Статті в журналах: "Secure psychiatric"

1

Exworthy, Tim. "Secure psychiatric services." Current Opinion in Psychiatry 13, no. 6 (November 2000): 581–85. http://dx.doi.org/10.1097/00001504-200011000-00019.

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2

Taylor, John, and Patricia Healy. "Education in secure psychiatric units." British Journal of Forensic Practice 3, no. 4 (December 2001): 3–7. http://dx.doi.org/10.1108/14636646200100021.

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3

Scannell, T. D. "SECURE ACCOMMODATION IN PSYCHIATRIC HOSPITALS." Lancet 328, no. 8502 (August 1986): 347. http://dx.doi.org/10.1016/s0140-6736(86)90037-1.

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4

Gordon, Harvey. "Suicide in secure psychiatric facilities." Advances in Psychiatric Treatment 8, no. 6 (November 2002): 408–17. http://dx.doi.org/10.1192/apt.8.6.408.

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Suicide may be defined as intentional self-killing, although the definition has been the subject of critical review (Fairbairn, 1995). As the determination of whether intent was present at the time of death by suicide can be difficult, coroner's inquests tend to underestimate the number of suicides. At the time of suicide, the vast majority of people are suffering from some form of mental disorder, although there may, exceptionally, be a few rational suicides. Suicide is a relatively uncommon event, but the possibility of suicide by those with mental disorders is always a potential hazard faced by health and allied professionals responsible for their care. Detention of a patient in hospital under mental health legislation is often precipitated by concern regarding risk of self-harm and/or risk of harm to others and potential for absconding and, at times, admission to a locked or secure facility is necessary. Detained patients in secure facilities include both offender patients, admitted through the courts or transferred during sentence from prison, and patients on civil orders under sections 2 or 3 of the Mental Health Act 1983. The relationship between suicidal behaviour and that which is violent or homicidal is complex but relevant to an understanding of the phenomenon of suicide in secure conditions.

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5

Natarajan, Muthusamy, and Jayanth Srinivas. "Relationships in secure psychiatric units." Psychiatric Bulletin 33, no. 1 (January 2009): 39. http://dx.doi.org/10.1192/pb.33.1.39.

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6

Mills, Alan. "Incident reports in secure psychiatric units." Nursing Standard 12, no. 6 (October 29, 1997): 34–35. http://dx.doi.org/10.7748/ns.12.6.34.s46.

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7

BOAST, NEIL, and PAUL CHESTERMAN. "BLACK PEOPLE AND SECURE PSYCHIATRIC FACILITIES." British Journal of Criminology 35, no. 2 (1995): 218–35. http://dx.doi.org/10.1093/oxfordjournals.bjc.a048495.

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8

Thomas, Stuart D. M., Mairead Dolan, Jenny Shaw, Samantha Thomas, Graham Thornicroft, and Morven Leese. "Redeveloping Secure Psychiatric Services for Women." Medicine, Science and the Law 45, no. 4 (October 2005): 331–39. http://dx.doi.org/10.1258/rsmmsl.45.4.331.

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Historically, a substantial proportion of women have been unduly detained in conditions of high security in England due to the lack of suitable alternative facilities. There have been no studies that have comprehensively examined the individual needs of these women in relation to their placement needs. A cross sectional survey was undertaken of the individual and placement needs of all females detained in the three high security psychiatric hospitals (HSPHs) in England on 18th October 1999. Whilst there are clearly differences in accommodation needs among the women, those requiring lower secure services are significantly less likely to have needs in relation to violence (OR 0.29, 95% CI 0.14-0.62) and drugs (OR 0.29, 95% CI 0.12-0.67) when length of stay is taken into account. They also have lower security, treatment and dependency needs than women still requiring HSPH treatment. A significant reorganisation of services is required. There is a need to gain further understanding of the relationships between traumatic histories, clinical presentation and antisocial behaviour and how these impact on assessed risk, treatment and care needs and outcome. The special needs of these women should be considered a priority when developing treatment and care packages.

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9

COID, J., N. KAHTAN, A. COOK, S. GAULT, and B. JARMAN. "Predicting admission rates to secure forensic psychiatry services." Psychological Medicine 31, no. 3 (April 2001): 531–39. http://dx.doi.org/10.1017/s003329170100366x.

