Independent Forensic Mental Health Review: final report

Annex E: Forensic mental health inpatient provision

The current configuration of forensic mental health services for inpatients developed from principles set down by the Scottish Executive in its letter HDL(2006)48 to NHS CEOs in 2006.  There are three different levels of secure hospital provision as described by the Forensic Network in its Security Matrix and each has been developed at a different national, regional or local level.  In general:

• High secure is provided at a national level;
• Medium secure services are provided at a regional level; and,
• Low secure services are provided at a local level.

This section provides an outline of the information provided to the review about the available provision at each level across Scotland.

High Secure

There is one national high secure unit in Scotland located in the State Hospital.  It has 144 high beds for males requiring maximum secure care and treatment.  There are 12 beds specifically for people with a learning disability.  It also provides high secure care and treatment for men from Northern Ireland.  Data from the Forensic Network’s annual inpatient census indicates a reduction in the number of men receiving high secure care between 2013 and 2017.  From 132 people in 2013, numbers have remained at around 110 since 2017.

There is no high secure unit for women in Scotland.  Women who require high secure care and treatment are referred to Rampton Hospital in Nottinghamshire, England.

Medium Secure

There are three regional medium secure units in Scotland.

Rowanbank Clinic, Stobhill Hospital, Glasgow - NHS Greater Glasgow and Clyde

Rowanbank is a 74 bed unit providing a number of different services.  It provides male mental illness medium secure care for the West of Scotland (NHS Greater Glasgow and Clyde, NHS Lanarkshire, NHS Ayrshire and Arran, NHS Dumfries and Galloway and the ‘Argyll part’ of NHS Highland).  There is a 12 bed admission ward and 44 rehabilitation beds across four wards.

It has six female medium secure beds for Greater Glasgow and Clyde patients and can consider female patients from across other regions on a case by case basis.

The National Medium Secure Intellectual Disability Service is also hosted by Rowanbank, providing eight male and four 4 female beds.

The Orchard Clinic, Royal Edinburgh Hospital – NHS Lothian

The Orchard Clinic is a 40 bed unit.  Based in Royal Edinburgh Hospital it is the regional medium secure unit for male mental illness within NHS Lothian for the East of Scotland (NHS Lothian, NHS Borders, NHS Fife and NHS Forth Valley).  It is a 40 bed unit with one admission/acute ward and two rehabilitation wards^.  Rooms can be adapted to provide male and female beds.  For reporting on available beds, the Forensic Network works on a configuration of seven female and 33 male beds.

Rohallion Clinic, Murray Royal Hospital, Perth – NHS Tayside

The North of Scotland regional medium secure unit for male mental illness is provided by NHS Tayside at the Rohallion Clinic based at the Murray Royal Hospital in Perth.  It has 32 male beds split between one admission ward and two recovery wards.  In practice not all beds are available and the functional capacity is 30 medium secure beds.  It provides care and treatment for NHS Tayside, NHS Grampian, NHS Highland (non-Argyll), NHS Orkney and NHS Shetland.

Low Secure

As low secure provision has developed locally, the provision across the country is varied.  The precise numbers of forensic beds available is harder to identify as a number of Board have no specific low secure provision and manage any forensic patients in general wards.  In addition, where there are low secure wards, they can often be treating forensic and non-forensic patients.  In its report on medium and low secure provision in 2017, the Mental Welfare Commission highlighted low secure wards were in effect catering for two distinct groups of people: people detained under criminal orders who may have committed serious offences and people detained under mental health act orders who are there because general adult services have been unable to manage their care safely.  For the report, they visited 32 low secure wards identifying 293 low secure beds, 63 of which were for people with a learning disability.^[26]  In its 2019 annual census figures, the Forensic Network found 215 forensic inpatients in low secure wards, 23 of whom were in independent provision.  There were also 11 people in locked learning disability wards, six in IPCUs, nine on open rehabilitation wards and two in other facilities.  In some services the use of IPCU beds is part of planned pathways, for example, for people transferred on assessment or treatment orders from court or custody, to assess restricted patients, or for women.  In others, IPCU beds are managed alongside other forensic wards to manage populations or because of limited capacity in the forensic wards.

