Journal articles on the topic 'Medium Secure Psychiatric Care'
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Kasmi, Yasir. "Profiling medium secure psychiatric intensive care unit patients." Journal of Psychiatric Intensive Care 6, no. 02 (December 10, 2009): 65–71. http://dx.doi.org/10.1017/s1742646409990185.
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Nelson, D. "Service innovations: the Orchard Clinic: Scotland's first medium secure unit." Psychiatric Bulletin 27, no. 03 (March 2003): 105–7. http://dx.doi.org/10.1192/s0955603600001641.
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The development of forensic psychiatry provision in Scotland lags behind that in other parts of the United Kingdom. Until recently, there were no medium secure units in the country and mentally disordered offenders (MDOs) requiring such care had to be managed in intensive psychiatric care unit (IPCU) settings. In November 2000, The Orchard Clinic, a medium secure unit sited at the Royal Edinburgh Hospital, was opened. This paper discusses the background to this development, the government policies setting out plans for the care, services and support of MDOs in Scotland, progress and work of the new unit to date and plans for developments in other parts of Scotland.
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Nelson, D. "Service innovations: the Orchard Clinic: Scotland's first medium secure unit." Psychiatric Bulletin 27, no. 3 (March 2003): 105–7. http://dx.doi.org/10.1192/pb.27.3.105.
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The development of forensic psychiatry provision in Scotland lags behind that in other parts of the United Kingdom. Until recently, there were no medium secure units in the country and mentally disordered offenders (MDOs) requiring such care had to be managed in intensive psychiatric care unit (IPCU) settings. In November 2000, The Orchard Clinic, a medium secure unit sited at the Royal Edinburgh Hospital, was opened. This paper discusses the background to this development, the government policies setting out plans for the care, services and support of MDOs in Scotland, progress and work of the new unit to date and plans for developments in other parts of Scotland.
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Beer, M. Dominic. "Psychiatric intensive care and low secure units: where are we now?" Psychiatric Bulletin 32, no. 12 (December 2008): 441–43. http://dx.doi.org/10.1192/pb.bp.108.019489.
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SummaryThe last decade has seen clinicians and policy makers develop psychiatric intensive care units and low secure units from the so-called ‘special care wards’ of the 1980s and 1990s. Psychiatric intensive care units are for short-term care, while low secure units are for care for up to about 2 years. Department of Health standards have been set for these units. A national survey has shown that there are two main patient groups in the low secure units: patients on forensic sections coming down from medium secure units and those on civil sections who are transferred from general psychiatric facilities. Recent clinical opinion has emphasised the important role both psychiatric intensive care units and low secure units play in providing a bridge between forensic and general mental health services.
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Lelliott, Paul, Bernard Audini, and Richard Duffett. "Survey of patients from an inner-London health authority in medium secure psychiatric care." British Journal of Psychiatry 178, no. 1 (January 2001): 62–66. http://dx.doi.org/10.1192/bjp.178.1.62.
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BackgroundUnderprovision by the National Health Service (NHS) has led to an increase in medium secure psychiatric beds managed by the independent sector. Black people are overrepresented in medium secure care.AimsTo describe those people from an inner-London health authority occupying all forms of medium secure provision. To compare those in NHS provision with those in the independent sector, and Black patients with White patients.MethodA census of those in medium secure care in August 1997.ResultsThe 90 patients in independent-sector units were similar to the 93 patients in NHS units except that they were more likely to have been referred from general psychiatric services (48% v. 19%) and less likely to have been referred from the criminal justice system or a high-security hospital (37% v. 63%). There were few differences between Black and White patients.ConclusionsThe NHS meets only part of the need for medium secure care of the population of this London health authority. This comparison of the characteristics of Black and White patients does not help to explain why Black people are overrepresented in medium secure settings.
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Broadhurst, Scott, and Kathryn Swindell. "Screening for ADHD in male medium secure psychiatric services." BJPsych Open 7, S1 (June 2021): S11. http://dx.doi.org/10.1192/bjo.2021.89.
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AimsRoughly 25% of the prison population are known to meet the criteria for attention-deficit/hyperactivity disorder (ADHD), a five-fold increase on the general population. Medium secure psychiatric services receive a high percentage of referrals from the prison service. ADHD has primary symptoms of inattention, hyperactivity and impulsivity. Untreated ADHD could clearly have a detrimental impact on the effectiveness of therapeutic interventions, as well as increasing incidents of violence, aggression and other transgressive behaviours.There are two aims: To screen the medium secure services population at the Spinney Hospital, Atherton, UK for ADHD, using a validated screening tool. This would generate candidates for further structured clinical assessment for ADHD; To implement ADHD screening as a feature of the Admission Care Plan within medium secure services at the Spinney.MethodThe study population is the medium secure service at The Spinney Hospital, Atherton. At the time of study this was 52 male service users.The team members have evaluated several screening tools. The tool eventually chosen was the B-BAARS, which is a simple 6-question tool that is validated for use in adults. The tool takes around 1 minute to complete. All 52 service users were screened between 20/01/2021 and 30/01/2021.Result1 of the 52 service users had a current diagnosis of ADHD and was being treated with medication. 3 of the 52 service users had childhood diagnoses of ADHD that had lapsed in adulthood and who were untreated. Of the remaining 51 service users without a current diagnosis of ADHD, 9 were positive on screening as worthy of further assessment (17.65%). Assessments of the 9 service users positive in screening will be completed by medical and psychology disciplines.ConclusionThere appears to be clear merit for routine screening for ADHD within medium secure psychiatric services, given the service user population and the results described above. As a result of this survey, within The Spinney Hospital the B-BAARS will be incorporated into the Admission Care Plan of all new admissions to medium secure services as a Quality Improvement Intervention. Over time this will be re-audited and there will be assessment of any impact on incidents and positive engagement with activities.
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Moss, Katrina R. "A Comparative Study of Admissions to Two Public Sector Regional Secure Units and One Independent Medium-Secure Psychiatric Hospital." Medicine, Science and the Law 40, no. 3 (July 2000): 216–22. http://dx.doi.org/10.1177/002580240004000305.
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To date there has been no research carried out in respect of the contribution being made by the independent sector to medium-secure psychiatric care. There are also no published studies comparing the provision of the independent sector with that of the public sector. As such this is a neglected field of study. This paper examines the characteristics of patients admitted to one independent medium-secure psychiatric hospital and two regional secure units in terms of their demographic characteristics, source, detention under the Mental Health Act, 1983, psychiatric diagnosis, criminal history and discharge. The results of the study are tested for their significance using the chi-square distribution. There is discussion of how the independent sector may be providing a service either unavailable within the National Health Service or for which the National Health Service is unsuitable in terms of patients either requiring medium- to long-term hospital care in conditions of security or those who cannot live independently and therefore require ‘asylum’, which is no longer an option within the National Health Service. In this sense, the independent sector could be seen as meeting a national need by acting as a ‘safety valve’ for National Health Service facilities.
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Davies, Steffan, Martin Clarke, Clive Hollin, and Conor Duggan. "Long-term outcomes after discharge from medium secure care: a cause for concern." British Journal of Psychiatry 191, no. 1 (July 2007): 70–74. http://dx.doi.org/10.1192/bjp.bp.106.029215.
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BackgroundThere are few long-term follow-up studies of patients discharged from medium secure units in the UK, even though these units were introduced over 20 years ago.AimsTo describe mortality, rates of reconviction at different time periods; violent behaviour (not leading to conviction), readmission and employment, after discharge from a medium secure unit.MethodOf 595 first admissions over a 20-year period, 550 discharged cases were followed-up. Multiple data sources were used.ResultsFifty-seven (10%) patients had died, of whom 18 (32%) died by suicide, and the risk of death was six times greater than in the general population. Almost half (49%) of those discharged were reconvicted and almost two-fifths (38%) of patients were readmitted to secure care.ConclusionsCommunity psychiatric services need to be aware that those discharged from medium secure care are a highly vulnerable group requiring careful follow-up if excess mortality high levels of psychiatric morbidity and further offending are to be prevented.
