What determines access to medium secure psychiatric provision

Medium secure units sit in the middle of a spectrum of forensic inpatient care, called upon both by those leaving maximum security and those testing the limits of local admission. Defining middles is never easy and 3 decades after the development of these units there is still little consensus on precisely what criteria should decide the need for admission, and limited information on what factors operate in practice. Clarity could make admission assessment a more predictable process than it currently is and could even underpin a more rational policy development for forensic psychiatric care. Perhaps with this in mind, in 1998 the Department of Health commissioned two national studies of admission to, and discharge from, medium secure psychiatric care in England and Wales. This issue of the Journal contains a series of three papers describing the study of admission. The initial research brief had ambitious aims. It specified that the study should include samples of referrals to medium secure psychiatric services; a comparison of different areas and models of service provision; generalisable data on who gains access to medium secure care and who does not; an analysis of the determinants of selection; an examination of decision making The Journal of Forensic Psychiatry & Psychology