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Background. The planning and development of secure forensic psychiatry services for mentally disordered offenders in England and Wales has proceeded independently within different regional areas. However, certain mental disorders, offenders, and offending behaviour are all more prevalent in geographical areas characterized by socio-economic deprivation and social disorganization. Failure to consider these factors has led to inadequate service provision in some areas and inequity in funding. A new model is required to predict admissions to these services as an aid to resource allocation.Method. Actual admissions (N=3155) to high and medium secure psychiatric services for seven of 14 (pre-reorganization) Regional Health Authorities, 1988–94. Expected admissions were calculated for each district using 1991 census data adjusted for under-enumeration. Standardized psychiatric admission ratios were calculated and a range of social, health status, and service provision data were used as explanatory variables in a regression analysis to determine variation between districts.Results. Actual psychiatric admissions varied from 160% above to 62% below expected for age, sex, and marital status, according to patients' catchment area of origin, measured according to deciles of the distribution of underprivileged area scores at ward level. The most powerful explanatory variables included a composite measure of social deprivation, ethnicity and availability of low secure beds at regional level.Conclusion. Admission rates to secure forensic psychiatry services demonstrate a linear correlation with measures of socio-economic deprivation in patients catchment area of origin. A model was developed to predict admissions from District Health Authorities and is recommended for future use in resource allocation. Identification of factors that explain higher admission rates of serious offenders with mental disorder from deprived areas is a priority for future research.

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10

Hill, Simon A., Gregory Mather, and Richard Laugharne. "Attitudes of psychiatrists towards forensic psychiatry: a survey." Medicine, Science and the Law 47, no. 3 (July 2007): 220–24. http://dx.doi.org/10.1258/rsmmsl.47.3.220.

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Forensic psychiatry has been rapidly expanding in recent years and more NHS forensic beds are planned. This study aimed to examine the attitudes of psychiatrists towards forensic psychiatry. A questionnaire was given to psychiatrists attending a regional Royal College of Psychiatrists conference. In addition forensic psychiatrists were surveyed in the two local regional secure units. Ninety-eight psychiatrists, including twenty-four forensic psychiatrists, completed the questionnaire. Forensic and non-forensic psychiatrists tended to agree with the expansion in forensic beds. Non-forensic psychiatrists wanted a lower threshold for admission to secure units. Forensic psychiatrists disagreed. Non-forensic psychiatrists tended to feel that forensic psychiatry has been over-funded compared with other psychiatric services. They also commented that forensic services should integrate more closely with other non-secure psychiatric services and should offer more community forensic services rather than concentrating care on in-patients. Forensic services should consider what services they provide and try to meet the desires of secondary services, such as more community forensic services and greater integration with other psychiatric services.

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11

Adams, Jonathon, Stuart Thomas, Tobias Mackinnon, and Damien Eggleton. "How secure are the secure psychiatric units in New South Wales?" Australasian Psychiatry 27, no. 1 (October 8, 2018): 32–35. http://dx.doi.org/10.1177/1039856218804334.

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Objectives: To evaluate the therapeutic security characteristics of the secure forensic mental health inpatient units in New South Wales, Australia. Methods: This study evaluated all eight secure inpatient units in New South Wales using a validated tool, the Security Needs Assessment Profile. Results: A pattern of decreasing therapeutic security across the secure units was found, consistent with their intended security levels, from high security through to open security. However, important inconsistencies across and between levels of security were highlighted. Conclusions: This study clarifies the therapeutic security structure of the New South Wales forensic mental health service, which is an essential first step in service development and reform.

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12

Falla, Sara, Philip Sugarman, and Lona Roberts. "Reconviction after Discharge from a Regional Secure Unit." Medicine, Science and the Law 40, no. 2 (April 2000): 156–57. http://dx.doi.org/10.1177/002580240004000212.

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There are at present no published data on criminal conviction following discharge from medium-secure psychiatric facilities in the United Kingdom. The results of an audit at the Kent Forensic Psychiatry Service found a 7% rate for serious offences in an average follow-up period of three years and five months, a figure similar to high-security hospital studies. Only one serious offence was unknown to the clinical team. Reports on larger samples are awaited.

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13

Exworthy, Tim, and Simon Wilson. "Escapes and absconding from secure psychiatric units." Psychiatrist 34, no. 3 (March 2010): 81–82. http://dx.doi.org/10.1192/pb.bp.108.024372.

