Two years after the trenchant criticism of Ashworth Hospital by a committee of inquiry chaired by Sir Louis Blom-Cooper, QC,1,2 the Department of Health has published its review of high security and related psychiatric provision. Dr John Reed, senior principal medical officer, and his committee recommend sweeping changes in the way treatment under special security is provided for patients in England and Wales.3,4

High security provision is a new term which should encourage us to think of services rather than institutions. The report accepts that such provision will always have a place in the range of psychiatric services but that a service based on the three existing special hospitals (Ashworth in Merseyside, Broadmoor in Berkshire, and Rampton in Nottinghamshire) administered from a special health authority in London cannot continue. What is needed is something “generally more attuned to the wider delivery of mental health care on the eve of the twenty first century.”

At present there are about 1700 patients in the special hospitals, two thirds of whom are subject to the authority …