The text below presents the information that was provided to the Review on low secure provision by each NHS Board, as well as independent providers.

Provider: *NHS Ayrshire and Arran

Low secure services: Woodlands View, Ayrshire Central Hospital, Irvine

• 8 bed low secure ward
• 10 bed open forensic rehabilitation ward
• Also use IPCU for people under assessment or treatment orders.

Provider: NHS Borders

Low secure services: No specific low inpatient provision.  Dependent on availability from other NHS Boards or private sector.

Provider: NHS Dumfries and Galloway: No specific low inpatient provision.

Low secure services: Midpark, Hospital

• Enhanced rehabilitation unit
• Use of IPCU

Provider: *NHS Fife

Low secure services: Lynebank Hospital, Dunfermline

• Daleview: 10 male LD beds – regional facility for NHS Fife, NHS Lothian, NHS Borders and NHS Forth Valley.
• Levendale: 8 bed male LD low secure unit

Stratheden Hospital, Cupar

• 10 male beds.  1 bed held for recalls from step-down unit
• 4 bed male step down unit.
• Use of IPCU and rehabilitation ward

Provider: *NHS Forth Valley

Low secure services: Bellsdyke Hospital, Falkirk

• 6 female MI beds
• 18 male MI beds
• Also use IPCU for initial assessment of all restricted patients.

Provider: *NHS Grampian

Low secure services: Blair Unit, Royal Cornhill Hospital

• 8 bed male acute forensic ward
• 16 bed male forensic rehabilitation ward
• 8 bed LD male forensic close supervision unit
• 8 bed IPCU has provision for 2 female beds
• 8 bed male MI step down facility

Provider: *NHS Greater Glasgow and Clyde

Low secure services: Leverndale Hospital, Glasgow

• 53 low secure beds
• 30 male MI across two admission/rehabilitation wards
• 9 male close supervision ward LD unit
• 9 male pre-discharge MI and LD ward
• 5 low secure female beds

Provider: NHS Highland

Low secure services: No specific forensic inpatient provision.  All low provision currently provided by independent sector.

New Craigs Hospital

• 8 bed IPCU use for forensic patients when appropriate (also serves Argyll and Bute)

Community rehabilitation facilities have been used as step-down unit for forensic patients.  

Provider: NHS Lanarkshire

Low secure services: Beckford Lodge, Hamilton

• Iona: 15 male low secure beds
• Gigha: 12 male and female open forensic rehabilitation unit.

Kirklands Hospital, Bothwell

• Kylepark: 10 bed unit for assessment/treatment and low secure LD beds.  

Provider: *NHS Lothian

Low secure services: There is no specific MI low secure unit within Lothian.

Glenlomond - 6 male LD beds locked forensic unit in the community.

William Fraser Centre – male and female LD provision (numbers vary).

IPCU at St John’s Hospital can admit short-term remand patients.  

Provider: NHS Orkney

Low secure services: No specific provision.  All forensic mental health services provided by NHS Grampian via a service level agreement

Provider: *NHS Tayside

Low secure services: Rohallion Clinic, Murray Royal Hospital, Perth

• 25 male MI beds across two wards;
  • Esk: mixed admission/rehabilitation ward
  • Lyon: rehabilitation ward with self-contained flat.
• IPCU can be used for females requiring care in a locked environment.

Strathmartine Hospital, Dundee

• 8 bed LD low secure forensic ward 

Provider: NHS Shetland

Low secure services: No specific provision.  All forensic mental health services provided by NHS Grampian via a service level agreement.

Provider: NHS Western Isles

Low secure services: No specific provision.  Contract these on an ad-hoc basis when required.  

Surehaven, Glasgow, Shaw Healthcare Independent provision available.

• 15 bed male low secure ward
• 6 bed female low secure ward 

Provider: *Priory Ayr Clinic, Ayr

Low secure services: Independent provision available.

• 12 bed female low secure admission unit
• 12 bed male low secure admission unit
• 12 bed mixed low secure rehabilitation
• 8 bedded male step down community house (not restricted patients
• 10 bed female step down community house (not restricted patients).  

* Review Chair visited the inpatient wards in these Board areas.