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SummaryA prominent radio news programme reported on escapes from secure psychiatric units in the UK and linked that with subsequent offending by psychiatric patients. The report cited did not distinguish between escapes and absconding but, it is argued here, these are very different activities. The acceptable rate both for escapes and absconding from secure psychiatric units is not defined. A certain level of absconding is a consequence of the therapeutic use of leave, which, as part of rehabilitation, is likely to be linked with a reduced reoffending rate post-discharge.

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14

Whyte, Sean, Fiona Scott, and Tony Maden. "Editorial: Substance misuse in secure psychiatric hospitals." Journal of Forensic Psychiatry & Psychology 15, no. 4 (December 2004): 591–94. http://dx.doi.org/10.1080/14789940412331305565.

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15

WHYTE, SEAN, and CHARLOTTE HARRISON. "Substance Misuse Services in Secure Psychiatric Units." Medicine, Science and the Law 44, no. 1 (January 2004): 71–74. http://dx.doi.org/10.1258/rsmmsl.44.1.71.

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16

Macdonald, A. J. D. "Hammering psychiatric practice: Secure in our insecurity." BMJ 306, no. 6888 (May 15, 1993): 1340. http://dx.doi.org/10.1136/bmj.306.6888.1340-d.

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17

Ireland, Jane L., Lee J. Priday, Carol A. Ireland, Simon Chu, Jennifer Kilcoyne, and Caroline Mulligan. "Predicting hospital aggression in secure psychiatric care." BJPsych Open 2, no. 1 (January 2016): 96–100. http://dx.doi.org/10.1192/bjpo.bp.115.002105.

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BackgroundRisk assessment instruments have become a preferred means for predicting future aggression, claiming to predict long-term aggression risk.AimsTo investigate the predictive value over 12 months and 4 years of two commonly applied instruments (Historical, Clinical and Risk Management - 20 (HCR-20) and Violence Risk Appraisal Guide (VRAG)).MethodParticipants were adult male psychiatric patients detained in a high secure hospital. All had a diagnosis of personality disorder. The focus was on aggression in hospital.ResultsThe actuarial risk assessment (VRAG) was generally performing better than the structured risk assessment (HCR-20), although neither approach performed particularly well overall. Any value in their predictive potential appeared focused on the longer time period under study (4 years) and was specific to certain types of aggression.ConclusionsThe value of these instruments for assessing aggression in hospital among patients with personality disorder in a high secure psychiatric setting is considered.

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18

Appelbaum, Paul. "Help Secure the Future Of Psychiatric Research." Psychiatric News 38, no. 3 (February 7, 2003): 3–28. http://dx.doi.org/10.1176/pn.38.3.0003.

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19

Nathan, Rajan. "Women patients in medium secure psychiatric units." Psychiatric Bulletin 25, no. 12 (December 2001): 485. http://dx.doi.org/10.1192/pb.25.12.485-b.

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20

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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21

Bullard, Henrietta, and Michael Bond. "Secure Units: Why They are Needed." Medicine, Science and the Law 28, no. 4 (October 1988): 312–18. http://dx.doi.org/10.1177/002580248802800410.

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ABSTRACT: The Beauchamp ISU based at Central Hospital, Warwick, has admitted 105 patients over a six-year period, 14 of these on more than one occasion, which has accounted for 121 admissions with 109 discharges. The opening of a pre-discharge unit in 1985 resulted in a 50 per cent increase in the number of patients admitted to the ISU. The majority of patients were male and had a diagnosis of schizophrenia, and 30 per cent of patients were of non-European origin. The mean length of stay was six months. The future role of secure units is discussed. There will be a need for the forensic psychiatric service to adapt to the changes resulting from the present government policy of community psychiatric care. The group of patients at present identified as requiring secure accommodation need a range of facilities and the number of patients requiring those facilities is likely to increase as psychiatric hospitals close. The special funding of the secure units must be maintained and any attempt to erode or to accept a lower level of funding must be resisted.

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22

Collins, Mick, Steffan Davies, and Chris Ashwell. "Meeting patients’ needs in secure forensic psychiatric units." Nursing Standard 17, no. 49 (August 20, 2003): 33–34. http://dx.doi.org/10.7748/ns2003.08.17.49.33.c3440.

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23

Davies, Steffan, and Chris Ashwell. "Meeting patients’ needs in secure forensic psychiatric units." Nursing Standard 17, no. 49 (August 20, 2003): 33–34. http://dx.doi.org/10.7748/ns.17.49.33.s51.

