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

Völlm, Birgit; Edworthy, Rachel; Holley, Jessica; Talbot, Emily; Majid, Shazmin; Duggan, Conor; Weaver, Tim; McDonald, Ruth

doi:10.3310/hsdr05110

Cited by 76 publications

(70 citation statements)

References 117 publications

(205 reference statements)

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“…However, given the recent changes in societal attitudes toward older offenders (ie, older offenders are treated less leniently than in the past, in particular when they commit sexual offences) and the phenomenon of an ageing population—among other factors—older patients in secure settings have now come to account for a higher share of the total population. In a national multicentre study of long‐stay patients in medium and high secure settings in England, around 30% were aged over 50 years old . Similar prevalence rates have been reported in other countries.…”

Section: Introductionsupporting

confidence: 70%

Ageing patients in forensic psychiatric settings: A review of the literature

Lorito

Völlm

Dening

2018

Int J Geriat Psychiatry

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Section: Introductionsupporting

confidence: 70%

Ageing patients in forensic psychiatric settings: A review of the literature

Lorito

Völlm

Dening

2018

Int J Geriat Psychiatry

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“…In recent years, prolonged inpatient treatment in psychiatry in general and forensic psychiatry in particular has faced more and more criticism and scientific scrutiny: Especially within involuntary treatment settings, inappropriately long stays have been viewed as potentially unethical (1)(2)(3)(4)(5)(6). In addition, doubts have been raised about the benefits of prolonged inpatient treatment for patients' rehabilitation (3,7).…”

Section: Background and Objectivesmentioning

confidence: 99%

“…The internationally observed prolongation of forensic hospitalizations in the past years (1,3,7,(15)(16)(17), as well as the ever-growing demand for forensic services (18)(19)(20)(21), have become a subject of socio-political debate with urgent need for more research on avenues to reduce the duration of inpatient treatments in order to reduce exploding costs whenever possible (2,4). A recent review of 38 studies in eleven countries summarized a rich set of patient characteristics contributing to length of stay in psychiatric inpatient treatment (6), but concluded that just ten studies were useful in identifying clinically useful predictive factors, since "more rigorous multivariate statistical techniques" are required in order to eliminate confounding factors. Its authors also conducted an extensive qualitative and quantitative exploratory inquiry of the topic drawing on information from all stakeholders (patients, treatment professionals, experts) and mentioned not conducting file reviews on long-stay versus non-long-stay patients in forensic psychiatry (using adequate sophisticated statistical tools) as a key limitation to their comprehensive work.…”

Section: Background and Objectivesmentioning

confidence: 99%

“…By for the first time (to our knowledge) applying machine learning to the study of predictors of length of stay in forensic psychiatry in order to better meet the statistical needs of this complexly (nonlinearly) interrelated set of data (6), the current study aims to help provide more clarity on prior inconsistencies. These will be summarized in the remainder of this section along with frequently confirmed prior findings since they have informed the primary set of variables explored in the present study (also see Table 1 for a summary).…”

Section: Findings and Inconsistencies Of Relevant Prior Researchmentioning

confidence: 99%

“…This left a total of 143 forensic patients meeting the inclusion criteria of this study. These strict criteria ensured presence of the same legal requirements for being released in all examined cases, and that the "true" length of inpatient treatment was considered, as recently proposed in a review of extant research (6).…”

Section: Subjectsmentioning

confidence: 99%

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Factors And Predictors Of Length Of Stay In Offenders Diagnosed With Schizophrenia- A Machine-learning-based Approach

Kirchebner

Günther

King

et al. 2020

Preprint

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Background Prolonged forensic psychiatric hospitalizations have raised ethical, economic, and clinical concerns. Due to the confounded nature of factors affecting length of stay of psychiatric offender patients, prior research has called for the application of a new statistical methodology better accommodating this data structure. The present study seeks to examine factors responsible for prolonged detentions of schizophrenic offenders referred to a Swiss forensic hospital using machine learning algorithms more apt to reveal non-linear interdependencies between variables.Methods In this retrospective file and registry study, multidisciplinary notes of 143 schizophrenic delinquents were reviewed by using a structured protocol on patients’ characteristics, criminal and medical history and course of treatment. Via a forward selection procedure, the most influential predictors for length of stay were preselected. Machine learning algorithms identified the most efficient model for predicting length-of-stay.Results/ Conclusions Ten factors prolonging forensic hospitalization were identified: Six were related to aspects of the index offence (index offence, number of crimes, extend of injury to the victim of the offence), two were related to psychopathology at admission or even prior to that (hallucinations in psychiatric history), one alluded to the course of therapy (self-harming during inpatient treatment), and one referred to biographical aspects (poverty during childhood/ adolescence). Results are discussed in light of earlier reports on the subject.

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A comparison of long‐term medium secure patients within NHS and private and charitable sector units in England

Kasmi

Duggan

Völlm

2020

Criminal Behav Ment Health

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Background In England, forensic psychiatric hospital services are provided at three security levels: high, medium and low. All are publicly funded and similarly regulated, but medium and low secure services are provided in the private and charitable (PCS) sector as well as the National Health Service (NHS). Originally, medium secure hospital services were conceived as for up to 2 years' inpatient stay, but numbers of longer stay patients have been rising. Little is known about their characteristics or whether they differ between NHS and PCS settings. Aims To describe and compare characteristics of long‐stay patients in NHS and in PCS medium security hospital units. Methods Data were extracted from clinical records in 14 NHS and 9 PCS hospital units for all patients fulfilling criteria for long stay: having been in high security for more than 10 years or medium security for more than 5 years or in a mix of both for more than 15 years in total. Results 178 NHS and 107 PCS patients were eligible for inclusion, respectively, 16 and 22% of the total patient populations in these settings. The mean length of stay in a medium or high secure setting was similar: 163 and 164 months. Characteristics of the patients, however, differed between unit type. NHS services admitted more patients from prison and PCS services more from other hospitals. NHS services included a lower proportion of patients with personality disorder or intellectual disability. 'Challenging behaviour' was more prevalent in PCS; a history of absconding was found more often among NHS patients. Conclusions The two systems of service appear to be used differently. More research is needed to explain why patients apparently without behavioural disturbances remain in specialist secure facilities for such a long time and whether their needs are truly being met in the least restrictive environment possible.

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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

Cited by 76 publications

References 117 publications

Ageing patients in forensic psychiatric settings: A review of the literature

Ageing patients in forensic psychiatric settings: A review of the literature

Factors And Predictors Of Length Of Stay In Offenders Diagnosed With Schizophrenia- A Machine-learning-based Approach

A comparison of long‐term medium secure patients within NHS and private and charitable sector units in England

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