Section two Focus on detention issues Uniquely in the UK, since November 2015 Scottish mental health legislation77 gives patients in high and medium secure care the right to apply to a tribunal for an order declaring that they are detained in conditions of excessive security which, if successful, should lead to their transfer to a lower level of security. This right previously only applied to patients detained in the high secure State Hospital. There have been significant reviews78 of secure care services in each jurisdiction within the past decade, resulting in important recommendations for future service delivery, including improving the flow between different levels of services, pathways within the system of secure care provision, gaps in secure care provision and configuration of the secure estate. Key principles International standards set out that patients should have the right to be treated in the least restrictive environment and with the least restrictive or intrusive treatment appropriate to their health needs and to protect the physical safety of others.79 In 1992, the Reed Report called for services to be provided according to individual need, near to the patient’s home or family, as far as possible in the community but otherwise in conditions of no greater security than is justified, with the ultimate aim of rehabilitation. All of these principles have been adopted or supported in key policy documents since. Issues identified by NPM members Organisation and availability of secure services across the UK Over the last two decades there has been a progressive reduction in the number of beds in high secure hospitals in the UK in favour of expansion of medium and low secure bed provision. However, recent reviews and reports have highlighted that this expansion has not been coordinated strategically and the planning and commissioning of many services is fragmented.80 There has been a largely ad hoc approach to commissioning new services, with significant differences in what has been commissioned in different areas leading to variations in service provision across geographical areas and jurisdictions. As a result, provision of care is patchy, with very limited range in many areas and patients unable to move around the system as needed. In addition, a large and increasing proportion of medium- and low-secure services are provided in the independent sector. While these services will have developed in response to identified needs, they may not always be located in geographical areas where needs are most prevalent. This is a 77. Mental Health (Scotland) Act 2015, s. 14–18. 78. Centre for Mental Health and National Mental Health Development Unit, 2011, Pathways to unlocking secure mental healthcare. Northern Ireland Department of Health, 2007. Bamford Review of Mental Health and Learning Disability (Northern Ireland). Welsh Assembly Government, 2009. A Review of Secure Mental Health Services. NHS England mental health taskforce, 2016. The Five Year Forward View for Mental Health. In 2016–17, a Forensic Estate Group was commissioned by the Scottish Government to review the clinical models of forensic mental health inpatient services in Scotland. 79. UN General Assembly Resolution 49/119 ‘Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care’. 80. For example, Joint Commissioning Panel for Mental Health, 2013, Guidance for commissioners of forensic mental health services; Welsh Assembly Government, 2009, A Review of Secure Mental Health Services. 31