Adolescent medium secure units

Young people with mental disorders who have committed serious offences may be treated in medium secure adolescent units, of which there are several in the UK. These provide a range of psychological therapies, including family therapy, and other interventions similar to both CAMHS and forensic services. In recent years, provision of services in this sector has not kept pace with the growing demand.

Medium secure personality disorder services

Entry into specialist medium secure forensic services for personality disorders may follow a structured clinical assessment and careful consideration of the best treatment option for the patient. In general, the essential admission criteria to a medium secure personality disorder service encompasses the following:

  • • Patients aged 18 years or over as the age threshold for admission
  • • A diagnosis of a personality disorder that merits detention under mental health legislation (where there is a dual diagnosis of mental illness, the mental illness should be stable and unlikely to interfere with treatment focusing on personality disorder)
  • • The patient presents a serious physical or psychological risk to others or potential risk of a degree that requires admission to a medium secure service, and there is a link between the personality disorder and high risk that can be clinically justified
  • • The treatment needs of the patient are best met in a secure NHS setting.

There are a variety of psychological interventions available that are specifically tailored in a care plan approach to the individual needs of the patient. A variety of therapies are available, including DBT, CBT, MBT, and schema-focused therapy. Further evidence-based research is required into these psychological modalities in this setting, as these services are relatively new and continually being shaped under the Offender Personality Disorder Strategy (see E

Offender Pathways Strategy in Chapter 8, pp. 423-4; Cognitive behavioural therapy in Chapter 2, pp. 30-4, and in Chapter 5, pp. 172-84; Dialectical behavioural therapy in Chapter 2, pp. 63-6, and in Chapter 5, pp. 220-9; Mentalization-based treatment in Chapter 2, pp. 66-70, and in Chapter 5, pp. 229-34; Schema therapy in Chapter 2, pp. 70-3, and in Chapter 5, pp. 234-8).

Private sector care

Low and medium secure hospital beds are provided by both the public and private sectors. The number of beds for people with mental illness in the NHS dropped from a peak of 148 000 in 1954 to 35 740 in 2000. As this decline accelerated, a private market has emerged for the provision of beds for long-stay patients across the UK. it is estimated that over a third of beds in England for patients in need of secure care are within privately owned institutions.

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