In recent years the courts have become more involved in the psychiatric services in Israel. Data reveal a gradual increase in the rate of court ordered hospitalizations according to Section 15 of the Law for the Treatment of the Mentally Ill. This paper examines the implications of this trend while focusing on the issues of security and safety in psychiatric hospitals. The work presents highlights from extensive British experience with this issue, while focusing on the implications on forensic psychiatry in Israel. The development of the hierarchy of security in the British psychiatric services beginning with the early 1970's, with the establishment of the Butler Committee that determined a hierarchy of three levels of security for the treatment of patients and culminating with the establishment of principles for the operation of medium security units in Britain (Read Committee, 1991) is reviewed. Forensic psychiatric services in Britain are based on these developments.

We examine the current status of mental health facilities in Israel, and the relevance of the British experience to the Israeli situation. In our opinion, a safe appropriate environment is a necessary condition for an appropriate treatment setting. As is in several European countries we are suggesting the establishment of medium security forensic psychiatry departments within a mental health facility that will enable concentration and classification of court ordered admissions as well as systemic flexibility and capacity for better treatment, commensurate with patient needs.