No abstract

In this paper, the authors describe the work of a group set up for those patients who are leaving a high security forensic psychiatric hospital, all having been detained under the 1983 Mental Health Act for England and Wales. Background information on the hospital is presented, as well as an overall view of the patients and their problems. The origins of the group are documented, followed with examples of group dynamics peculiar to the practice of forensic psychotherapy and conscious and unconscious anxieties on the part of the therapists as well as the patients.

Aims and MethodRecent government legislation has highlighted the importance of implementation of the Care Programme Approach (CPA) within prisons, as part of the expectation that prisoners receive equivalent standards of healthcare to those provided by the National Health Service. To effectively plan the service provision at HMP Belmarsh, we retrospectively established the number of prisoners in a one-year period who would have fulfilled the criteria for enhanced CPA.ResultsOf the 91 prisoners found to fulfil the criteria for enhanced CPA, the majority (77%) had a diagnosis of schizophrenia, schizoaffective or delusional disorder, and 58% required transfer to a psychiatric hospital. Of those who required hospital treatment, 75% needed conditions of high- or medium-security.Clinical ImplicationsSuccessful implementation of the CPA for all prisoners who meet enhanced CPA criteria is likely to have significant resource implications, both for mental health teams working within prisons and local psychiatric services.

A leavers' group appeared to be a valued therapy option for people who had spent a long time in high secure psychiatric care, or those who continued to require hospital treatment beyond prison tariffs. There was a low return rate from trial leave, which made the evaluation of this outcome difficult. A detailed study into both the reasons for return from trial leave and successes would provide further information on ideal preparation for moving on. Copyright © 2016 John Wiley & Sons, Ltd.