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Long, Clive G., Olga Dolley, Ruth Barron, and Clive R. Hollin. "Women transferred from prison to medium-secure psychiatric care: the therapeutic challenge." Journal of Forensic Psychiatry & Psychology 23, no. 2 (March 30, 2012): 261–73. http://dx.doi.org/10.1080/14789949.2012.674151.
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McClean, Rowan James. "Assessing the security needs of patients in medium secure psychiatric care in Northern Ireland." Psychiatrist 34, no. 10 (October 2010): 432–36. http://dx.doi.org/10.1192/pb.bp.109.027672.
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Aims and methodTo determine the security needs of patients in medium secure services in Northern Ireland and to identify those requiring long-term secure care. Patients were rated on the Security Needs Assessment Profile.ResultsFifteen patients (45%) could be managed in conditions of low security. Twelve patients (36%) require over 5 years' further treatment in secure care. Particular security needs include relational nursing skills, restricted access to alcohol and drugs, and robust physical security.Clinical implicationsThis study should be replicated across the UK to determine whether forensic services are responding to patients' needs. Pathways out of medium security need to be better developed, with regional expansion of low secure services.
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Woods, Laura, Laura Craster, and Andrew Forrester. "Mental Health Act transfers from prison to psychiatric hospital over a six-year period in a region of England." Journal of Criminal Psychology 10, no. 3 (June 27, 2020): 219–31. http://dx.doi.org/10.1108/jcp-03-2020-0013.
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Purpose There are high levels of psychiatric morbidity amongst people in prisons. In England and Wales, prisoners who present with the most acute mental health needs can be transferred to hospital urgently under part III of the Mental Health Act 1983. This project reviewed all such transfers within one region of England, with an emphasis on differences across levels of security. Design/methodology/approach Over a six-year period (2010–2016) within one region of England, 930 psychiatric referrals were received from seven male prisons. From these referrals, 173 (18.5%) secure hospital transfers were required. Diagnostic and basic demographic information were analysed, along with hospital security categorisation (high secure, medium secure, low secure, psychiatric intensive care unit and other) and total time to transfer in days. Findings There were substantial delays to urgent hospital transfer across all levels of hospital security. Prisoners were transferred to the following units: medium security (n = 98, 56.9%); psychiatric intensive care units (PICUs) (n = 34, 19.7%); low secure conditions (n = 20, 11.6%); high secure conditions (n = 12, 6.9%); other (n = 9, 5.2%). Mean transfer times were as follows: high secure = 159.6 days; other = 68.8 days; medium secure = 58.6 days; low secure = 54.8 days; and psychiatric intensive care = 16.1 days. Research limitations/implications In keeping with the wider literature in this area, transfers of prisoners to hospital were very delayed across all levels of secure psychiatric hospital care. Mean transfer times were in breach of the national 14-day timescale, although transfers to PICUs were quicker than to other units. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. Originality/value This paper extends the available literature on the topic of transferring prisoners with mental illness who require compulsory treatment. There is a small but developing literature in this area, and this paper largely confirms that delays to hospital transfer remain a serious problem in England and Wales. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. This could include different referral and transfer models as a component of service-based and pathways research or combining referral pathways across units to improve their efficacy.
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Edworthy, R., and B. Vollm. "Long-stay in high and medium secure forensic psychiatric care – Prevalence, patient characteristics and pathways in England." European Psychiatry 33, S1 (March 2016): S180. http://dx.doi.org/10.1016/j.eurpsy.2016.01.385.
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IntroductionForensic psychiatric services are costly and highly restrictive for patients. Clinical experience and the limited research available indicate some patients stay for too long in these settings. A proportion of patients may, however, require long-term (potentially life-long) secure forensic psychiatric care but their needs may not be met by existing service provision designed for faster throughput.ObjectivesWe conducted a national, multi-centre, cross sectional study exploring the prevalence of long-stay and characteristics of long-stayers in high and medium secure forensic psychiatric care in England.Aims(1) Estimate the prevalence of long-stay in secure settings in England (length of stay over 5 years in medium secure care or 10 years in high secure care); (2) describe the characteristics, needs and care pathways of long-stay patients. Develop recommendations following the exploration of international models for this patient group.MethodsWe employed a mixed-methods approach including the analysis of administrative data, case file reviews, patient interviews, consultant questionnaires, interviews with clinicians and commissioners and a Delphi survey.ResultsTwenty-five percent (n = 401) of our sample were experiencing long-stay. This patient group has a heterogeneous set of characteristics and needs relating to their diagnosis, offending history, risk and therapeutic need and have experienced a variety of care pathways through secure care.ConclusionsWe found a greater number of long-stay patients than originally estimated with a set of characteristics and needs that are arguably different to that of the general forensic population, therefore calling for a specific care pathway and service provision for this patient group with a greater focus on autonomy and quality of life.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Hassell, Yonette, and Annie Bartlett. "The changing climate for women patients in medium secure psychiatric units." Psychiatric Bulletin 25, no. 9 (September 2001): 340–42. http://dx.doi.org/10.1192/pb.25.9.340.
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Aims and MethodWe conducted a telephone survey of medium secure units in England and Wales to determine the distribution of women patients.ResultsThe survey identified 1836 medium secure beds, housing 342 women patients. Women in the NHS were housed primarily in mixed-gender units (170 women, 94%). Most NHS beds in single-gender units were for men (56 beds), whereas most private sector beds in single-gender units were for women (79 beds).Clinical ImplicationsIncreased awareness of the often inappropriateness of services for women in mixed-gender units has led to units deciding not to admit women patients and, inadvertently, more single-gender beds for men in NHS units than for women. The NHS units have to rely on private sector units to provide beds in single-gender units for women, perhaps at the expense of effective continuity of care.
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Das, Kavita, Kevin Murray, Rick Driscoll, and S. Rao Nimmagadda. "A comparative study of healthcare and placement needs among older forensic patients in a high secure versus medium/low secure hospital setting." International Psychogeriatrics 23, no. 5 (November 25, 2010): 847–48. http://dx.doi.org/10.1017/s1041610210002231.
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It is predicted that there will be a significant growth in the population aged over 65 years in the U.K., from 15.9% in 2000 to 23.3% in 2050, with the fastest growth rate being among the oldest old (United Nations, 2005). In line with such growth, there will be a commensurate increase in the population of older people suffering from psychiatric conditions. This will lead to a demand for increased health care services and the need for reorganization and prioritization of resources channeled into health care for this group.
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Doyle, Michael, Jeremy Coid, Laura Archer-Power, Lindsay Dewa, Alice Hunter-Didrichsen, Rachel Stevenson, Verity Wainwright, Costas Kallis, Simone Ullrich, and Jenny Shaw. "Discharges to prison from medium secure psychiatric units in England and Wales." British Journal of Psychiatry 205, no. 3 (September 2014): 177–82. http://dx.doi.org/10.1192/bjp.bp.113.136622.
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BackgroundEarly findings from a national study of discharges from 32 National Health Service medium secure units revealed that nearly twice as many patients than expected were discharged back to prison.AimsTo compare the characteristics of those discharged back to prison with those discharged to the community, and consider the implications for ongoing care and risk.MethodProspective cohort follow-up design. All forensic patients discharged from 32 medium secure units across England and Wales over a 12-month period were identified. Those discharged to prison were compared with those who were discharged to the community.ResultsNearly half of the individuals discharged to prison were diagnosed with a serious mental illness and over a third with schizophrenia. They were a higher risk, more likely to have a personality disorder, more symptomatic and less motivated than those discharged to the community.ConclusionsFindings suggest that alternative models of prison mental healthcare should be considered to reduce risks to the patient and the public.
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Dolan, Mairead, and Alan Lawson. "Characteristics and outcomes of patients admitted to a psychiatric intensive care unit in a medium secure unit." Psychiatric Bulletin 25, no. 8 (August 2001): 296–99. http://dx.doi.org/10.1192/pb.25.8.296.
