The needs of males detained under the legal category of 'psychopathic disorder' in high security: implications for policy and service development

Approximately a quarter of the high secure psychiatric hospital (HSPH) population is detained under the 1983 Mental Health Act legal category of 'psychopathic disorder' (PD). To date, there have been no studies specifically examining the security, treatment, and placement needs of this group despite recent policy developments. We conducted a cross-sectional survey of the needs of all males detained under the legal category of PD in the HSPHs in England. We found that 60% continued to require high secure care. Ongoing needs primarily related to substance misuse, interpersonal relationships, and sexual offending. Security and political issues were key factors associated with the continued need for HSPH care. High levels of Axis I and II co-morbidity were found. Although a substantial proportion did not require HSPH care, organisational and service-related factors prevented or delayed their transfer to appropriate services. The findings are discussed in light of proposed legislative reforms and service developments.