The author documents the harm caused by secure institutions. Policy makers must accept that a search for other models of care is necessary, otherwise the institutions remaining will never be able to meet the diverse needs of their inhabitants. This book makes the case for 'flexible' institutions which would offer resources to staff in local hospitals and residential accommodation to enable them to deal with periodic outbursts of difficult or dangerous behaviour without transferring the patient to a secure institution. The author argues forcibly that it is now time for government and mental health professionals to consider the problems, and to advance their own ideas for the reform of institutions badly in need of change.