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Aims and MethodThere have been no reports on psychiatric intensive care units (PICUs) in medium secure psychiatric facilities. Using case files, we retrospectively examined the characteristics and outcomes of 73 patients who were admitted to a PICU in a medium secure unit between 1 July 1994 and 30 April 1998.ResultsThe PICU population was predominantly male, suffering from illness and detained under Part III of the Mental Health Act, 1983. Although the mean length of stay was 75 days, the majority were ultimately transferred to less intensive nursing environments and only nine required transfer to maximum security. In 10% of cases PICU admission was owing to lack of appropriate facilities elsewhere.Clinical ImplicationsAlthough the PICU was intended as a crisis facility for the management of challenging behaviours, its function was affected by the lack of clear admission and discharge criteria and appropriate facilities for patients with diverse mental, physical and security needs.
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Gibbon, Simon, Emma McPhail, Georgina Mills, Martin McBride, Rebakah Storer, Nicholas Taylor, and Lucy McCarthy. "Uptake of COVID-19 Vaccination in a Medium Secure Psychiatric Hospital Population." BJPsych Open 8, S1 (June 2022): S60—S61. http://dx.doi.org/10.1192/bjo.2022.217.
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AimsCompared with the general population, people with mental health disorders are at increased risk of negative physical and mental health outcomes following SARS-CoV-2 infection. In the UK, all adult mental health in-patients were offered COVID-19 vaccination as a priority group. Patients admitted to medium secure care have greatly increased mortality compared with the general population. Understanding COVID-19 vaccine uptake, and reasons for refusal, in patients in medium secure hospitals is important given the high prevalence of chronic physical health comorbidities such as obesity and diabetes, as these conditions are also associated with poor clinical outcomes in COVID-19 disease. Aims: To assess the proportions of patients who accepted or declined the COVID-19 vaccine, and explore their reasoning. To examine vaccine uptake between White and Black Asian minority ethnic (BAME) patients, and between younger/older patients.MethodsThe study took place at a medium secure hospital with male and female inpatients. All patients were offered a COVID-19 vaccine, and had a capacity and physical health evaluation completed by their Consultant Forensic Psychiatrist.ResultsData regarding capacity to consent to the vaccine, acceptance/refusal, and demographics were retrospectively collected from the clinical records. In total, 85 patients (92.4% of eligible patients) had capacity to decide if they wanted the COVID-19 vaccine. Of these 68 (80.0%) consented and 17 (20.0%) declined to consent.A similar proportion of patients aged under and over 40 years old consented. Those from a BAME background were more likely to decline than White British patients. The reasons for capacitous refusal appeared similar to the general population.ConclusionCOVID immunisation was broadly acceptable for patients in medium secure hospitals. The prevalence and reasoning of capacitous refusal appears similar to the general English population.The indication that BAME patients were more likely than White patients to decline the vaccination echoes the findings of research conducted in the Leicester general hospital. Further consideration needs to be given to how the uptake of COVID-19 vaccination can be improved in people with BAME ethnicity, especially as this group is also overrepresented in secure hospital settings.The study demonstrates that similar services should be able to approach the vaccination process with confidence. As many people with severe mental disorder also have high physical comorbidity that would increase the risk of a poor clinical outcome if they contracted COVID-19, protecting this vulnerable population through vaccination must be a priority for mental health services.
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Thomson, Lindsay D. G. "Management of schizophrenia in conditions of high security." Advances in Psychiatric Treatment 6, no. 4 (July 2000): 252–60. http://dx.doi.org/10.1192/apt.6.4.252.
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There are four high-security hospitals in the UK: Broadmoor Hospital in Berkshire (founded in 1863), Rampton Hospital in Nottinghamshire (1914), Ashworth Hospital in Merseyside (1990), which opened following the amalgamation of Park Lane (1974) and Mosside Hospitals (1913), and the State Hospital at Carstairs in Lanarkshire (1948). The first three are known as the special hospitals and serve England and Wales. The latter offers a special security service, combining high and medium secure care, for the whole of Scotland and Northern Ireland – there is no form of medium secure psychiatric provision in these countries. All four hospitals provide care for patients with mental disorders and dangerous, violent or criminal propensities. There are approximately 1550 beds in these facilities and all patients are formally detained under mental health or criminal legislation. The special hospitals are currently administered by the high-security psychiatric services commissioning team, managed locally as individual authorities, although in the future it is intended to integrate them more fully into the National Health Service (NHS) and to organise both high and medium secure services at a regional level. Carstairs is administered by the State Hospital Board for Scotland which has the status of a special health board.
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Basrak, N., Y. Khogali, R. Twomey, C. O’Leary, D. Prashant, M. Elhassan Elamin, H. Kennedy, and M. Davoren. "Stratification of a medium secure forensic care pathway according to risk and need: A study from dundrum hospital." European Psychiatry 64, S1 (April 2021): S374. http://dx.doi.org/10.1192/j.eurpsy.2021.1002.
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IntroductionSecure forensic mental health services have a dual role, to treat mental illness and reduce violent recidivism. Those admitted to secure forensic services have a significant history of violence and treatment needs in multiple domains including psychiatric illness, violence and other areas such as substance misuse and physical health.ObjectivesThe aim of this study was to ascertain if the units in a medium secure forensic hospital are stratified according to individual risks and needs. We also aimed to clarify if there were differences in the symptom level, risks and needs of those with and without community leave and to clarify the risks and needs of the female patients and ID patients.MethodsThis is a cross sectional study a cohort of patients (n=138) in a secure forensic hospital.ResultsThere was a total of 138 patients, the majority of whom were male (n=123, 89.1%). The most common diagnosis was schizophrenia (n=99, 71.7%). Placements in the care pathway of the medium secure forensic hospital were associated with level of symptomatology (PANSS positive), dynamic violence risk (F=26.880,P<0.001), DUNDRUM-3 therapeutic programme completion (F=44.067,P<0.001), and DUNDRUM 4 recovery (F=59.629,P<0.001). Patients with community leave had better scores than those without leave on violence risk (F=77.099, P<0.001), therapeutic programme completion (F=116.072, P<0.001) and recovery (F=172.211, P<0.001).ConclusionsStratifying secure forensic psychiatric hospitals according to individual risks and needs provides in-patient care in the least restrictive setting appropriate for individuals, however niche groups such as female forensic patients and ID patients may need special consideration.
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Durand, Mary Alison, Paul Lelliott, and Nicholas Coyle. "Availability of treatment for substance misuse in medium secure psychiatric care in England: A national survey." Journal of Forensic Psychiatry & Psychology 17, no. 4 (December 2006): 611–25. http://dx.doi.org/10.1080/14789940600911577.
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Melzer, David, Brian DM Tom, Traolach Brugha, Tom Fryers, Rebecca Gatward, Adrian Grounds, Tony Johnson, and Howard Meltzer. "Access to medium secure psychiatric care in England and Wales. 1: A national survey of admission assessments." Journal of Forensic Psychiatry & Psychology 15, no. 1 (March 2004): 7–31. http://dx.doi.org/10.1080/14789940310001648203.
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Melzer, David, Brian DM Tom, Traolach Brugha, Tom Fryers, Rebecca Gatward, Adrian Grounds, Tony Johnson, and Howard Meltzer. "Access to medium secure psychiatric care in England and Wales. 3: The clinical needs of assessed patients." Journal of Forensic Psychiatry & Psychology 15, no. 1 (March 2004): 50–65. http://dx.doi.org/10.1080/14789940410001661856.
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Hambridge, J. A. "Referrals to an out-patient forensic psychology service." Psychiatric Bulletin 16, no. 4 (April 1992): 222–23. http://dx.doi.org/10.1192/pb.16.4.222.
