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The treatment and security needs of special-hospital patients: a nursing perspective.

Psychiatric nurses who are key workers or primary nurses within special hospitals are well placed to comment on their patients' needs and the benefits, and shortfalls, of trying to meet these within a maximum-security environment. In this survey, nurse respondents gave information on two groups of special-hospital clients, though they themselves were unaware of any group differentiation. Those who were not seen as requiring continued care within maximum security, as judged by other team investigators, were conceptualized by the researcher as 'leavers'. The survey revealed that in relation to those continuing to require maximum security--the 'stayers'--'leavers' retained exceptionally high levels of deficits related to their potential for community reintegration. Deficits in cognitive, social and life skills were as prevalent among those considered to need lower levels of security, and closer contact with the community, as those remaining within the special-hospital service. It also became clear that the effective management of special-hospital residents demanded a necessary conflict of interests: client-centred flexibility within the constraints of secure custody. There were also inconsistent features between the hospitals, as was shown in the differential provision of parole for patients. Only the survey sample from Broadmoor had access to this important resource. The conclusion is that, with the special hospitals' unequivocal commitment to maintain security, not all treatment and security needs of patients are appropriately met. Certain opportunities should, perhaps, be provided within new, alternative facilities.