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A shortage of medium secure psychiatric beds is widely recognized, but there is little data on patients referred for admission but not accepted. This paper examines the relationships between assessed need for and admission to medium security. The method used was interview survey with principal clinical assessors of patients assessed for admission to medium secure units in England and Wales in the first half of 1999. A stratified random sample totalling 418 patients from 34 medium secure units, including 98% of relevant beds nationally was used. Factors associated with being assessed as needing medium security (but not necessarily being admitted) included having features of acute schizophrenia, non-compliance with treatment, a history of sexually inappropriate behaviour, and being referred because of self-harm. A ‘grave’ current offence and a history of recent or many past custodial sentences were also important. For patients seen in prison, NHS or community services, just under a fifth of those assessed a...

The needs of patients in medium secure psychiatric units are well documented, but little is known of the range of clinical and security needs of those assessed but put on waiting lists or not admitted. The aim of the study was to quantify needs for treatment and care of a nationally representative sample of patients assessed for admission to medium secure care. 34 units containing 98% of medium secure beds in England and Wales in 1999 participated. All assessments were logged. A random sub-sample was selected for detailed interviews with assessing clinicians. Higher sampling fractions were used in smaller units. Unit monthly waiting lists averaged 5 patients for each available bed. Common reasons for referral were aggressive behaviour, deteriorating mental state, need for diagnostic assessment, and non-compliance with treatment. 42 per cent of assessed patients needed medium secure care, one-third on a long-term basis. The assessing units refused some patients who needed medium secure care, and accepted s...

Decisions to admit to medium secure psychiatric care are complex, discretionary professional judgements. It is important to understand the assessor's ‘decision frame’, i.e. the values, assumptions and contextual pressures that shape the clinician's decision-making. The aims were to elucidate the values, beliefs and professional insights underpinning decisions to admit to medium security. The methods used were semi-structured interviews with a purposive sample of 55 lead clinicians from 36 medium secure units in England and Wales in 1999. Interviews were tape-recorded and a thematic content analysis of the verbatim transcripts was carried out. The results showed that a range of contextual pressures impinge on admission decisions, including the need to maintain a collaborative, shared vision amongst staff. Clinicians have a strong gate-keeping role in which collective views about appropriate patients, and the need to ensure turnover of places, are dominant considerations. The gate-keeping role involves mana...

Objective: To collect data on facilities and patient throughput in general ICUs throughout Yorkshire. Design: Prospective data collection on all admissions to 19 units over six months in 1992. A questionnaire to establish facilities in individual units. Participants: Eighteen of a possible 19 general units in Yorkshire. Results: Nineteen general ICUs in Yorkshire had 90 staffed beds. In six months 18 units admitted 3,185 patients. Many were potentially suitable for high-dependency unit (HDU) care as 36% were categorised as low nurse dependency and 27% had no significant therapeutic interventions. Ten units had no dedicated 24-hour medical cover. Facilities for children were inadequate in terms of local facilities and regional referral units. Conclusions: There is a real need for a reassessment of organisation and delivery of intensive care services at local and regional level. Of many options available, the provision of adequate high-dependency facilities would have a major impact on costs and pressure on...

(1990). Review: The use of aspirin in pregnancy. Journal of Obstetrics and Gynaecology: Vol. 10, No. 6, pp. 467-482.

There is not necessarily any clear distinction between the nature of screening and diagnosis. A very simple screening procedure applied by nonmedical personnel may give a precise etiological diagnosis, as in phenylketonuria. A doctor in a situation that allows him few or no technological aids may make a superficial judgment as to whether his patient is likely to be a "case" or not and treat on that basis. The distinction lies more in the manner

In Britain we have traditionally bemoaned the lack of accurate, comprehensive, mental health statistics. With the inherent problems of psychiatric diagnosis, the impossibility of defining "abnormal" in the absence of satisfactory standards of "normality," and the diffuseness and variety of agencies that offer help, this lack is neither surprising nor reprehensible. It does, however, make planning difficult. In recent years much progress has been made; and some gaps have been filled, not least by the psychiatric case registers, which have now provided at least a series of base-line statistical descriptions of the use of mental health services and offered opportunities for more effective evaluation (Wing & Hailey, 1972). The statistical descriptions themselves are not enough, of course; but even with very simple figures, questions relatingto social phenomena may be clarified and raised into prominence as important and susceptible to the attentions of both administrators and clinicians. Such statistics are greatly multiplied in usefulness, and general lessons may be learned, if several registers can produce comparable figures. This has recently been done by the Camberwell and Salford registers (Wing & Fryers, 1976). Both these areas are entirely urban and within large conurbations, Camberwell in S. E. London and Salford in Greater Manchester. The Camberwell service focuses on the Maudsley Hospital and has relatively high provision in most respects, but the Salford service can reasonably be considered fairly representative of psychiatric provision in urban England. This paper presents statistical data from studies in Salford, with some comparative data from the Camberwell register, which

(1968). Atmospheric pollution on the moon: A future problem? Atmosphere: Vol. 6, No. 4, pp. 142-144.