“I couldn’t have done it on my own.” Perspectives of patients preparing for discharge from a UK high secure hospital

Abstract

Purpose -Discharge preparation from high to medium levels of security has received little attention from researchers to date, but is a critical stage in a patient's pathway. This paper aims to capture the perspectives of patients who are preparing to move on from high to medium security. Design/methodology/approach -Nine patients who were in the "discharge preparation" stage of their pathway were interviewed to capture their perspectives on the process. Interview transcripts were analysed using thematic analysis. Findings -Nine themes were identified as representing the patient interviews: trust and support, feeling empowered, journey of self-acceptance, skilling-up, getting to know the Medium Secure Unit (MSU), feeling disempowered and unvalued, issues with the system, anxiety about endings, and stigma and society. Originality/value -This paper gives voice to patients across clinical directorates at a UK high secure hospital regarding their perspectives on what has helped and hindered their discharge preparation. It presents some new findings, and recommended good practice, which should be of use to clinicians and managers who wish to enhance discharge preparation interventions for patients within high secure services.

Everything moves on: referral trends to a leavers' group in a high secure hospital and trial leave progress of group graduates

“…A high-security hospital generally provides a stable and predictable environment in which patients commonly form attachments to staff (Adshead, 1998;Jamieson et al, 2006). By contrast, those patients often come from chaotic and sometimes abusive environments and, even though they usually go to another hospital in the first instance, their uncertainties about their personal capabilities for living more independently and in a less structured environment in the longer term may affect their progress (Pescosolido et al, 1999;Main and Gudjonsson, 2005;Madders and George, 2014). Further, removal of some perceived privileges attached to high-security care and/or anticipation of taking the label of 'high-security patient' into a new community may also pose problems.…”

“…Trial leave permits recall to the originating service if significant concerns arise over risk or mental health (Her Majesty's Stationery Office, 2007). A c omplimentary approach to promoting transfer success has been recommended in the form of active preparation of patients for the move (Skelly, 1994;Main and Gudjonsson, 2005); although this is not invariably offered (Kruppa andJones, 2012, as cited in Madders andGeorge, 2014).…”