Addressing substance misuse in medium secure settings in the UK and Ireland – a survey of current practice

Jeremy Sandbrook (General Adult and Community Forensic Psychiatry, Cornwall Partnership NHS Foundation Trust, Cornwall, United Kingdom.)
Tom Clark (Forensic Psychiatry, Birmingham & Solihull Mental Health NHS Trust, Birmingham, United Kingdom.)
Karen Amanda Cocksedge (Department of Psychiatry, Cornwall Partnership NHS Foundation Trust, Cornwall, United Kingdom.)

The Journal of Forensic Practice

ISSN: 2050-8794

Publication date: 10 August 2015



Rates of co-morbid substance misuse are high within forensic populations. Addressing these problems should be a priority as mental disorder with co-morbid substance misuse is associated with worse outcomes, including rates of re-offending and violence recidivism. A study undertaken in 2006 by the Royal College of Psychiatrists’ Research and Training Unit concluded that the provision of substance misuse treatments in medium-secure units (MSUs) at that time was inadequate. The purpose of this paper is to investigate how services may have developed since then to inform discussion over future development and best practice.


A postal survey, supported by the Quality Network for Forensic Mental Health Services, was sent to 62 MSUs across the UK and Ireland. This questioned prevalence, interventions and staff training in substance misuse.


In total, 41 units responded (66 per cent). The data suggest rates of substance misuse within MSUs have reduced and provision of treatment has increased in recent years. The majority of MSUs provide a variety of interventions to address substance misuse and are internally resourced, in tune with current national guidance. However, the data suggest many MSU staff are not receiving adequate training in substance misuse treatments and some MSUs do not appear to have a cohesive strategy that would be consistent with best practice.

Practical implications

This study provides an up-to-date overview of the provision of treatment for substance misuse within MSUs.


There is no other source for this information, which will provide an invaluable reference point for services seeking to develop or improve their clinical services.



The authors would like to thank Sarah Tucker, Sarah Stubbs and colleagues at the Royal College of Psychiatrists Quality Network for Forensic Mental Health for their assistance with this project.


Sandbrook, J., Clark, T. and Cocksedge, K. (2015), "Addressing substance misuse in medium secure settings in the UK and Ireland – a survey of current practice", The Journal of Forensic Practice, Vol. 17 No. 3, pp. 192-203.

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