22% of high secure and 18% of medium secure patients meet long-stay criteria. Average continuous secure stay is 14.5 years with 20% exceeding 20 years. 58% are violent offenders and 22% committed both sexual and violent crimes. Schizophrenia diagnoses 60% and personality disorder 47% mostly antisocial and borderline. 27% convicted of violent or sexual offenses while institutionalized. 26% assaulted staff seriously in last 5 years. 16% have intellectual disability. 7% never convicted of any offense. 16.5% lack index offense prompting admission. High secure longstayers show more offenses against persons and property. High secure patients more often assault staff and require seclusion. 67% history of self-harm or suicidality. Complex pathways average 1.43 site changes with frequent up and down security moves. 33% had unsuccessful referrals to lower security in last 5 years. Majority male, single, UK-born, unqualified, and unemployed.