A lack of “step down” services is adding to pressures on secure mental health services, say researchers.

A report for the National Mental Health Development Unit found mental health hospital beds for criminal offenders were “blocked” by a lack of community and lower security services for recovering service users to move on to.

It said secure services were “typified by slow patient turnover”, with inpatient admissions outweighing discharges.

The review, conducted by the Centre for Mental Health, was based on visits to seven sites across England.

Centre for Mental Health deputy chief executive Andy Bell said the problem was happening across England.

He said: “The pathways through the system, right through from identification [of the need to admit to a secure service] to the point where they can move on to something else, are full of blockages.”

He said a “stepped” system of care would be ideal but “we’re missing the bottom rungs”.

Clinicians in medium secure services were “not confident” lower levels were well provided enough to support patients and protect the public, said Mr Bell.

January board papers from City and Hackney Teaching Primary Care Trust indicated the problem was acute at East London Foundation Trust, where nearly a third of patients in the medium secure unit had been there for two years or longer.

Secure services are generally commissioned by specialised commissioning groups in block regional contracts, which do not provide for lower level services.

The Centre for Mental Health report said the contracts created incentives for high bed occupancy rates.

North West London Foundation Trust clinical director Annie Bartlett agreed “there is a perverse incentive to maintain 100 per cent bed occupancy”.

She said more services in the community would help to move people out of secure services.

Last week the government announced a £5m investment in 100 “diversion sites”. The pilots will take offenders with mental health problems out of the criminal justice system and refer them to mental health services.

Dr Bartlett said the scheme could help alleviate the blockages in medium secure units by diverting those for whom they are “unnecessarily secure”.