Introduction

This paper might have been better entitled: ‘A glimpse of the private sector’, since I consider myself unable to generalize about provision for mentally abnormal offenders within the private sector as a whole. Instead, I must draw heavily upon my personal experience of the recent expansion of services at Kneesworth House Hospital. Hopefully, this may not prove too limited or biased a sampling of current service provision. The views expressed are essentially my own, and should not be considered to reflect the official views of the management at Kneesworth House Hospital, nor those of the managers of the Psychiatric Division of AMI Healthcare Group pic.1 I will first consider the context which appears to have created the need and opportunity for the emergence of private sector provision for these patients. Then I will give an account of this provision with specific reference to Kneesworth House Hospital and the functions it has served. Finally, I will take a very tentative look at the future.

The context: ‘a right to treatment?’

In contrast with previous legislation, the Mental Health Act 1959 can be described as being more utilitarian in seeking to ensure that mentally abnormal offenders should have access to treatment. Although the Mental Health Act 1983 has been described as a shift towards legalism, it has preserved and potentially strengthened this utilitarian ideal concerning the disposal of offenders. Thus, Gostin (1983) suggests that part of the current legal approach to psychiatry is the ‘ideology of entitlement’, i.e. ‘that access to health and social services should not be based upon charitable or professional discretion, but upon enforceable rights’.

As Shapland and Williams (1983) have commented, such entitlement begs the issue of the availability and adequacy of treatment services to meet the needs of the abnormal offender. Thus, both Mental Health Acts have also supported the move away from services based upon large institutions, towards community care. As Bluglass commented as early as 1978, the open door policy in local psychiatric hospitals and the transfer of services to district general hospital settings, have resulted in an increasing reluctance to accept difficult patients (Bluglass, 1978).