Medium secure care and research in forensic psychiatry.

There is a problem with medium secure psychiatric care in London. As Lelliott psychiatric care in London. As Lelliott et al et al (2000) show, patients from (2000) show, patients from Lambeth, Southwark and Lewisham Lambeth, Southwark and Lewisham Health Authority who find themselves Health Authority who find themselves in medium security are as likely to be in medium security are as likely to be looked after by the private sector as by looked after by the private sector as by the National health Service (NHS). Does the National health Service (NHS). Does this matter? After all, many patients in this matter? After all, many patients in the NHS hospitals would happily the NHS hospitals would happily upgrade to a private bed. Within medium upgrade to a private bed. Within medium security, the physical environment and security, the physical environment and range of specialist treatments may in range of specialist treatments may in some cases be superior to their NHS some cases be superior to their NHS equivalents. In this sense, it does not equivalents. In this sense, it does not matter that patients are treated privately. matter that patients are treated privately. In fact, as forensic psychiatrists working In fact, as forensic psychiatrists working in medium security are sometimes prone in medium security are sometimes prone to complacency, it could be argued that to complacency, it could be argued that the existence of competing private units the existence of competing private units has an important influence in raising has an important influence in raising the overall standard of care. the overall standard of care. Problems arise because of the location Problems arise because of the location of the private units. The patients are of the private units. The patients are usually in London; the private secure usually in London; the private secure units are not. Some are several hundred units are not. Some are several hundred kilometres away, presenting a formidable kilometres away, presenting a formidable obstacle to patients who wish to maintain obstacle to patients who wish to maintain contact with their families. It is difficult contact with their families. It is difficult enough to maintain these ties anyway, enough to maintain these ties anyway, when admissions often exceed a year in when admissions often exceed a year in length. In addition, the psychological length. In addition, the psychological impact on patients and relatives should impact on patients …