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Following the recommendations of the Butler Report (Home Office, 1975), there has been a slow growth in the number of Regional Secure Units (RSUs) (Snowden, 1985), which aim to assess and treat mentally disordered offenders in England and Wales in conditions of “medium security”. One particular recommendation of the Butler Report was that:“The main emphasis in forensic psychiatric services … should be on community care and out-patient work.” (paragraph 20.14)
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Grounds, Adrian, Loraine Gelsthorpe, Marie Howes, David Melzer, Brian DM Tom, Traolach Brugha, Tom Fryers, Rebecca Gatward, and Howard Meltzer. "Access to medium secure psychiatric care in England and Wales. 2: A qualitative study of admission decision-making." Journal of Forensic Psychiatry & Psychology 15, no. 1 (March 2004): 32–49. http://dx.doi.org/10.1080/14789940310001648212.
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Woodward, R., R. Lingam, and F. Papouli. "Cost-effectiveness of a Specialised Medium Secure Personality Disorder Service." European Psychiatry 41, S1 (April 2017): S87—S88. http://dx.doi.org/10.1016/j.eurpsy.2017.01.275.
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IntroductionThe Oswin unit located in the North East of England is commissioned primarily for offenders screened on the offender personality disorder (OPD) pathway based on measures of personality disorder being linked to moderate to high risks to other persons.ObjectivesThe Oswin Unit was re-designed in early 2014 meeting commissioning specifications to meet objectives based on access, measuring quality and reducing. The primary objective of this pathway is to ensure personality Disorder offenders have access to “community-to-community”, joint-up care and monitoring of risks. The Oswin unit implemented a re-designed service offering individuals formulation based assessments and risk management embedded in the OPD pathway. The overall objective of this project is to evaluate the effectiveness and risk amelioration of this hospital-based service.AimAs part of a broader service development and evaluation project, the cost-effectiveness of the current model of the unit was compared to that of the unit prior to the redesign of the service.MethodCollection of data on number of admission and length of stay and calculation of expenses per capita. Retrospective analysis of costs of care.ResultsAnalysis of comparative figures post-implementation of this new model of care found 41% more episodes of care. Cost-analysis indicated a saving of £200,000.ConclusionThe new Oswin Model meets commissioning objectives in offering access to hospital-based care and focused treatments for prisoners ‘stuck’ in prison pathways. This finding led to further investigation using thematic measures of quality of care to evaluate the effectiveness of this service and risk amelioration.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Ghosh, Sanjib Kumar, and Eddie Chaplin. "Personal experiences of autism and secure units." Advances in Autism 2, no. 3 (July 4, 2016): 147–50. http://dx.doi.org/10.1108/aia-04-2016-0010.
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Purpose – A consultant forensic psychiatrist and an individual with autism under his care discuss their experiences of working with autism in secure care. Dr Ghosh is a Consultant Forensic Psychiatrist who analyses some of the practice issues and concerns for clinicians working with people with autism in secure care. He includes comments on the issues raised by one individual with autism (who has consented to sharing his thoughts) in secure care based on his experiences. This is particularly relevant given the recent publication of Building the Right Support, which offers national guidance to develop community services and close inpatient facilities for people with a learning disability and/or autism who display challenging behaviour, including those with a mental health condition. The paper aims to discuss these issues. Design/methodology/approach – X is an autistic patient on a medium secure unit. His viewpoint, together with his then inpatient consultant psychiatrist ' s view, is given. Findings – There are multiple issues for patients and staff to consider when on a secure unit. The approach to take is focusing on holistic management. Originality/value – This paper starts with the patient perspective of his experiences with autism in the community and in hospital. This provides a framework for the paper to demonstrate how theoretical knowledge and holistic, patient-centred management can be applied to address the issues raised for an autistic patient who has spent a number of years as an inpatient on a medium secure unit. It shows how such plans can directly involve the patient and be adapted to suit the patient ' s self-identified needs and wishes. It also looks at the challenges longer-term inpatients with autism face in their rehabilitative journey from the patient and clinician perspectives.
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Hood, Abigail, Johanna Andersson, Charlotte Jones, and Lisa Gardiner. "The physical healthcare of patients in secure hospitals: setting standards for medical equipment." BJPsych Open 7, S1 (June 2021): S193—S194. http://dx.doi.org/10.1192/bjo.2021.521.
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AimsThe increased morbidity and mortality relating to the poor physical health of patients with severe mental illness has repeatedly been an area identified as requiring improvement. Despite this, no national minimum standard has been published around the minimum level of physical health equipment that should be available within an inpatient psychiatric setting.The aim of this project was to improve and standardise availability of physical health equipment across the five clinical areas within a medium secure inpatient forensic setting, thus enabling optimal and timely medical care and physical examination of patients to occur.MethodThis project used a combination of audit and quality improvement practices. An audit standard was created and current practice was established within the 5 clinical areas of a Medium Secure Forensic Unit. Improvements were made in a systematic and measured way and two audit cycles were completed.ResultAt baseline, the attainment of audit standard ranged from 14-76%. Clinical areas were sharing equipment and there was an inconsistency as to where and how equipment was being stored. Changes implemented included redistribution and reorganisation of equipment which increased attainment to between 48% - 86%. Following this further equipment was ordered and the equipment was separated into that which was required on a daily basis to conduct physical observations and more specialist specific examination equipment. Re-audit found attainment across the five clinical areas being between 90-100%.ConclusionMonitoring of physical health within psychiatric inpatient settings is a key area of patient care, and is frequently identified as requiring improvement. Without access to equipment to monitor and assess physical health, this becomes challenging and potentially poorly completed. By standardizing available equipment and furthermore through practical steps such as separating the equipment required on a daily basis and that used less frequently the retention of equipment improved. This enables delivery of high quality, timely and thorough monitoring and assessment of physical health to be achievable.
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Kanyeredzi, Ava, Steven D. Brown, Laura McGrath, Paula Reavey, and Ian Tucker. "The atmosphere of the ward: Attunements and attachments of everyday life for patients on a medium-secure forensic psychiatric unit." Sociological Review 67, no. 2 (February 28, 2019): 444–66. http://dx.doi.org/10.1177/0038026119829751.
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The climate or atmosphere of a ward in secure psychiatric care is typically studied by examining the relationship between social and environmental factors. However the experiences of patients are irreducible to a set of discrete dimensions or factors. Drawing on recent work in affect theory and architectural studies, we argue for an approach to atmosphere that places it ‘in-between’ persons and space, as a ‘spatially extended quality of feeling’ of which patients are intimately aware. The article discusses empirical material drawn from a broader study of inpatient medium-secure forensic care in a large hospital in the South of England. We show how the process of becoming attuned to the fluctuations and shifts in the atmosphere of the ward is a critical aspect of everyday life for patients. Attunement cuts across existing notions of power and resistance in these settings. We also demonstrate how attachments to a range of objects, some created by patients, can either expand or punctualize attunement, enabling change in the overall atmosphere. We conclude by speculating on how we might rethink spaces of recovery on an ethospheric basis.
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McDonnaugh, Tanya, Alan Underwood, and Amanda Williams. "“Swimming against the tide”: conditional discharge from medium secure care." Journal of Forensic Practice 22, no. 2 (February 13, 2020): 57–69. http://dx.doi.org/10.1108/jfp-06-2019-0023.
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Purpose The purpose of this paper is to explore the experiences of mentally disordered offenders (MDOs) conditionally discharged from secure hospitals on a restrictive Section of the Mental Health Act (Section 37/41). Design/methodology/approach Data were derived from seven semi-structured interviews from three forensic community teams. Findings Thematic analysis identified seven predominant themes: (1) the uncertainty of the discharge timeframe; (2) fear of jeopardising discharge; (3) progress; (4) engagement with community life; (5) barriers to social engagement; (6) evolving identity and (7) someone to turn to. Findings are discussed in relation to the recovery model and the good lives model. Practical implications The findings highlight the importance of fostering trust between MDOs and their care teams to encourage help-seeking. They also suggest that resources should be sequenced appropriately throughout the discharge process, to match the “window of engagement” and maximize impact and effectiveness. Originality/value This research gained rarely obtained first-hand perspectives from MDOs, with the findings contributing to a more effective evaluation of the discharge pathway.
