Domains of Need in a High Secure Hospital Setting: A Model for Streamlining Care and Reducing Length of Stay

Abstract

There are financial and humanitarian consequences to unmet need amongst service users of high secure hospital care, not least in terms of length of stay. This paper presents two reviews of high secure service user needs. They provide support for the sequencing of interventions to meet service user needs and the utility of a structured framework for their review. Through analyses of these reviews, eight domains of need were identified: Therapeutic Engagement, Risk Reduction, Education, Occupational, Mental Health Recovery, Physical Health Restoration, Cultural and Spiritual Needs, Care Pathway Management. A model is presented, within which logically sequenced, timely and relevant interventions could be framed in order to provide a comprehensive and streamlined pathway through a high secure hospital. Domains of Need 3 Reducing Length of Stay in High Secure Hospital Settings: A Model for Streamlining CareThere are three high secure hospitals in England and Wales, the function of which are to provide a service to people who cannot be managed in conditions of lesser security, predominantly mentally disordered offenders (MDOs). More specifically, service users are detained under legislation which mandates assessment and treatment and emphasises public protection (Sarkar, 2010). Grounds for detention must include 'mental disorder' -any disorder or disability of mind -and a risk of harm to self or others (Mental Health Act 1983 as amended 2007. MDOs can be diverted into the Mental Health System from the Criminal Justice System at the point of contact with the police, during the pre-trial period of assessing fitness to plead, at trial, post-trial (advice on disposal prior to sentencing) and on disposal to a prison or psychiatric hospital (Wrench and Dolan, 2010). Some individuals will encounter the Criminal Justice System secondary to the Mental Health System and might find themselves transferring to facilities of increasing levels of security, through low, medium and high security. Under the Mental Health Act (1983 as amended 2007), provisions exist for MDOs to be admitted to hospital for assessment of mental disorder and risk, for offenders to be treated in hospital rather than serve a prison sentence and for prisoners to be transferred for 'urgent' treatment (for more complete descriptions of forensic mental health systems, services and concepts in England and Wales the reader is referred to Bartlett and McGauley, 2010).Broadmoor Hospital is one of three, publically-funded National Health Service (NHS), high secure hospitals in England and Wales which admit people with serious mental illness and severe personality disorders, often in combination (Adshead, 2010), who pose a serious risk of harm to themselves or others. Service users are most often referred from courts, prisons and Domains of Need 4 secure hospitals of lesser security (see Völlm, Daley and Silva, 2009 for further description) and most commonly have restrictions on their movement and liberty at the discretion of the Ministry of Justice (the gov...

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

“…Thirty-two of the 38 studies had samples that were predominantly male (75% to 99% of sample) and four were all-male. 37,84,88,97 Two UK studies had samples drawn from a women's medium secure unit. 40,87 An earlier UK study of Broadmoor high secure patients by Dell et al 33 used an 8-year threshold, the authors observing that 53% of those with a 'psychopathic disorder' and 42% of those with a 'mental illness' classification of the (then) MHA were 'long-termers' who were detained for > 8 years.…”

“…12,26,28,29,33,34,37,[39][40][41][42]57,74, Eleven countries were represented: the UK (n = 22 12,26,28,29,33,34,37,39-42,77-80, 82,84,86,87,89,92,97 ), the USA (n = 4 90,94,96,99 ), Ireland (n = 2 81,98 ), Germany [n = 2 93 (one of which was personal communication: Dönisch-Seidel, Ministerium für Gesundheit, Emanzipation, Pflege und Alter des Landes Nordrhein-Westfalen, 2013)], Croatia (n = 2 57,88 ), Australia (n = 1 85 ), Malaysia (n = 1 83 ), New Zealand (n = 1 95 ), Norway (n = 1 91 ), the Netherlands (n = 1 74 ) and Sweden (n = 1 76 ). The studies from the UK had samples drawn from high secure (n = 5 29,33,78,84,89 ), medium secure (n = 14 26,37,[39][40][41][42]77,79,80,82,86,87,92,97 ) and mixed secure (n = 3 12,28,34 ) settings. The Norwegian study was based in a 'maximum' secure setting.…”

Life after homicide: accounts of recovery and redemption of offender patients in a high security hospital – a qualitative study

“…Treatment in forensic psychiatric inpatient services usually involves both medication and psychological therapies, especially therapies that address risk reduction and understanding of the index offence (Glorney, Perkins, Adshead, McGauley, Murray, Noak & Sichau, 2010).…”

Critical Incidents During Leave From an Australian Security Hospital – A 12 Year Audit

“…Rather, diversion into treatment, including detention in a security hospital, should offer an opportunity for specialised multi-disciplinary teams to address the complex and challenging needs of forensic patients. 27 The criteria for admission to a security hospital are the same criteria which predict increased theoretical risk of critical incidents and increased theoretical risk of future harm to the community. However, cautious, graduated leave from the hospital as a prelude to transition into the community is integral to the recovery, rehabilitation and discharge planning for all but the most problematic forensic patients.…”