A protocol in action: Recovery approach for patients within high secure care: A 20+ year follow‐up

Abstract

Objectives: A person-centred approach to recovery is increasingly represented within mainstream mental health literature. Little examination of recovery among forensic mental health patients is evidenced. This study plans to address that insufficiency.Methods: This protocol paper details a novel approach to exploring recovery among a cohort of 241 patients detained under conditions of high secure care in Scotland during August 1992 to August 1993. Under discussion is the repurposing of previous research to circumnavigate length of inpatient stay commonly associated with forensic mental health care. The methodology adopted, while considering data leakage given the vulnerable participant group, will be discussed.Results: Repurposing and extending previous research attempts to address the file cabinet effect with 85% of health care research being wasted and future uncertainty regarding research funding in a post-Brexit era. This is an ongoing study. Ethical, confidentiality, privacy issues, and permissions are considered within the methodology.Conclusions: Ethical arguments can be made for tracing and attempting contact with vulnerable groups under-represented in the literature. A well-considered methodology putting the focus on participant welfare and confidentiality at every step is essential. The reported methodology provides an opportunity to expand and re-examine previously collected data through a contemporary lens. with the underlying principle of the need to obtain the maximum benefit for patients detained under its provisions, with medical treatment defined in broad terms that include both habilitation and rehabilitation.The person-centred recovery approach to mental illness focuses on an individual's journey and potential for recovery. This involves developing hope, supportive relationships, coping skills, and a life with meaning. Given the current economic climate of budget constraints and with 85% of health care research reportedly being wasted, 14 the decision was made to pull some previously collected data out of the filing drawer.Examining it through a contemporary lens cuts costs, breathes new life into previously collected data, and facilitates exploration of issues reliant upon time passed, such as recovery within a forensic mental health context. Uncertainty surrounding Brexit and European funding has also made repurposing and enhancing existing data a more attractive pursuit. 3. To compare the outcomes of patients progressing to varying security levels in terms of factors more likely to lead to meaningful recovery.4. To identify factors associated with readmission to a higher level of security.5. To determine the current and future needs of high secure care patients and how well they are met within existing resources and services.

Exploration of morbidity, suicide and all-cause mortality in a Scottish forensic cohort over 20 years

“…Supplemental approvals and the wider study protocol are described elsewhere. 17 Written informed consent was obtained from all living participants.…”

“…[1][2][3] The number of years of life lost in relation to all-cause mortality varies from 7 to 24 depending on the nature of the condition. 2 Substance use disorder (SUD) conveys the highest potential number of years lost (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24); however, this is closely followed by the ranges for personality disorders (13-22 years), schizophrenia (10-20 years) and bipolar disorder (9-20 years) demonstrating a psychophysiological influence (which we define as a physiological response mediated by biochemical pathways to psychological distress) upon morbidity/mortality beyond the physical impact of illicit substances.…”

A national census of forensic in‐patients with intellectual disability and five‐year follow‐up

“…This study was approved by a number of organisations namely: NHS Scotland A Research Ethics Committee, reference number 13-SS-0133; Integrated Research Application System, project identification number 130998 and the National Caldicott Guardian, reference number 2013-28. An amendment was subsequently approved through the Public Benefit and Privacy Panel, reference number 2013-28 (Rees et al, 2018).…”