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Gulati, Gautam, Kizito Otuokpaikhian, Maeve Crowley, Vishnu Pradeep, David Meagher, and Colum P. Dunne. "Mental healthcare interfaces in a regional Irish prison." International Journal of Prisoner Health 15, no. 1 (March 11, 2019): 14–23. http://dx.doi.org/10.1108/ijph-06-2017-0029.
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PurposeThe purpose of this paper is to study the demographic, clinical characteristics and outcomes for those prisoners referred to secondary mental healthcare in a regional Irish prison and the proportion of individuals diverted subsequently from prison to psychiatric settings.Design/methodology/approachThe authors conducted a retrospective review of 130 successive psychiatric assessment case records at a regional mixed gender prison serving six southern Irish counties. The authors analysed demographics, clinical characteristics and outcomes. Where diversion out of prison was undertaken, Dangerousness, Understanding, Recovery and Urgency Manual (DUNDRUM) scores were retrospectively completed to assess security need.FindingsIn total, 8.6 per cent of all committals from liberty were referred by a general practitioner and 8.1 per cent subsequently assessed by the visiting psychiatrist. Predominantly, these were young males charged with a violent offence. In all, 42.2 per cent of those assessed by secondary care were diagnosed with a substance misuse disorder and 21.1 per cent with a personality disorder. In total, 20.3 per cent suffered from a psychotic disorder and 10.6 per cent with an affective disorder. Of those seen by psychiatric services, 51.2 per cent required psychotropic medication, 29.2 per cent required psychological input and 59.3 per cent required addiction counselling. In all, 10.6 per cent of those assessed were diverted from prison, the majority to approved centres. Mean DUNDRUM-1 scores suggested that those referred to high and medium secure hospitals were appropriately placed, whereas those diverted to open wards would have benefited from a low secure/intensive care setting.Originality/valueThe multifaceted need set of those referred strengthens the argument for the provision of multidisciplinary mental healthcare into prisons. The analysis of security needs for those diverted from prisons supports the need for Intensive Care Regional Units in Ireland.
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Patel, Harikrishna, Kathryn Robinson, and Alexandra Kennard. "Improving Standards of Physical Health Care of Patients in Secure Mental Health Hospital." BJPsych Open 8, S1 (June 2022): S107. http://dx.doi.org/10.1192/bjo.2022.327.
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AimsEvidence suggests that individuals with serious mental illness (SMI) die up to twenty years prematurely compared to the average population without SMI with the main causes of death linked to preventable cardiovascular disease, respiratory failure, and endocrine disorders. This early mortality remains despite national efforts to recognise the issue and promote development of processes to enhance quality of physical health care in patients with SMI. The National Institute for Health and Care Excellence (NICE) clinical guidelines (CG178) recommendation 1.5.3.5 states that healthcare professionals in secondary care should ensure individuals with SMI receive physical health checks from primary care. This idea may be suitable for patients in the community setting or those who undergo shorter hospital admissions, however the process of psychiatric rehabilitation in secure mental health hospitals is challenged by long average stays resulting in no access to routine primary care facilities. The aim of the project is to introduce tailored measures that would aid in delivering high quality physical health care to patients within secure mental health hospitals.MethodsRavenswood House Medium Secure Hospital supported a project to improve the physical health of individuals with SMI. An audit was completed to evaluate the assessment and management of baseline physical health measures that would have usually been completed in primary care as per the standards set out in NICE guidelines. The results showed that not all measures were being met and there was room for improvement.Based on these NICE recommendations, an annual health check template and a centralised documentation toolkit were implemented and integrated within a new Physical Health Care Pathway in collaboration with General Practitioners, Dentists, Physiotherapists and other Allied Healthcare professionals.ResultsFollowing implementation of the Physical Health Care Pathway, the number and quality of annual physical health checks in Ravenswood House Medium Secure Hospital increased resulting in significantly better-quality outcomes for patients by completing appropriate referrals and follow-up care.ConclusionThis collaborative approach of providing a high-quality physical health care was delivered in-house by arrangement with external healthcare practitioners. This pathway of providing care assisted us in overcoming several challenges faced within secure hospitals due to legal sanctions and related security protocols involving the patient group.
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Gray, Nicola S., John Taylor, and Robert J. Snowden. "Predicting violent reconvictions using the HCR-20." British Journal of Psychiatry 192, no. 5 (May 2008): 384–87. http://dx.doi.org/10.1192/bjp.bp.107.044065.
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BackgroundRisk assessment of future violent acts is of great importance for both public protection and care planning. Structured clinical assessments offer a method by which accurate assessments could be achieved.AimsTo test the efficacy of the Historical, Clinical and Risk Management Scales (HCR–20) structured risk assessment scheme on a large sample of male forensic psychiatric patients discharged from medium secure units in the UK.MethodIn a pseudo-prospective study, 887 male patients were followed for at least 2 years. The HCR-20 was completed using only pre-discharge information, and violent and other offending behaviour post-discharge was obtained from official records.ResultsThe HCR–20 total score was a good predictor of both violent and other offences following discharge. The historical and risk sub-scales were both able to predict offences, but the clinical sub-scale did not produce significant predictions. The predictive efficacy was highest for short periods (under 1 year) and showed a modest fall in efficacy over longer periods (5 years).ConclusionsThe results provide a strong evidence base that the HCR–20 is a good predictor of both violent and non-violent offending following release from medium secure units for male forensic psychiatric patients in the UK.
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G. Long, Clive, Olga Dolley, and Clive R. Hollin. "Personality disordered women in secure care: a treatment evaluation." Journal of Criminal Psychology 4, no. 1 (March 12, 2014): 44–58. http://dx.doi.org/10.1108/jcp-04-2013-0009.
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Purpose – The purpose of this paper is to assess the effectiveness of a gender-specific group treatment programme for personality disordered (PD) women in a medium secure psychiatric setting. Design/methodology/approach – In all, 56 consecutive admissions with a primary diagnosis of personality disorder (mostly borderline type) and co-morbidity were assessed according to their participation in, and benefit from, a core set of five manualised group treatments that focused on social and interpersonal deficits, instability of mood and problematic substance use. A single cohort pre-test post-test comparison design was used with evaluation based on global change over an amalgam of self-report group specific outcome measures. Findings – In all, 70 per cent of patients attended three or more core groups, with attendance for each group ranging from 85 to 53 per cent. Between 65 and 77 per cent of patients showed a significant improvement on pre-group psychometrics. Patients who achieved a significant positive change in one group tended to do so in others. In all, 85 per cent of patients who completed two or more groups had overall positive direction of change scores. Those who benefited from treatment engaged more quickly, were more likely to have been admitted from hospital, to have previously engaged in therapy and to score lower on measures of impulsivity and personality pathology. Research limitations/implications – In a clinically representative study the absence of a control group limits the extent to which observed changes can be attributed to described interventions. Practical implications – Findings reflect the importance of providing a broad clinical approach to changing cognitive behavioural functioning with PD patients in secure settings. They also highlight the need to improve ways of engaging patients at an earlier stage of hospital stay and of increasing the acceptability and uptake of relevant group treatments. Further evidence-informed service developments are needed to meet these challenges. Originality/value – The study adds to a small literature on the clinical impact of a gender-specific group treatment programme for PD women in secure settings.
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Pillay, Selena M., Brid Oliver, Louise Butler, and Harry G. Kennedy. "Risk stratification and the care pathway." Irish Journal of Psychological Medicine 25, no. 4 (December 2008): 123–27. http://dx.doi.org/10.1017/s0790966700011228.
