnerships work in practice, how we respond to AWOL patients, etc., etc; but that we were actually required to ‘keep the peace’.
The same thing happened again a few years later when consultation took place for a new medium secure unit – again a facility to ensure that patients were given care in their own area rather than being shipped ‘out of area’ for a want of beds. In fact, the MSU proposals were raised in Parliament and led to public protests.
By sheer coincidence of timing, I was then policing the area where the established MSU was based. On the very day of a public meeting for the proposed new facility there was an escape from the existing facility of a dangerous offender who did pose a risk. My name ended up in the local evening paper doing one of those “Do not approach this man, please call 999” type media notices as we reached the stage in the missing person’s enquiry where a press release would be done. Unfortunately for the mental health trust, everyone who attended the consultation meeting turned up with the evening paper to wave at them.