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24

Grounds, Adrian, David Melzer, Tom Fryers, and Traolach Brugha. "What determines access to medium secure psychiatric provision?" Journal of Forensic Psychiatry & Psychology 15, no. 1 (March 2004): 1–6. http://dx.doi.org/10.1080/14789940410001661810.

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25

Faulk, M., and J. C. Taylor. "Psychiatric Interim Regional Secure Unit: Seven Years' Experience." Medicine, Science and the Law 26, no. 1 (January 1986): 17–22. http://dx.doi.org/10.1177/002580248602600104.

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26

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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27

Boast, Neil. "Discharges to prison from medium secure psychiatric units." British Journal of Psychiatry 206, no. 3 (March 2015): 253. http://dx.doi.org/10.1192/bjp.206.3.253.

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28

Kaye, Charles. "Hallmarks of a secure psychiatric service for women." Psychiatric Bulletin 22, no. 3 (March 1998): 137–39. http://dx.doi.org/10.1192/pb.22.3.137.

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Dissatisfaction with current psychiatric services provided for women in secure health environments is described. Mention is made of recent improvements in the special hospitals. A set of key criteria is suggested to judge the effectiveness of services wherever provided.

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29

McCabe, Jennifer. "Women In Special Hospitals and Secure Psychiatric Containment." Mental Health Review Journal 1, no. 2 (June 1996): 28–30. http://dx.doi.org/10.1108/13619322199600019.

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30

Clarke, Martin, Conor Duggan, Clive R. Hollin, Nick Huband, Lucy McCarthy, and Steffan Davies. "Readmission after discharge from a medium secure unit." Psychiatrist 37, no. 4 (April 2013): 124–29. http://dx.doi.org/10.1192/pb.bp.112.039289.

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Aims and methodWe examined readmission to psychiatric hospital of 550 patients discharged from one medium secure unit over 20 years. Multiple sources were used to obtain readmission data.ResultsReadmission was common, particularly to non-secure psychiatric hospitals. At least 339 patients (61.6%) were readmitted to any psychiatric hospital (mean follow-up 9.5 years), with over a third (37.6%) subsequently being readmitted to medium- or high-security or both. Of those discharged directly to the community, having previous in-patient treatment and a Mental Health Act classification of mental illness were associated with shorter time to first readmission.Clinical implicationsThe long-standing nature of disorders is evident in the high rates of readmission overall and the need for readmission to medium and high secure services, suggesting that these patients require long-term follow-up and support from mental health services.

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31

James, Adrian. "Practical experience from a regional secure unit." Psychiatric Bulletin 16, no. 2 (February 1992): 84–85. http://dx.doi.org/10.1192/pb.16.2.84.

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The Royal College of Psychiatrists' Working Party on Medical Audit has emphasised the multidisciplinary nature of patient care in psychiatry (Royal College of Psychiatrists, 1989). Much has been published on individual audit topics and on definitions of the various aspects of audit such as peer review, performance indicators and quality assurance. The essential element of audit is its systematic nature and little has been written concerning an overall structure for clinical audit within an individual psychiatric setting. It is not sufficient to start with ‘a simple project with minimum of cost in terms of both time and money expended’, as recommended by the Royal College of Psychiatrists' Working Party. What is needed is an overall structure for regular review so that the systematic nature of the process is not lost and that recommendations from audit meetings are reviewed regularly for their usefulness and level of implementation.

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32

Völlm, Birgit A., Martin Clarke, Vicenç Tort Herrando, Allan O. Seppänen, Paweł Gosek, Janusz Heitzman, and Erik Bulten. "European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders." European Psychiatry 51 (June 2018): 58–73. http://dx.doi.org/10.1016/j.eurpsy.2017.12.007.

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AbstractForensic psychiatry in Europe is a specialty primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders (MDOs) are often cared for in secure psychiatric environments or prisons. In this guidance paper we first present an overview of the field of forensic psychiatry from a European perspective. We then present a review of the literature summarising the evidence on the assessment and treatment of MDOs under the following headings: The forensic psychiatrist as expert witness, risk, treatment settings for mentally disordered offenders, and what works for MDOs. We undertook a rapid review of the literature with search terms related to: forensic psychiatry, review articles, randomised controlled trials and best practice. We searched the Medline, Embase, PsycINFO, and Cochrane library databases from 2000 onwards for adult groups only. We scrutinised publications for additional relevant literature, and searched the websites of relevant professional organisations for policies, statements or guidance of interest. We present the findings of the scientific literature as well as recommendations for best practice drawing additionally from the guidance documents identified. We found that the evidence base for forensic-psychiatric practice is weak though there is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only. Practitioners need to follow general psychiatric guidance as well as that for offenders, adapted for the complex needs of this patient group, paying particular attention to long-term detention and ethical issues.

