Assessing the need for low secure care in Northern Ireland

It is self evident that what is needed in one part of a service will depend on the provision in other parts of the service. Mental Health Services in Northern Ireland have undergone substantial change in the past ten years through the implementation of the Bamford Review and Transforming Your Care.1, 2, 3 A significant consequence has been a change in the provision of inpatient care. A reduction in average available mental health beds by 35% over the past 5 years combined with high occupancy rates (90%) and a 19% reduced length of stay reflect a reduction in inpatient bed availability.4 A regional network of forensic mental health services has been developing including the opening of the first medium secure unit, Shannon Clinic, in 2005, the development of community forensic mental health teams, and mental health services in prison. There are plans for the closure of long stay wards over the next few years.4 The Bamford Adult Implementation Group is chaired by commissioners and is tasked with planning the provision of low secure care. Low secure units provide rehabilitation for patients who need to be detained to hospital under mental health legislation. The criteria for detention to hospital are that the person suffers from a mental illness and failure to detain them would create a substantial risk of serious physical harm to self or others. The secure component of care consists of physical security, such as locked doors and fences, procedural security, such as control of various items coming into the ward, and relational security, which involves fostering therapeutic relationships through an in depth knowledge of the patient's illness and behaviour. Low secure rehabilitation aims to reintegrate the patient back into society through multidisciplinary treatment of their illness and a reduction in the risk of harm that led to their detention. This survey aimed to assess the current need for the provision low secure services in the region. Unlike other parts of the UK, there is no private sector provision of secure mental healthcare in Northern Ireland.