NCJ Number
73094
Journal
Royal Society of Medicine Proceedings Volume: 70 Issue: 12 Dated: (December 1977) Pages: 877-880
Date Published
1977
Length
4 pages
Annotation
The pressure to reorganize England's secure psychiatric facilities has inspired many profound but neglected recommendations since 1961 and developed models of security reorganization that include both integrated and parallel models.
Abstract
The greatest anxiety is that adequate finance for reorganization is not forthcoming; yet, the concept of security is threatening to institutional staff who have battled since the early 1950's to open the doors to community care; to provide adequate, informal, rehabilitative treatment; and to move away from the role of custodian. Those advocating that protection of the mentally disturbed from their own selves is the job of a caring health service are decried by others who see asylum as harsh institutionalization. Another underlying issue is whether a security program should be integrated with National Health Service (NHS) psychiatric facilities or run parallel to them. Two forms of health care which can be applied to mentally abnormal offenders are the care by the penal system and the NHS (special hospitals, regional security units, and general psychiatric facilities). A parallel system would have three systems of health care: the penal system; a system of special hospitals, regional security units, and community facilities; and the general psychiatric system. An integrated system would involve every hospital or district offering a full range of facilities and skills. Both systems involve the problem of 'banishment pressure,' whereby patients will be increasingly designated as in need of placement to the security institutions. Thus, firm programs of rehabilitation and resettlement will be needed. The South East Thames Region is one area where an integrated system is being developed with some elements of the parallel system maintained. Each area has a responsibility to develop some kind of integrated local service, while a small regional unit will be established to keep the special hospitals and local facilities integrated. Given the shortage of funds and the reluctance of some regions to develop security policies, perhaps the best tactic is to rely on administrative empiricism, encourage development by adequate funds, and allow different schemes to develop in different regions. Included are 11 references and 2 charts.