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AbstractObjectives: It was hypothesised that patients admitted to forensic mental health facilities are stratified along the pathway through care according to levels of need. Level of risk and psychopathology should vary with different levels of security.Method: Seventy-five men in a forensic hospital were interviewed by three trained clinicians using the HCR-20 (Historical Clinical Risk Assessment) – clinical and risk items, The Health of the Nation Scales – Secure (HoNOS-SECURE), PANSS (Positive and Negative Syndrome Scale), GAF (Global Assessment of Functioning) and the CANFOR (Camberwell Assessment of need Forensic Version).Results: The mean scores on a variety of clinical measures were higher in admission/high security areas and progressively lower in rehabilitation and pre-discharge areas. As patients moved through the pathways of care, they improved in a number of areas including psychiatric morbidity, risk, function, unmet needs. The following results stratified significantly; the HCR-20 summated clinical and risk (F = 9.2, df = 5, p < 0.001), the HoNOS secure (F = 18.2, df = 5, p < 0.001), PANSS (positive, general and total), GAF, staff and user unmet needs on the CANFOR.Conclusions: The data indicate that the theoretical organisation of the units of the hospital into high, medium and low security units to form a coherent pathway through care is reflected in practice. This is a transparent route out of secure care in which restrictions are proportionate to risk and supports proportionate to need. It is unclear whether alternative models, consisting of a series of generic unstratified units for admission and discharge, all at the same level of therapeutic security, allow for the provision of treatment programmes and relational interventions appropriate to the patient's stage of recovery and rehabilitation.
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Chester, Verity, Birgit Völlm, Samuel Tromans, Chaya Kapugama, and Regi T. Alexander. "Long-stay patients with and without intellectual disability in forensic psychiatric settings: comparison of characteristics and needs." BJPsych Open 4, no. 4 (June 28, 2018): 226–34. http://dx.doi.org/10.1192/bjo.2018.24.
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BackgroundIn recent years, concerns have been raised that too many patients stay for too long in forensic psychiatric services and that this is a particular problem in those with an intellectual disability.AimsTo compare the characteristics, needs, and care pathways of long-stay patients with and without intellectual disability within forensic psychiatric hospital settings in England.MethodFile reviews and questionnaires were completed for all long-stay patients in high secure and a representative sample of those in medium secure settings in England. Between-group analyses comparing patients with and without intellectual disability are reported.ResultsOf the 401 long-stay patients, the intellectual disability and non-intellectual disability groups were strikingly similar on many sociodemographic, clinical and forensic variables. The intellectual disability group had significantly lower lengths of stay, fewer criminal sections, restriction orders and prison transfers, and higher levels of behavioural incidents and risk assessment scores.ConclusionsIn spite of similar offence histories and higher risk levels, those with intellectual disability appear to be diverted away from the criminal justice system and have shorter lengths of stay. This has implications about the applicability of the Transforming Care programme to this group.
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Terkildsen, M., H. Kennedy, A. Di Lieto, B. Jensen, and L. Uhrskov. "Care & custody: E-sport and patient-professional power-relations in forensic psychiatry. A qualitative study." European Psychiatry 64, S1 (April 2021): S377—S378. http://dx.doi.org/10.1192/j.eurpsy.2021.1011.
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IntroductionRecovery orientated care emphasizes equality in relations. Forensic psychiatric professionals need to engage in care-relationships with patients in ways where power is symmetrically distributed among them. However, professionals also need to focus on security at the ward. This promotes patient-professional power-relations that are asymmetrically skewed towards professionals. New practical ways of balancing between the power-relations defined by a care and custody dichotomy in forensic care need to be developed and studied to guide clinical practice.ObjectivesTo study how power-relations are articulated between patient-professional within a social gaming activity (E – sport) in a Danish medium secure forensic psychiatric ward.MethodsThree months of observational data, collected via anthropological fieldwork Interviews with 3 professionals and 6 patients Data was analyzed using sociologist Pierre Bourdieu’s notions of field, capital and powerResultsThe E-sport intervention consists of two fields “in-game” and “over-game” In-game concerns the practice of gaming Over-game concerns the interventions organization Power in each field is driven by specific values and access to certain competencies Power in-game was equally open to patients and professionals leading to symmetric power relations Power over-game was open to professionals only leading to asymmetrical power relations Professionals may allow power distribution to patients during gameplay, while still retaining the overall power over the interventionConclusionsIt is possible to balance between care-and-custody in forensic psychiatry. This study provides important insights to guide further practice.
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Long, C. G., S. Harding, K. Payne, and L. Collins. "Nursing and health-care assistant experience of supervision in a medium secure psychiatric service for women: implications for service development." Journal of Psychiatric and Mental Health Nursing 21, no. 2 (April 2, 2013): 154–62. http://dx.doi.org/10.1111/jpm.12066.
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Swain, Rachel, Maja Dujic, and Timothy Leung. "Increasing routine HIV testing in low and medium secure forensic settings." BJPsych Open 7, S1 (June 2021): S223. http://dx.doi.org/10.1192/bjo.2021.596.
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AimsThere remain a number of barriers to patients taking HIV tests, and prevalence of HIV in patients with severe mental illness can be higher than those without. Patients in forensic settings may be at even greater risk. National standards state that in areas of high and extremely high prevalence of HIV, testing should be offered routinely on admission to hospital. A review of compliance with these standards took place across low and medium secure male forensic wards in West London, followed by implementation of targeted interventions to increase testing rates. A reaudit was later completed to assess if changes had resulted in lasting effectsMethodA retrospective review of computer records took place to identify all inpatients residing on the low and medium secure wards on the day of data collection. Their pathology records were checked to ascertain if HIV test results were available. If no test was documented here, then patient psychiatric records were searched for documentation of the test being offered.After the initial audit, education of patients and staff regarding the benefits of HIV testing took place, HIV testing was incorporated into primary healthcare routine admission screening and separate consent forms were eradicated.The reaudit took place with data collection occurring in an identical manner.Result183 patients were initially identified across 5 low and 7 medium secure male wards, and 184 on reaudit. The initial audit found that only 30.6% (56/183) of patients had either been offered an HIV test or had a result recorded on the pathology system, but this rose to 82.6% (154/184) on reaudit. After the interventions, 43.4% of all patients had HIV test results available, compared to 23.5% initially. Even where no test result existed, the number of tests offered rose from 7.1% to 39.1% of all patients.ConclusionThis study shows that simple measures to normalise HIV testing and make it part of routine admission screening had dramatic implications for the number of patients being offered an HIV test.There is still room for improvement, however, with 17.4% of patients having neither test results available, nor documentation that a test was offered. This could be a result of poor general engagement with health care services, and would benefit from thorough documentation and assertive outreach.
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Edworthy, R., V. Furtado, and B. Vollm. "EPA-0119 – Characteristics and needs of long stay patients in high and medium secure forensic psychiatric care - implications for service organisation." European Psychiatry 29 (2014): 1. http://dx.doi.org/10.1016/s0924-9338(14)77593-5.
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Völlm, Birgit, Rachel Edworthy, Jessica Holley, Emily Talbot, Shazmin Majid, Conor Duggan, Tim Weaver, and Ruth McDonald. "A mixed-methods study exploring the characteristics and needs of long-stay patients in high and medium secure settings in England: implications for service organisation." Health Services and Delivery Research 5, no. 11 (February 2017): 1–234. http://dx.doi.org/10.3310/hsdr05110.
