Difficulties in the pathway from high to medium secure services for personality-disordered patients

Abstract

Personality-disordered patients detained in high secure psychiatric hospitals appear to experience difficulties progressing to medium secure services. Accordingly, this study sought to explore the problems encountered in this pathway. To do this, data relating to referrals to medium secure services were collated for previous and current patients from a Personality Disorder service (n ¼ 68) and a Dangerous and Severe Personality Disorder service (n ¼ 12) in one English high secure hospital. The results highlighted the poor success rate of referrals to medium secure units and revealed the extensive delays encountered in the transfer process. Further to this, they also identified the poor success rate of patients periods of trial leave at medium secure units. Taken together, these findings are consistent with reports that consultants in medium secure units are reluctant to accept personality-disordered patients and that these units lack the infrastructure to treat this patient group.

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

“…116 It is questionable whether this need is currently met sufficiently in medium secure settings. 114 …”

“…[113][114][115] Various suggestions have been made to improve this system, including paper-based assessments, single assessments and appeal panels, and these warrant further investigation. 116 …”

“…In addition, previous research suggests that medium secure units may be reluctant to accept personality-disordered patients, as the units lack the infrastructure to treat this patient group. 114 Chapter 8 International service models for long stay…”

The dangerous and severe personality disorder experiment – Review of empirical research

“…We found five studies investigating treatments, pathways and outcomes (Taylor, ; Sheldon et al, ; Tetley et al, ; Burns et al, ; Draycott et al, ) although, disappointingly, none of the studies provided good quality evidence for the effectiveness or otherwise of any interventions in this population.…”

“…Even those deemed to have benefited from treatment and considered by their team as ready for progression to less secure conditions appear to have had difficulties moving on. Tetley et al () described success rates of referrals to medium secure units of PD and DSPD patients. For DSPD patients, only 41% of referrals were considered suitable for medium secure care by the gatekeepers, and only 24% were accepted by their regional secure units.…”