Decision making in medium security: Can he have leave?

Abstract

This qualitative study investigates how the decision is taken to grant leave to patients in a forensic psychiatric in-patient medium secure unit. This study aims to understand better the process of decision making at multidisciplinary ward rounds. The study is based in a single medium secure unit. Data were collected by a researcher from ward rounds over a period of 15 months using non-participant observation. These data were subjected to content analysis. Two main thematic dialectics emerged: risk and humanity and power and responsibility. Leave decisions were made in 96 instances and risk, per se, was seldom explicitly discussed. This study raises key questions about the balance between explicit information and implicit clinical knowledge that underpins routine clinical decisions. This study is important because it has implications for the reliance on written records in the review of clinical practice, specifically in relation to serious acts of violence committed by psychiatric patients.

Predictors of Mental Health Review Tribunal (MHRT) outcome in a forensic inpatient population: a prospective cohort study

“…Whilst ours is the first study to have examined this specific factor, previous research has acknowledged that leave is an essential part of the rehabilitation of forensic patients and it is highly unlikely that a patient would be discharged without having been granted some form of leave [38]. …”

Never ever? Characteristics, outcomes and motivations of patients who abscond or escape: A 5‐year review of escapes and absconds from two medium and low secure forensic units

“…Clinical teams nevertheless try to predict the risk of escape or absconding from secure psychiatric facilities, so that they can try to manage that risk (Huws and Shubsachs, ; Bowers et al, 2005; Brook et al, 1999). Suggested strategies to improve clinicians' ability to predict and manage this risk more effectively include: better documentation of the nature and content of multi‐disciplinary team discussions (Lyall and Bartlett, ), more transparent and recorded decision making (Kasmi and Brennan, 2015) and more structured and systematic processes around the granting of leave to patients (Nichols 2007). A dedicated Leave/Abscond Risk Assessment (LARA) tool has even been suggested (Hearn et al, ).…”

Admitting offenders with antisocial personality disorder to a medium secure unit: a qualitative examination of multidisciplinary team decision-making

“…Complex relational interactions are only ever intelligible from the standpoint of a specific location. Furthermore, researchers who pursue data collection beyond the point of data saturation inevitably encounter ‘repetitive discussions’ of decisional dynamics taking place within that institution (Lyall & Bartlett, 2010, p. 891). The findings below demonstrate that single site research has an important role to play in the development of moderatum generalisations (those linked to the broad features of the research) of use for future researchers pursuing (multisite) research.…”