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BackgroundForensic psychiatric services provide care for those with mental disorders and offending behaviour. Concerns have been expressed that patients may stay for too long in too high levels of security. The economic burden of these services is high, and they are highly restrictive for patients. There is no agreed standard for ‘long stay’; we defined a length of stay exceeding 5 years in medium secure care, 10 years in high secure care or 15 years in a combination of both settings as long stay.ObjectivesTo (1) estimate the number of long-stay patients in secure settings; (2) describe patients’ characteristics, needs and care pathways and the reasons for their prolonged stay; (3) identify patients’ perceptions of their treatment and quality of life; and (4) explore stakeholders’ views on long stay.DesignA mixed-methods approach, including a cross-sectional survey (on 1 April 2013) of all patients in participating units to identify long-stay patients [work package (WP) 1], file reviews and consultant questionnaires for long-stay patients (WP2), interviews with patients (WP3) and focus groups with other stakeholders (WP4).SettingAll three high secure hospitals and 23 medium secure units (16 NHS and 9 independent providers) in England.ParticipantsInformation was gathered on all patients in participating units (WP1), from which 401 long-stay patients were identified (WP2), 40 patients (WP3), 17 international and 31 UK experts were interviewed and three focus groups were held (WP4).ResultsApproximately 23.5% of high secure patients and 18% of medium secure patients were long-stay patients. We estimated that there are currently about 730 forensic long-stay patients in England. The source of a patient’s admission and the current section of the Mental Health Act [Great Britain.Mental Health Act 1983 (as Amended by the Mental Health Act 2007). London: The Stationery Office; 2007] under which they were admitted predicted long-stay status. Long-stay patients had complex pathways, moving ‘around’ between settings rather than moving forward. They were most likely to be detained under a hospital order with restrictions (section 37/41) and to have disturbed backgrounds with previous psychiatric admissions, self-harm and significant offending histories. The most common diagnosis was schizophrenia, but 47% had been diagnosed with personality disorder. Only 50% had current formal psychological therapies. The rates of violent incidents within institutions and seclusion were high, and a large proportion had unsuccessful referrals to less secure settings. Most patients had some contact with their families. We identified five classes of patients within the long-stay sample with different characteristics. Patients differed in their attribution of reasons for long stay (internal/external), outlook (positive/negative), approach (active/passive) and readiness for change. Other countries have successfully developed specific long-stay services; however, UK experts were reluctant to accept the reality of long stay and that the medical model of ‘cure’ does not work with this group.LimitationsWe did not conduct file reviews on non-long-stay patients; therefore, we cannot say which factors differentiate between long-stay patients and non-long-stay patients.ConclusionsThe number of long-stay patients in England is high, resulting in high resource use. Significant barriers were identified in developing designated long-stay services. Without a national strategy, these issues are likely to remain.Future workTo compare long-stay patients and non-long-stay patients. To evaluate new service models specifically designed for long-stay patients.Study registrationThe National Institute for Health Research (NIHR) Clinical Research Network Portfolio 129376.FundingThe NIHR Health Services and Delivery Research programme.
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Yacoub, Evan, Ian Hall, and Jane Bernal. "Secure in-patient services for people with learning disability: is the market serving the user well?" Psychiatric Bulletin 32, no. 6 (June 2008): 205–7. http://dx.doi.org/10.1192/pb.bp.107.018523.
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Medium-secure care services developed in England following the Butler report (Home Office & Department of Health and Social Security, 1975). They were established to address the major gap in provision between high-secure and local mental health services. However, the development of special secure services for offenders with a learning disability has largely been neglected (Snowden, 1995). People with learning disability who require secure in-patient care are often placed in remote and costly units because suitable local facilities do not exist. Such placements do not usually accord with user and carer wishes.
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McKenna, J. "In-patient characteristics in a regional secure unit." Psychiatric Bulletin 20, no. 5 (May 1996): 264–68. http://dx.doi.org/10.1192/pb.20.5.264.
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A survey of 100 completed Regional Secure Unit (RSU) in-patient episodes shows that most patients are young, male, short-stay and suffering from chronic psychotic disorders. Substance abuse is prevalent, and many currently face serious charges. A significant minority of patients had previously been admitted to the Unit, especially those admitted directly from the community. Nearly half of all discharges were directly into community placements, and nearly as many remained under the care of the forensic service. Despite the sampling frame, it is clear that a few ‘long-stay’ patients contribute disproportionately to overall bed occupancy, so that beds for acute admissions may be blocked. Further, ‘parallel care’ is operating to a significant degree in this service, with the inevitable accumulation of patients who will continue to require future in-patient care. These two factors in particular suggest that the ability of the RSU to fulfil its basic functions may become increasingly compromised, particularly with respect to emergency requirements for medium secure beds at the district level.
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Rampling, Jeremy, Shay-Anne Pantall, and Hannah Woodman. "Is pregnancy status being assessed within women's secure services?" BJPsych Open 7, S1 (June 2021): S344. http://dx.doi.org/10.1192/bjo.2021.902.
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AimsTo establish rates of pregnancy testing on admission of women within a blended secure service.BackgroundWomen with psychiatric illness are known to be at increased risk of pregnancy, often due to engagement in risky sexual behaviours such as having a higher numbers of sexual partners and engaging in sexual activity whilst under the influence of drugs or alcohol. Awareness of pregnancy at the point of admission to psychiatric hospital would inform ongoing care plans to manage the pregnancy in the safest, least restrictive environment and inform future prescribing decisions, to minimise the risk of teratogenicity associated with some psychotropic medications. Ardenleigh in Birmingham is a blended female secure unit. No pregnancy screening guidelines for this population currently exist. This audit sought to establish current rates of pregnancy testing at the point of admission with a view to developing future guidelines.MethodA retrospective case note audit of electronic records of all patients admitted to Ardenleigh blended women's service as of 1st September 2019 (n = 26). The expected standard for pregnancy testing within one month of admission was set as 100%.ResultKey results include: The majority of patients (67%) were aged under 35 years (range 20–56). The most common ethnicities were Caucasian (42%) and African-Caribbean (38%). Almost half (46%) had a primary diagnosis of paranoid schizophrenia.Two women were known to be pregnant at the point of admission. Only 54% of women with an unknown pregnancy status were screened for pregnancy within one month of admission.Rates of screening were particularly poor in women aged under 25 years (43%) and between 36 and 45 (0%).Women not screened for pregnancy were typically admitted from other hospital settings, including AWA services (27%) or other medium secure units (55%). 2 women admitted from prison were not tested (29%)Of those tested, the majority were checked using urine hCG (92%).None of the women tested were found to be pregnant.ConclusionOverall pregnancy testing on admission to the unit was poor, with only 54% of service users screened. Less than 100% compliance could result in serious consequences for both the woman and unborn baby if a pregnancy is not discovered. Updating the admission checklist for Ardenleigh to include pregnancy testing may prove beneficial. It is recommended that a re-audit is completed 6 months following checklist introduction.
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Harris, Mike. "Her Majesty's Government's pleasure: providing appropriate community intervention can improve care and save money." Psychiatrist 34, no. 10 (October 2010): 411–12. http://dx.doi.org/10.1192/pb.bp.110.032235.
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SummaryIn answer to Louis Appleby's editorial, I am proposing that the role of mental health services in offender healthcare is to improve people's mental health and it is the role of the courts and the government to reduce the prison population. I also argue that with a reinvestment of existing resources into prison mental health we can reduce admission to expensive medium secure and low secure placements, save money and further reinvest in better care.
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Svanberg, P. O., Lisa Mennet, and Susan Spieker. "Promoting a secure attachment: A primary prevention practice model." Clinical Child Psychology and Psychiatry 15, no. 3 (July 2010): 363–78. http://dx.doi.org/10.1177/1359104510367584.
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It is increasingly recognized that early sensitive care-giving predicts a secure attachment in infancy and early childhood.This preliminary report details the development, implementation and evaluation of a clinical programme that used a targeted prevention approach following a universally-offered screening of parent—infant interactions. The CARE-Index was used to assign dyads to low, medium and high risk groups, and interventions — featuring reflective videotape-based feedback — were tailored to each risk group in order to increase maternal sensitivity and improve infant attachment status. Results showed improved maternal sensitivity in the intervention conditions compared to comparisons. In addition, infants in the intervention conditions were significantly more likely to be classified as secure, and significantly less likely to be classified as having DMM complex attachment strategies. Methodological shortcomings, however, mean that these findings should be regarded as tentative.
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Grimason, Amy, and Adrian East. "A review of patients discharged from Shannon Clinic- are shorter stays in secure hospitals associated with poorer patient outcomes?" BJPsych Open 7, S1 (June 2021): S323. http://dx.doi.org/10.1192/bjo.2021.850.