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33

Oakley, Clare, Josie Jenkinson, and Femi Oyebode. "Psychiatric training for the next generation." Psychiatrist 37, no. 1 (January 2013): 25–29. http://dx.doi.org/10.1192/pb.bp.112.040071.

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SummaryRecent concerns about the future of psychiatry have led to various calls for action. We argue that an overhaul of postgraduate training in psychiatry is the necessary first step to ensuring a strong future for the profession. Central to these improvements are reaffirming the ideals of psychiatric training, ensuring appropriate prominence of crucial knowledge and skills in the curriculum and providing tailored training placements with an emphasis on excellence. It is imperative that short-term service-provision need does not adversely have an impact on the training that is needed to ensure excellent patient care for the future. We urge the College to continue to work closely with psychiatric trainees to secure their future.

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34

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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35

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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36

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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37

Coid, Jeremy, Nadji Kahtan, Simon Gault, and Brian Jarman. "Patients with personality disorder admitted to secure forensic psychiatry services." British Journal of Psychiatry 175, no. 6 (December 1999): 528–36. http://dx.doi.org/10.1192/bjp.175.6.528.

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BackgroundTreatment of patients with personality disorder remains controversial and severe mental illness is prioritised in secure forensic psychiatry services.AimsTo compare patients with personality disorder and mental illness according to demography, referral, criminality, previous institutionalisation and diagnostic comorbidity.MethodA record survey of 511 patients with personality disorder and 2575 with mental illness admitted to secure forensic psychiatry services between 1 January 1988 and 31 December 1994 from half of England and Wales.ResultsPersonality disorder admissions declined over time; more were female, White, younger and extensively criminal (specifically, sexual and arson offences). Personality disorder was highly comorbid; antisocial, borderline, paranoid and dependent personality disorder were most prevalent.ConclusionsPatients with personality disorder were highly selected and previously known to psychiatric services. Referrer, diagnostic comorbidity and behavioural presentation determined their pathways into care. Future research must determine whether their continuing admission represents effective use of scarce resources and whether new services are required.

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38

Allely, Clare S. "A systematic PRISMA review of individuals with autism spectrum disorder in secure psychiatric care: prevalence, treatment, risk assessment and other clinical considerations." Journal of Criminal Psychology 8, no. 1 (February 5, 2018): 58–79. http://dx.doi.org/10.1108/jcp-06-2017-0028.

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Purpose Patients with autism spectrum disorder (ASD) present with specific assessment, specific difficulties, needs and therapeutic issues and therefore are a challenging group for forensic services. Given the challenge that individuals with ASD present to forensic services, the suggested increase in the number of this group within this setting and the relatively little amount of research which suggests they face a number of difficulties within the prison environment, the purpose of this paper is to identify and review all the studies which have been carried out investigating any aspect of ASD in relation to secure hospital settings. Design/methodology/approach Seven internet-based bibliographic databases were used for the present review. The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Findings A total of 12 studies were included in this review; 3 looked at the prevalence of ASD in secure psychiatric hospitals. One study evaluated the clinical utility of the AQ screening tool to assess self-reported autistic traits in secure psychiatric settings. Three explored any type of characteristics of patients with ASD detained in secure psychiatric hospitals. One study investigated the experiences or quality of life of patients with an ASD detained in secure psychiatric care. Two studies investigated awareness, knowledge and/or views regarding patients with ASD held by staff working within secure psychiatric hospitals. Lastly, three studies (one of which was also included in the prevalence category above) looked at the effectiveness of interventions or treatment of patients with ASD in secure psychiatric hospitals. Clinical recommendations and future research directions are discussed. Originality/value To the author’s knowledge, this is the first review to explore what research has been carried out looking specifically at patients with ASD in relation to secure forensic settings.

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39

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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Whyte, Lawrence, and Charles Brooker. "Working With a Multidisciplinary Team in Secure Psychiatric Environments." Journal of Psychosocial Nursing and Mental Health Services 39, no. 9 (September 2001): 26–34. http://dx.doi.org/10.3928/0279-3695-20010901-06.

