Long‐term care needs in male medium security

Abstract

Medium secure units were designed to treat patients for up to three years, but some patients spend longer in acute medium secure settings which in general do not have a 'longer term focus'. The aim of this investigation was to assess and describe the needs of these patients. A survey questionnaire was designed and sent to responsible clinicians who had patients admitted at least five years previously to the Three Bridges Medium Secure Unit (males) in West London. Carer ratings using the Camberwell Assessment of Need: forensic version (CAN-FOR) were completed by the primary nurse for each patient, complementing the survey questionnaire. Of 122 medium secure male patients 25 (21%) had been admitted at least five years before. We found high levels of co-morbidity and treatment resistance. The CAN-FOR revealed two groups, one with chronic challenging behaviour, treatment-resistant mental illness and need for a high level of support, and another more able group not needing as much support but with a dependency on the hospital. It is considered here whether certain groups would benefit from a different approach or setting.

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

“…Information on patient characteristics prior to this period is now likely to be obsolete. In putting our findings in the context of the wider literature we therefore draw particularly on Brown et al, 37 Jacques et al, 38 Shah et al 42 and Wilkes. 97 We also refer to Knapp et al, 86 Harty et al, 18 Ricketts et al 92 and Thomas et al, 29 despite their study dates, owing to unique aspects of relevance (e.g.…”

“…The combination of different security levels and the time of this study (1999), again, limits the meaningfulness of any comparisons. Studies using our cut-off point of 5 years for LoS in medium secure care in England reported figures of 10% 82 (based on an admission sample at one unit), 21% 38 (based on a cross-sectional survey in one unit) and 9.3% 42 (based on a discharge sample in one unit). Some of these figures seem lower than ours, which can be attributed to methodological factors as described above; it is also of note that the units in these studies were NHS rather than independent provider units; the one with the higher figure had opened a ward specifically addressing the needs of a long-stay group.…”

“…A number of studies have explored the needs of service users in forensic settings from staff perspectives (e.g. Reed and Lyne 43 and Jacques et al 38 ). There has, however, been a shift away from using the views of professionals towards accessing and representing the views of recipients of care.…”

“…Studies in medium secure settings have identified severity of psychopathology, psychiatric history, seriousness of offending, patients being on 'restriction orders' (requiring Ministry of Justice permission for transfer), non-engagement in interventions, dependency needs and lack of step-down facilities as factors associated with long stay. [37][38][39][40][41][42] …”

Long-Term Forensic Mental Health Services: An Exploratory Comparison of 18 European Countries

“…In England, research has found an average LoS in high secure care of eight years (Dell, Robertson, & Parker, 1987), and for medium secure care it is a little over two years (Edwards, Steed, & Murray, 2002). However, some authors have described a trend for patients to stay for five years or more (Rutherford & Duggan, 2007;Shah et al, 2011;Jacques, Spencer, & Gilluley, 2010) with around a third of medium secure patients deemed to need long-term care (Melzer et al, 2004). A more recent cross-sectional study identified that around 16% of patients resident in high secure settings in England had been resident for more than 10 years, and around 3% for more than 20 years (Völlm, 2015).…”