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AimsShannon Clinic was established as the regional secure unit in Northern Ireland in 2005 and provides medium secure care to Northern Ireland's population of 1.8 million. Previous research has shown that inpatient admissions are shorter when compared to other secure units. Northern Ireland has less secure beds per population than the other UK nations, which can be a driver for shorter hospital stays. This review was undertaken to examine if shorter inpatient stays were associated with poorer outcomes.MethodAll the discharges from Shannon Clinic to the Southern Health and Social Care Trust were reviewed over a period of 10 years (2009-2019). The outcome measures examined were mortality, readmission rate and reoffending rate. Crude rates for these were calculated. To allow for comparison, these rates were compared to the systematic review findings of Fazel et al (2016), which was an international review examining patient outcomes following discharge from secure hospitals.DUNDRUM 1 Triage Security scores for the patient group were also reviewed, to ensure a sample representative of patients needing medium secure care.Result41 patients had been discharged during this period. DUNDRUM 1 Triage Security scores ranged from 2.44 to 3.2.The average length of admission was 415.5 days. This is shorter than the average reported by Fazel et al (2016).The crude rates for all of the variables calculated (mortality, readmission to hospital and reoffending) for patients discharged from Shannon to the trust were less of those reported in the systematic review by Fazel et al (2016).ConclusionThis review suggests that patient outcomes are not negatively impacted by shorter inpatient stays in secure hospitals. A possible reason for this is the regional model of care approach, which helps ensure continuity and safe management of the transition between secure care and the community. In addition, there is close multidisciplinary working with supported living providers in the trust area to ensure patients' needs are met.Following this initial review, there are now plans to review discharge outcomes for all patients discharged during this period. There are five trust areas in total in Northern Ireland so this will allow for comparison across the region.The review has also been used within the unit to develop information leaflets for patients at admission and posters for display in the unit. We hope this will provide clarity to patients about secure care and a sense of optimism from the start of their admission.
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Brown, Steven D., Ava Kanyeredzi, Laura McGrath, Paula Reavey, and Ian Tucker. "Organizing the sensory: Ear-work, panauralism and sonic agency on a forensic psychiatric unit." Human Relations 73, no. 11 (October 23, 2019): 1537–62. http://dx.doi.org/10.1177/0018726719874850.
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How are relations of care and security between hospital staff and patients organized through sound? This article argues that a shifting distinction between meaningful sound and noise is fundamental to the lived experience of immersion in an organizational acoustic environment. Based around a qualitative study of listening practices and ‘ear-work’ at a medium-secure forensic psychiatric hospital, using interview and photo-production methods, the article positions the organizing of the sensory as central to formal organization. Analysis of empirical material demonstrates how the refinement of key listening practices is critical to the ways in which staff and patients orient to the hospital setting. It also details how the design process for the unit has undermined the capacity to manage and control through sound, or ‘panauralism’, rendering it as a reversible and contested struggle to make sense of the acoustic environment, and describes the attempts by patients to create alternative acoustic spaces and exercise ‘sonic agency’. We contend that ‘acoustic organizational research’ offers an experience-near means of mapping organizational space and power relations and invites a renewed questioning of the role of the sensory as form of organizing in itself.
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Duggan, Conor, Lauren Mason, Penny Banerjee, and John Milton. "Value of standard personality assessments in informing clinical decision-making in a medium secure unit." British Journal of Psychiatry 190, S49 (May 2007): s15—s19. http://dx.doi.org/10.1192/bjp.190.5.s15.
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BackgroundAssessing those with personality disorder for treatment in secure settings is known to be unsatisfactory.AimTo examine the utility of a standardised assessment of offenders with personality disorder referred for treatment in secure care in a naturalistic study.MethodA consecutive series of 89 men were assessed with a battery of four recommended instruments measuring personality and risk. Decisions on whether or not to admit were based on a multidisciplinary discussion informed by these assessments.ResultsOf the 89 comprehensively assessed referrals, 60 (67%) were offered admission. High scores on the Psychopathy Checklist–Revised (especially on Factor 1) was the only measure that was associated with rejection. Of 44 patients discharged, 29 (66%) failed to complete treatment; none of the pre-admission assessments distinguished ‘completers' from ‘non-completers'. Although skills were acquired on the unit, follow-up of 24 men in the community showed that this had only a marginal effect on re-offending rate (58%).ConclusionsCurrent recommended assessment methods appear unsatisfactory in identifying those who either (a) complete treatment or (b) benefit from treatment. Our results throw doubt on their value.
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Rogers, BA, F. Pease, and DM Ricketts. "The Surgical Management of Patients Who Deliberately Self-Harm." Annals of The Royal College of Surgeons of England 91, no. 1 (January 2009): 59–62. http://dx.doi.org/10.1308/003588409x359204.
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INTRODUCTION Deliberate self-harm is a common problem that often requires orthopaedic treatment. Patients with injuries due to deliberate self-harm are often referred to our unit. This study assessed the type of treatment required and the cost of treatment. PATIENTS AND METHODS We undertook a retrospective survey of deliberate self-harm patients with known ICD-10 psychiatric disorders admitted for orthopaedic care from a medium-secure, female-only, psychiatric unit. Data were collected on admission rate, duration of stay, surgical interventions and complications. RESULTS Over a 36-month period there were 73 admissions for 15 patients (mean age, 25.1 years) requiring 65 operative interventions, a mean of 4.3 (range, 0–9) per patient. Over 50% of patients were admitted more than 3 times, totalling 416 hospital bed-days and 80% had methicillin-resistant Staphylococcus aureus (MRSA) isolated. The orthopaedic treatment costs for these patients was £453,000 during the period studied. DISCUSSION The significant resources required to manage this patient cohort demonstrates the need for a co-ordinated management policy. We recommend day-case surgery for infected wounds only. Postoperatively, wounds should be protected with plaster of Paris. All patients with deliberate self-harm should be regarded as being infected with MRSA.
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Iyer, Sruthi Easwaran, and Abigail Williamson. "Audit Cycle on Medical Reviews of Seclusion in Medium and Low Secure Learning Disability Units." BJPsych Open 8, S1 (June 2022): S153. http://dx.doi.org/10.1192/bjo.2022.435.
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AimsSeclusion is defined as “the supervised confinement and isolation of a patient, away from other patients, in an area from which the patient is prevented from leaving, where it is of immediate necessity for the purpose of the containment of severe behavioural disturbance which is likely to cause harm to others”. Patients in seclusion require reviews at the frequency set out in the Mersey Care NHS Foundation Trust policy, “The use of seclusion and long-term segregation” (SD28). This is based on the requirements set out in the Chapter 26 of the Mental Health Act 1983 Code of Practice (2015).This audit will look at whether medical reviews for secluded patients in the secure learning disability wards meet with the expectations set out in the Trust Policy. In doing so, the audit will establish whether medical reviews of seclusion meet and uphold the guiding principles of the Mental Health Act Code of Practice as highlighted in Chapter 26.110.MethodsRetrospective audit that collected data from inpatients on secure learning disability wards in Mersey Care. After reviewing data, we actioned plans which involved educating colleagues working in secure services. This was re audited after three months. One month of seclusion reviews was audited in each cycle, which equated to 39 reviews in the first cycle and 100 reviews in the second.ResultsThe re-audit data showed an improvement in most parameters.Re-audit showed that 66% (34%) of the seclusion reviews had an initial medical review within the first hour. The on call consultant was informed in 60% (50%) of the situations and 4 hourly reviews took place in 66% (50%) of scenarios. All MDT reviews took place within 24 hours, Responsible Clinician was present in 100% (67%) of reviews.34% (33%) of MDT reviews had only 2 MDT members.There was 100% compliance with reviewing physical health in both audits. 100% (90%) of the reviews commented on mental health, 72% (20%) commented on medications used, 51% (39%) of reviews commented on level of observations and 89% (48%) included risk assessment. 95% (92%) of reviews assessed need for continuing seclusion. 84% (59%) of reviews commented on reducing restriction in seclusion.ConclusionThis audit cycle has focused on the quality of medical reviews and not just the frequency. The improvement in practice will strengthen the safeguard provided by these reviews.