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Gateway reference 15893
Secure mental health services are specialist services providing treatment for adults with mental disorders including personality disorders that mean that they are at significant risk of harming themselves or others. Patients are detained under the Mental Health Act 1983 and many, but not all, will be convicted offenders.
Some prisoners and people detained under the Immigration Act may require inpatient treatment for mental disorder under the Mental Health Act. DH publishes a guide to the procedure for transferring prisoners and detainees to inpatient care, this can be accessed at:
In this context, ‘secure’ relates to the range of physical, relational and procedural measures put in place to ensure the provision of a safe and secure environment in which to deliver treatment. There are three levels of secure care, high, medium and low with guidance governing provision at each level. Depending on individual needs, patients may go through an integrated care and treatment pathway that spans one or more levels of care.
The purpose of security measures is to ensure the safety of patients and the public, to prevent escape and absconding and reduce the likelihood of patients failing to return from agreed periods of leave. It is important to understand the differences between these three events: DH guidance on the definitions of each can be found at the link below.
DH has published an interactive guide for staff working in secure services to support knowledge and understanding of relational security. This can be accessed at the link below.
High secure services are provided at Ashworth, Broadmoor and Rampton hospitals, each hospital is part of an NHS Trust. At present, DH’s relationship with high secure hospitals is different to the relationship to any other NHS service as the NHS Act 2006 places a specific duty on the Secretary of State for Health to provide high secure hospital services. Patients in high secure hospitals present a grave and immediate danger to the public and require a significant period of treatment.
High secure services because of their nature have a national performance management and oversight structure. Details about the current arrangements can be found at:
Medium secure services are provided by a range of NHS and independent sector organisations, and are for people who present a significant danger. Many patients will have a history of offending and some will have been transferred from prison or from court to receive inpatient treatment. Typically, patients will remain in treatment between 2 and 5 years.
Guidance on the provision of medium secure services can found at the link below.
Specific services for women requiring an enhanced level of secure care are currently being evaluated. More information on this programme is available at the link below.
Low secure services are for people detained under the Mental Health Act who because of the level of risk or challenge they present cannot be treated in open mental health settings. Services are provided by a range of independent sector organisations and NHS Trusts. Patients may have a history of offending and may have been transferred from prison or courts to receive inpatient treatment.
The current guidance published by DH in 2002 on the provision of low secure services is in the process of being updated. The current guidance is available at:
