Prevalence and Characteristics of Long-Stay Patients: Results from a Study in England

  • Birgit VöllmEmail author


Forensic psychiatric services provide care for those with mental disorders and offending behaviour. Some patients may stay in such services for excessive periods of time. This causes an economic burden to society and might limit the quality of life of patients. This research therefore aimed to estimate the number of long-stay patients in secure settings in England and to describe their characteristics and care pathways in order to inform service provision. We defined a length of stay exceeding 5 years in medium secure care or 10 years in high secure care or 15 years in a combination of both services as ‘long-stay’. A cross-sectional survey (on April 01, 2013) of all patients resident in all 3 high and 23 medium secure units (16 NHS and 9 independent provider units) was undertaken. Overall, 23.5% of high secure and 18.1% of medium secure patients were long-stayers according to our criteria. One fifth of the long-stayers had stayed in services for more than 20 years. The files of long-stayers were further inspected and their characteristics and pathways identified. Long-stayers had complex pathways, moving ‘around’ between settings rather than moving forward to less secure care. Patients typically had disturbed backgrounds with previous psychiatric admissions, including to secure care, self-harm and significant offending histories. Rates for violent incidents within institutions and seclusion were also high. However, a significant proportion had not shown any recent incidents, and only 50% of patients were involved in psychological therapies. The most common diagnosis was schizophrenia, but about half of the patients were (sometimes additionally) diagnosed with at least one personality disorder. There were a large proportion of unsuccessful referrals to less secure settings. On a positive note, most patients had some form of contact with their families. Implications for service organisation are discussed.



The study was funded by the National Institute for Health Research, reference HS&DR 34 11/1024/06. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or Department of Health and Social Care.

The sponsor of the study was Nottinghamshire Healthcare NHS Foundation Trust.

The findings of this study have been published as full report in Völlm et al. [10], and the text presented here partly overlaps with this chapter.


  1. 1.
    Appelbaum PS. The new preventive detention: psychiatry’s problematic responsibility for the control of violence. Am J Psychiatry. 1988;145:779–85.CrossRefGoogle Scholar
  2. 2.
    Carroll A, Lyall M, Forrester A. Clinical hopes and public fears in forensic mental health. J Forens Psychiatry Psychol. 2004;15:407–25.CrossRefGoogle Scholar
  3. 3.
    Forrester A. Preventive detention, public protection and mental health. J Forensic Psychiatry. 2002;13:329–44.CrossRefGoogle Scholar
  4. 4.
    Rutherford M, Duggan S. Forensic mental health services: facts and figures on current provision. Br J Forens Pract. 2008;10:4–10.CrossRefGoogle Scholar
  5. 5.
    McCrone P, Dhanasiri S, Patel A, Knapp M, Lawton-Smith S. Paying the Price: the cost of mental health care in England to 2026. London: The King’s Fund; 2008.Google Scholar
  6. 6.
    Maden A, Rutter S, McClintock C, Friendship C, Gunn J. Outcome of admission to a medium secure psychiatric unit. Br J Psychiatry. 1999;175:313–6.CrossRefGoogle Scholar
  7. 7.
    Pierzchniak P, Farnham F, de Taranto N, Bull D, Gill H, Bester P, et al. Assessing the needs of patients in secure settings: a multi-disciplinary approach. J Forensic Psychiatry. 1999;10:343–54.CrossRefGoogle Scholar
  8. 8.
    Reed J. The need for longer term psychiatric care in medium or low security. Crim Behav Ment Health. 1997;7:201–12.CrossRefGoogle Scholar
  9. 9.
    Mental Health Act 1983 (as Amended by the Mental Health Act 2007). London: The Stationery Office; 1983.Google Scholar
  10. 10.
    Völlm B, Edworthy E, Holley J, Talbot E, Majid S, Duggan C, Weaver T, McDonald R. A mixed-methods study exploring the characteristics and needs of long-stay patients in high and medium secure settings in England: implications for service organisation. Health Serv Deliv. 2017;5(11).Google Scholar
  11. 11.
    Hare Duke L, Furtado V, Guo B, Völlm B. Long-stay in forensic-psychiatric care in the UK. Soc Psychiatry Psychiatr Epidemiol. 2018;53:313–21.CrossRefGoogle Scholar
  12. 12.
    Shah A, Waldron G, Boast N, Coid JW, Ullrich S. Factors associated with length of admission at a medium secure forensic psychiatric unit. J Forensic Psychiatry Psychol. 2011;22:496–512.CrossRefGoogle Scholar
  13. 13.
    Sahota S, Davies S, Duggan C, Clarke M, Huband N, Owen V. Women admitted to medium secure care: their admission characteristics and outcome as compared with men. Int J Forensic Ment Health. 2010;9(2):110–7.CrossRefGoogle Scholar
  14. 14.
    Ricketts D, Carnell H, Davies S, Kaul A, Duggan C. First admissions to a regional secure unit over a 16-year period: changes in demographic and service characteristics. J Forensic Psychiatry. 2001;12:78–89.CrossRefGoogle Scholar
  15. 15.
    Harty M, Shaw J, Thomas S, Dolan M, Davies L, Thornicroft G, et al. The security, clinical and social needs of patients in high security psychiatric hospitals in England. J Forensic Psychiatry Psychol. 2004;15:208–21.CrossRefGoogle Scholar
  16. 16.
    Thomas S, Leese M, Dolan M, Harty M, Shaw J, Middleton H, et al. The individual needs of patients in high secure psychiatric hospitals in England. J Forensic Psychiatry Psychol. 2004;15:222–43.CrossRefGoogle Scholar
  17. 17.
    Alexander R, Devapriam J, Michael D, McCarthy J, Chester V, Rai R, et al. “Why can’t they be in the community?” A policy and practice analysis of transforming care for offenders with intellectual disability. Adv Ment Health Intellect Disabil. 2015;9(3):139–48.CrossRefGoogle Scholar
  18. 18.
    Cormac I, Ferriter M, Benning R, Saul C. Physical health and health risk factors in a population of long-stay psychiatric patients. Psychiatrist. 2005;29:18–20.Google Scholar
  19. 19.
    Giesler M. Long-term forensic psychiatric care (LFPC): why, who? how? 12th Annual conference of the International Association of Forensic Mental Health Services, Miami, FL; 2012.Google Scholar
  20. 20.
    Uppal G, McMurran M. Recorded incidents in a high-secure hospital: a descriptive analysis. Crim Behav Ment Health. 2009;19:265–76.CrossRefGoogle Scholar
  21. 21.
    Davoren M, Byrne O, O’Connell P, O’Neill H, O’Reilly K, Kennedy HG. Factors affecting length of stay in forensic hospital setting: need for therapeutic security and course of admission. BMC Psychiatry. 2015;15:301.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Institute of Forensic PsychiatryUniversity of RostockRostockGermany

Personalised recommendations