ArticleBJPsych open2026
Delays and disparities in access to secure psychiatric services in England: national study of referrals and access assessments.
Article in BJPsych open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSecure psychiatric services (SPS) are vital for people with severe mental disorders who pose significant risks, yet national evidence on referral pathways, acceptance and timeliness of admission is limited. Delays and variability in access are especially concerning in prisons, where mental health crises are frequent and alternatives limited.
aimsThis study presents the first national analysis of SPS referral and admission patterns in England following the introduction of provider collaboratives. It identifies predictors of referral acceptance and delays across the referral-to-admission pathway to inform equity and performance improvement.
methodData were drawn from 149 low-secure and 98 medium-secure services across 15 provider collaboratives, encompassing 1356 referrals. Multivariable models examined predictors of acceptance and delay, benchmarked against national policy standards.
resultsAlmost half of referrals originated from prisons (46%,
conclusionsAccess to SPS remains inconsistent, with substantial variation in acceptance and widespread delays across referral pathways. Despite faster processing of prison referrals, national assessment and admission standards were rarely met, particularly for this group. These findings highlight gaps between policy expectations and practice, indicating a need for improved adherence to national timeframes, greater standardisation of decision-making and enhanced system oversight, to reduce inequities in access.
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