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Daniels, Hannah, Deborah Skinner, and Sarah Todd. "Shared-experience groups in a high-secure psychiatric hospital." Mental Health Practice 18, no. 4 (December 10, 2014): 14–21. http://dx.doi.org/10.7748/mhp.18.4.14.e947.

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Long, Clive, Elizabeth Ritchie, Olga Dolley, and Lesley Collins. "Secure psychiatric care: How appearance and neglect affect women." Mental Health Practice 16, no. 8 (May 2013): 12–17. http://dx.doi.org/10.7748/mhp2013.05.16.8.12.e836.

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Beazley, Peter, Amy Carter, Sarah-Jane Stewart, and Julia Renton. "Practicalities of HCR-20 implementation within secure psychiatric services." Journal of Psychiatric Intensive Care 13, no. 1 (April 1, 2017): 47–56. http://dx.doi.org/10.20299/jpi.2017.003.

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Fuller, Julian R. "Treatment Environments in Secure Psychiatric Units: A Case Study." International Journal of Offender Therapy and Comparative Criminology 29, no. 1 (March 1985): 63–78. http://dx.doi.org/10.1177/0306624x8502900106.

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Ros, Nienke, Peer Van der Helm, Inge Wissink, Geert-Jan Stams, and Petra Schaftenaar. "Institutional climate and aggression in a secure psychiatric setting." Journal of Forensic Psychiatry & Psychology 24, no. 6 (December 2013): 713–27. http://dx.doi.org/10.1080/14789949.2013.848460.

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Bhui, K. "Over-representation of Black people in secure psychiatric facilities." British Journal of Psychiatry 178, no. 6 (June 2001): 575. http://dx.doi.org/10.1192/bjp.178.6.575.

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McMurran, Mary, Pauline Clerkin, and Harold Rosenberg. "Problems of female patients in a secure psychiatric hospital." Psychology, Crime & Law 3, no. 1 (January 1997): 15–19. http://dx.doi.org/10.1080/10683169608409791.

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Ireland, Carol A., Jane L. Ireland, Naomi S. Jones, Simon Chu, and Michael Lewis. "Predicting security incidents in high secure male psychiatric care." International Journal of Law and Psychiatry 64 (May 2019): 40–52. http://dx.doi.org/10.1016/j.ijlp.2019.01.004.

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Maden, A., S. Rutter, T. McClintock, C. Friendship, and J. Gunn. "Outcome of admission to a medium secure psychiatric unit." British Journal of Psychiatry 175, no. 4 (October 1999): 313–16. http://dx.doi.org/10.1192/bjp.175.4.313.

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BackgroundThis is the first long-term follow-up of patients discharged from a medium secure unit.AimsTo describe the short– and long-term outcomes of admission for all patients discharged during a 14-year period.MethodA longitudinal cohort study of all 234 patients discharged from the Denis Hill Unit, Bethlem Royal Hospital, between 1980 and 1994, followed for an average 6.6 years.ResultsAlthough 48% of admissions were from prison, only 8% returned there, with most being transferred to another psychiatric bed. One-fifth of patients spent none of the follow-up time in the community; 75% of patients had at least one readmission; only 24% were convicted of further offences.ConclusionsRe-offending rates are comparable with those for patients discharged from high-security hospitals, and much lower than those for released prisoners. The high readmission rates indicate the need for a range of services to maintain former patients in the community.

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Maden, A., C. Friendship, T. McClintock, and S. Rutter. "Outcome of admission to a medium secure psychiatric unit." British Journal of Psychiatry 175, no. 4 (October 1999): 317–21. http://dx.doi.org/10.1192/bjp.175.4.317.

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BackgroundA follow-up of patients discharged from medium secure psychiatric units is used to compare outcome in patients of different ethnic origin.AimsTo test the hypothesis that there are systematic differences in clinical outcome between ethnic groups.MethodA descriptive, longitudinal cohort study of discharges from a medium secure unit is used to compare the 125 patients of White/European ethnic origin and the 104 patients of Black/African–Caribbean origin.ResultsPatients of African – Caribbean origin were admitted at three times the rate of White patients, had a higher prevalence of psychosis and a lower prevalence of personality disorder. There was no difference in outcome as measured by location at follow-up, readmission or re-offending.ConclusionsThe higher rate of admission of African–Caribbean patients is consistent with a higher level of demand. There is a need for studies of the pathways by which patients from ethnic minorities reach medium-security accommodation, with a view to early intervention.

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